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Rojas-Solé C, Pinilla-González V, Lillo-Moya J, González-Fernández T, Saso L, Rodrigo R. Integrated approach to reducing polypharmacy in older people: exploring the role of oxidative stress and antioxidant potential therapy. Redox Rep 2024; 29:2289740. [PMID: 38108325 PMCID: PMC10732214 DOI: 10.1080/13510002.2023.2289740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Increased life expectancy, attributed to improved access to healthcare and drug development, has led to an increase in multimorbidity, a key contributor to polypharmacy. Polypharmacy is characterised by its association with a variety of adverse events in the older persons. The mechanisms involved in the development of age-related chronic diseases are largely unknown; however, altered redox homeostasis due to ageing is one of the main theories. In this context, the present review explores the development and interaction between different age-related diseases, mainly linked by oxidative stress. In addition, drug interactions in the treatment of various diseases are described, emphasising that the holistic management of older people and their pathologies should prevail over the individual treatment of each condition.
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Affiliation(s)
- Catalina Rojas-Solé
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Víctor Pinilla-González
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - José Lillo-Moya
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Tommy González-Fernández
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luciano Saso
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Faculty of Pharmacy and Medicine, Sapienza University, Rome, Italy
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
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2
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Ma Q, Li Y, Yu G, Liu S, Jiang Y, Duan H, Wang D, He Y, Chen X, Yao N, Lin X, Wan H, Shen J. Sex-Specific Associations of Five Serum Essential Metal Elements with Thyroid Nodules in Euthyroid Adults: a Cross‑sectional Study. Biol Trace Elem Res 2024; 202:4357-4366. [PMID: 38157093 DOI: 10.1007/s12011-023-04024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
The association between the serum essential metal elements (magnesium, iron, copper, zinc, and calcium) and thyroid nodules is still inconsistent. The current study aims to investigate the relationship of metal elements with thyroid nodules and their malignant tendency. A total of 6480 Chinese euthyroid adults were included in our study. We collect basic information through questionnaires and medical checkups. We diagnose thyroid nodules by ultrasound and detect serum trace metal concentrations by using an automatic biochemical analyzer. Binary and multinomial logistic regressions were used to investigate the associations. As a result, we found that serum copper concentrations were positively associated with thyroid nodules in the second, third, and fourth quartiles, compared to the first quartile (P = 0.024, P = 0.016, P = 0.032) in women and P for trend is 0.038. There is a significant sex-specific association between copper concentrations and thyroid nodules (P for interaction = 0.009). The results of the multinomial logistic regression analyses indicate high serum calcium and magnesium concentrations emerged as consistent risk factors for thyroid nodules in both genders, whereas low zinc was a sex-specific factor. We also observed significant sex interactions in the relationships of magnesium (P for interaction = 0.043) with thyroid nodules with malignant tendency among participants with thyroid nodules. In conclusion, our study suggests that gender is an important factor when studying the association between serum metals and thyroid nodules. The imbalance of selected metal elements (calcium, copper, zinc, and magnesium) may relate to thyroid nodules and their malignant tendency, and future prospective studies are needed to further confirm the associations.
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Affiliation(s)
- Qintao Ma
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Ying Li
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Genfeng Yu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Siyang Liu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Yuqi Jiang
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Hualin Duan
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Dongmei Wang
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Yajun He
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Xingying Chen
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Nanfang Yao
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Xu Lin
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Heng Wan
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China.
| | - Jie Shen
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), No.1 of Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China.
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Yamamoto T, Isaka Y. Pathological mechanisms of kidney disease in ageing. Nat Rev Nephrol 2024; 20:603-615. [PMID: 39025993 DOI: 10.1038/s41581-024-00868-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
The kidney is a metabolically active organ that requires energy to drive processes such as tubular reabsorption and secretion, and shows a decline in function with advancing age. Various molecular mechanisms, including genomic instability, telomere attrition, inflammation, autophagy, mitochondrial function, and changes to the sirtuin and Klotho signalling pathways, are recognized regulators of individual lifespan and pivotal factors that govern kidney ageing. Thus, mechanisms that contribute to ageing not only dictate renal outcomes but also exert a substantial influence over life expectancy. Conversely, kidney dysfunction, in the context of chronic kidney disease (CKD), precipitates an expedited ageing trajectory in individuals, leading to premature ageing and a disconnect between biological and chronological age. As CKD advances, age-related manifestations such as frailty become increasingly conspicuous. Hence, the pursuit of healthy ageing necessitates not only the management of age-related complications but also a comprehensive understanding of the processes and markers that underlie systemic ageing. Here, we examine the hallmarks of ageing, focusing on the mechanisms by which they affect kidney health and contribute to premature organ ageing. We also review diagnostic methodologies and interventions for premature ageing, with special consideration given to the potential of emerging therapeutic avenues to target age-related kidney diseases.
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Affiliation(s)
- Takeshi Yamamoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Yu X, Li S, Zhong J, Ji X, Xu H, Chen Q, Li Q. Single-cell transcriptome sequencing partially revealed the changes of T cells in the early stage of aging kidney. Mol Immunol 2024; 173:61-70. [PMID: 39059207 DOI: 10.1016/j.molimm.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/23/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024]
Abstract
Aging is a gradual, inevitable physiologic process. The organ aging is related to the persistence of chronic inflammation, but the understanding of inflammatory state during renal aging is lacking currently. Single-cell transcriptome sequencing was performed on aging mouse kidney to reveal the molecular phenotype and composition changes of different cell types. In the early stage of aging, immune cells such as T, B cells and mononuclear macrophages increased in kidney. The molecular state of T cells in aging kidney changed and polarized. Among them, we identified a group of GZMK+ CD8 + T cells with high expression of Eomes, Pdcd1 and Ifng and a group of Il17a+ T cells with high expression of Il17a and Il23r. Moreover, the cytokines and inflammations can aggravate tissue damage eventually. Furthermore, we found the interaction between different types of epithelial cells and T cells increased during the renal aging. These results identify the changes of T cells in the early stage of aging kidney and suggest that GZMK+CD8+ T cells might be a potential target to ameliorate age-associated dysfunctions of kidney(Graphical Abstract).
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Affiliation(s)
- Xinyi Yu
- Department of Nephrology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Shuying Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jinjie Zhong
- Department of Nephrology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xiaoqian Ji
- Institute for Advanced Study and School of Physical Science and Technology, Soochow University, Suzhou, Jiangsu, China
| | - Huizhong Xu
- Institute for Advanced Study and School of Physical Science and Technology, Soochow University, Suzhou, Jiangsu, China
| | - Qilin Chen
- Department of Nephrology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | - Qiu Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
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McLaughlin L, Zhang B, Sharma S, Knoten AL, Kaushal M, Purkerson JM, Huyck H, Pryhuber GS, Gaut JP, Jain S. Three Dimensional Multiscalar Neurovascular Nephron Connectivity Map of the Human Kidney Across the Lifespan. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.29.605633. [PMID: 39211059 PMCID: PMC11361085 DOI: 10.1101/2024.07.29.605633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The human kidney is a vital organ with a remarkable ability to coordinate the activity of up to a million nephrons, its main functional tissue unit (FTU), and maintain homeostasis. We developed tissue processing and analytical methods to construct a 3D map of neurovascular nephron connectivity of the human kidney and glean insights into how this structural organization enables coordination of various functions of the nephron, such as glomerular filtration, solute and water absorption, secretion by the tubules, and regulation of blood flow and pressure by the juxtaglomerular apparatus, in addition to how these functions change across disease and lifespans. Using light sheet fluorescence microscopy (LSFM) and morphometric analysis we discovered changes in anatomical orientation of the vascular pole, glomerular density, volume, and innervation through postnatal development and ageing. The extensive nerve network exists from cortex FTUs to medullary loop of Henle, providing connectivity within segments of the same nephron, and between separate nephrons. The nerves organize glomeruli into discreet communities (in the same network of nerves). Adjacent glomerular communities are connected to intercommunal "mother glomeruli" by nerves, a pattern repeating throughout the cortex. These neuro-nephron networks are not developed in postnatal kidneys and are disrupted in diseased kidneys (diabetic or hydronephrosis). This structural organization likely poises the entire glomerular and juxtaglomerular FTUs to synchronize responses to perturbations in fluid homeostasis, utilizing mother glomeruli as network control centers.
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Muglia L, Di Dio M, Filicetti E, Greco GI, Volpentesta M, Beccacece A, Fabbietti P, Lattanzio F, Corsonello A, Gembillo G, Santoro D, Soraci L. Biomarkers of chronic kidney disease in older individuals: navigating complexity in diagnosis. Front Med (Lausanne) 2024; 11:1397160. [PMID: 39055699 PMCID: PMC11269154 DOI: 10.3389/fmed.2024.1397160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Chronic kidney disease (CKD) in older individuals is a matter of growing concern in the field of public health across the globe. Indeed, prevalence of kidney function impairment increases with advancing age and is often exacerbated by age-induced modifications of kidney function, presence of chronic diseases such as diabetes, hypertension, and cardiovascular disorders, and increased burden related to frailty, cognitive impairment and sarcopenia. Accurate assessment of CKD in older individuals is crucial for timely intervention and management and relies heavily on biomarkers for disease diagnosis and monitoring. However, the interpretation of these biomarkers in older patients may be complex due to interplays between CKD, aging, chronic diseases and geriatric syndromes. Biomarkers such as serum creatinine, estimated glomerular filtration rate (eGFR), and albuminuria can be significantly altered by systemic inflammation, metabolic changes, and medication use commonly seen in this population. To overcome the limitations of traditional biomarkers, several innovative proteins have been investigated as potential, in this review we aimed at consolidating the existing data concerning the geriatric aspects of CKD, describing the challenges and considerations in using traditional and innovative biomarkers to assess CKD in older patients, highlighting the need for integration of the clinical context to improve biomarkers' accuracy.
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Affiliation(s)
- Lucia Muglia
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Michele Di Dio
- Unit of Urology, Department of Surgery, Annunziata Hospital, Cosenza, Italy
| | - Elvira Filicetti
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | - Giada Ida Greco
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | - Mara Volpentesta
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | - Alessia Beccacece
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Paolo Fabbietti
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy
| | - Andrea Corsonello
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, School of Medicine and Digital Technologies, University of Calabria, Arcavacata di Rende, Italy
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
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Xu L, Yu C, Chen A, Li C, Mao Y. Longitudinal Analysis of Renal Function Changes in Elderly Populations: Health Status Evaluation and Risk Factor Assessment. Clin Interv Aging 2024; 19:1217-1224. [PMID: 38974512 PMCID: PMC11227831 DOI: 10.2147/cia.s450388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/15/2024] [Indexed: 07/09/2024] Open
Abstract
Background This study aims to investigate GFR decline in elderly subjects with varying physical conditions and analyze key risk factors impacting renal function changes. Methods We obtained data from patients between 2017 and 2019, and matched healthy elderly subjects based on gender and age. Data collected for all subjects included annual measurements of fast blood glucose (GLU), glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c), blood albumin (ALB), blood uric acid (UA), urine protein (UP), and systolic blood pressure (SBP). Additionally, information on coexisting diseases was gathered. The Full Age Spectrum (FAS) equation was used to calculate eGFR. Results A total of 162 patients with complete 3-year renal dynamic imaging were included, including 84 patients in the kidney disease group (K group) and 78 patients in the non-kidney disease group (NK group). Ninety individuals were selected as the healthy group (H group). The annual decline rate in the K group was the fastest, which exceeded 5mL/min/1.73m2 (P < 0.05). Group (K group: β=-40.31, P<0.001; NK group: β=-26.96, P<0.001), ALB (β=-0.38, P=0.038) and HbA1c (β=1.36, P=0.029) had a significant negative impact on the eGFR changes. For participants who had negative proteinuria: K group had the most significant annual eGFR decline. Conclusion The presence of kidney disease, along with proteinuria nor not, can lead to a marked acceleration in kidney function decline in elderly. We categorize elderly individuals with an annual eGFR decline of more than 5 mL/min/1.73m2 as the "kidney accelerated aging" population.
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Affiliation(s)
- Lengnan Xu
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chen Yu
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Aiqun Chen
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chuanbao Li
- Department of Laboratory Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yonghui Mao
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Zhang Y, Yu C, Li X. Kidney Aging and Chronic Kidney Disease. Int J Mol Sci 2024; 25:6585. [PMID: 38928291 PMCID: PMC11204319 DOI: 10.3390/ijms25126585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The process of aging inevitably leads to an increase in age-related comorbidities, including chronic kidney disease (CKD). In many aspects, CKD can be considered a state of accelerated and premature aging. Aging kidney and CKD have numerous common characteristic features, ranging from pathological presentation and clinical manifestation to underlying mechanisms. The shared mechanisms underlying the process of kidney aging and the development of CKD include the increase in cellular senescence, the decrease in autophagy, mitochondrial dysfunction, and the alterations of epigenetic regulation, suggesting the existence of potential therapeutic targets that are applicable to both conditions. In this review, we provide a comprehensive overview of the common characteristics between aging kidney and CKD, encompassing morphological changes, functional alterations, and recent advancements in understanding the underlying mechanisms. Moreover, we discuss potential therapeutic strategies for targeting senescent cells in both the aging process and CKD.
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Affiliation(s)
- Yingying Zhang
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Chen Yu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, China;
| | - Xiaogang Li
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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Bianchi D, Sethi NK, Velasco G, Qureshi UA, deWeber K. Care of The Older Fighter: Position Statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38708547 DOI: 10.1080/00913847.2024.2344227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes' risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.
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Affiliation(s)
- Davide Bianchi
- Medbase Cornavin Sports Center, SwissBoxing, Geneva, Switzerland
| | - Nitin K Sethi
- Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - George Velasco
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uneeb A Qureshi
- United States Public Health Service, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kevin deWeber
- Program Director, SW Washington Sports Medicine Fellowship, Vancouver, WA USA
- Affiliate Associate Professor of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- Clinical Assistant Professor of Family Medicine, University of Washington, Seattle, WA, USA
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10
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Muzaale A, Khan A, Glassock RJ, Tantisattamoa E, Ahdoot RS, Ammary FA. Kidney function assessment in the geriatric population. Curr Opin Nephrol Hypertens 2024; 33:267-271. [PMID: 37965904 PMCID: PMC10872478 DOI: 10.1097/mnh.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Kidney function declines with normal aging. But it also declines with the progression of some diseases. This review calls for a more nuanced interpretation of kidney function in the geriatric population, who may have frailty and comorbidities. RECENT FINDINGS GFR declines with healthy aging kidneys. Aging kidney changes include decreased cortical volume, senescent global glomerulosclerosis, and reduced nephron numbers. Yet normal aging is not associated with increased glomerular volume or single-nephron GFR. The prevalence of GFR less than 60 ml/min/1.73 m 2 in the geriatric population is high. However, the decline in GFR with normal aging may not reflect true CKD without albuminuria. Although the risk of ESKD and mortality increases in all age groups when eGFR less than 45 ml/min/m 2 , there is no significant increased relative risk of ESKD and mortality in the geriatric population when eGFR 45-59 ml/min/m 2 in the absence of albuminuria. Innovative approaches are needed to better estimate GFR and define CKD in the geriatric population. SUMMARY The expected GFR decline in the geriatric population is consistent with normal aging kidney changes. To avoid CKD overdiagnosis and unnecessary referrals to nephrology for possible CKD, age-adapted definitions of CKD in the absence of albuminuria are needed.
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Affiliation(s)
- Abimereki Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adnan Khan
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Richard J. Glassock
- Department of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Rebecca S. Ahdoot
- Department of Medicine, University of California Irvine, Orange, California
| | - Fawaz Al Ammary
- Department of Medicine, University of California Irvine, Orange, California
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Zhang L, Wang Z, Tang F, Wu M, Pan Y, Bai S, Lu B, Zhong S, Xie Y. Identification of Senescence-Associated Biomarkers in Diabetic Glomerulopathy Using Integrated Bioinformatics Analysis. J Diabetes Res 2024; 2024:5560922. [PMID: 38292407 PMCID: PMC10827377 DOI: 10.1155/2024/5560922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
Background Cellular senescence is thought to play a significant role in the onset and development of diabetic nephropathy. The goal of this study was to explore potential biomarkers associated with diabetic glomerulopathy from the perspective of senescence. Methods Datasets about human glomerular biopsy samples related to diabetic nephropathy were systematically obtained from the Gene Expression Omnibus database. Hub senescence-associated genes were investigated by differential gene analysis and Least Absolute Shrinkage and Selection Operator analysis. Cluster analysis was employed to identify senescence molecular subtypes. A single-cell dataset was used to validate the above findings and further evaluate the senescence environment. The relationship between these genes and the glomerular filtration rate was explored based on the Nephroseq database. These gene expressions have also been explored in various kidney diseases. Results Twelve representative senescence-associated genes (VEGFA, IQGAP2, JUN, PLAT, ETS2, ANG, MMP14, VEGFC, SERPINE2, CXCR2, PTGES, and EGF) were finally identified. Biological changes in immune inflammatory response, cell cycle regulation, metabolic regulation, and immune microenvironment have been observed across different molecular subtypes. The above results were also validated based on single-cell analysis. Additionally, we also identified several significantly altered cell communication pathways, including COLLAGEN, PTN, LAMININ, SPP1, and VEGF. Finally, almost all these genes could well predict the occurrence of diabetic glomerulopathy based on receiver operating characteristic analysis and are associated with the glomerular filtration rate. These genes are differently expressed in various kidney diseases. Conclusion The present study identified potential senescence-associated biomarkers and further explored the heterogeneity of diabetic glomerulopathy that might provide new insights into the diagnosis, assessment, management, and personalized treatment of DN.
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Affiliation(s)
- Li Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215008, Jiangsu, China
- Department of Endocrinology, The First People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
| | - Zhaoxiang Wang
- Department of Endocrinology, The First People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
| | - Fengyan Tang
- Department of Endocrinology, The First People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
| | - Menghuan Wu
- Department of Cardiology, Xuyi People's Hospital, Xuyi 211700, Jiangsu, China
| | - Ying Pan
- Department of Endocrinology, The First People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
| | - Song Bai
- Department of Cardiology, Xuyi People's Hospital, Xuyi 211700, Jiangsu, China
| | - Bing Lu
- Department of Endocrinology, The First People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
| | - Shao Zhong
- Department of Endocrinology, The First People's Hospital of Kunshan, Kunshan 215300, Jiangsu, China
| | - Ying Xie
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215008, Jiangsu, China
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12
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Wang J, Zhou Y, Zhang Q, Li J, Zhai D, Li J, Han B, Liu Z. Loneliness among older Chinese individuals: the status quo and relationships with activity-related factors. BMC Geriatr 2024; 24:42. [PMID: 38200432 PMCID: PMC10782757 DOI: 10.1186/s12877-023-04611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND With the rapid population aging, healthy aging has become a concern for society as a whole. In this study, loneliness and its relationships with activity-related individual factors were examined among older Chinese individuals from the perspective of mental health and daily leisure activities. METHODS The data were from the fourth investigation of the Sample Survey of the Aged Population in Urban and Rural China, which had a total of 220,506 participants. Activity ability was assessed by the Barthel Activity of Daily Living Index, a self-designed activity type questionnaire was used to evaluate activity participation, and loneliness was measured with a single-item question. RESULTS The prevalence of varying degrees of loneliness among Chinese older individuals was 36.6%. The prevalence of loneliness among the older individuals differed significantly by age gender, age, physical health status, annual household income, education level, marital status, living status, ethnic minority status, religious faith and territory of residence. There were differences in activity participation among older Chinese adults in terms of all the demographic factors mentioned above, while there were no significant differences in living status or religious faith, and significant differences in several other demographic factors in terms of activity ability. Self-care ability, as a form of activity ability, and activity participation significantly predicted loneliness among the older participants. CONCLUSION The topic of loneliness among Chinese older individuals is complex and requires greater attention. The buffering effect of activity-related factors on loneliness suggests that old people should improve their activity ability and participate more in daily activities.
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Affiliation(s)
- Jiazhou Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, 100101, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Yueyue Zhou
- Department of Psychology, Henan University, 475004, Kaifeng, China
| | - Qiuxia Zhang
- China Research Center on Aging, 100011, Beijing, China
| | - Jing Li
- China Research Center on Aging, 100011, Beijing, China
| | - Dehua Zhai
- China Research Center on Aging, 100011, Beijing, China
| | - Jia Li
- China Research Center on Aging, 100011, Beijing, China
| | - Buxin Han
- CAS Key Laboratory of Mental Health, Institute of Psychology, 100101, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, 100049, Beijing, China.
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, 100101, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, 100049, Beijing, China.
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13
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Gungor O, Ulu S, Inci A, Topal K, Kalantar-Zadeh K. The Relationship Between Sarcopenia And Proteinuria, What Do We Know? Curr Aging Sci 2024; 17:93-102. [PMID: 38904152 DOI: 10.2174/0118746098232969231106091204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 06/22/2024]
Abstract
Sarcopenia is one of the most common geriatric syndromes in the elderly. It is defined as a decrease in muscle mass and function, and it can lead to physical disability, falls, poor quality of life, impaired immune system, and death. It is known that, the frequency of sarcopenia increases in the kidney patient population compared to healthy individuals. Although it is known that kidney disease can lead to sarcopenia; our knowledge of whether sarcopenia causes kidney disease is limited. Prior studies have suggested that protein energy wasting may be a risk of de novo CKD. Proteinuria is an important manifestation of kidney disease and there is a relationship between sarcopenia and proteinuria in diabetes, geriatric population, kidney transplant, and nephrotic syndrome. Does proteinuria cause sarcopenia or vice versa? Are they both the results of common mechanisms? This issue is not clearly known. In this review, we examined the relationship between sarcopenia and proteinuria in the light of other studies.
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Affiliation(s)
- Ozkan Gungor
- Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Beşiktaş, İstanbul, Turkey
| | - Sena Ulu
- Faculty of Medicine, Bahçeşehir University, Beşiktaş/İstanbul, Turkey
| | - Ayca Inci
- Department of Nephrology, Antalya Eğitim ve Araştırma Hastanesi, Antalya, Turkey
| | - Kenan Topal
- Department of Family Medicine, Adana Numune Eğitim ve Araştırma Hastanesi, Yüreğir, Adana, Turkey
| | - Kamyar Kalantar-Zadeh
- Department of Nephrology, University of California Irvine School of Medicine, Irvine, CA 92617, United States
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14
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Salcedo-Mingoarranz AL, Medellín-Garibay SE, Barcia-Hernández E, García-Díaz B. Population Pharmacokinetics of Digoxin in Nonagenarian Patients: Optimization of the Dosing Regimen. Clin Pharmacokinet 2023; 62:1725-1738. [PMID: 37816957 DOI: 10.1007/s40262-023-01313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE The aim of this study was to develop a population pharmacokinetic model of digoxin in patients over 90 years old and to propose an equation for adjusting digoxin dose in this population. METHODS We included 326 nonagenarian patients admitted to Severo Ochoa University Hospital (Spain) who received digoxin and were under therapeutic drug monitoring. All data were retrospectively collected, and population modeling was performed with non-linear mixed-effect modeling software (NONMEM®). One- and two-compartment models were tested to calculate digoxin clearance (Cl), volume of distribution (Vd), absorption rate constant (Ka), and bioavailability (bioavailable fraction, F). The covariates were evaluated by stepwise covariate model building, and the final model was internally validated by bootstrap analysis with 1000 resamples. External validation was performed with another population of 95 patients with the same characteristics as the modeling group. RESULTS The population was 26% males, with a mean age of 93.2 years (90-103 years), mean creatinine 1.11 mg/dL (0.42-3.81 mg/dL), and mean total body weight 61.2 kg (40-100 kg). The pharmacokinetics of digoxin were best described by a one-compartment model (ADVAN2 TRANS2), with first-order conditional estimation with interaction. The covariates with influence on our model were creatinine clearance based on the Cockcroft-Gault equation (CG), serum potassium (K), co-administration of loop diuretics, and sex: Cl/F = 4.55 · (CG/36.4)0.468 · 0.83LD · 1.21SEX; Vd/F = 355 · (K/4.3)-0.849; Ka = 1.22 h-1 [where LD indicates loop diuretics (1 for administered, 0 for otherwise) and SEX indicates patient sex (1 for male, 0 for female)]. Based on our results, we proposed an equation to adjust the digoxin dosing regimen in nonagenarian patients: dose (mg) = 0.144 · (CG/36.4)0.468 · 0.83LD · 1.21SEX. CONCLUSIONS The greatest influence on digoxin clearance came from renal function calculated by the Cockcroft-Gault equation. Vd was decreased by K. The model developed showed a precise predictive performance to be applied for therapeutic drug monitoring.
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Affiliation(s)
| | - Susanna Edith Medellín-Garibay
- Department of Pharmacy and Drug Technology, Faculty of Chemical Sciences, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Emilia Barcia-Hernández
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Universidad Complutense de Madrid, Ciudad Universitaria s/n, 28040, Madrid, Spain
| | - Benito García-Díaz
- Pharmacy Department, Severo Ochoa University Hospital, Avenida Orellana s/n, 28911, Leganés, Spain
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15
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Shankland SJ, Rule AD, Kutz JN, Pippin JW, Wessely O. Podocyte Senescence and Aging. KIDNEY360 2023; 4:1784-1793. [PMID: 37950369 PMCID: PMC10758523 DOI: 10.34067/kid.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
As the population in many industrial countries is aging, the risk, incidence, and prevalence of CKD increases. In the kidney, advancing age results in a progressive decrease in nephron number and an increase in glomerulosclerosis. In this review, we focus on the effect of aging on glomerular podocytes, the post-mitotic epithelial cells critical for the normal integrity and function of the glomerular filtration barrier. The podocytes undergo senescence and transition to a senescence-associated secretory phenotype typified by the production and secretion of inflammatory cytokines that can influence neighboring glomerular cells by paracrine signaling. In addition to senescence, the aging podocyte phenotype is characterized by ultrastructural and functional changes; hypertrophy; cellular, oxidative, and endoplasmic reticulum stress; reduced autophagy; and increased expression of aging genes. This results in a reduced podocyte health span and a shortened life span. Importantly, these changes in the pathways/processes characteristic of healthy podocyte aging are also often similar to pathways in the disease-induced injured podocyte. Finally, the better understanding of podocyte aging and senescence opens therapeutic options to slow the rate of podocyte aging and promote kidney health.
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Affiliation(s)
- Stuart J. Shankland
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Andrew D. Rule
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - J. Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, Washington
| | - Jeffrey W. Pippin
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Oliver Wessely
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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16
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Downie ML, Desjarlais A, Verdin N, Woodlock T, Collister D. Precision Medicine in Diabetic Kidney Disease: A Narrative Review Framed by Lived Experience. Can J Kidney Health Dis 2023; 10:20543581231209012. [PMID: 37920777 PMCID: PMC10619345 DOI: 10.1177/20543581231209012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
Purpose of review Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD) for which many treatments exist that have been shown to prevent CKD progression and kidney failure. However, DKD is a complex and heterogeneous etiology of CKD with a spectrum of phenotypes and disease trajectories. In this narrative review, we discuss precision medicine approaches to DKD, including genomics, metabolomics, proteomics, and their potential role in the management of diabetes mellitus and DKD. A patient and caregivers of patients with lived experience with CKD were involved in this review. Sources of information Original research articles were identified from MEDLINE and Google Scholar using the search terms "diabetes," "diabetic kidney disease," "diabetic nephropathy," "chronic kidney disease," "kidney failure," "dialysis," "nephrology," "genomics," "metabolomics," and "proteomics." Methods A focused review and critical appraisal of existing literature regarding the precision medicine approaches to the diagnosis, prognosis, and treatment of diabetes and DKD framed by a patient partner's/caregiver's lived experience. Key findings Distinguishing diabetic nephropathy from CKD due to other types of DKD and non-DKD is challenging and typically requires a kidney biopsy for a diagnosis. Biomarkers have been identified to assist with the prediction of the onset and progression of DKD, but they have yet to be incorporated and evaluated relative to clinical standard of care CKD and kidney failure risk prediction tools. Genomics has identified multiple causal genetic variants for neonatal diabetes mellitus and monogenic diabetes of the young that can be used for diagnostic purposes and to specify antiglycemic therapy. Genome-wide-associated studies have identified genes implicated in DKD pathophysiology in the setting of type 1 and 2 diabetes but their translational benefits are lagging beyond polygenetic risk scores. Metabolomics and proteomics have been shown to improve diagnostic accuracy in DKD, have been used to identify novel pathways involved in DKD pathogenesis, and can be used to improve the prediction of CKD progression and kidney failure as well as predict response to DKD therapy. Limitations There are a limited number of large, high-quality prospective observational studies and no randomized controlled trials that support the use of precision medicine based approaches to improve clinical outcomes in adults with or at risk of diabetes and DKD. It is unclear which patients may benefit from the clinical use of genomics, metabolomics and proteomics along the spectrum of DKD trajectory. Implications Additional research is needed to evaluate the role of the use of precision medicine for DKD management, including diagnosis, differentiation of diabetic nephropathy from other etiologies of DKD and CKD, short-term and long-term risk prognostication kidney outcomes, and the prediction of response to and safety of disease-modifying therapies.
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Affiliation(s)
- Mallory L. Downie
- McGill University Health Center Research Institute, Montreal, QC, Canada
| | - Arlene Desjarlais
- Kidney Research Scientist Core Education and National Training Program, Montreal, QC, Canada
| | - Nancy Verdin
- Kidney Research Scientist Core Education and National Training Program, Montreal, QC, Canada
| | - Tania Woodlock
- Kidney Research Scientist Core Education and National Training Program, Montreal, QC, Canada
| | - David Collister
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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17
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Yeşiltaş MA, Koyuncu AO, Ak HY, Haberal İ. Endovascular treatments of atherosclerotic renovascular disease: a narrative review and literature search. J Int Med Res 2023; 51:3000605231206057. [PMID: 37882729 PMCID: PMC10605686 DOI: 10.1177/03000605231206057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
In recent years, endovascular treatments have become more common in patients with renal artery stenosis and aneurysm. Although the treatment algorithms are not universally accepted, endovascular therapy can be readily utilized for the appropriate indications in the context of surgical treatment for renovascular diseases. The most important factor to consider is that the correct indication is applied for such treatment. Although the applied procedures are believed to have minimal risk, any complications that occur may result in major problems. Moreover, the pathology that is being treated (e.g., hypertension, high serum creatinine concentration, or low glomerular filtration rate) must be well defined. As stent and balloon technologies continue to be developed, more positive results are expected in the coming years. In the present study, we reviewed the endovascular treatment algorithms for atherosclerotic renovascular disease and performed a narrative review of the current literature.
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Affiliation(s)
- Mehmet Ali Yeşiltaş
- Department of Cardiovascular Surgery, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ahmet Ozan Koyuncu
- Department of Cardiovascular Surgery, Istanbul University-Cerrahpasa Cardiology Institute, Istanbul, Turkey
| | - Hulya Yilmaz Ak
- Department of Anesthesiology and Reanimation, Istanbul Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - İsmail Haberal
- Department of Cardiovascular Surgery, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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18
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Prediction models for the recipients' ideal perioperative estimated glomerular filtration rates for predicting graft survival after adult living-donor kidney transplantation. Front Med (Lausanne) 2023; 10:1187777. [PMID: 37720509 PMCID: PMC10501755 DOI: 10.3389/fmed.2023.1187777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The impact of the perioperative estimated glomerular filtration rate (eGFR) on graft survival in kidney transplant recipients is yet to be evaluated. In this study, we developed prediction models for the ideal perioperative eGFRs in recipients. Methods We evaluated the impact of perioperative predicted ideal and actual eGFRs on graft survival by including 1,174 consecutive adult patients who underwent living-donor kidney transplantation (LDKT) between January 2008 and December 2020. Prediction models for the ideal perioperative eGFR were developed for 676 recipients who were randomly assigned to the training and validation sets (ratio: 7:3). The prediction models for the ideal best eGFR within 3 weeks and those at 1, 2, and 3 weeks after LDKT in 474 recipients were developed using 10-fold validation and stepwise multiple regression model analyzes. The developed prediction models were validated in 202 recipients. Finally, the impact of perioperative predicted ideal eGFRs/actual eGFRs on graft survival was investigated using Fine-Gray regression analysis. Results The correlation coefficients of the predicted ideal best eGFR within 3 weeks and the predicted ideal eGFRs at 1, 2, and 3 weeks after LDKT were 0.651, 0.600, 0.598, and 0.617, respectively. Multivariate analyzes for graft loss demonstrated significant differences in the predicted ideal best eGFR/actual best eGFR within 3 weeks and the predicted ideal eGFRs/actual eGFRs at 1, 2, and 3 weeks after LDKT. Discussion The predicted ideal best eGFR/actual best eGFR within 3 weeks and the predicted ideal eGFRs/actual eGFRs at 1, 2, and 3 weeks after LDKT were independent prognostic factors for graft loss. Therefore, the perioperative predicted ideal eGFR/actual eGFR may be useful for predicting graft survival after adult LDKT.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yuki Hasegawa
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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19
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Eckersley A, Morais MR, Ozols M, Lennon R. Peptide location fingerprinting identifies structural alterations within basement membrane components in ageing kidney. Matrix Biol 2023; 121:167-178. [PMID: 37437747 DOI: 10.1016/j.matbio.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
During ageing, the glomerular and tubular basement membranes (BM) of the kidney undergo a progressive decline in function that is underpinned by histological changes, including glomerulosclerosis and tubular interstitial fibrosis and atrophy. This BM-specific ageing is thought to result from damage accumulation to long-lived extracellular matrix (ECM) protein structures. Determining which BM proteins are susceptible to these structure-associated changes, and the possible mechanisms and downstream consequences, is critical to understand age-related kidney degeneration and to identify markers for therapeutic intervention. Peptide location fingerprinting (PLF) is an emerging proteomic mass spectrometry analysis technique capable of identifying ECM proteins with structure-associated differences that may occur by damage modifications in ageing. Here, we apply PLF as a bioinformatic screening tool to identify BM proteins with structure-associated differences between young and aged human glomerular and tubulointerstitial compartments. Several functional regions within key BM components displayed alterations in tryptic peptide yield, reflecting potential age-dependent shifts in molecular (e.g. laminin-binding regions in agrin) and cellular (e.g. integrin-binding regions in laminins 521 and 511) interactions, oxidation (e.g. collagen IV) and the fragmentation and release of matrikines (e.g. canstatin and endostatin from collagens IV and XVIII). Furthermore, we found that periostin and the collagen IV α2 chain exhibited structure-associated differences in ageing that were conserved between human kidney and previously analysed mouse lung, revealing BM components that harbour shared susceptibilities across species and organs.
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Affiliation(s)
- Alexander Eckersley
- Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Mychel Rpt Morais
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Wellcome Centre for Cell-Matrix Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Matiss Ozols
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Human Genetics, Wellcome Sanger Institute, Genome Campus, Hinxton, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - Rachel Lennon
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Wellcome Centre for Cell-Matrix Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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20
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Tanriover B, Stewart D, Kamal L, Saeed M, Cooper M, Foutz J, McGehee H, Gupta G. The Independent Effects of Kidney Length and Vascular Plaque on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants. Transpl Int 2023; 36:11373. [PMID: 37519905 PMCID: PMC10379651 DOI: 10.3389/ti.2023.11373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
The independent effects of deceased donor kidney length and vascular plaque on long-term graft survival are not established. Utilizing DonorNet attachments from 4,480 expanded criteria donors (ECD) recovered between 2008 and 2012 in the United States with at least one kidney biopsied and transplanted, we analyzed the relationship between kidney length and vascular plaques and 10-year hazard of all-cause graft failure (ACGF) using causal inference methods in a Cox regression framework. The composite plaque score (range 0-4) and the presence of any plaque (yes, no) was also analyzed. Kidney length was modeled both categorically (<10, 10-12, >12 cm) as well as numerically, using a restricted cubic spline to capture nonlinearity. Effects of a novel composite plaque score 4 vs. 0 (HR 1.08; 95% CI: 0.96, 1.23) and the presence of any vascular plaque (HR 1.08; 95% CI: 0.98, 1.20) were attenuated after adjustment. Likewise, we identified a potential nonlinear relationship between kidney length and the 10-year hazard of ACGF, however the strength of the relationship was attenuated after adjusting for other donor factors. The independent effects of vascular plaque and kidney length on long-term ECD graft survival were found to be minimal and should not play a significant role in utilization.
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Affiliation(s)
- Bekir Tanriover
- Division of Nephrology, University of Arizona, Tucson, AZ, United States
| | - Darren Stewart
- Department of Surgery, New York University Langone Health, New York City, NY, United States
| | - Layla Kamal
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA, United States
| | - Muhammad Saeed
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA, United States
| | - Matthew Cooper
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Julia Foutz
- United Network for Organ Sharing, Richmond, VA, United States
| | | | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA, United States
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21
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Ray N, Reddy PH. Structural and physiological changes of the kidney with age and its impact on chronic conditions and COVID-19. Ageing Res Rev 2023; 88:101932. [PMID: 37031725 PMCID: PMC10081878 DOI: 10.1016/j.arr.2023.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
The kidney is an essential organ that removes waste products, balances the body's fluids, releases hormones that regulate blood pressure, produces an active form of vitamin D, promotes healthy bones, and controls the production of red blood cells. Structural and functional abnormalities occur in kidney with age. Alterations in kidney structure are based on physiological functions and environmental pressures. Variations in its structure across vertebrates are primarily due to the nature of alterations in number, complexity, arrangement, and location of the kidney tubules. Globally, individuals aged 65 and older are part of the fastest expanding population demographic, and as a result, a greater number of older patients are receiving a diagnosis of impaired renal function. The purpose of our mini-review is to summarize recent findings of the structural and functional differences between the normal and aging kidney, examine the evolutionary biology of the kidney across species, and demonstrate the role of aging in conditions such as diabetes, chronic kidney disease, and hypertension, along with their impact on SARS-CoV-2. Additional aims include discussing the potential therapeutic strategies to treat aged individuals with kidney health issues and how the impact of a healthy lifestyle, diet, and exercise can improve health conditions with aged kidneys.
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Affiliation(s)
- Nandini Ray
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Nutritional Sciences, School of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA.
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22
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Bilal A, Pratley RE. Newer Glucose-Lowering Therapies in Older Adults with Type 2 Diabetes. Endocrinol Metab Clin North Am 2023; 52:355-375. [PMID: 36948784 DOI: 10.1016/j.ecl.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Diabetes is prevalent in older adults and older adults with diabetes are more likely to have multiple comorbidities. It is, therefore, important to personalize diabetes management in this group. Newer glucose-lowering drugs, including dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists can be safely used in older patients and are preferred choices in many cases due to their safety, efficacy, and low risk of hypoglycemia.
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Affiliation(s)
- Anika Bilal
- AdventHealth Translational Research Institute, 301 East Princeton Street, Orlando, FL 32804, USA
| | - Richard E Pratley
- AdventHealth Translational Research Institute, 301 East Princeton Street, Orlando, FL 32804, USA; AdventHealth Diabetes Institute, 2415 North Orange Avenue, Suite 501, Orlando, FL 32804, USA.
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Ajibola O, Aremu TO, Dada SO, Ajibola O, Adeyinka KO, Ajibola A, Oluwole OE. The Trend of Cefepime-Induced Neurotoxicity: A Systematic Review. Cureus 2023; 15:e40980. [PMID: 37503476 PMCID: PMC10370502 DOI: 10.7759/cureus.40980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
There has been increased use of cefepime due to concerns about the nephrotoxic effects of the combined use of vancomycin and Zosyn. However, cefepime is associated with neurotoxicity. We conducted a systematic review using online data to explore the trend of cefepime-induced neurotoxicity over the last 10 years. Forty-six articles met our inclusion criteria, including 73 cases of cefepime-induced neurotoxicity. We noticed a steady increase in the reports of cefepime-induced neurotoxicity, from one case in 2013 to 11 cases in 2022. Individuals aged 65 and older accounted for most cefepime-induced neurotoxicity cases (52%). The top three indications for cefepime administration included bone and joint infections (25%), urinary tract infections (22.7%), and pneumonia (22.7%). Most patients with renal impairment have never had a renal adjustment of their cefepime dosage (either 2 g 12 hours a day or 2 g eight hours a day). Most cases of cefepime-induced neurotoxicity occurred between days two and five (n=29, 71%), while most resolution occurred between days one and five (n=29, 85%). While cefepime continues to be a popularly used and effective antibiotic against gram-negative bacteria like Pseudomonas aeruginosa, its dosage needs to be adjusted in patients with renal impairment to avoid neurotoxicity.
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Affiliation(s)
- Oluwafemi Ajibola
- Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Taiwo O Aremu
- Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, USA
- Pediatrics, University of Minnesota School of Medicine, Minneapolis, USA
- Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, USA
| | - Stephen O Dada
- Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Olawale Ajibola
- Medicine, American University of St. Vincent School of Medicine, Leeward Hwy, VCT
| | | | | | - Oluwatosin E Oluwole
- Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
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24
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Bani Hani A, Abu Abeeleh M, Al-Najjar S, Alzibdeh A, Mansour S, Bsisu I, Awamleh N, Farah R. Incidence, risk factors and outcomes of acute kidney injury in surgical intensive care unit octogenarians at the Jordan University Hospital. BMC Geriatr 2023; 23:266. [PMID: 37142956 PMCID: PMC10158325 DOI: 10.1186/s12877-023-03975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Acute kidney damage (AKI) is among the most severe consequences observed in surgical intensive care units (SICUs). We aim to observe the incidence, risk factors, and outcomes of acute kidney injury in SICU octogenarians. METHODS A cross-sectional retrospective study was conducted at the SICU of Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between January 2018 and December 2019. Patients who were 80 years or older at the time of data collection were included. The definition of AKI was based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory data were reviewed. RESULTS A total number of 168 patients were included. The mean age was 84.0 ± 3.8 years, and 54.8% of the participants were women. Of those, 115 (68.5%) had surgery before or during ICU stay, and 28.7% of the patients' surgeries were an emergency surgery. Also, 47.8% of surgeries were considered by anesthesia to be high-risk surgeries. A total of 55 patients (32.7%) developed AKI during their SICU stay. The factors that were significantly associated with AKI in the ICU patients included use of beta blocker [AOR: 3.7; 95% CI: 1.2-11.8; p = 0.025], and inotropes [AOR:4.0; 95% CI: 1.2-13.3; p = 0.03]. The factors that were significantly associated with mortality in the ICU included using mechanical ventilation [AOR:18.7; 95% CI: 2.4-141.9; p = 0.005] and inotropes use [AOR: 12.3; 95% CI: 1.2-120.7; p = 0.031]. CONCLUSIONS The incidence of AKI during SICU stay in this study was 32.7% and it was significantly associated with the use of beta blockers, mechanical ventilation, and inotropes. The mortality rate among octogenarians who developed AKI during SICU stay was 36.4%. Further studies are needed globally to assess the incidence of AKI in octogenarian surgical patients and identify risk factors to provide preventative measurements and strategies.
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Affiliation(s)
- Amjad Bani Hani
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mahmoud Abu Abeeleh
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Sondos Al-Najjar
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | - Shahd Mansour
- School of Medicine, The University of Jordan, Amman, 11942, Jordan.
| | - Isam Bsisu
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Nour Awamleh
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Randa Farah
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
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25
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Al Khaldi SS, Al Harbi R, Albastaki S, Al Turki N, Ashari L, Alhassan K, Abduljabbar A, Hibbert D, Almughamsi A, Al Homoud S, Alsanea N. Deterioration in renal function after stoma creation: a retrospective review from a Middle Eastern tertiary care center. Ann Saudi Med 2023; 43:76-81. [PMID: 37031376 PMCID: PMC10082943 DOI: 10.5144/0256-4947.2023.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Stomas are associated with multiple complications including dehydration which ultimately affects renal function. These complications begin with changes in the estimated glomerular filtration rate (GFR). OBJECTIVES Evaluate changes in GFR after stoma creation by stoma type and identify how different types of stoma affect GFR. DESIGN Retrospective, analytical cohort SETTING: Tertiary care center in Saudi Arabia PATIENTS AND METHODS: The colorectal surgery database was reviewed for all adult patients who underwent stoma creation (permanent and temporary ileostomies and colostomies) or reversal in 2000-2015. GFR was estimated at the first encounter, before the index surgery, at the time of stoma reversal, and upon the last follow-up. Patients with renal impairment, including low GFR before stoma creation, patients who had a temporary stoma converted to a permanent stoma, and patients who died with a stoma were excluded. We studied the association of several demographic and clinical factors on changes in GFR by univariate and multivariate analysis. MAIN OUTCOME MEASURES Estimated GFR at the last clinic visit for the permanent stoma group and at stoma closure for the temporary stoma group. SAMPLE SIZE 394 patients (149 ileostomates, 245 colostomates) RESULTS: Thirty-three (8.4%) of the 394 patients had a low GFR: 11 (7.4%) in the ileostomy group and 22 (9%) in the colostomy group (P= .579). The rate of readmissions with ileostomies was higher (11.4%) than with colostomies (3.3%) (P≤.001). The number of temporary ileostomies (n=9, 7.0%) differed from temporary colostomies (n=2, 1.9%) but the difference was not statistically significant (P=.06). In the multivariate analysis, stoma permanency, hypertension, chemotherapy and nephrotoxic drugs were risk factors associated with low GFR. CONCLUSION Ileostomies were not associated with a high rate of renal function deterioration in comparison to colostomies, but had a significantly higher rate of readmission due to dehydration and electrolytes imbalance possibly due to the hot climate in Saudi Arabia. LIMITATIONS Retrospective nature and limited sample size which may have resulted in a type 2 statistical error. CONFLICTS OF INTEREST None.
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Affiliation(s)
- Shimaa Saad Al Khaldi
- From the Section of Colorectal Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Reem Al Harbi
- From the Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sara Albastaki
- From the Department of Colorectal Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Neamat Al Turki
- From the Section of Colorectal Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Luai Ashari
- From the Section of Colorectal Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khuloud Alhassan
- From the Section of Colorectal Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alaa Abduljabbar
- From the Section of Colorectal Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Denise Hibbert
- From the Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Asim Almughamsi
- From the College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Samar Al Homoud
- From the Section of Colorectal Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nasser Alsanea
- From the Director of General Health Affairs, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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26
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Wan H, Jiang Y, Yang J, Ma Q, Liu L, Peng L, Liu H, Xiong N, Guan Z, Yang A, Cao H, Shen J. Sex-specific associations of the urinary fourteen-metal mixture with NAFLD and liver fibrosis among US adults: A nationally representative study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 248:114306. [PMID: 36402077 DOI: 10.1016/j.ecoenv.2022.114306] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Although previous studies have examined the hepatotoxicity of single metal exposure, the associations between metal mixture and non-alcoholic fatty liver disease (NAFLD) or fibrosis remain unclear. This study investigated the associations of urinary metal mixture with the risks of NAFLD and liver fibrosis in US adults using data from the National Health and Nutrition Examination Survey (NHANES) from 2017.01 to 2020.03. Vibration-controlled transient elastography was used to detect the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), which are indicators of NAFLD and liver fibrosis respectively. Three novel mixture modeling approaches including the Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression and quantile g-computation (qgcomp) were used to estimate the associations of the urinary fourteen-metal mixture with Ln CAP and Ln LSM. There were 2283 adults aged over 18 years (1209 women and 1074 men) were included. Among women, urinary metal mixture was positively associated with Ln CAP in the BKMR and qgcomp models (both P < 0.05). However, no significantly associations of urinary metal mixture with Ln CAP were observed among men in all models (all P > 0.05). The metal mixture was not associated with Ln LSM in the three models regardless of genders (all P > 0.05). In conclusion, we observed sex-specific associations between urinary metal mixture and the prevalence of NAFLD in US adults. These findings emphasize the role of environmental heavy metal exposure in the development of NAFLD, and confirm the need for more prospective cohort studies on sex-specific manner.
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Affiliation(s)
- Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Yuqi Jiang
- Institute and Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Qintao Ma
- Institute and Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Lan Liu
- Institute and Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Leiyang Peng
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Han Liu
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Ning Xiong
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhuofan Guan
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Huanyi Cao
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Jie Shen
- Institute and Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China.
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Structural and Functional Changes in Aging Kidneys. Int J Mol Sci 2022; 23:ijms232315435. [PMID: 36499760 PMCID: PMC9737118 DOI: 10.3390/ijms232315435] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The renal condition is one of the crucial predictors of longevity; therefore, early diagnosis of any dysfunction plays an important role. Kidneys are highly susceptible to the aging process. Unfavorable conditions may lead to a significant disturbance of the body's homeostasis. Apart from physiological changes, there are some conditions such as hypertension, diabetes or obesity which contribute to the acceleration of the aging process. A determination of macroscopic and microscopic changes is essential for assessing the progression of aging. With age, we observe a decrease in the volume of renal parenchyma and an increase in adipose tissue in the renal sinuses. Senescence may also be manifested by the roughness of the kidney surface or simple renal cysts. The main microscopic changes are a thickening of the glomerular basement membrane, nephrosclerosis, an accumulation of extracellular matrix, and mesangial widening. The principal aspect of stopping unfavorable changes is to maintain health. Studies have shown many useful ways to mitigate renal aging. This review is focused especially on medications such as renin-angiotensin-aldosterone system blockers or resveratrol, but even eating habits and lifestyle.
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28
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Xie Y, Jin D, Qiu H, Lin L, Sun S, Li D, Sha F, Zhou W, Jia M. Assessment of urinary podocalyxin as an alternative marker for urinary albumin creatinine ratio in early stage of diabetic kidney disease in older patients. Nefrologia 2022; 42:664-670. [PMID: 36402681 DOI: 10.1016/j.nefroe.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/01/2021] [Indexed: 06/16/2023] Open
Abstract
This study's objective is to evaluate the correlation relationship between Podocalyxin (PCX), an urinary marker of podocytes, urinary albumin-creatinine ratio (ACR) and the predictive value of PCX in the routine screen of early diabetic kidney disease (DKD) among older people. We also aimed to explore its prediction value despite of other metabolic factor and how PCX alters in the predictive power for early stage of diabetic nephropathy. In retrospective, 320 cases of older patients diagnosed with type 2 diabetes mellitus who met both inclusion and exclusion criteria were collected and divided with levels of urinary albumin, that is, normal albuminuria group, microalbuminuria group and healthy group. The correlation coefficient between PCX and ACR, and the odds ratio of PCX were gauged in the study. Area under the receiver operating characteristic (ROC) curve was also calculated. There were 188 patients in the normal group with urine ACR<30mg/g, and 132 patients in the microproteinuria group with urine ACR 30-300mg/g. 132 cases of DKD diagnosed with ACR, among them, 104 cases of DKD were predicted by PCX. The percentage correction value was 78.8%. The following parameters such as gender, age, course of disease, glycated hemoglobin, triglyceride, total cholesterol, BMI, blood pressure, uric acid, and eGFR were used as variables for adjustment to establish the prediction model of urine PCX and ACR. Multiple logistic regression test was carried out to evaluate against the predictive ability of the model. The area under the ROC curve corresponding to the regression model after adjustment is 0.952. Although factors such as the course of disease, HbA1C, UA, and eGFR could influence on the predictive ability of PCX, PCX still has a good ability to predict early DKD in older patients. Therefore, it could be used as a diagnostic indicator for early-stage DKD in older patients.
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Affiliation(s)
- Yuxian Xie
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Donghua Jin
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Hong Qiu
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Lihua Lin
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Shaobo Sun
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Damei Li
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Feifei Sha
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Wenming Zhou
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China
| | - Miao Jia
- Department of Nephrology, People's Hospital of Suzhou New District, Suzhou, China.
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29
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Oni OO, Akinwusi PO, Owolabi JI, Odeyemi AO, Israel GM, Ala O, Akande JO, Durodola A, Israel OK, Ajibola I, Aremu AO. Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:774-783. [PMID: 38018719 DOI: 10.4103/1319-2442.390257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative.
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Affiliation(s)
- Opeyemi O Oni
- Department of Medicine, Bowen University, Iwo, Nigeria
| | | | | | | | | | | | - Joel O Akande
- Department of Chemical Pathology, Bowen University, Iwo, Nigeria
| | | | | | - Idowu Ajibola
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Ayodele O Aremu
- Department of Community Medicine, Bowen University, Iwo, Nigeria
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30
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Ji Y, Cho H, Seon S, Lee K, Yoon H. A deep learning model for CT-based kidney volume determination in dogs and normal reference definition. Front Vet Sci 2022; 9:1011804. [PMID: 36387402 PMCID: PMC9649823 DOI: 10.3389/fvets.2022.1011804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/13/2022] [Indexed: 10/07/2023] Open
Abstract
Kidney volume is associated with renal function and the severity of renal diseases, thus accurate assessment of the kidney is important. Although the voxel count method is reported to be more accurate than several methods, its laborious and time-consuming process is considered as a main limitation. In need of a new technology that is fast and as accurate as the manual voxel count method, the aim of this study was to develop the first deep learning model for automatic kidney detection and volume estimation from computed tomography (CT) images of dogs. A total of 182,974 image slices from 386 CT scans of 211 dogs were used to develop this deep learning model. Owing to the variance of kidney size and location in dogs compared to humans, several processing methods and an architecture based on UNEt Transformers which is known to show promising results for various medical image segmentation tasks including this study. Combined loss function and data augmentation were applied to elevate the performance of the model. The Dice similarity coefficient (DSC) which shows the similarity between manual segmentation and automated segmentation by deep-learning model was 0.915 ± 0.054 (mean ± SD) with post-processing. Kidney volume agreement analysis assessing the similarity between the kidney volume estimated by manual voxel count method and the deep-learning model was r = 0.960 (p < 0.001), 0.95 from Lin's concordance correlation coefficient (CCC), and 0.975 from the intraclass correlation coefficient (ICC). Kidney volume was positively correlated with body weight (BW), and insignificantly correlated with body conditions score (BCS), age, and sex. The correlations between BW, BCS, and kidney volume were as follows: kidney volume = 3.701 × BW + 11.962 (R 2 = 0.74, p < 0.001) and kidney volume = 19.823 × BW/BCS index + 10.705 (R 2 = 0.72, p < 0.001). The deep learning model developed in this study is useful for the automatic estimation of kidney volume. Furthermore, a reference range established in this study for CT-based normal kidney volume considering BW and BCS can be helpful in assessment of kidney in dogs.
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Affiliation(s)
- Yewon Ji
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, South Korea
| | | | | | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, South Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, South Korea
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Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne) 2022; 9:769329. [PMID: 36186775 PMCID: PMC9519889 DOI: 10.3389/fmed.2022.769329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/24/2022] [Indexed: 12/11/2022] Open
Abstract
In the last decades, improvements in the average life expectancy in the world population have been associated with a significant increase in the proportion of elderly people, in parallel with a higher prevalence of non-communicable diseases, such as hypertension and diabetes. As the kidney is a common target organ of a variety of diseases, an adequate evaluation of renal function in the approach of this population is of special relevance. It is also known that the kidneys undergo aging-related changes expressed by a decline in the glomerular filtration rate (GFR), reflecting the loss of kidney function, either by a natural senescence process associated with healthy aging or by the length of exposure to diseases with potential kidney damage. Accurate assessment of renal function in the older population is of particular importance to evaluate the degree of kidney function loss, enabling tailored therapeutic interventions. The present review addresses a relevant topic, which is the effects of aging on renal function. In order to do that, we analyze and discuss age-related structural and functional changes. The text also examines the different options for evaluating GFR, from the use of direct methods to the implementation of several estimating equations. Finally, this manuscript supports clinicians in the interpretation of GFR changes associated with age and the management of the older patients with decreased kidney function.
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Affiliation(s)
- Irene L. Noronha
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Irene L. Noronha
| | | | - Lucia Andrade
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Venceslau A. Coelho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rosilene M. Elias
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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32
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Dlamini SB, Wu MT, Dahms HU. Factors Associated with Antiretroviral Therapy Toxicity Out-Comes in Patients with and without Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11051. [PMID: 36078765 PMCID: PMC9518525 DOI: 10.3390/ijerph191711051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Negative effects of antiretroviral therapy (ART) drugs on HIV/AIDS patients are one of the major health issues in the therapeutic treatment of this communicable disease. This holds particularly for people living with HIV (PLHIV) who might have a non-communicable disease (like hypertension), which also requires a lifetime treatment. In this study, we investigated the association between hypertension and other possible factors on ART toxicity markers in patients with hypertension, compared to those without hypertension. METHODS This retrospective longitudinal study reviewed chronic patient files of 525 patients (of which 222 were hypertensive) who satisfied the inclusion criteria and were on ART at a hospital in central Eswatini. Specific levels of estimated glomerular filtration (eGFR), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were used as drug toxicity markers. To analyze the longitudinal data between the exposure of interest and outcome variables, a Generalized Estimated Equation method was employed. RESULTS Participants with hypertension had decreased eGFR compared to those without hypertension (β = -2.22; p-value = 0.03). There was no significant association between ALT, AST and hypertension (p-value = 0.34 and 0.20, respectively). Factors that were found to have a significant association with ART toxicity markers included age, sex, ART duration, hypertension treatment and time of study. The eGFR was found to be significantly increasing over the study period (p-value < 0.001) for all participants. The significance was consistent in both hypertensive and non-hypertensive participants independently (p-value = 0.002 and <0.001, respectively). The overall trends of ALT and AST over time were also significant (p-value = 0.003 and <0.001, respectively). CONCLUSIONS Patients with hypertension had decreased eGFR, and there was a significant association of eGFR with time of the study. Special attention, therefore, to monitor calamities which are indicated by a decrease of eGFR (like renal impairment) should be given in PLHIV on ART with hypertension, especially more so if they were on ART for longer time.
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Affiliation(s)
- Sabelo Bonginkosi Dlamini
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ming-Tsang Wu
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hans-Uwe Dahms
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80708, Taiwan
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33
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Ben Moshe Y, Bekheirnia N, Smith RJH, Hicks J, Braun MC, Bekheirnia MR. Genetic diagnosis and renal biopsy findings in the setting of a renal genetics clinic. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:302-308. [PMID: 36239278 DOI: 10.1002/ajmg.c.32009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
As genetic testing becomes more available, its utilization as an early diagnostic tool in nephrology is more common. The objective of the study is to examine diagnostic agreement between the renal biopsy findings and genetic diagnoses. A retrospective study was conducted in February 2022. A total of 28 patients had both genetic diagnosis and histologic results (n = 1 nephrectomy, n = 27 biopsy). We collected clinical, renal biopsy findings, and genetic information. The relationship between the histologic findings and the genetic diagnoses was classified as: concordant, nonspecific, and discordant. A total of 15 males and 13 females were included (mean age = 9.6 years). Clinical suspicion of Alport syndrome was the most common reason for referral (n = 11, 39.3%), followed by nephrotic syndrome (n = 8, 28.5%), "other" (n = 6, 21.4%), cystic kidney disease (n = 1, 3.6%), isolated hematuria (n = 1, 3.6%), and non-nephrotic proteinuria (n = 1, 3.6%). The overall concordance rate between renal histologic and genetic diagnoses was 71.4% (20/28), nonspecific biopsy results were observed in 17.9% (5/28), and discordant results were observed in 10.7% (3/28). All patients referred for suspected Alport Syndrome had pathogenic/likely pathogenic variants in one of the COL4A genes. Two cases of Lowe syndrome and one of PAX2-associated nephropathy had discordant histology findings. Agreement between renal histologic findings and genetic results varies based on the reason for referral. There was a complete agreement for patients referred for Alport Syndrome; However, there were examples that renal biopsy showed secondary findings that were not specifically associated with the underlying genetic results.
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Affiliation(s)
- Yishay Ben Moshe
- Texas Children's Hospital, Houston, Texas, USA.,Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Nasim Bekheirnia
- Texas Children's Hospital, Houston, Texas, USA.,Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - John Hicks
- Texas Children's Hospital, Houston, Texas, USA.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Michael C Braun
- Texas Children's Hospital, Houston, Texas, USA.,Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Mir Reza Bekheirnia
- Texas Children's Hospital, Houston, Texas, USA.,Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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34
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Tariq H, Ramakrishnan M, Gupta A. Insights into Cognitive Brain Health in Chronic Kidney Disease. GERONTOLOGY & GERIATRICS : RESEARCH 2022; 8:1074. [PMID: 37671071 PMCID: PMC10478617 DOI: 10.26420/gerontolgeriatrres.2022.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Cognitive impairment and Chronic Kidney Disease (CKD) are common in older adults. With advances in medicine, the average lifespan is expected to increase, further increasing the prevalence of both conditions. The mechanisms underlying cognitive impairment in CKD are unclear. While mild-moderately low estimated glomerular filtration rate (eGFR) may not be associated with cognitive impairment, severely decreased eGFR and albuminuria do. Patients on dialysis have a high prevalence of cognitive impairment. Cognitive function improves after kidney transplantation. However, some residual cognitive deficits persist after transplantation, indicating that restoring the kidney function alone may not be enough to restore cognitive function, and other etiological factors may play a role. Albuminuria, another marker of CKD is also associated with cognitive impairment. However, albuminuria is often undiagnosed. Improving early identification and management of patients with albuminuria may be a good population-based dementia prevention strategy. Other factors associated with cognitive impairment in CKD include anemia and other metabolic derangements commonly observed in CKD. In this article, we reviewed the prevalence of cognitive impairment in CKD, the potential mechanisms underlying cognitive impairment in CKD, andthecurrent evidence on the association between cognitive impairment and eGFR and albuminuria.
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Affiliation(s)
- H Tariq
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - M Ramakrishnan
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - A Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
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35
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Grasing M, Kennedy K, Sarnak MJ, Burns JM, Gupta A. Mild to moderate decrease in eGFR and cognitive decline in older adults. Nephrol Dial Transplant 2022; 37:1499-1506. [PMID: 34289074 PMCID: PMC9317170 DOI: 10.1093/ndt/gfab226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whether mild to moderately low estimated glomerular filtration rate (eGFR) is associated with cognitive decline in older adults is not clear. We evaluated changes in cognition in relation to baseline eGFR in older adults participating in the Alzheimer's Disease Neuroimaging Initiative (ADNI). METHODS This is a longitudinal secondary analysis of an established observational cohort. We used data from the ADNI, an National Institutes of Health-funded, multicenter longitudinal observational study that includes participants with and without cognitive impairment who were administered a comprehensive battery of neuropsychological tests every 6 months. We related the Chronic Kidney Disease Epidemiology Collaboration eGFR with previously validated cognition composite scores for memory (ADNI-Mem) and executive function (ADNI-EF) in multivariable linear regression analysis adjusted for age, sex, race and level of education. RESULTS A total of 1127 ADNI participants (mean age 74 ± 7 years, 57% men, 97% Caucasian, mean follow-up 6 ± 2.6 years) were included in the analysis. The mean baseline eGFR was 76 ± 19 mL/min/1.73 m2, with 6% with eGFR <45, 22% with eGFR 45-<60, 51% with eGFR 60-90 and 21% with eGFR >90 mL/min/1.73 m2 at baseline. Both ADNI-Mem and ADNI-EF scores declined over time. In the multivariable linear regression model, older age (β = -0.117, P = 0.01), female sex (β = 0.312, P < 0.001) and lower education (β = 0.079, P < 0.001) were associated with a decline in ADNI-Mem scores, whereas baseline eGFR (each 10 mL/min/1.73 m2 change) was not {β = -0.03 [confidence interval (CI) -0.06-0.001], P = 0.11}. Similarly, older age (β = -0.278, P < 0.001) and lower education (β = 0.099, P < 0.001) were associated with a decline in ADNI-EF scores, whereas baseline eGFR was not [β = 0.004 (95% CI -0.04-0.04), P = 0.84]. CONCLUSIONS In this cohort from the ADNI study, there was no association between baseline eGFR and cognitive decline in older adults with mild to moderately low eGFR.
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Affiliation(s)
- Michael Grasing
- University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Mark J Sarnak
- Division of Nephrology and Hypertension, Tufts Medical Center, Boston, MA, USA
| | - Jeffrey M Burns
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
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36
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Hara S, Yamaguchi Y, Zoshima T, Mizushima I, Yamada K, Inoue R, Muto H, Mizutomi K, Hirata M, Araki H, Miyazaki R, Kawano M. Central fibrous area in the glomerular vascular pole consists of fibrous collagens and is associated with advanced age: a cross-sectional study. BMC Nephrol 2022; 23:204. [PMID: 35690711 PMCID: PMC9188109 DOI: 10.1186/s12882-022-02835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background For the optimal management of patients with both allograft kidneys and native kidney diseases, the recognition of the histological features associated with older age is important. This is because most pathological findings are non-specific. Central fibrous areas (CFAs) have recently been proposed to be age-related. However, the components of CFAs and whether CFAs are observed in various kidney diseases remain undetermined. This cross-sectional study was undertaken to clarify the histological features, epidemiology, and clinicopathological features of CFAs. Methods One hundred and one consecutive kidney needle biopsy specimens were retrospectively collected from seven facilities in the Hokuriku region and diagnosed at the Kanazawa University Hospital in 2015. First, the components of CFAs were analyzed using normal histostaining, immunostaining, and electron microscopy. Second, the patients were divided into two groups (CFA [+] or CFA [−]) according to the presence of CFA in the obtained samples. Clinical and histological features were compared between the two groups, and factors associated with CFA formation were determined using univariate and multivariate analyses. The number of CFAs per specimen was counted in the CFA (+) group. Third, the presence of myofibroblasts in CFA was examined by immunostaining. Results CFAs were observed in 56 of 101 patients (55.4%) with various kidney diseases. CFAs consist of fibrillar collagens (collagen I and III) in addition to non-fibrillar collagens (collagen IV and VI), as confirmed by electron microscopy. Clinically, the CFA (+) group was older and had a significantly higher prevalence of hypertension and hyperlipidemia than the CFA (−) group. Histologically, elastofibrosis of the interlobular artery, arteriolar hyalinosis, and membranous nephropathy were significantly more evident in the CFA (+) group than in the CFA (−) group. Multivariate analysis revealed that older age was the sole factor associated with CFA formation. Finally, 27 of 58 (46.6%) CFA-containing glomeruli in 26 cases included alpha-smooth muscle actin-positive cells in or adjacent to the CFA. Conclusions CFAs consist of fibrous collagens in addition to matrix collagens. CFA formation is associated with older age and was observed in various kidney diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02835-2.
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Affiliation(s)
- Satoshi Hara
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan.,Medical Education Research Center, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan
| | - Yutaka Yamaguchi
- Yamaguchi's Pathology Laboratory, 1-31-20Minoridai, Matsudo, Chiba, Japan
| | - Takeshi Zoshima
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan
| | - Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan
| | - Kazunori Yamada
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan
| | - Ryo Inoue
- Department of Internal Medicine, Saiseikai Kanazawa Hospital, Ni13-6 Akatsuchimachi, Kanazawa, Ishikawa, Japan
| | - Hisao Muto
- Department of Internal Medicine, Hokuriku Central Hospital, 123 Nodera, Oyabe, Toyama, Japan
| | - Kazuaki Mizutomi
- Department of Internal Medicine, Kaga Medical Center, Ri 36 Sakumimachi, Kaga, Ishikawa, Japan
| | - Masayoshi Hirata
- Department of Internal Medicine, Takaoka City Hospital, 4-1 Takaramachi, Takaoka, Toyama, Japan
| | - Hideo Araki
- Department of Nephrology and Rheumatology, Fukui Prefecture Hospital, 2-8-1 Yotsui, Fukui, Fukui, Japan
| | - Ryoichi Miyazaki
- Department of Internal Medicine, Fujita Memorial Hospital, 4-15-7 Houei, Fukui, Fukui, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan.
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37
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Nussbaum JC, Hussain A, Min KC, Marbury TC, Lasseter K, Stoch SA, Iwamoto M. Effects of Renal Impairment on the Pharmacokinetics of Gefapixant, a P2×3 Receptor Antagonist. J Clin Pharmacol 2022; 62:1435-1444. [PMID: 35656754 DOI: 10.1002/jcph.2094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
Gefapixant, a P2×3 receptor antagonist, has demonstrated efficacy in patients with refractory or unexplained chronic cough. We investigated the effect of renal impairment (RI) on the pharmacokinetics (PK) of gefapixant 50 mg in an open-label, single-dose study enrolling participants with moderate (n = 6) or severe (n = 6) RI, end stage renal disease (ESRD; n = 6) under hemodialysis (HD) and non-HD conditions, and healthy matched controls (n = 6). Serial plasma and urine samples for gefapixant concentrations were collected at selected time points over 72 hours and 48 hours post dose, respectively. Linear regression analysis predicted a 1.87-, 2.79-, and 3.76-fold higher exposure (AUC) for participants with mild, moderate, and severe RI, respectively, than that for healthy matched control participants. Categorical analysis exhibited a 2.98-, 4.43-, and 4.74-fold higher exposure for participants with moderate RI, severe RI, and ESRD, respectively, than that for healthy matched control participants. Clearance (CL/F and CLr) was lower in participants with various degrees of RI, by 66-90%, compared with healthy matched control participants, explaining the increased gefapixant exposure with increasing degrees of renal impairment. Gefapixant AUC and Cmax decreased by ∼25% under HD conditions compared to non-HD conditions. Single dose administration of gefapixant was generally well tolerated in this study. The data from this trial informed the enrollment of Phase 3 clinical trials that evaluated the efficacy and safety of gefapixant in over 2,000 participants with refractory or unexplained chronic cough. Those efficacy and safety data, combined with analysis of population pharmacokinetics from across the entire development program, will be used to evaluate the magnitude of the renal impairment effect in the refractory or unexplained chronic cough population and to determine any dose adjustment recommendations. This article is protected by copyright. All rights reserved.
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38
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Mohammad Zadeh Gharabaghi MA, Rezvanfar MR, Saeedi N, Aghajani F, Alirezaei M, Yarahmadi P, Nakhostin-Ansari A. Comparison of effects of Empagliflozin and Linagliptin on renal function and glycaemic control: a double-blind, randomized clinical trial. Clin Diabetes Endocrinol 2022; 8:5. [PMID: 35610696 PMCID: PMC9131518 DOI: 10.1186/s40842-022-00142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed to compare the effects of Linagliptin and Empagliflozin on renal function and glycaemic control in patients with type 2 diabetes mellitus (DM). Method We conducted a randomized, double-blind, parallel trial on patients aged 30 to 80 years with type 2 DM and HbA1c ≤ 9%, regardless of background medical therapy, to compare the effects of Empagliflozin and Linagliptin on albuminuria, FBS, HbA1c, and eGFR. Participants were given the mentioned drugs for 12 weeks. Statistical analysis was performed using appropriate tests in IBM™SPSS® statistics software for windows version 24. Results In total, 60 patients participated in the study, thirty patients in each group. The mean age of participants was 56.8 (SD = 8.15) in the Empagliflozin group and 60.9 (SD = 7.22) in the Linagliptin group. Before the intervention, FBS, HbA1C, and albuminuria values were significantly higher in the Empagliflozin group than those in the Linagliptin group (P < 0.05), but there was no significant difference between groups regarding eGFR (P = 0.271). Changes in the FBS, HbA1C, and eGFR were not significantly different between groups (P > 0.05), but there was more decrease in albuminuria in the Empagliflozin group compared to the Linagliptin group (P = 0.001, Cohen’s d = 0.98). Conclusions Regardless of baseline albuminuria, eGFR, or HbA1c, Empagliflozin 10 mg daily significantly reduced albuminuria at 12 weeks compared to Linagliptin 5 mg daily in patients with type 2 diabetes. Trial registration Iranian Registry of Clinical Trials, IRCT20200722048176N1. Registered 3 August 2020.
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Affiliation(s)
| | - Mohammad Reza Rezvanfar
- Internal Medicine Department, Arak University of Medical Sciences, A'lam-Al-Hoda Street, Shahid Shiroodi Street, Arak, Iran
| | - Nasser Saeedi
- Internal Medicine Department, Arak University of Medical Sciences, A'lam-Al-Hoda Street, Shahid Shiroodi Street, Arak, Iran
| | - Faezeh Aghajani
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pourya Yarahmadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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39
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Liu F, Chen J, Li Z, Meng X. Recent Advances in Epigenetics of Age-Related Kidney Diseases. Genes (Basel) 2022; 13:genes13050796. [PMID: 35627181 PMCID: PMC9142069 DOI: 10.3390/genes13050796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
Renal aging has attracted increasing attention in today’s aging society, as elderly people with advanced age are more susceptible to various kidney disorders such as acute kidney injury (AKI) and chronic kidney disease (CKD). There is no clear-cut universal mechanism for identifying age-related kidney diseases, and therefore, they pose a considerable medical and public health challenge. Epigenetics refers to the study of heritable modifications in the regulation of gene expression that do not require changes in the underlying genomic DNA sequence. A variety of epigenetic modifiers such as histone deacetylases (HDAC) inhibitors and DNA methyltransferase (DNMT) inhibitors have been proposed as potential biomarkers and therapeutic targets in numerous fields including cardiovascular diseases, immune system disease, nervous system diseases, and neoplasms. Accumulating evidence in recent years indicates that epigenetic modifications have been implicated in renal aging. However, no previous systematic review has been performed to systematically generalize the relationship between epigenetics and age-related kidney diseases. In this review, we aim to summarize the recent advances in epigenetic mechanisms of age-related kidney diseases as well as discuss the application of epigenetic modifiers as potential biomarkers and therapeutic targets in the field of age-related kidney diseases. In summary, the main types of epigenetic processes including DNA methylation, histone modifications, non-coding RNA (ncRNA) modulation have all been implicated in the progression of age-related kidney diseases, and therapeutic targeting of these processes will yield novel therapeutic strategies for the prevention and/or treatment of age-related kidney diseases.
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Affiliation(s)
- Feng Liu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
| | - Jiefang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
| | - Zhenqiong Li
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
- Correspondence: (Z.L.); (X.M.)
| | - Xianfang Meng
- Department of Neurobiology, Institute of Brain Research, School of Basic Medical Sciences, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (Z.L.); (X.M.)
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Quaglia M, Merlotti G, Colombatto A, Bruno S, Stasi A, Franzin R, Castellano G, Grossini E, Fanelli V, Cantaluppi V. Stem Cell-Derived Extracellular Vesicles as Potential Therapeutic Approach for Acute Kidney Injury. Front Immunol 2022; 13:849891. [PMID: 35359949 PMCID: PMC8960117 DOI: 10.3389/fimmu.2022.849891] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022] Open
Abstract
Acute kidney injury is a frequent complication of hospitalized patients and significantly increases morbidity and mortality, worsening costs and length of hospital stay. Despite this impact on healthcare system, treatment still remains only supportive (dialysis). Stem cell-derived extracellular vesicles are a promising option as they recapitulate stem cells properties, overcoming safety issues related to risks or rejection or aberrant differentiation. A growing body of evidence based on pre-clinical studies suggests that extracellular vesicles may be effective to treat acute kidney injury and to limit fibrosis through direct interference with pathogenic mechanisms of vascular and tubular epithelial cell damage. We herein analyze the state-of-the-art knowledge of therapeutic approaches with stem cell-derived extracellular vesicles for different forms of acute kidney injury (toxic, ischemic or septic) dissecting their cytoprotective, regenerative and immunomodulatory properties. We also analyze the potential impact of extracellular vesicles on the mechanisms of transition from acute kidney injury to chronic kidney disease, with a focus on the pivotal role of the inhibition of complement cascade in this setting. Despite some technical limits, nowadays the development of therapies based on stem cell-derived extracellular vesicles holds promise as a new frontier to limit acute kidney injury onset and progression.
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Affiliation(s)
- Marco Quaglia
- Nephrology and Kidney Transplantation Unit, "Maggiore della Carità" University Hospital, Department of Translational Medicine, Translational Research on Autoimmune and Allergic Disease (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Guido Merlotti
- Nephrology and Kidney Transplantation Unit, "Maggiore della Carità" University Hospital, Department of Translational Medicine, Translational Research on Autoimmune and Allergic Disease (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Andrea Colombatto
- Nephrology and Kidney Transplantation Unit, "Maggiore della Carità" University Hospital, Department of Translational Medicine, Translational Research on Autoimmune and Allergic Disease (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Stefania Bruno
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessandra Stasi
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Rossana Franzin
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Kidney Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Grossini
- Laboratory of Physiology, Department of Translational Medicine, Translational Research on Autoimmune and Allergic Disease (CAAD), University of Piemonte Orientale, Novara, Italy
| | - Vito Fanelli
- Department of Anesthesiology and Intensive Care, University of Torino, Torino, Italy
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, "Maggiore della Carità" University Hospital, Department of Translational Medicine, Translational Research on Autoimmune and Allergic Disease (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
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41
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Wang M, Hsu HC, Yu MC, Wang IK, Huang CC, Chan M, Weng CH, Huang WH, Hsu CW, Huang LM, Tam FWK, Yen TH. Impact of kidney size on the outcome of diabetic patients receiving hemodialysis. PLoS One 2022; 17:e0266231. [PMID: 35358262 PMCID: PMC8970390 DOI: 10.1371/journal.pone.0266231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Diabetic patients normally have enlarged or normal-sized kidneys throughout their lifetime, but some diabetic uremic patients have small kidneys. It is uncertain if kidney size could have any negative impact on outcome in hemodialysis patients.
Methods
This longitudinal, observational cohort study recruited 301 diabetic hemodialysis patients in 2015, and followed until 2019. Patients were stratified into two subgroups according to their kidney sizes before dialysis, as small (n = 32) or enlarged or normal (n = 269). Baseline demographic, hematological, biochemical, nutritional, inflammatory and dialysis related data were collected for analysis.
Results
Patients with small kidney size were not only older (P<0.001) and had lower body mass index (P = 0.016), but had also higher blood uric acid concentration (P<0.001) compared with patients with enlarged or normal kidney size. All patients received adequate doses of hemodialysis since the Kt/V and urea reduction ratio was 1.7±0.3 and 0.7±0.1, respectively. Patients with small size kidneys received higher erythropoietin dose than patients with enlarged or normal kidney size (P = 0.031). At the end of analysis, 92 (30.6%) patients expired. Kaplan-Meier analysis revealed no survival difference between both groups (P = 0.753). In a multivariate logistic regression model, it was demonstrated that age (P<0.001), dialysis duration (P<0.001), as well as blood albumin (P = 0.012) and low-density lipoprotein (P = 0.009) concentrations were significantly correlated with mortality.
Conclusions
Small kidney size on starting hemodialysis was not related with an augmented risk for death in diabetic patients receiving hemodialysis. Further studies are necessary.
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Affiliation(s)
- Min Wang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chiao Hsu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Mei-Ching Yu
- Division of Pediatric Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung, and China Medical University, Taichung, Taiwan
| | - Chien-Chang Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Ming‐Jen Chan
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Lan-Mei Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Frederick W. K. Tam
- Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Native kidney biopsies in older adults: disease spectrum, long-term kidney and patient survival and safety. Int Urol Nephrol 2022; 54:2365-2373. [DOI: 10.1007/s11255-022-03143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
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Carter B, Ramsay EA, Short R, Goodison S, Lumsden J, Khan A, Braude P, Vilches-Moraga A, Quinn TJ, McCarthy K, Hewitt J, Myint PK, Bruce E, Einarsson A, McCrorie K, Aggrey K, Bilan J, Hartrop K, Murphy C, McGovern A, Clini E, Guaraldi G, Verduri A, Bisset C, Alexander R, Kelly J, Murphy C, Mutasem TEJ, Singh S, Paxton D, Harris W, Moug S, Galbraith N, Bhatti E, Edwards J, Duffy S, Espinoza MFR, Kneen T, Dafnis A, Allafi H, Vidal MN, Price A, Pearce L, Lee T, Sangani S, Garcia M, Davey C, Jones S, Lunstone K, Cavenagh A, Silver C, Telford T, Simmons R. Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study. BMC Geriatr 2022; 22:119. [PMID: 35151257 PMCID: PMC8840680 DOI: 10.1186/s12877-022-02782-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality. Methods Patient clinical and demographic data was taken from the COVID-19 in Older People (COPE) study during two periods (February–June 2020 and October 2020–March 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics. Results One thousand eight hundred two patients (55.0% male; median [IQR] 80 [73–86] years) were included in the study. 28-day mortality was 42.3% (n = 742). 48% (n = 801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR ≥ 60 [Stage 1&2]): eGFR 45–59 [Stage 3a] aHR = 1.26 (95%CI 1.02–1.55); eGFR 30–44 [Stage 3b] aHR = 1.41 (95%CI 1.14–1.73); eGFR 1–29 [Stage 4&5] aHR = 1.42 (95%CI 1.13–1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR) = 1.18 (95%CI 0.88–1.58), Stage 3b aOR = 1.40 (95%CI 1.03–1.89); and Stage 4&5 aOR = 1.65 (95%CI 1.16–2.35). Conclusion eGFR on admission is a good independent predictor of mortality in hospitalised older patients with COVID-19 population. We found evidence of a dose-response between reduced renal function and increased mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02782-5.
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Grasing M, Sharma P, Lepping RJ, Honea R, Burns JM, Brooks WM, Gupta A. Association between the Estimated Glomerular Filtration Rate and Brain Atrophy in Older Adults. Am J Nephrol 2022; 53:176-181. [PMID: 35130538 PMCID: PMC9060294 DOI: 10.1159/000521892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
End-stage kidney disease has been associated with cognitive impairment and brain atrophy. It remains unclear if mild to moderate kidney dysfunction is associated with brain atrophy, especially in older adults. We used cross-sectional data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), an NIH-funded multicenter longitudinal cohort study, to better understand the association between estimated glomerular filtration rate (eGFR) and brain volumes. We included all ADNI participants with both baseline serum creatinine values and MRI brain volume assessments. We used multiple linear regression modeling to assess cross-sectional associations between eGFR and whole-brain gray matter, hippocampus, entorhinal, fusiform, and middle temporal brain volumes. Participants (n = 1,596) were 74 ± 7 years old with a mean eGFR of 69.4 ± 14.8 mL/min/1.73 m2; 53% had mild cognitive impairment, and 19% had dementia. Unadjusted analysis showed an association between lower eGFR and smaller brain volumes. After adjusting for age, sex, and education, there was no association between eGFR brain volumes (p > 0.05 for all). These results remained consistent after subgroup analysis by age stratification and baseline cognitive status. Age was a confounding variable in the unadjusted association between the eGFR and brain volumes. Thus, a mild to moderately reduced eGFR was not associated with brain atrophy in ADNI participants.
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Affiliation(s)
- Michael Grasing
- The School of medicine, University of Kansas Medical Center, Kansas City, KS
| | - Palash Sharma
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS
| | - Rebecca J Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS
| | - Robyn Honea
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Jeffrey M Burns
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Frontiers Clinical & Translational Science Institute at the University of Kansas, University of Kansas Medical Center, Kansas City, KS
| | - William M Brooks
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Frontiers Clinical & Translational Science Institute at the University of Kansas, University of Kansas Medical Center, Kansas City, KS
| | - Aditi Gupta
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
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Central fibrous areas: changes in glomerular vascular pole lesions associated with age and disease. Int Urol Nephrol 2022; 54:2263-2273. [PMID: 35099688 PMCID: PMC9371997 DOI: 10.1007/s11255-022-03126-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
Purpose Central fibrous areas (CFAs) are small, hyalinotic, monotonous nodular areas observed in glomerular vascular pole lesions. We attempted to clarify the relationship between CFA formation and age in healthy kidneys and in those affected by immunoglobulin A (IgA) nephropathy. Methods Zero-hour biopsy specimens from living renal donors (135 cases) and IgA nephropathy biopsy specimens (67 cases) were collected retrospectively. We observed each biopsy specimen and determined the total number of glomeruli, total level of glomerulosclerosis, number of observable glomerular vascular poles, number of glomeruli with CFAs, serum creatinine level, and estimated glomerular filtration rate (eGFR). Additionally, we calculated the glomerular sclerosis rate (GSR), vascular pole appearance rate (PAR), and CFA rate (CFAR) to evaluate the relationship between these factors and patient age. Results There was a significant negative correlation between patient age and eGFR for both the zero-hour (p < 0.0001 in Spearman, p = 0.0009 in multiple regression, the same hereafter) and IgA (p = 0.0022, p = 0.0001) groups. In the zero-hour group, we observed a significant positive correlation between patient age and GSR (p = 0.0001, p < 0.0001); however, there was no such correlation in the IgA group. In both groups, there was a significant positive correlation between patient age and CFAR (zero-hour group: p = 0.0003, p = 0.0091, IgA group; p < 0.0001, p = 0.0004). The slope of the regression line of the IgA group formula was also significantly higher than that of the zero-hour group formula (p < 0.01). Conclusion These findings indicate that CFA may be a useful indicator of kidney aging, especially in patients with kidney disease caused by IgA nephropathy.
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Hull KL, Adenwalla SF, Topham P, Graham-Brown MP. Indications and considerations for kidney biopsy: an overview of clinical considerations for the non-specialist. Clin Med (Lond) 2022; 22:34-40. [PMID: 38589098 DOI: 10.7861/clinmed.2021-0472] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Around 3 million people in the UK have chronic kidney disease and 20% of hospital admissions are complicated by acute kidney injury. Decline in kidney function is not a diagnosis; it is essential to identify and treat underlying causes of acute and chronic kidney disease to either achieve recovery or slow the decline of kidney function. Thorough clinical assessment and simple investigations help determine the category of kidney injury (pre-renal, intrinsic or post-renal) and inform the need for kidney biopsy, which can provide significant information in the evaluation of suspected intrinsic kidney disease, supporting diagnosis, guiding prognosis and management, and identifying disease relapse. The procedure is invasive and not without risk, which although small has the potential to be both organ- and life-threatening. This review outlines roles of kidney biopsy for the non-specialist, with focus of its role in patients with diabetes, lupus, myeloma and in the older patient.
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Affiliation(s)
- Katherine L Hull
- University Hospitals of Leicester NHS Trust, Leicester, UK and University of Leicester, Leicester, UK; *joint first authors
| | - Sherna F Adenwalla
- University Hospitals of Leicester NHS Trust, Leicester, UK and University of Leicester, Leicester, UK; *joint first authors
| | - Peter Topham
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthew P Graham-Brown
- University Hospitals of Leicester NHS Trust, Leicester, UK and University of Leicester, Leicester, UK.
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Treadmill Exercise Training Ameliorates Functional and Structural Age-Associated Kidney Changes in Male Albino Rats. ScientificWorldJournal 2021; 2021:1393372. [PMID: 34887703 PMCID: PMC8651424 DOI: 10.1155/2021/1393372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 12/28/2022] Open
Abstract
Aging is a biological process that impacts multiple organs. Unfortunately, kidney aging affects the quality of life with high mortality rate. So, searching for innovative nonpharmacological modality improving age-associated kidney deterioration is important. This study aimed to throw more light on the beneficial effect of treadmill exercise on the aged kidney. Thirty male albino rats were divided into three groups: young (3-4 months old), sedentary aged (23-24 months old), and exercised aged (23-24 months old, practiced moderate-intensity treadmill exercise 5 days/week for 8 weeks). The results showed marked structural alterations in the aged kidney with concomitant impairment of kidney functions and increase in arterial blood pressure with no significant difference in kidney weight. Also, it revealed that treadmill exercise alleviated theses effects in exercised aged group with reduction of urea and cystatin C. Exercise training significantly decreased glomerulosclerosis index, tubular injury score, and % area of collagen deposition. Treadmill exercise exerted its beneficial role via a significant reduction of C-reactive protein and malondialdehyde and increase in total antioxidant capacity. In addition, exercise training significantly decreased desmin immunoreaction and increased aquaporin-3, vascular endothelial growth factor, and beclin-1 in the aged kidney. This study clarified that treadmill exercise exerted its effects via antioxidant and anti-inflammatory mechanisms, podocyte protection, improving aquaporin-3 and vascular endothelial growth factor expression, and inducing autophagy in the aged kidney. This work provided a new insight into the promising role of aerobic exercise to ameliorate age-associated kidney damage.
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Song Y, Guo F, Zhao Y, Zhao L, Fan X, Zhang Y, Liu Y, Qin G. Verapamil ameliorates proximal tubular epithelial cells apoptosis and fibrosis in diabetic kidney. Eur J Pharmacol 2021; 911:174552. [PMID: 34627808 DOI: 10.1016/j.ejphar.2021.174552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/22/2022]
Abstract
Diabetic kidney disease (DKD) is a severe complication of diabetes mellitus for which there is still no effective treatment. We previously showed that upregulation of thioredoxin-interacting protein (TXNIP), an endogenous inhibitor of thioredoxin (TRX), accelerates the progression of DKD. In this study, we hypothesized whether verapamil, a calcium channel blocker and an established TXNIP inhibitor, might exert a renal-protective effect on DKD by regulating TXNIP expression. Herein, a systemic pharmacological network study was performed and multiple molecules and pathways targeted by verapamil on DKD were characterized. Furthermore, diabetic mice were induced by streptozotocin (STZ), and verapamil (100 mg/kg/day) or saline was intraperitoneally injected into the mice. After 16 weeks, mice were analyzed for blood glucose, blood pressure, and functional parameters followed by sacrifice and evaluation of renal tubular injury, alterations in TXNIP, apoptosis and fibrosis markers. Additionally, the effects of treatment with verapamil (50 μM, 100 μM, 150 μM) under high glucose conditions on the expression of TXNIP and signaling pathway components in proximal tubular epithelial cells (PTEC, HK-2 cells) were explored. According to these findings, we conclude that verapamil might serve as a potential agent for the prevention and treatment of DKD.
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Affiliation(s)
- Yi Song
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450052, China; Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Feng Guo
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450052, China; Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yanyan Zhao
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lin Zhao
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xunjie Fan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450052, China; Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yuanyuan Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yanling Liu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Guijun Qin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Shankland SJ, Wang Y, Shaw AS, Vaughan JC, Pippin JW, Wessely O. Podocyte Aging: Why and How Getting Old Matters. J Am Soc Nephrol 2021; 32:2697-2713. [PMID: 34716239 PMCID: PMC8806106 DOI: 10.1681/asn.2021050614] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/26/2021] [Indexed: 02/04/2023] Open
Abstract
The effects of healthy aging on the kidney, and how these effects intersect with superimposed diseases, are highly relevant in the context of the population's increasing longevity. Age-associated changes to podocytes, which are terminally differentiated glomerular epithelial cells, adversely affect kidney health. This review discusses the molecular and cellular mechanisms underlying podocyte aging, how these mechanisms might be augmented by disease in the aged kidney, and approaches to mitigate progressive damage to podocytes. Furthermore, we address how biologic pathways such as those associated with cellular growth confound aging in humans and rodents.
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Affiliation(s)
- Stuart J. Shankland
- Division of Nephrology, University of Washington, Seattle, Washington
- Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, Washington
| | - Yuliang Wang
- Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, Washington
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington
| | - Andrey S. Shaw
- Department of Research Biology, Genentech, South San Francisco, California
| | - Joshua C. Vaughan
- Department of Chemistry, University of Washington, Seattle, Washington
- Department of Physiology and Biophysics, University of Washington, Seattle, Washington
| | - Jeffrey W. Pippin
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Oliver Wessely
- Lerner Research Institute, Department of Cardiovascular & Metabolic Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
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Xie Y, Jin D, Qiu H, Lin L, Sun S, Li D, Sha F, Zhou W, Jia M. Assessment of urinary podocalyxin as an alternative marker for urinary albumin creatinine ratio in early stage of diabetic kidney disease in older patients. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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