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Delanaye P, Pottel H, Cavalier E, Flamant M, Stehlé T, Mariat C. Diagnostic standard: assessing glomerular filtration rate. Nephrol Dial Transplant 2024; 39:1088-1096. [PMID: 37950562 DOI: 10.1093/ndt/gfad241] [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: 07/14/2023] [Indexed: 11/12/2023] Open
Abstract
Creatinine-based estimated glomerular filtration rate (eGFR) is imprecise at individual level, due to non-GFR-related serum creatinine determinants, including atypical muscle mass. Cystatin C has the advantage of being independent of muscle mass, a feature that led to the development of race- and sex-free equations. Yet, cystatin C-based equations do not perform better than creatinine-based equations for estimating GFR unless both variables are included together. The new race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation had slight opposite biases between Black and non-Black subjects in the USA, but has poorer performance than that the previous version in European populations. The European Kidney Function Consortium (EKFC) equation developed in 2021 can be used in both children and adults, is more accurate in young and old adults, and is applicable to non-white European populations, by rescaling the Q factor, i.e. population median creatinine, in a potentially universal way. A sex- and race-free cystatin C-based EKFC, with the same mathematical design, has also be defined. New developments in the field of GFR estimation would be standardization of cystatin C assays, development of creatinine-based eGFR equations that incorporate muscle mass data, implementation of new endogenous biomarkers and the use of artificial intelligence. Standardization of different GFR measurement methods would also be a future challenge, as well as new technologies for measuring GFR. Future research is also needed into discrepancies between cystatin C and creatinine, which is associated with high risk of adverse events: we need to standardize the definition of discrepancy and understand its determinants.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
| | - Martin Flamant
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, and Université Paris Cité, UMR 1149, Paris, France
| | - Thomas Stehlé
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
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Ofori EK, Nketiah-Dwomo I, Tagoe EA, Amponsah SK, Adams I, Nyarko ENY, Amanquah SD. Comparative Determination of Glomerular Filtration Rate Estimation Formulae in Type 2 Diabetic Patients: An Observational Study. BIOMED RESEARCH INTERNATIONAL 2024; 2024:9532236. [PMID: 38903148 PMCID: PMC11189678 DOI: 10.1155/2024/9532236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/02/2024] [Accepted: 05/02/2024] [Indexed: 06/22/2024]
Abstract
Assessing glomerular filtration rate (GFR) involves collecting timed urine samples for 24 hours, requiring significant time and resources in the clinical setting. Using predictive GFR formulae to assess renal function may be a better alternative. Our goal was to determine which predictive GFR formula had the highest level of concordance with the GFR that has been measured in a resource-poor setting. This is an observational study. We selected fifty (50) individuals diagnosed with type 2 diabetes (T2DM) in Kumasi, Ghana. The sociodemographic and clinical characteristics were obtained using a structured questionnaire. Urine was obtained from each subject over 24 hours. The levels of glucose (FBG) and creatinine in patients' blood, as well as the levels of creatinine in their urine, were measured after the patients had fasted overnight. Participants had a mean age of 57.4 ± 10.7 (years), BMI of 27.8 ± 4.1 (kg/m2), FBG of 9.0 ± 3.1 (mmol/L), and creatinine concentrations of 95.6 ± 29.1 (μmol/L). A Krouwer plot was used to compare the measured GFR with three formulae: Chronic Kidney Disease Epidemiology (CKD-EPI), Modification of Diet in Renal Disease (MDRD), and Cockroft-Gault (CG) for GFR prediction. Among the 3 estimates, CG showed nonsignificance (p > 0.05) with the measured GFR. The primary finding was that the GFR calculated using the CG formula was not different from the GFR measured, suggesting that CG is the most appropriate alternative GFR estimate among a cross-section of T2DM patients in Ghana.
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Affiliation(s)
| | | | | | | | - Ismaila Adams
- Department of Medical PharmacologyU.G.M.S.University of Ghana, Accra, Ghana
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Rudolph MD, Sutphen CL, Register TC, Whitlow CT, Solingapuram Sai KK, Hughes TM, Bateman JR, Dage JL, Russ KA, Mielke MM, Craft S, Lockhart SN. Associations among plasma, MRI, and amyloid PET biomarkers of Alzheimer's disease and related dementias and the impact of health-related comorbidities in a community-dwelling cohort. Alzheimers Dement 2024; 20:4159-4173. [PMID: 38747525 PMCID: PMC11180870 DOI: 10.1002/alz.13835] [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: 11/08/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION We evaluated associations between plasma and neuroimaging-derived biomarkers of Alzheimer's disease and related dementias and the impact of health-related comorbidities. METHODS We examined plasma biomarkers (neurofilament light chain, glial fibrillary acidic protein, amyloid beta [Aβ] 42/40, phosphorylated tau 181) and neuroimaging measures of amyloid deposition (Aβ-positron emission tomography [PET]), total brain volume, white matter hyperintensity volume, diffusion-weighted fractional anisotropy, and neurite orientation dispersion and density imaging free water. Participants were adjudicated as cognitively unimpaired (CU; N = 299), mild cognitive impairment (MCI; N = 192), or dementia (DEM; N = 65). Biomarkers were compared across groups stratified by diagnosis, sex, race, and APOE ε4 carrier status. General linear models examined plasma-imaging associations before and after adjusting for demographics (age, sex, race, education), APOE ε4 status, medications, diagnosis, and other factors (estimated glomerular filtration rate [eGFR], body mass index [BMI]). RESULTS Plasma biomarkers differed across diagnostic groups (DEM > MCI > CU), were altered in Aβ-PET-positive individuals, and were associated with poorer brain health and kidney function. DISCUSSION eGFR and BMI did not substantially impact associations between plasma and neuroimaging biomarkers. HIGHLIGHTS Plasma biomarkers differ across diagnostic groups (DEM > MCI > CU) and are altered in Aβ-PET-positive individuals. Altered plasma biomarker levels are associated with poorer brain health and kidney function. Plasma and neuroimaging biomarker associations are largely independent of comorbidities.
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Affiliation(s)
- Marc D. Rudolph
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Courtney L. Sutphen
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Thomas C. Register
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Christopher T. Whitlow
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kiran K. Solingapuram Sai
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Timothy M. Hughes
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James R. Bateman
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jeffrey L. Dage
- Department Of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kristen A. Russ
- Department Of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michelle M. Mielke
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Suzanne Craft
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Samuel N. Lockhart
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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Mathialagan S, Chung G, Pye K, Rodrigues AD, Varma MVS, Brown C. Significance of Organic Anion Transporter 2 and Organic Cation Transporter 2 in Creatinine Clearance: Mechanistic Evaluation Using Freshly Prepared Human Primary Renal Proximal Tubule Cells. J Pharmacol Exp Ther 2024; 388:201-208. [PMID: 37977812 DOI: 10.1124/jpet.123.001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
Creatinine, a clinical marker for kidney function, is predominantly cleared by glomerular filtration, with active tubular secretion contributing to about 30% of its renal clearance. Recent studies suggested the potential involvement of organic anion transporter (OAT)2, in addition to the previously known organic cation transporter (OCT)2-mediated basolateral uptake, in creatinine active secretion. Here we characterized the transport mechanisms of creatinine using transfected human embryonic kidney (HEK)293 cells and freshly prepared human primary renal proximal tubule epithelial cells (hPTCs). Creatinine showed transport by OAT2 in transfected HEK293 cells. In addition, both creatinine and metformin showed transport by OCT2 and multidrug and toxin extrusion pump (MATE)1 and MATE2K, while penciclovir was selective for OAT2. Time-dependent cell accumulation was observed for creatinine and metformin in hPTCs. Their accumulation was increased by pyrimethamine but inhibited by decynium-22, likely due to differential inhibition of OCT2 versus MATEs. Additionally, indomethacin (an OAT2 inhibitor) reduced penciclovir uptake (∼75%) in hPTCs illustrating functional OAT2 activity. However, no modulation of creatinine and metformin cell accumulation was apparent with indomethacin. Creatinine transport characteristics in the presence of inhibitors approached those of metformin, an OCT2/MATE substrate, but were distinct from those of penciclovir, an OAT2-selective substrate. Moreover, indomethacin showed no significant effect on the basolateral-to-apical transport and net secretion of creatinine across hPTC monolayers. Collectively, the functional studies suggest OCT2 as the primary basolateral uptake mechanism and that OAT2 has a minimal role, in creatinine renal secretion. Our results highlight the utility of hPTCs to enable the functional assessment of renal transport mechanisms. SIGNIFICANCE STATEMENT: Our results obtained with primary hPTCs indicate that OCT2/MATE (vs. OAT2) play a major role in the active renal secretion of creatinine. Quantitative pharmacokinetic models should therefore focus on OCT2/MATE when describing serum creatinine and creatinine clearance modulation by inhibitor drugs and genotype- or disease-related activity changes. The present study highlights the utility of freshly isolated hPTCs to support solute carrier phenotyping to enable the functional assessment of renal transport mechanisms.
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Affiliation(s)
- Sumathy Mathialagan
- Medicine Design, Pfizer Research and Development, Pfizer Inc., Groton, Connecticut (S.M., A.D.R., M.V.S.V.); and Newcells Biotech Limited, The Biosphere, Newcastle Upton Tyne, United Kingdom (G.C., K.P., C.B.)
| | - Git Chung
- Medicine Design, Pfizer Research and Development, Pfizer Inc., Groton, Connecticut (S.M., A.D.R., M.V.S.V.); and Newcells Biotech Limited, The Biosphere, Newcastle Upton Tyne, United Kingdom (G.C., K.P., C.B.)
| | - Keith Pye
- Medicine Design, Pfizer Research and Development, Pfizer Inc., Groton, Connecticut (S.M., A.D.R., M.V.S.V.); and Newcells Biotech Limited, The Biosphere, Newcastle Upton Tyne, United Kingdom (G.C., K.P., C.B.)
| | - A David Rodrigues
- Medicine Design, Pfizer Research and Development, Pfizer Inc., Groton, Connecticut (S.M., A.D.R., M.V.S.V.); and Newcells Biotech Limited, The Biosphere, Newcastle Upton Tyne, United Kingdom (G.C., K.P., C.B.)
| | - Manthena V S Varma
- Medicine Design, Pfizer Research and Development, Pfizer Inc., Groton, Connecticut (S.M., A.D.R., M.V.S.V.); and Newcells Biotech Limited, The Biosphere, Newcastle Upton Tyne, United Kingdom (G.C., K.P., C.B.)
| | - Colin Brown
- Medicine Design, Pfizer Research and Development, Pfizer Inc., Groton, Connecticut (S.M., A.D.R., M.V.S.V.); and Newcells Biotech Limited, The Biosphere, Newcastle Upton Tyne, United Kingdom (G.C., K.P., C.B.)
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He J, Liang P, Wang T, Han S. A magnetic solid phase chemiluminescent immunoassay for quantification of Cystatin C in human serum. BMC Biotechnol 2023; 23:45. [PMID: 37821832 PMCID: PMC10568915 DOI: 10.1186/s12896-023-00813-6] [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: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
A chemiluminescent immunoassay for human serum Cystatin C (Cys C) was established using a direct-antibody sandwich model. The immunoassay kit uses magnetic separation technology, using magnetic particles as the reaction solid phase, alkaline phosphatase as the marker enzyme, and a new chemiluminescent substrate APLS as the substrate. It has the characteristics of high sensitivity and short reaction time. This product uses high-affinity antibodies, resulting in a high specificity. The established method showed good accuracy, uniformity, and stability. The limit of detection was 2.39 ng/mL. The intra-assay coefficient of variation (CV) was 3.36%-6.00%, the interassay CV was 4.12%-5.35%, and the recovery rate was 99.07%. The correlation coefficient (r) of Cys-C kit was 0.999388 ≥ 0.9900. The accuracy of the developed method was tested by automatic chemiluminescence instrument (P > 0.05). The lowest titer was 0.92500, and the highest was 1.10000. The developed method showed a good correlation with the product from Roche by comparing these two kits in 240 clinical samples from China. In total, 1392 clinical patient from China samples were measured using the reagent kit developed in this study.
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Affiliation(s)
- Jian He
- Department of Clinical Laboratory, Affiliated Children's Hospital of Jiangnan University, Wuxi, China
| | - Ping Liang
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Tingting Wang
- Department of Clinical Laboratory, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
- Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, 214062, China.
| | - Shuang Han
- Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, 214062, China.
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Cho YJ, Hyeon C, Nam K, Lee S, Ju JW, Kang J, Han JK, Kim HS, Jeon Y. Effects of low versus high inspired oxygen fraction on myocardial injury after transcatheter aortic valve implantation: A randomized clinical trial. PLoS One 2023; 18:e0281232. [PMID: 37531368 PMCID: PMC10395822 DOI: 10.1371/journal.pone.0281232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Oxygen therapy is used in various clinical situation, but its clinical outcomes are inconsistent. The relationship between the fraction of inspired oxygen (FIO2) during transcatheter aortic valve implantation (TAVI) and clinical outcomes has not been well studied. We investigated the association of FIO2 (low vs. high) and myocardial injury in patients undergoing TAVI. METHODS Adults undergoing transfemoral TAVI under general anesthesia were randomly assigned to receive FIO2 0.3 or 0.8 during procedure. The primary outcome was the area under the curve (AUC) for high-sensitivity cardiac troponin I (hs-cTnI) during the first 72 h following TAVI. Secondary outcomes included the AUC for postprocedural creatine kinase-myocardial band (CK-MB), acute kidney injury and recovery, conduction abnormalities, pacemaker implantation, stroke, myocardial infarction, and in-hospital mortality. RESULTS Between October 2017 and April 2022, 72 patients were randomized and 62 were included in the final analysis (n = 31 per group). The median (IQR) AUC for hs-cTnI in the first 72 h was 42.66 (24.82-65.44) and 71.96 (35.38-116.34) h·ng/mL in the FIO2 0.3 and 0.8 groups, respectively (p = 0.066). The AUC for CK-MB in the first 72 h was 257.6 (155.6-322.0) and 342.2 (195.4-485.2) h·ng/mL in the FIO2 0.3 and 0.8 groups, respectively (p = 0.132). Acute kidney recovery, defined as an increase in the estimated glomerular filtration rate ≥ 25% of baseline in 48 h, was more common in the FIO2 0.3 group (65% vs. 39%, p = 0.042). Other clinical outcomes were comparable between the groups. CONCLUSIONS The FIO2 level did not have a significant effect on periprocedural myocardial injury following TAVI. However, considering the marginal results, a benefit of low FIO2 during TAVI could not be ruled out.
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Affiliation(s)
- Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheun Hyeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeehoon Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Kyu Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Mueller-Peltzer K, von Krüchten R, Lorbeer R, Rospleszcz S, Schulz H, Peters A, Bamberg F, Schlett CL, Mujaj B. Adipose tissue is associated with kidney function parameters. Sci Rep 2023; 13:9151. [PMID: 37280396 DOI: 10.1038/s41598-023-36390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
Obesity is characterized by the accumulation of adipose tissue in different body compartments. Whether adipose tissue directly affects kidney function is still unknown. We aimed to investigate the role of the adipose tissue and circulating creatinine, cystatin C and kidney function in subjects free of cardio-renal diseases. In the KORA-MRI population-based study, 377 subjects (mean age 56.2 ± 9.2 years; 41.6% female) underwent whole-body 3T-MRI examination. Adipose tissue defined as visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were quantified from T1-DIXON sequence using a semi-automatic algorithm. Serum creatinine and cystatin C were measured using standard laboratory and estimated glomerular filtration rate (e-GFR) was performed based on creatinine (e-GFRcrea), cystatin C (e-GFRcys) and creatinine-cystatin C (e-GFRcc). Linear regression analysis, adjusted for risk factors, was used to investigate the relationship between adipose tissue and circulating creatinine, cystatin C, and kidney function. In multivariate analyses VAT was inversely associated with eGFRcys (ß = - 4.88, p = < 0.001), and positively associated with serum cystatin C (ß = 0.05, p = < 0.001), respectively. No association was found between other adipose parameters such as total adipose tissue (TAT) and subcutaneous adipose tissue (SAT) and serum creatinine, urine microalbumin and eGFRcrea. Stratified analyses according to BMI revealed confirmatory results for category of BMI > 30. VAT is positively associated with serum cystatin C and inversely with eGFR based on cystatin C, suggesting a direct involvement of visceral adipose tissue in increased metabolism of cystatin C and consequently decreased kidney function.
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Affiliation(s)
- Katharina Mueller-Peltzer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine Freiburg, Medical Center, Universitätsklinikum Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine Freiburg, Medical Center, Universitätsklinikum Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Susanne Rospleszcz
- Chair of Epidemiology, Medical Faculty, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munchen, Germany
| | - Holger Schulz
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Peters
- Chair of Epidemiology, Medical Faculty, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munchen, Germany
- German Center for Diabetes Research, München-Neuherberg, Neuherberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine Freiburg, Medical Center, Universitätsklinikum Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine Freiburg, Medical Center, Universitätsklinikum Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Blerim Mujaj
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine Freiburg, Medical Center, Universitätsklinikum Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
- General Practice, Huisartsenpraktijk, Bremtstraat 116, 9320, Aalst, Belgium.
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Surendrakumar V, Aitken E, Mark P, Motallebzadeh R, Hunter J, Amer A, Summers D, Rennie K, Rooshenas L, Garbi M, Sylvester K, Hudson C, Banks J, Sidders A, Norton A, Slater M, Bartlett M, Knight S, Pettigrew G. Cardiorespiratory Optimisation By Arteriovenous fistula Ligation after renal Transplantation (COBALT): study protocol for a multicentre randomised interventional feasibility trial. BMJ Open 2023; 13:e067668. [PMID: 36759026 PMCID: PMC9923321 DOI: 10.1136/bmjopen-2022-067668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Cardiovascular events are a major cause of mortality following successful kidney transplantation.Arteriovenous fistulas (AVFs) are considered the best option for haemodialysis, but may contribute to this excess mortality because they promote adverse cardiac remodelling and ventricular hypertrophy. This raises the question whether recipients with a well-functioning kidney transplant should undergo elective AVF ligation. METHODS AND ANALYSIS The COBALT feasibility study is a multicentre interventional randomised controlled trial (RCT) that will randomise renal transplant patients with stable graft function and a working AVF on a 1:1 basis to standard care (continued conservative management) or to AVF ligation. All patients will perform cardiopulmonary exercise testing (CPET) on recruitment and 6 months later. Daily functioning and quality of life will be additionally assessed by questionnaire completion and objective measure of physical activity. The primary outcome-the proportion of approached patients who complete the study (incorporating rates of consent, receipt of allocated intervention and completion of both CPETs without withdrawal)-will determine progression to a full-scale RCT. Design of the proposed RCT will be informed by an embedded qualitative assessment of participant and healthcare professional involvement. ETHICS AND DISSEMINATION This study has been approved by the East Midlands-Derby Research Ethics Committee (22/EM/0002) and the Health Research Authority. The results of this work will be disseminated academically through presentation at national and international renal meetings and via open access, peer-reviewed outputs. Existing networks of renal patient groups will also be used to disseminate the study findings to other key stakeholders. TRIAL REGISTRATION NUMBER ISRCTN49033491.
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Affiliation(s)
- Veena Surendrakumar
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Emma Aitken
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Patrick Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Reza Motallebzadeh
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - James Hunter
- Department of Transplant and Dialysis Access Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Aimen Amer
- Institute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Dominic Summers
- Department of Surgery, University of Cambridge, Cambridge, UK
- Department of Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kirsten Rennie
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Madalina Garbi
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Karl Sylvester
- Respiratory Physiology Services, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cara Hudson
- Statistics and Clinical Studies, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Jennifer Banks
- Statistics and Clinical Studies, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Anna Sidders
- Clinical Trials Unit, NHSBT Clinical Trials Unit, Cambridge, UK
| | - Andrew Norton
- Addenbrooke's Kidney Patients Association, Cambridge, UK
| | - Matthew Slater
- Department of Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew Bartlett
- Vascular Studies, Royal Free London NHS Foundation Trust, London, UK
| | - Simon Knight
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Gavin Pettigrew
- Department of Surgery, University of Cambridge, Cambridge, UK
- Department of Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Sakai M, Hirai T, Shitara S, Iwamoto T, Shiga T. Comparison of creatinine-based equations for estimating renal function for digoxin dose adjustment in patients with atrial fibrillation and heart failure. Pharmacol Res Perspect 2023; 11:e01050. [PMID: 36628508 PMCID: PMC9832284 DOI: 10.1002/prp2.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to determine an appropriate equation for estimating renal function to dose regulate the serum digoxin trough concentration to a target of <0.9 ng/ml in patients with atrial fibrillation (AF) and heart failure (HF). All patients received 0.125 mg oral digoxin daily. The estimated glomerular filtration rate by the Modification of Diet in Renal Disease (eGFRMDRD ) equation deindexed based on body surface area had the highest correlation with digoxin trough concentrations (r = -0.450) compared to the Cockcroft-Gault equation (r = -0.415) or deindexed eGFR based on the Chronic Kidney Disease Epidemiology Collaboration (eGFRCKD-EPI ) equation (r = -0.416). The median digoxin trough concentrations were 0.60, 0.77, 0.97 and 1.30 ng/ml in patients with a deindexed eGFRMDRD ≥ 60, 45-59, 30-44 and < 30 ml/min, respectively. The deindexed eGFRMDRD is an appropriate equation for digoxin dose adjustment in patients with AF and HF.
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Affiliation(s)
| | - Toshinori Hirai
- Department of Clinical Pharmacology and TherapeuticsThe Jikei University School of MedicineTokyoJapan
- Department of PharmacyMie University Hospital, Faculty of Medicine, Mie UniversityTsuMieJapan
| | - Satoshi Shitara
- Department of Clinical Pharmacology and TherapeuticsThe Jikei University School of MedicineTokyoJapan
| | - Takuya Iwamoto
- Department of PharmacyMie University Hospital, Faculty of Medicine, Mie UniversityTsuMieJapan
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and TherapeuticsThe Jikei University School of MedicineTokyoJapan
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
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10
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Tang Y, Hou L, Sun T, Li S, Cheng J, Xue D, Wang X, Du Y. Improved equations to estimate GFR in Chinese children with chronic kidney disease. Pediatr Nephrol 2023; 38:237-247. [PMID: 35467153 DOI: 10.1007/s00467-022-05552-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is currently no specific equation for estimating glomerular filtration rate (GFR) in Chinese children with chronic kidney disease (CKD). The commonly used equations are less robust than expected; we therefore sought to derive more appropriate equations for GFR estimation. METHODS A total of 751 Chinese children with CKD were divided into 2 groups, training group (n = 501) and validation group (n = 250). In the training group, a univariate linear regression model was used to calculate predictability of variables associated with GFR. Residuals were compared to determine multivariate predictability of GFR in the equation. Standard regression techniques for Gaussian data were used to determine coefficients of GFR-estimating equations after logarithmic transformation of measured GFR (iGFR), height/serum creatinine (height/Scr), cystatin C, blood urea nitrogen (BUN), and height. These were compared with other well-known equations using the validation group. RESULTS Median 99mTc-DTPA GFR was 90.1 (interquartile range: 67.3-108.6) mL/min/1.73 m2 in training dataset. Our CKD equation, eGFR (mL/min/1.73 m2) = 91.021 [height(m)/Scr(mg/dL)/2.7]0.443 [1.2/Cystatin C(mg/L)]0.335 [13.7/BUN (mg/dL)]-0.095 [ 0.991male] [height(m)/1.4]0.275, was derived. This was further tested in the validation group, with percentages of eGFR values within 30% and 15% of iGFR (P30 and P15) of 76.00% and 48.40%, respectively. For centres with no access to cystatin C, a creatinine-based equation, eGFR (mL/min/1.73 m2) = 89.674 [height(m)/Scr(mg/dL)/2.7]0.579 [ 1.007male] [height(m)/1.4]0.187, was derived, with P30 and P15 73.60% and 49.20%, respectively. These were significantly higher compared to other well-known equations (p < 0.05). CONCLUSION We developed equations for GFR estimation in Chinese children with CKD based on Scr, BUN and cystatin C. These are more accurate than commonly used equations in this population.
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Affiliation(s)
- Ying Tang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tingting Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shanping Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Junli Cheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dan Xue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiuli Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
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11
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Pottel H, Cavalier E, Björk J, Nyman U, Grubb A, Ebert N, Schaeffner E, Eriksen BO, Melsom T, Lamb EJ, Mariat C, Dubourg L, Hansson M, Littmann K, Sundin PO, Åkesson A, Larsson A, Rule A, Delanaye P. Standardization of serum creatinine is essential for accurate use of unbiased estimated GFR equations: evidence from three cohorts matched on renal function. Clin Kidney J 2022; 15:2258-2265. [PMID: 36381377 PMCID: PMC9664577 DOI: 10.1093/ckj/sfac182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Differences in the performance of estimated glomerular filtration rate (eGFR) equations have been attributed to the mathematical form of the equations and to differences between patient demographics and measurement methods. We evaluated differences in serum creatinine (SCr) and eGFR in cohorts matched for age, sex, body mass index (BMI) and measured GFR (mGFR). METHODS White North Americans from Minnesota (n = 1093) and the Chronic Renal Insufficiency Cohort (CRIC) (n = 1548) and White subjects from the European Kidney Function Consortium (EKFC) cohort (n = 7727) were matched for demographic patient characteristics (sex, age ± 3 years, BMI ± 2.5 kg/m2) and renal function (mGFR ± 3 ml/min/1.73 m2). SCr was measured with isotope dilution mass spectrometry (IDMS)-traceable assays in the Minnesota and EKFC cohorts and with non-standardized SCr assays recalculated to IDMS in the CRIC. The Minnesota cohort and CRIC shared a common method to measure GFR (renal clearance of iothalamate), while the EKFC cohort used a variety of exogenous markers and methods, all with recognized sufficient accuracy. We compared the SCr levels and eGFR predictions [for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and EKFC equations] of patients fulfilling these matching criteria. RESULTS For 305 matched individuals, mean SCr (mg/dL) was not different between the Minnesota and EKFC cohorts (females 0.83 ± 0.20 versus 0.86 ± 0.23, males 1.06 ± 0.23 versus 1.12 ± 0.37; P > .05) but significantly different from the CRIC [females 1.13 ± 0.23 (P < .0001), males 1.42 ± 0.31 (P < .0001)]. The CKD-EPI equations performed better than the EKFC equation in the CRIC, while the opposite was true in the Minnesota and EKFC cohorts. CONCLUSION Significant differences in SCr concentrations between the Minnesota and EKFC cohorts versus CRIC were observed in subjects with the same level of mGFR and equal demographic characteristics and can be explained by the difference in SCr calibration.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund, Lund University, Sweden
| | - Natalie Ebert
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Elke Schaeffner
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Björn O Eriksen
- Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
| | - Toralf Melsom
- Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
| | - Edmund J Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Magnus Hansson
- Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge and Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Karin Littmann
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Per-Ola Sundin
- Department of Geriatrics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Åkesson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Andrew Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Pierre Delanaye
- Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
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12
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Cai D, Xiao T, Zou A, Mao L, Chi B, Wang Y, Wang Q, Ji Y, Sun L. Predicting acute kidney injury risk in acute myocardial infarction patients: An artificial intelligence model using medical information mart for intensive care databases. Front Cardiovasc Med 2022; 9:964894. [PMID: 36158815 PMCID: PMC9489917 DOI: 10.3389/fcvm.2022.964894] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Predictive models based on machine learning have been widely used in clinical practice. Patients with acute myocardial infarction (AMI) are prone to the risk of acute kidney injury (AKI), which results in a poor prognosis for the patient. The aim of this study was to develop a machine learning predictive model for the identification of AKI in AMI patients. Methods Patients with AMI who had been registered in the Medical Information Mart for Intensive Care (MIMIC) III and IV database were enrolled. The primary outcome was the occurrence of AKI during hospitalization. We developed Random Forests (RF) model, Naive Bayes (NB) model, Support Vector Machine (SVM) model, eXtreme Gradient Boosting (xGBoost) model, Decision Trees (DT) model, and Logistic Regression (LR) models with AMI patients in MIMIC-IV database. The importance ranking of all variables was obtained by the SHapley Additive exPlanations (SHAP) method. AMI patients in MIMIC-III databases were used for model evaluation. The area under the receiver operating characteristic curve (AUC) was used to compare the performance of each model. Results A total of 3,882 subjects with AMI were enrolled through screening of the MIMIC database, of which 1,098 patients (28.2%) developed AKI. We randomly assigned 70% of the patients in the MIMIC-IV data to the training cohort, which is used to develop models in the training cohort. The remaining 30% is allocated to the testing cohort. Meanwhile, MIMIC-III patient data performs the external validation function of the model. 3,882 patients and 37 predictors were included in the analysis for model construction. The top 5 predictors were serum creatinine, activated partial prothrombin time, blood glucose concentration, platelets, and atrial fibrillation, (SHAP values are 0.670, 0.444, 0.398, 0.389, and 0.381, respectively). In the testing cohort, using top 20 important features, the models of RF, NB, SVM, xGBoost, DT model, and LR obtained AUC of 0.733, 0.739, 0.687, 0.689, 0.663, and 0.677, respectively. Placing RF models of number of different variables on the external validation cohort yielded their AUC of 0.711, 0.754, 0.778, 0.781, and 0.777, respectively. Conclusion Machine learning algorithms, particularly the random forest algorithm, have improved the accuracy of risk stratification for AKI in AMI patients and are applied to accurately identify the risk of AKI in AMI patients.
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Affiliation(s)
- Dabei Cai
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Tingting Xiao
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Ailin Zou
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Lipeng Mao
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Boyu Chi
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Yu Wang
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Qingjie Wang
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
- *Correspondence: Qingjie Wang,
| | - Yuan Ji
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Yuan Ji,
| | - Ling Sun
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
- Ling Sun,
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13
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Flowers KC, Tuddenham E, Leiva A, Garrison L, Morris JE, Cromwell T, Boa FG. Negative interference from immunoglobulin M paraproteinaemia on the Roche enzymatic creatinine method. Ann Clin Biochem 2022; 59:205-210. [PMID: 35133213 DOI: 10.1177/00045632221074867] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although enzymatic creatinine methods are subject to fewer interferences than traditional Jaffe creatinine methods, every method in clinical chemistry has limitations. We report, for the first time in the literature, a case of an immunoglobulin M (IgM) paraproteinaemia causing an undetectably low creatinine result on the Roche enzymatic assay. This interference did not occur with other enzymatic creatinine methods produced by Abbott and Siemens or the Roche Jaffe, VITROS dry slide and liquid chromatography with tandem mass spectrometry (LC-MS/MS) creatinine methods. IgM interference was confirmed as patient serum precipitated with polyethylene glycol (PEG) and anti-IgM antiserum yielded detectable Roche enzymatic creatinine results comparable to unaffected methods. The patient's serum formed an obvious precipitate when mixed with reagent one of the Roche enzymatic creatinine method. This is in contrast to a report of positive interference from IgM paraproteinaemia in a different enzymatic creatinine method, which showed that a precipitate formed when mixing blood with reagent two. As each patient's paraprotein has a unique structure, it is possible that there are variations in the chemical characteristics of IgM paraproteins between patients. This, as well as IgM-class antibodies' tendency to form multimers and aggregates, can lead to unpredictable assay interferences and precipitation tendencies between different manufacturers of enzymatic creatinine reagents and their incubation steps. This case highlights the importance of continuing to question and investigates results that do not fit the clinical picture, especially as more laboratories switch from primarily using traditional Jaffe creatinine methods to enzymatic creatinine methods.
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Affiliation(s)
- Kade C Flowers
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
| | - Emma Tuddenham
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anya Leiva
- 434486Parkshot Medical Practice, Richmond, UK
| | - Lisa Garrison
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
| | - Joanne E Morris
- Protein Reference Unit, South West London Pathology, 4968St George's Hospital, London, UK
| | - Tamsyn Cromwell
- Clinical Biochemistry and Immunology, Royal Sussex County Hospital, 8721University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Frances G Boa
- Department of Clinical Blood Sciences, South West London Pathology, 4968St George's University Hospitals NHS Foundation Trust, London, UK
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Li Y, Andersson A, Xu Y, Pineda D, Nilsson CA, Lindh CH, Jakobsson K, Fletcher T. Determinants of serum half-lives for linear and branched perfluoroalkyl substances after long-term high exposure-A study in Ronneby, Sweden. ENVIRONMENT INTERNATIONAL 2022; 163:107198. [PMID: 35447437 DOI: 10.1016/j.envint.2022.107198] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are persistent substances with surfactant and repellent properties. Municipal drinking water contaminated with PFAS had been distributed for decades to one third of households in Ronneby, Sweden. The source was firefighting foam used in a nearby airfield since the mid-1980s. Clean water was provided from December 16, 2013. AIMS The purpose was to estimate serum half-lives and their determinants in the study population for different PFAS. METHODS Up to ten blood samples were collected between 2014 and 2018 from 114 participants (age 4-84 years at entry, 53% female). 19 PFAS were analysed. Linear mixed models were used to estimate the half-lives. RESULTS Eight PFAS were increased in Ronneby: perfluorooctanoic acid (PFOA), perfluoropentane sulfonate (PFPeS), perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), linear perfluorooctane sulfonate (L-PFOS) and three branched perfluorooctane sulfonates (1 m-PFOS, 3/4/5m-PFOS and 2/6m-PFOS). The mean estimated half-lives (in years) were 0.94 (95 %CI 0.86-1.02) for PFPeS, 2.47 (2.27-2.7) for PFOA, 2.67 (2.51-2.85) for 2/6m-PFOS, 2.73 (2.55-2.92) for L-PFOS, 3.43 (3.19-3.71) for 3/4/5m-PFOS, 4.52 (4.14-4.99) for PFHxS, 4.55 (4.14-5.06) for PFHpS, and 5.01 (4.56-5.55) for 1 m-PFOS. The most important determinants of a shorter half-life were young age, and better kidney function measured by estimated glomerular filtration rate and ratio of paired urine and serum PFAS levels, followed by female sex during their fertile period aged 15-50. Markers of gut inflammation and reduced permeability i.e. zonulin and calprotectin were also possibly associated with shorter half-life. The results also suggested a time-dependent PFAS elimination process, with more rapid elimination in the first year after the end of exposure. CONCLUSION The half-life estimates are in line with past estimates for some PFAS such as PFOA, and the novel results for different PFOS isomers. These results provide observational support for elimination routes - renal, fecal and maternal.
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Affiliation(s)
- Ying Li
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Axel Andersson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Yiyi Xu
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Daniela Pineda
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Carina A Nilsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, UK
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15
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Utility of Estimated Glomerular Filtration Rate Equations in Assessing Renal Allograft Function: Are They Accurate? Transplant Proc 2022; 54:329-334. [DOI: 10.1016/j.transproceed.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
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16
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Davis S, Mohan S. Managing Patients with Failing Kidney Allograft: Many Questions Remain. Clin J Am Soc Nephrol 2022; 17:444-451. [PMID: 33692118 PMCID: PMC8975040 DOI: 10.2215/cjn.14620920] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patients who receive a kidney transplant commonly experience failure of their allograft. Transplant failure often comes with complex management decisions, such as when and how to wean immunosuppression and start the transition to a second transplant or to dialysis. These decisions are made in the context of important concerns about competing risks, including sensitization and infection. Unfortunately, the management of the failed allograft is, at present, guided by relatively poor-quality data and, as a result, practice patterns are variable and suboptimal given that patients with failed allografts experience excess morbidity and mortality compared with their transplant-naive counterparts. In this review, we summarize the management strategies through the often-precarious transition from transplant to dialysis, highlighting the paucity of data and the critical gaps in our knowledge that are necessary to inform the optimal care of the patient with a failing kidney transplant.
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Affiliation(s)
- Scott Davis
- Department of Medicine, University of Colorado, Aurora, Colorado,Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sumit Mohan
- Department of Medicine, University of Colorado, Aurora, Colorado .,Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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17
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Gaebe K, White CA, Mahmud FH, Scholey JW, Elia YT, Sochett EB, Cherney DZ. Evaluation of novel glomerular filtration rate estimation equations in adolescents and young adults with type 1 diabetes. J Diabetes Complications 2022; 36:108081. [PMID: 34756765 DOI: 10.1016/j.jdiacomp.2021.108081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/25/2022]
Abstract
AIMS Individuals with type 1 diabetes (T1D) are at an increased risk of chronic kidney disease making estimation of glomerular filtration rate (eGFR) an important component of diabetes care. Which eGFR equation is most appropriate to use in patients with T1D during the transition to adult care is unclear. We, therefore, sought to evaluate the performance of five eGFR equations in adolescents and young adults with T1D. METHODS Measured iohexol-based glomerular filtration rate was compared to the Chronic Kidney Disease and Epidemiology Collaboration (CKD-EPI) eGFR, Chronic Kidney Disease in Children (CKiD) eGFR, and three recently developed age-adjusted versions of these in 53 patients with T1D and preserved GFR using bias, precision, and accuracy. RESULTS The best performance was found in the sex-dependent CKiD equation (bias: -0.8, accuracy: 11.8 ml/min/1.73 m2). Bias and accuracy (26.4 and 26.8 ml/min/1.73 m2) were worst in the CKD-EPI equation. Age-dependent adjustment improved performance for this equation (bias: 5.3, accuracy: 13.4 ml/min/1.73 m2), but not for the CKiD equation (bias: 15.5, accuracy: 18.8 ml/min/1.73 m2). CONCLUSION Age-adjustment improved performance for the CKD-EPI equation, but not for the CKiD equation. The sex-adjusted CKiD equation performed best out of all equations.
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Affiliation(s)
- Karolina Gaebe
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - James W Scholey
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yesmino T Elia
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Etienne B Sochett
- Division of Endocrinology and Metabolism, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Z Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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18
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Forssten MP, Bass GA, Scheufler KM, Mohammad Ismail A, Cao Y, Martin ND, Sarani B, Mohseni S. Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index. Eur J Trauma Emerg Surg 2021; 48:4481-4488. [PMID: 34839374 DOI: 10.1007/s00068-021-01841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. METHODS All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. RESULTS 259,399 patients met the study's inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01-1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05-1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11-1.90), p = 0.006], compared to RCRI 0. CONCLUSION An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.
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Affiliation(s)
- Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kai-Michael Scheufler
- Department of Neurosurgery, Orebro University Hospital, 70185, Örebro, Sweden.,Medical School, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | - Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Niels Douglas Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden. .,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden.
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19
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Delanaye P, Mariat C, Cavalier E, Glassock RJ, Gemenne F, Pottel H. The « race » correction in estimating glomerular filtration rate: an European point of view. Curr Opin Nephrol Hypertens 2021; 30:525-530. [PMID: 34456237 DOI: 10.1097/mnh.0000000000000739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW There is currently a heated debate ongoing whether or not to use the race coefficient for black people in the Modification of Diet in Renal Diseases and Chronic Kidney Disease Epidemiology-equation. The use of the race coefficient is thought by several American authors as a source of discrimination. RECENT FINDINGS It has recently been shown that the race coefficient is inaccurate in European and African black people. Therefore, it seems that the race correction is more a correction for black Americans, rather than for black in general. This 'correction' at the glomerular filtration rate (GFR)-level has been criticized, as it is misleading, and should be abandoned, as it has not been shown that GFR is different between black and white people. However, as differences in creatinine generation between black and white people might exist, a correction or adjustment, different for black and white people, at the creatinine level might be required, very similar to the different scaling of creatinine for males and females. SUMMARY The current debate on the race coefficient is particularly difficult because of the absence of good scientific data in black subjects and there lies the real discrimination in our opinion. We therefore call for future dedicated studies, both in Europe and USA.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - François Gemenne
- The Hugo Observatory, University of Liège (ULiege), Liège, Belgium
- Sciences Po, Paris, France
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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20
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Liang P, Chen Y, Li S, Xu C, Yuan G, Hu D, Kamel I, Zhang Y, Li Z. Noninvasive assessment of kidney dysfunction in children by using blood oxygenation level-dependent MRI and intravoxel incoherent motion diffusion-weighted imaging. Insights Imaging 2021; 12:146. [PMID: 34674043 PMCID: PMC8531182 DOI: 10.1186/s13244-021-01091-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives To explore whether multiparametric approach including blood oxygenation level-dependent MRI (BOLD-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can be applied in the assessment of renal function in children with chronic kidney disease (CKD). Materials and methods This prospective study included 74 children (CKD stage 1–3, 51; CKD stage 4–5, 12; healthy volunteers, 11) for renal MRI examinations including coronal T2WI, axial T1WI and T2WI, BOLD-MRI, and DWI sequences. We measured the renal cortex and medulla T2*, ADC, Dt, Dp, and fp values on BOLD and DWI images. Appropriate statistical methods were applied for comparing MRI-derived parameters among the three groups and calculating the correlation coefficients between MRI-derived parameters and clinical data. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of MRI-derived parameters. Results There were significant differences in cortex T2*, ADC, Dt, fp and medulla T2*, ADC, Dt among the three groups. Cortex T2*, ADC, Dt, fp and medulla T2*, ADC, Dt had a trend: CKD stage 4–5 < CKD stage 1–3 < healthy volunteers. Cortex and medulla T2*, ADC, Dt were significantly correlated with eGFR, serum creatinine (Scr), cystatin C. In addition, cortex T2* and eGFR showed the highest correlation coefficient (r = 0.824, p < 0.001). Cortex Dt and medulla T2* were optimal parameters for differentiating healthy volunteers and CKD stage 1–3 or CKD stage 4–5 and CKD stage 1–3, respectively. Conclusions BOLD-MRI and IVIM-DWI might be used as a feasible method for noninvasive assessment of renal function in children with CKD.
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Affiliation(s)
- Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yaxian Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - ShiChao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 4240, Baltimore, MD, 21287, USA
| | - Yu Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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21
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Mariat C, Mjøen G, Watschinger B, Sever MS, Crespo M, Peruzzi L, Oniscu GC, Abramowicz D, Hilbrands L, Maggiore U. Assessment of Pre-Donation Glomerular Filtration Rate: Going Back To Basics A Position Paper from the DESCARTES Working Group of the ERA-EDTA. Nephrol Dial Transplant 2021; 37:430-437. [PMID: 34519827 DOI: 10.1093/ndt/gfab259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
The 2017 version of the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines is the most recent international framework for the evaluation and care of living kidneys donors. Along with the call for an integrative approach evaluating the long-term end-stage kidney disease risk for the future potential donor, several recommendations are formulated regarding the predonation glomerular filtration rate (GFR) adequacy with no or little consideration for the donor candidate's age and for the importance of using reference methods of GFR measurements. Herein, we question the position of the KDIGO guidelines and discuss the rationale and modalities for a more basic, but not less demanding GFR evaluation susceptible to enable a more efficient selection of the potential kidney donor.
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Affiliation(s)
- Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation rénale, Centre Hospitalier Universitaire de Saint Etienne, Hôpital NORD, Université de LYON, Université Jean MONNET, Saint Etienne, France
| | | | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | | | - Marta Crespo
- Hospital del Mar, Nephrology Department, Barcelona, Spain
| | | | | | | | - Luuk Hilbrands
- Radboud university medical center, Department of Nephrology, Nijmegen, The Netherlands
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22
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Garza Tovar OA, Pérez AAM, Pérez MEG, Robledo IU, Galarza FFG, Márquez FCL. Serum electrolytes and renal alterations in HIV-seropositive Mexican subjects. Medicine (Baltimore) 2021; 100:e26016. [PMID: 34011103 PMCID: PMC8137016 DOI: 10.1097/md.0000000000026016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/29/2021] [Indexed: 01/05/2023] Open
Abstract
To examine potential risk factors associated with biochemical alterations in renal function in a population diagnosed with HIV/AIDS undergoing antiretroviral treatment.This is an observational, transversal, and relational design study that included 179 HIV-seropositive subjects. Glucose serum, cholesterol, triglycerides, total proteins, albumin, creatine, urea, blood urea nitrogen (BUN), and electrolytes levels were determined for each individual. Renal function was evaluated through the glomerular filtration rate (GFR), using the CKD-EPI equation. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. Univariate model significant variables, with a 95% confidence interval (CI), were included in a multivariate logistic regression analysis.CKD prevalence in patients was 7.3%, with comorbidities of 7.8% for type 2 diabetes mellitus, 7.3% for arterial hypertension, and 35.2% for dyslipidemia. Additionally, both hypernatremia and hypophosphatemia were detected in 57% (n = 102) of the patients. Multivariate logistic regression suggested that CD4+ T cell count < 200 (P = .02; OR 0.2; CI 95% 0.08-0.8) was associated to hyponatremia; similarly, detectable viral load was associated to hypokalemia (P = .02; OR 5.1; CI 95% 1.2-21.3), hypocalcemia (P = .01; OR 4.1; CI 95% 1.3-12.3), and hypermagnesemia (OR 3.9; CI 95% 1.1-13.6). Patient age was associated to both hypophosphatemia (P = .01; OR 2.4; CI 95% 1.1-5.0) and hypermagnesemia (P = .01; OR 2.8; IC 95% 1.1-7.0), and high creatinine levels were associated to nucleoside reverse transcriptase inhibitor treatment (P = .001; OR 42.5; CI 95% 2.2-806.9). Lastly, high BUN levels were associated to age (P = .03; OR 3.8; CI 95% 1.0-14.4), while GFR 60 to 89 mL/min/1.73 m2 was associated to dyslipidemia (P = .02; OR 2.2; CI 95% 1.1-4.5).CD4+ T cell and viral load were the main factors associated with renal biochemical alterations.
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Affiliation(s)
- Oscar Antonio Garza Tovar
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - Alberto Alejandro Miranda Pérez
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - María Elena Gutiérrez Pérez
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - Ivonne Urraza Robledo
- High Specialty Medical Unit (UMAE) # 71, Mexican Social Security Institute, Torreón, Coahuila, México
| | - Faviel F. González Galarza
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - Francisco Carlos López Márquez
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
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23
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You A, Li Y, Tomlinson B, Yue L, Zhao K, Fan H, Liu Z, Zhang Y, Zheng L. Association Between Renal Dysfunction and Low HDL Cholesterol Among the Elderly in China. Front Cardiovasc Med 2021; 8:644208. [PMID: 34055931 PMCID: PMC8149893 DOI: 10.3389/fcvm.2021.644208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a high morbidity and mortality among the elderly. Low levels of high-density lipoprotein cholesterol (HDL-C), a traditional risk marker for CVD, are common in CKD patients. Little is known about the association of low HDL-C with renal dysfunction in the community dwelling population. Methods: This was a population-based cross-sectional study included 4,753 participants enrolled in a prospective study, the Shanghai Elderly Cardiovascular Health (SHECH) study. Estimated glomerular filtration rate (eGFR), calculated by the Chinese Modification of Diet in Renal Disease (C-MDRD equation), was used to assess renal dysfunction. Associations between renal dysfunction and low HDL-C were evaluated using multiple logistic regression models and restricted cubic splines. Results: Of 4,649 individuals who met inclusion criteria, 620 (13.34%) had low HDL-C at <40 mg/dl. In the fully adjusted model, lower eGFR of <60 ml/min/1.73 m2 (OR, 2.03; 95% CI, 1.21-3.43) and marginal eGFR of 60 to 90 ml/min/1.73 m2 (OR, 1.26; 95% CI, 1.01-1.58) were significantly associated with low HDL-C, compared with normal eGFR of ≥90 ml/min/1.73 m2. Moreover, consistent findings were obtained in subsidiary analyses using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Fully adjusted cubic spline models indicated a significant dose-response relationship between eGFR and low HDL-C (P for non-linearity, 0.356). Conclusion: In this general elderly population, renal dysfunction was independently and significantly associated with low HDL-C, and the prevalence of low HDL-C increased with decreasing eGFR, such that even slight changes in renal function may be associated with altered lipid levels.
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Affiliation(s)
- Aijun You
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, China
| | - Yaxin Li
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, China
| | - Brian Tomlinson
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | | | - Kaijie Zhao
- Community Health Service Center, Shanghai, China
| | - Huimin Fan
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongmin Liu
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuzhen Zhang
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Zheng
- Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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24
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Kobalava ZD, Shavarov AA, Vatsik-Gorodetskaya MV. Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Renal Dysfunction. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.
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Affiliation(s)
- Z. D. Kobalava
- Peoples Friendship University of Russia (RUDN University)
| | - A. A. Shavarov
- Peoples Friendship University of Russia (RUDN University)
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25
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Funamoto M, Osho AA, Li SS, Moonsamy P, Mohan N, Ong CS, Melnitchouk S, Sundt TM, Astor TL, Villavicencio MA. Factors Related to Survival in Low-Glomerular Filtration Rate Cohorts Undergoing Lung Transplant. Ann Thorac Surg 2021; 112:1797-1804. [PMID: 33421391 DOI: 10.1016/j.athoracsur.2020.12.021] [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] [Received: 02/14/2020] [Revised: 10/25/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Historically, a glomerular filtration rate (GFR) of less than 50 mL/min per 1.73 m2 has been considered a contraindication to lung transplantation. Combined or sequential lung-kidney transplantation is an option for those with a GFR less than 30 mL/min per 1.73 m2. Patients with a GFR of 30 to 50 mL/min per 1.73 m2 are provided with no options for transplantation. This study explores factors associated with improved survival in patients who undergo isolated lung transplantation with a GFR of 30 to 50 mL/min per 1.73 m2. METHODS The United Network for Organ Sharing database was queried for adult patients undergoing primary isolated lung transplantation between January 2007 and March 2018. Regression models were used to identify factors associated with improved survival in lung recipients with a preoperative GFR of 30 to 50 mL/min per 1.73 m2. The propensity score method was used to match highly performing patients (outpatient recipients aged less than 60 years) with a GFR of 30 to 50 mL/min per 1.73 m2 with patients who had a GFR greater than 50 mL/min per 1.73 m2. Kaplan-Meier, Cox, and logistic regression analyses compared outcomes in matched populations. RESULTS A total of 21,282 lung transplantations were performed during the study period. Compared with patients with a GFR greater than 50 mL/min per 1.73 m2, survival was significantly worse for patients with a GFR of 30 to 50 mL/min per 1.73 m2. Multivariate analysis of patients with a GFR of 30 to 50 mL/min per 1.73 m2 demonstrated outpatient status and age less than 60 years to be predictive of superior survival. After propensity matching, survival of this highly performing subset with a GFR of 30 to 50 mL/min per 1.73 m2 was no different from that of patients with a normal GFR. CONCLUSIONS Outpatient recipients aged less than 60 years represent an optimal subset of patients with a GFR of 30 to 50 mL/min per 1.73 m2. Lung transplant listing should not be declined based only on a GFR less than 50 mL/min per 1.73 m2.
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Affiliation(s)
- Masaki Funamoto
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Selena S Li
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Philicia Moonsamy
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Navyatha Mohan
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin Siang Ong
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Todd L Astor
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Mauricio A Villavicencio
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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26
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Drug dosing in cancer patients with decreased kidney function: A practical approach. Cancer Treat Rev 2020; 93:102139. [PMID: 33370636 DOI: 10.1016/j.ctrv.2020.102139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Correct drug dosing of anticancer agents is essential to obtain optimal outcomes. Overdosing will result in increased toxicity, treatment interruption and possible cessation of anticancer treatment. Underdosing may result in suboptimal anti-cancer effects and may increase the risk of cancer-related mortality. As it is practical nor feasible to perform therapeutic drug monitoring for all anti-cancer drugs, kidney function is used to guide drug dosing for those drugs whose primary mode of excretion is through the kidney. However, it is not well-established what method should be utilized to measure or estimate kidney function and the choice of method does influence treatment decisions regarding eligibility for anti-cancer drugs and their dose. In this review, we will provide an overview regarding the importance of drug dosing, the preferred method to determine kidney function and a practical approach to drug dosing of anticancer drugs.
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27
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Delay A, Moranne O, Fafin C, Mariat C, Alamartine E, Delanaye P, Maillard N. Relationship between decline in estimated or measured glomerular filtration rate and 16-year postrenal transplant outcome. Clin Kidney J 2020; 14:1665-1672. [PMID: 34084462 PMCID: PMC8162849 DOI: 10.1093/ckj/sfaa203] [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: 03/25/2020] [Accepted: 08/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background Glomerular filtration rate (GFR) decline ≥30% over 2 years can substitute for the conventional ‘doubling of serum creatinine’ to predict end-stage renal disease in patients with native kidneys. While chronic kidney disease trajectory is less predictable in transplanted patients, recent data have suggested that similar GFR decline might be an acceptable surrogate for long-term transplant outcome. We sought (i) to confirm the prognostic value of an early GFR decline in kidney transplant recipients and (ii) to determine whether using direct measurement of GFR with inulin improves the performance of this surrogate. Methods We retrospectively analysed all recipients transplanted between 1989 and 2000 in our centre, with inulin-measured and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated GFR at 1 and 5 years post-transplant, and evaluated the performance [time-dependent area under the receiver operating characteristic curve (ROC AUC) and subdistribution hazard ratio (sdHR) with competing risk model] of GFR change to predict graft failure and all-cause mortality. Results Out of 417 kidney transplant recipients, 116 patients had lost their graft and 77 had died 16 years after transplantation. While being significantly associated with graft failure [sdHR = 2.37 (95% confidence interval 1.47–3.83)], CKD-EPI-GFR decline ≥30% failed to appropriately predict long-term graft survival (C-statistics of 0.63). Concordance between inulin-GFR and CKD-EPI-GFR to detect similar GFR change was only 53%. Inulin-GFR change was, however, not a better predictor (C-statistics of 0.59). Comparable results were observed for mortality. Conclusions Our data suggest that early GFR decline is a poor surrogate for long-term transplant outcome, even when change in GFR is directly measured by a reference method.
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Affiliation(s)
- Agnes Delay
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, EA 3065, Université Jean MONNET, Saint-Etienne, France
| | - Olivier Moranne
- Service de Néphrologie, Dialyse, Aphérèse, Hôpital Caremeau, CHU de Nîmes, France.,EA 2415, Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Coraline Fafin
- Service de Néphrologie, Dialyse, Aphérèse, Hôpital Caremeau, CHU de Nîmes, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, EA 3065, Université Jean MONNET, Saint-Etienne, France
| | - Eric Alamartine
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, EA 3065, Université Jean MONNET, Saint-Etienne, France
| | - Pierre Delanaye
- Service de Néphrologie, CHU Sart Tilman, Université de Liège, Liège, Belgium
| | - Nicolas Maillard
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, EA 3065, Université Jean MONNET, Saint-Etienne, France
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Nieblas-Bedolla E, Christophers B, Nkinsi NT, Schumann PD, Stein E. Changing How Race Is Portrayed in Medical Education: Recommendations From Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1802-1806. [PMID: 32379145 DOI: 10.1097/acm.0000000000003496] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The medical community has been complicit in legitimizing claims of racial difference throughout the history of the United States. Unfortunately, a rigorous examination of the role medicine plays in perpetuating inequity across racial lines is often missing in medical school curricula due to time constraints and other challenges inherent to medical education. The imprecise use of race-a social construct-as a proxy for pathology in medical education is a vestige of institutionalized racism. Recent examples are presented that illustrate how attributing outcomes to race may contribute to bias and unequal care. This paper proposes the following recommendations for guiding efforts to mitigate the adverse effects associated with the use of race in medical education: emphasize the need for incoming students to be familiar with how race can influence health outcomes; provide opportunities to hold open conversations about race in medicine among medical school faculty, students, and staff; craft and implement protocols that address and correct the inappropriate use of race in medical school classes and course materials; and encourage a large cultural shift within the field of medicine. Adoption of an interdisciplinary approach that taps into many fields, including ethics, history, sociology, evolutionary genetics, and public health is a necessary step for cultivating more thoughtful physicians who will be better prepared to care for patients of all racial and ethnic backgrounds.
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Affiliation(s)
- Edwin Nieblas-Bedolla
- E. Nieblas-Bedolla is a second-year student, University of Washington School of Medicine, Seattle, Washington; ORCID: http://orcid.org/0000-0001-5879-1800
| | - Briana Christophers
- B. Christophers is a second-year MD-PhD student, Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York; ORCID: http://orcid.org/0000-0001-5248-069X
| | - Naomi T Nkinsi
- N.T. Nkinsi is a second-year MD-MPH student, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0002-0504-696X
| | - Paul D Schumann
- P.D. Schumann is a second-year student, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth Stein
- E. Stein is a second-year student, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0002-1820-3821
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Porta C, Bamias A, Danesh FR, Dębska-Ślizień A, Gallieni M, Gertz MA, Kielstein JT, Tesarova P, Wong G, Cheung M, Wheeler DC, Winkelmayer WC, Małyszko J. KDIGO Controversies Conference on onco-nephrology: understanding kidney impairment and solid-organ malignancies, and managing kidney cancer. Kidney Int 2020; 98:1108-1119. [PMID: 33126977 DOI: 10.1016/j.kint.2020.06.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
The association between kidney disease and cancer is multifaceted and complex. Persons with chronic kidney disease (CKD) have an increased incidence of cancer, and both cancer and cancer treatments can cause impaired kidney function. Renal issues in the setting of malignancy can worsen patient outcomes and diminish the adequacy of anticancer treatments. In addition, the oncology treatment landscape is changing rapidly, and data on tolerability of novel therapies in patients with CKD are often lacking. Caring for oncology patients has become more specialized and interdisciplinary, currently requiring collaboration among specialists in nephrology, medical oncology, critical care, clinical pharmacology/pharmacy, and palliative care, in addition to surgeons and urologists. To identify key management issues in nephrology relevant to patients with malignancy, KDIGO (Kidney Disease: Improving Global Outcomes) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology in December 2018. This report covers issues related to kidney impairment and solid organ malignancies as well as management and treatment of kidney cancer. Knowledge gaps, areas of controversy, and research priorities are described.
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Affiliation(s)
- Camillo Porta
- Department of Internal Medicine and Therapeutics, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
| | - Aristotelis Bamias
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Greece
| | - Farhad R Danesh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alicja Dębska-Ślizień
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan T Kielstein
- Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Petra Tesarova
- Department of Oncology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | | | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK; George Institute for Global Health, Sydney, Australia
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Poland.
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30
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Zou LX, Sun L, Nicholas SB, Lu Y, K SS, Hua R. Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation. Eur J Intern Med 2020; 80:29-34. [PMID: 32522444 DOI: 10.1016/j.ejim.2020.04.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The directly measured glomerular filtrate rate (mGFR) is the gold standard for kidney function, but it is invasive and costly. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have been widely used to estimate GFR, however, the comparative accuracy of estimated GFR (eGFR) using creatinine and cystatin C in CKD-EPI equations remains unclear. We performed this meta-analysis to assess the bias and accuracy of eGFR using equations of CKD-EPIcrea, CKD-EPIcys, and CKD-EPIcrea/cys in adult populations relevant to primary health care. METHODS Pubmed, Web of Science, EMBASE, and the Cochrane Library were searched from inception until December 2019 for related studies. RESULTS A total of 35 studies with 23,667 participants, which reported the data on the bias, and/or P30, and/or R were included. The difference in the bias of eGFR using CKD-EPIcys was 4.84 mL/min/1.73 m2 (95% CI, 1.88~7.80) lower than using CKD-EPIcrea, and 1.50 mL/min/1.73 m2 (95% CI, 0.05~2.95) lower than using CKD-EPIcrea/cys. These gaps increased in subgroups of low mGFR (<60 mL/min/1.73 m2). CKD-EPIcrea/cys eGFR achieved the highest accuracy, 7.50% higher than CKD-EPIcrea (95% CI, 4.81~10.18), and 3.21% higher than CKD-EPIcys (95% CI, -0.43~6.85); and the best correlation with mGFR, with Fisher's z transformed R of 1.20 (95% CI, 0.89-1.50). CONCLUSIONS CKD-EPIcrea/cys and CKD-EPIcys gave less bias and more accurate estimates of mGFR than CKD-EPIcrea. More variables and coefficients could be added in CKD-EPI equations to achieve less bias and more accuracy in future research.
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Affiliation(s)
- Lu-Xi Zou
- Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ling Sun
- Division of Nephrology, Xuzhou Central Hospital, Medical College of Southeast University, Xuzhou, Jiangsu, China; Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Susanne B Nicholas
- Divisions of Nephrology and Endocrinology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Yan Lu
- Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Satyesh Sinha K
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Ruixue Hua
- Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
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31
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Borštnar Š, Večerić-Haler Ž, Boštjančič E, Pipan Tkalec Ž, Kovač D, Lindič J, Kojc N. Uromodulin and microRNAs in Kidney Transplantation-Association with Kidney Graft Function. Int J Mol Sci 2020; 21:ijms21165592. [PMID: 32764335 PMCID: PMC7460670 DOI: 10.3390/ijms21165592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
Uromodulin and microRNAs (miRNAs) have recently been investigated as potential biomarkers for kidney graft associated pathology and outcome, with a special focus on biomarkers indicating specific disease processes and kidney graft survival. The study's aim was to determine whether expression of serum uromodulin concentration and selected miRNAs might be related to renal function in kidney transplant recipients (KTRs). The uromodulin concentration and expression of six selected miRNAs (miR-29c, miR-126, miR-146a, miR-150, miR-155, and miR-223) were determined in the serum of 100 KTRs with stable graft function and chronic kidney disease of all five stages. Kidney graft function was estimated with routine parameters (creatinine, urea, cystatin C, and Chronic Kidney Disease Epidemiology Collaboration study equations) and precisely measured using chromium-51 labelled ethylenediaminetetraacetic-acid clearance. The selected miRNAs were shown to be independent of kidney graft function, indicating their potential as biomarkers of associated kidney graft disease processes. In contrast, the serum uromodulin level depended entirely on kidney graft function and thus reflected functioning tubules rather than any specific kidney graft injury. However, decreased concentrations of serum uromodulin can be observed in the early course of tubulointerstitial injury, thereby suggesting its useful role as an accurate, noninvasive biomarker of early (subclinical) kidney graft injury.
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Affiliation(s)
- Špela Borštnar
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (Š.B.); (Ž.V.-H.); (D.K.); (J.L.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Željka Večerić-Haler
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (Š.B.); (Ž.V.-H.); (D.K.); (J.L.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Emanuela Boštjančič
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia; (E.B.); (Ž.P.T.)
| | - Živa Pipan Tkalec
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia; (E.B.); (Ž.P.T.)
| | - Damjan Kovač
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (Š.B.); (Ž.V.-H.); (D.K.); (J.L.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Jelka Lindič
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia; (Š.B.); (Ž.V.-H.); (D.K.); (J.L.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nika Kojc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia; (E.B.); (Ž.P.T.)
- Correspondence: ; Tel.: +386-1-543-7125
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Zhou X, Hong W, Chen W, Feng X, Zhang Z, Zhang X, Fu C, Xiao J, Ye Z. The urinary β 2 microglobulin-creatinine ratio is inversely associated with lumbar spine bone mineral density in the elderly Chinese males. Arch Osteoporos 2020; 15:90. [PMID: 32556596 DOI: 10.1007/s11657-020-00764-x] [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: 08/13/2019] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Renal tubule cells play a pivotal role in maintaining bone homeostasis. Hence, renal tubular function may be associated with bone mineral density. Our study found that urinary β2 microglobulin-creatinine ratio (UBCR) levels correlated negatively with lumbar spine bone mineral density (BMD) and T and Z values, and may be a marker for osteoporosis in Chinese elderly male adults. PURPOSE To study the association of UBCR levels with BMD and the predictive value of UBCR for osteoporosis in elderly Chinese male adults. METHODS A cross-sectional study of 149 (65 to 85 years, 69.7 ± 4.6) Chinese male adults who underwent health checkups in Huadong Hospital in Shanghai China was conducted. BMD was measured by dual-energy X-ray absorptiometry. The clinical variables and BMD of the participants in the low UBCR group (B1, UBCR < 300 μg/g) and the high UBCR group (B2, UBCR ≥ 300 μg/g) were compared. Associations between UBCR with clinical variables and BMD were analyzed by Pearson's correlation coefficient and multiple regression analysis. BMD and T and Z values were compared between the B1 and B2 groups. The odds ratios (ORs) for dose-dependent increases in osteoporosis between B1 and B2 were analyzed by binary logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was used to analyze the capacity of UBCR to predict osteoporosis. RESULTS UBCR was significantly higher in the osteoporosis group. After adjusting for multiple confounders, UBCR levels correlated negatively with BMD and T and Z values of the lumbar spine. Lumbar spine BMD and T and Z values were significantly lower in the B2 UBCR group than in the B1 UBCR group. Compared with the B1 participants, the ORs for "osteoporosis" were 12.401 times higher in B2 participants (P = 0.005) by binary logistic regression analysis after adjusting for potential confounders. The UBCR index (cutoff = 362.48 μg/g) had a sensitivity of 78.6% and a specificity of 68.7% for identifying osteoporosis, with an area under the ROC curve of 0.760. CONCLUSIONS These results suggest that UBCR levels correlate negatively with lumbar spine BMD and T and Z values and may serve as a marker for osteoporosis in Chinese elderly male adults.
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Affiliation(s)
- Xun Zhou
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Wei Hong
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Weijun Chen
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Xinhui Feng
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Zhenxing Zhang
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Xiaoli Zhang
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Chensheng Fu
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Jing Xiao
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.
| | - Zhibin Ye
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine, No. 221 West Yan'an Road, Shanghai, 200040, People's Republic of China.
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Liakopoulos V, Franzén S, Svensson AM, Sattar N, Miftaraj M, Björck S, Ottosson J, Näslund I, Gudbjörnsdottir S, Eliasson B. Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits. Diabetes Care 2020; 43:1276-1284. [PMID: 32152136 DOI: 10.2337/dc19-1703] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined detailed renal and cardiovascular (CV) outcomes after gastric bypass (GBP) surgery in people with obesity and type 2 diabetes mellitus (T2DM), across several renal function categories, in a nationwide cohort study. RESEARCH DESIGN AND METHODS We linked data from the National Diabetes Register and the Scandinavian Obesity Surgery Register with four national databases holding information on socioeconomic variables, medications, hospitalizations, and causes of death and matched 5,321 individuals with T2DM who had undergone GBP with 5,321 who had not (age 18-65 years, mean BMI >40 kg/m2, mean follow-up >4.5 years). The risks of postoperative outcomes were assessed with Cox regression models. RESULTS During the first years postsurgery, there were small reductions in creatinine and albuminuria and stable estimated glomerular filtration rate (eGFR) in the GBP group. The incidence rates of most outcomes relating to renal function, CV disease, and mortality were lower after GBP, being particularly marked for heart failure (hazard ratio [HR] 0.33 [95% CI 0.24, 0.46]) and CV mortality (HR 0.36 [(95% CI 0.22, 0.58]). The risk of a composite of severe renal disease or halved eGFR was 0.56 (95% CI 0.44, 0.71), whereas nonfatal CV risk was lowered less (HR 0.82 [95% CI 0.70, 0.97]) after GBP. Risks for key outcomes were generally lower after GBP in all eGFR strata, including in individuals with eGFR <30 mL/min/1.73 m2. CONCLUSIONS Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.
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Affiliation(s)
- Vasileios Liakopoulos
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden .,Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Franzén
- National Diabetes Register, Center of Registers, Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,National Diabetes Register, Center of Registers, Gothenburg, Sweden
| | - Naveed Sattar
- The Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Mervete Miftaraj
- National Diabetes Register, Center of Registers, Gothenburg, Sweden
| | - Staffan Björck
- National Diabetes Register, Center of Registers, Gothenburg, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,National Diabetes Register, Center of Registers, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Agarwal R, Delanaye P. Glomerular filtration rate: when to measure and in which patients? Nephrol Dial Transplant 2020; 34:2001-2007. [PMID: 30520986 DOI: 10.1093/ndt/gfy363] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 10/16/2018] [Indexed: 02/06/2023] Open
Abstract
Of the glomerular, tubular and endocrine functions of the kidney, nephrologists have mostly focused their attention on the glomerular functions-albuminuria and glomerular filtration rate (GFR)-to grade the severity of chronic kidney disease (CKD). Although both albuminuria and GFR are associated with renal and cardiovascular morbidity and mortality, the utility of measured GFR (mGFR) has been questioned. GFR when measured adequately is the most precise measure of glomerular function and can be useful to individualize therapy among patients with CKD. In situations where estimated GFR is known to provide imprecise estimates of glomerular function, for example, sarcopenia and advanced cirrhosis, the measurement of GFR may be especially important. We discuss several clinical situations where mGFR can potentially influence the quality of life or complications of therapy because of interventions based on imperfect knowledge of GFR. We reason that although large databases may not detect the benefits of mGFR at the population level, precision medicine requires that therapy be individualized based on the best estimate of GFR that can be obtained particularly when the risk of harm is increased. The recent standardization of mGFRs is a step in the right direction and may help in treating the individual patient with CKD with a lower risk of complications and a better quality of life. We call for research in these subgroups of patients where it is clinically felt that mGFR is useful for clinical decision-making.
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Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University and Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (CHU ULg), Liège, Belgium
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35
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Sprangers B, Abudayyeh A, Latcha S, Perazella MA, Jhaveri KD. How to determine kidney function in cancer patients? Eur J Cancer 2020; 132:141-149. [PMID: 32361629 DOI: 10.1016/j.ejca.2020.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/29/2020] [Indexed: 12/18/2022]
Abstract
A precise and efficient method for estimating kidney function in cancer patients is important to determine their eligibility for clinical trials and surgery and to allow for appropriate dose adjustment of anti-cancer drugs, especially toxic drugs with a narrow therapeutic index. Since direct measurement of glomerular filtration rate (GFR) is cumbersome, several formulae have been developed to estimate kidney function. Most of these are based on serum creatinine concentration. Though the CKD-EPI formula is recognised as being the most accurate, there is an ongoing debate on which is the optimal formula for cancer patients. In this review, we provide an overview of different GFR estimating equations for kidney function and the advantages and disadvantages of each method and compare their performance in cancer patients. We discuss the importance of body surface area-indexing and propose a framework for evaluating kidney function in cancer patients.
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Affiliation(s)
- Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Belgium; Division of Nephrology, University Hospitals Leuven, Both in Leuven, Belgium.
| | - Ala Abudayyeh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sheron Latcha
- Renal Division, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark A Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA; Veterans Affairs Medical Center, West Haven, CT, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
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Pottel H, Delay A, Maillard N, Mariat C, Delanaye P. 20-year longitudinal follow-up of measured and estimated glomerular filtration rate in kidney transplant patients. Clin Kidney J 2020; 14:909-916. [PMID: 33777374 PMCID: PMC7986444 DOI: 10.1093/ckj/sfaa034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background The slopes of estimated glomerular filtration rate (eGFR) equations are used in the longitudinal follow-up of transplant patients. A 30% reduction in eGFR over 2 years is often used to predict the subsequent risk of mortality or end-stage renal disease. Whether, at the individual level, such changes in eGFR correspond to changes in measured GFR (mGFR) is actually unknown. Methods The performance of serum creatinine–based eGFR equations was compared with mGFR during the longitudinal follow-up of 20 years in a monocentric study of 417 transplanted patients. Results The accuracy within 30% for the eGFR equations varied between 70 and 75%. All eGFR equations showed a similar pattern, very like the mGFR time profiles. Individual changes (slopes) of mGFR or eGFR were predictive of graft loss in the next months or years, following the decline in GFR, with no evidence for a difference. However, although the tendency is the same as for mGFR, the percentage of transplant patients with a >30% GFR decrease in the last period before graft loss is significantly lower for eGFR than for mGFR, with discordant results from mGFR in ~25% of the cases. Conclusions All eGFR equations showed similar trends as mGFR, but eGFR predictions may not be very useful at the individual patient level.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Agnès Delay
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Nicolas Maillard
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
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Delanaye P, Flamant M, Dubourg L, Vidal-Petiot E, Lemoine S, Cavalier E, Schaeffner E, Ebert N, Pottel H. Single- versus multiple-sample method to measure glomerular filtration rate. Nephrol Dial Transplant 2019; 33:1778-1785. [PMID: 29319814 DOI: 10.1093/ndt/gfx345] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/12/2017] [Indexed: 01/09/2023] Open
Abstract
Background There are many different ways to measure glomerular filtration rate (GFR) using various exogenous filtration markers, each having their own strengths and limitations. However, not only the marker, but also the methodology may vary in many ways, including the use of urinary or plasma clearance, and, in the case of plasma clearance, the number of time points used to calculate the area under the concentration-time curve, ranging from only one (Jacobsson method) to eight (or more) blood samples. Methods We collected the results obtained from 5106 plasma clearances (iohexol or 51Cr-ethylenediaminetetraacetic acid (EDTA)) using three to four time points, allowing GFR calculation using the slope-intercept method and the Bröchner-Mortensen correction. For each time point, the Jacobsson formula was applied to obtain the single-sample GFR. We used Bland-Altman plots to determine the accuracy of the Jacobsson method at each time point. Results The single-sample method showed within 10% concordances with the multiple-sample method of 66.4%, 83.6%, 91.4% and 96.0% at the time points 120, 180, 240 and ≥300 min, respectively. Concordance was poorer at lower GFR levels, and this trend is in parallel with increasing age. Results were similar in males and females. Some discordance was found in the obese subjects. Conclusion Single-sample GFR is highly concordant with a multiple-sample strategy, except in the low GFR range (<30 mL/min).
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (CHU ULg), Liège, Belgium
| | - Martin Flamant
- Department of Renal Physiology, DHU-FIRE, Hôpital Bichat, AP-HP, Inserm U1149, and Paris Diderot University, Sorbonne Paris-Cité, Paris, France
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension artérielle et Exploration fonctionnelle rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Laboratory of Tissue Biology and Therapeutic Engineering, UMR 5305 CNRS, University Claude Bernard Lyon 1, Lyon, France
| | - Emmanuelle Vidal-Petiot
- Department of Renal Physiology, DHU-FIRE, Hôpital Bichat, AP-HP, Inserm U1149, and Paris Diderot University, Sorbonne Paris-Cité, Paris, France
| | - Sandrine Lemoine
- Néphrologie, Dialyse, Hypertension artérielle et Exploration fonctionnelle rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège (CHU ULg), Liège, Belgium
| | - Elke Schaeffner
- Charité University Hospital, Institute of Public Health, Berlin, Germany
| | - Natalie Ebert
- Charité University Hospital, Institute of Public Health, Berlin, Germany
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Chou HW, Lin MH, Chen YS, Yu HY. Impact of MELD score and cardiopulmonary bypass duration on post-operative hypoxic hepatitis in patients with liver cirrhosis undergoing open heart surgery. J Formos Med Assoc 2019; 119:838-844. [PMID: 31530414 DOI: 10.1016/j.jfma.2019.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/21/2019] [Accepted: 08/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The outcome of open-heart surgery for patients with liver cirrhosis (LC) varies widely, indicating multifactorial influences on liver injury after cardiopulmonary bypass (CPB). METHODS This observational single center study evaluated adult LC patients receiving open heart surgery with CPB during 2007 and 2017. The primary endpoint was post-operative hypoxic hepatitis (POHH), defined by post-operative serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase more than 10 times the pre-operative value. RESULTS In total, 61 patients were included in the study, of whom 14 (18.7%) developed POHH. Hospital mortality of non-POHH group (4.3%) was similar to that estimated using Euroscore II (4.0%), but that of the POHH group (21.4%) was 2.7 times as that estimated using Euroscore II (8.0%). Model for End-Stage Liver Disease (MELD) score and CPB duration were found as independent risk factors for POHH by multivariate logistic regression. POHH incidence was 0.0% if MELD <5 and 80.0% of MELD >20 regardless of CPB duration. For those with MELD between 5 and 20, POHH incidence increases as CPB duration increases. CONCLUSION For LC patients undergoing cardiac surgery with CPB, the incidence of POHH is highly associated with MELD score and CPB duration. To prevent POHH, the CPB duration should be shortened for those with MELD score between 5 and 20, and CPB be avoid for those with MELD >20.
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Affiliation(s)
- Heng-Wen Chou
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan university, Taiwan
| | - Ming-Hsien Lin
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu County, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
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Yayo E, Ayé M, Yao C, Gnionsahé A, Attoungbré ML, Cavalier E, Pottel H, Monnet D, Delanaye P. Measured (and estimated) glomerular filtration rate: reference values in West Africa. Nephrol Dial Transplant 2019; 33:1176-1180. [PMID: 28992086 DOI: 10.1093/ndt/gfx244] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/20/2017] [Indexed: 02/07/2023] Open
Abstract
Background Establishment of normal reference values for glomerular filtration rate (GFR) is mandatory in nephrology. However, no data are available for measured GFR (mGFR) in Africa. Methods GFR was measured in 237 healthy adult subjects (103 women and 134 men, mean age 34 ± 10 years) by iohexol plasma clearance. Results The mean mGFR was 103 ± 17 mL/min/1.73 m2 and the median value was 103 mL/min/1.73 m2 (2.5th and 97.5th percentiles are 76 and 137 mL/min/1.73 m2, respectively). No significant difference in mGFR results was observed in patients < 40 years of age, whereas a significant decline in mGFR was observed after 40 years of age. There was no significant difference between mGFR in men and women. Conclusions Normal GFR values and descriptions of percentiles are now available for West Africa. As in Caucasians, no significant difference was observed between men and women. Moreover, the same age-associated decline in mGFR is also observed after 40 years of age, as in Caucasians.
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Affiliation(s)
- Eric Yayo
- Département de Biochimie, UFR sciences pharmaceutiques et Biologiques, University Felix Houphouet Boigny, Abidjan, Côte D'Ivoire
| | - Mireille Ayé
- Département d'Hématologie, UFR sciences pharmaceutiques et Biologiques, University Felix Houphouet Boigny, Abidjan, Côte D'Ivoire
| | - Carine Yao
- Département de Biochimie, UFR sciences pharmaceutiques et Biologiques, University Felix Houphouet Boigny, Abidjan, Côte D'Ivoire
| | - Appolinaire Gnionsahé
- Département de Néphrologie, UFR sciences Médicales, University Felix Houphouet Boigny, Abidjan, Côte D'Ivoire
| | - Marie-Laure Attoungbré
- Département de Biochimie, UFR sciences pharmaceutiques et Biologiques, University Felix Houphouet Boigny, Abidjan, Côte D'Ivoire
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care at Kulak, KU Leuven Kulak, Kortrijk, Belgium
| | - Dagui Monnet
- Département de Biochimie, UFR sciences pharmaceutiques et Biologiques, University Felix Houphouet Boigny, Abidjan, Côte D'Ivoire
| | - Pierre Delanaye
- Department of Nephrology Dialysis Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
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Validating the Performance of 5 Risk Scores for Major Adverse Cardiac Events in Patients Who Achieved Complete Revascularization After Percutaneous Coronary Intervention. Can J Cardiol 2019; 35:1058-1068. [PMID: 31376907 DOI: 10.1016/j.cjca.2019.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk scores, like the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (SS), clinical SS, logistic SS (core model and extended model [LSSextended]), Age, Creatinine, and Ejection Fraction (ACEF) score, and modified ACEF score, are predictive for major adverse cardiac events (MACE; including all-cause mortality, myocardial infarction [MI], and revascularization) in patients who have undergone percutaneous coronary intervention (PCI). However, few studies have validated the performance of these scores in complete revascularization (CR) patients. We aimed to compare the performance of previous risk scores in patients who achieved CR after PCI. METHODS All patients (N = 10,724) who underwent PCI at Fuwai Hospital in 2013 were screened, and those who achieved CR after PCI were enrolled. Risk scores were calculated by experienced cardiologists blinded to the clinical outcomes. Discrimination of risk scores was assessed according to the area under the receiver operating characteristic curve (AUC). RESULTS Fifty-one percent (5375/10,724) of patients who underwent PCI achieved CR. At a mean follow-up of 2.4 years, the mortality, MI, revascularization, and MACE rates were 1.2%, 1.0%, 6.3%, and 7.7%, respectively. SS was not predictive for mortality (AUC, 0.51; 95% confidence interval [CI], 0.44-0.59). All scores involving clinical variables, especially modified ACEF score (AUC, 0.73; 95% CI, 0.66-0.79), could predict mortality. LSSextended was the most accurate for MI (AUC, 0.68; 95% CI, 0.61-0.75). SS and LSSextended were predictive for revascularization, with marginally significant AUCs (SS, 0.54; LSSextended, 0.55). No score was particularly accurate for predicting MACE, with AUCs ranging from 0.51 (ACEF score) to 0.58 (LSSextended). CONCLUSIONS In CR patients, risk scores involving clinical variables might help to predict mortality; however, no risk scores showed helpful discrimination for MACE.
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Metabolites related to eGFR: Evaluation of candidate molecules for GFR estimation using untargeted metabolomics. Clin Chim Acta 2019; 489:242-248. [DOI: 10.1016/j.cca.2018.08.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/22/2022]
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Corsonello A, Roller-Wirnsberger R, Di Rosa M, Fabbietti P, Wirnsberger G, Kostka T, Guligowska A, Tap L, Mattace-Raso F, Gil P, Guardado-Fuentes L, Meltzer I, Yehoshua I, Artzi-Medevdik R, Formiga F, Moreno-González R, Weingart C, Freiberger E, Ärnlöv J, Carlsson AC, Lattanzio F. Estimated glomerular filtration rate and functional status among older people: A systematic review. Eur J Intern Med 2018; 56:39-48. [PMID: 29936073 DOI: 10.1016/j.ejim.2018.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive value of different eGFR equations in regard to frailty and disability outcomes. METHODS We searched Pubmed from inception to March 2018 for studies investigating the association between eGFR and self-reported and/or objective measures of frailty or disability. Cross-sectional and longitudinal studies were separately analysed. RESULTS We included 16 studies, one of which reporting both cross-sectional and longitudinal data. Three out of 7 cross-sectional studies compared different eGFR equations in regard to their association with functional status: two studies showed that cystatin C-based, but not creatinine-based eGFR may be associated with hand-grip strength or frailty; another study showed that two different creatinine-based eGFR equations may be similarly associated with disability. Four out of 10 longitudinal studies provided comparative data: two studies reported similar association with disability for different creatinine-based eGFR equations; one study showed that creatinine-based eGFR was not associated with frailty, but a not significant trend for association was observed with cystatin C-based eGFR; one study showed that cystatin C-based but not creatinine-based eGFR may predict incident mobility disability, while both methods may predict gait speed decline. High heterogeneity was observed in regard to confounders included in reviewed studies. None of them included the most recently published equations. CONCLUSION Available data do not support the superiority of one of the eGFR equations in terms of measuring or predicting functional decline.
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Affiliation(s)
- Andrea Corsonello
- Italian National Research Center on Aging (INRCA), Ancona, Fermo and Cosenza, Italy.
| | | | - Mirko Di Rosa
- Italian National Research Center on Aging (INRCA), Ancona, Fermo and Cosenza, Italy
| | - Paolo Fabbietti
- Italian National Research Center on Aging (INRCA), Ancona, Fermo and Cosenza, Italy
| | | | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland
| | - Lisanne Tap
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Pedro Gil
- Department of Geriatric Medicine, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Itshak Meltzer
- The Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | | | - Rada Artzi-Medevdik
- The Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel; Maccabi Healthcare Services Southern Region, Israel
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department and Nephrology Department, Bellvitge University Hospital - IDIBELL - L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Moreno-González
- Geriatric Unit, Internal Medicine Department and Nephrology Department, Bellvitge University Hospital - IDIBELL - L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christian Weingart
- Department of General Internal Medicine and Geriatrics, Krankenhaus Barmherzige Brüder Regensburg and Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Ellen Freiberger
- Department of General Internal Medicine and Geriatrics, Krankenhaus Barmherzige Brüder Regensburg and Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Johan Ärnlöv
- Department of Medical Sciences, Uppsala University, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden; Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Axel C Carlsson
- Department of Medical Sciences, Uppsala University, Sweden; Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Fabrizia Lattanzio
- Italian National Research Center on Aging (INRCA), Ancona, Fermo and Cosenza, Italy
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Dantec A, Selistre L, Lemoine S, Buron F, de Souza VC, Rimmelé T, Thaunat O, Badet L, Morelon E, Dubourg L, Sicard A. Performances of creatinine-based glomerular filtration rate estimating equations in simultaneous pancreas-kidney transplant recipients: a single center cohort study. Transpl Int 2018; 32:75-83. [DOI: 10.1111/tri.13333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/11/2018] [Accepted: 08/11/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Allyriane Dantec
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
| | | | - Sandrine Lemoine
- Service de Néphrologie, dialyse, hypertension et exploration fonctionnelle rénale; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- Laboratoire CarMeN; INSERM 1060; Lyon France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
| | | | - Thomas Rimmelé
- Université Lyon 1; Lyon France
- Service d'anesthésie-réanimation; Hôpital Edouard-Herriot; Lyon France
| | - Olivier Thaunat
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- Unité INSERM U1111; Lyon France
| | - Lionel Badet
- Université Lyon 1; Lyon France
- Service d'Urologie et Transplantation; Hôpital Edouard Herriot; Lyon France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- Unité INSERM U1111; Lyon France
| | - Laurence Dubourg
- Service de Néphrologie, dialyse, hypertension et exploration fonctionnelle rénale; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- UMR 5305 CNRS/UCBL; Biologie Tissulaire et Ingénierie Thérapeutique; Lyon France
| | - Antoine Sicard
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
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Wang CH, Rubinsky AD, Minichiello T, Shlipak MG, Price EL. Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants. J Gen Intern Med 2018; 33:1299-1306. [PMID: 29855865 PMCID: PMC6082212 DOI: 10.1007/s11606-018-4461-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/13/2017] [Accepted: 04/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current practice in anticoagulation dosing relies on kidney function estimated by serum creatinine using the Cockcroft-Gault equation. However, creatinine can be unreliable in patients with low or high muscle mass. Cystatin C provides an alternative estimation of glomerular filtration rate (eGFR) that is independent of muscle. OBJECTIVE We compared cystatin C-based eGFR (eGFRcys) with multiple creatinine-based estimates of kidney function in hospitalized patients receiving anticoagulants, to assess for discordant results that could impact medication dosing. DESIGN Retrospective chart review of hospitalized patients over 1 year who received non-vitamin K antagonist anticoagulation, and who had same-day measurements of cystatin C and creatinine. PARTICIPANTS Seventy-five inpatient veterans (median age 68) at the San Francisco VA Medical Center (SFVAMC). MAIN MEASURES We compared the median difference between eGFR by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation using cystatin C (eGFRcys) and eGFRs using three creatinine-based equations: CKD-EPI (eGFREPI), Modified Diet in Renal Disease (eGFRMDRD), and Cockcroft-Gault (eGFRCG). We categorized patients into standard KDIGO kidney stages and into drug-dosing categories based on each creatinine equation and calculated proportions of patients reclassified across these categories based on cystatin C. KEY RESULTS Cystatin C predicted overall lower eGFR compared to creatinine-based equations, with a median difference of - 7.1 (IQR - 17.2, 2.6) mL/min/1.73 m2 versus eGFREPI, - 21.2 (IQR - 43.7, - 8.1) mL/min/1.73 m2 versus eGFRMDRD, and - 25.9 (IQR - 46.8, - 8.7) mL/min/1.73 m2 versus eGFRCG. Thirty-one to 52% of patients were reclassified into lower drug-dosing categories using cystatin C compared to creatinine-based estimates. CONCLUSIONS We found substantial discordance in eGFR comparing cystatin C with creatinine in this group of anticoagulated inpatients. Our sample size was limited and included few women. Further investigation is needed to confirm these findings and evaluate implications for bleeding and other clinical outcomes. NIH TRIAL REGISTRY NUMBER Not applicable.
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Affiliation(s)
- Christina Hao Wang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Anna D Rubinsky
- Kidney Health Research Collaborative, UCSF and SFVAMC, San Francisco, CA, USA
| | - Tracy Minichiello
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Michael G Shlipak
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Kidney Health Research Collaborative, UCSF and SFVAMC, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Erika Leemann Price
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
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Li DY, Yin WJ, Zhou LY, Ma RR, Liu K, Hu C, Zhou G, Zuo XC. Utility of cystatin C-based equations in patients undergoing dialysis. Clin Chim Acta 2018; 485:282-287. [PMID: 30006283 DOI: 10.1016/j.cca.2018.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 01/13/2023]
Abstract
Serum cystatin C (CysC) measurement is regarded as a simple and practical alternative to measure residual renal function for dialysis patients. Recent studies have shown that CysC has better diagnostic accuracy or at least equivalence to creatinine in predicting the early stages of renal damage, and is closely related to clinical outcomes of dialysis patients. Thus, the applicability of CysC-derived equations in patients undergoing dialysis should be paid attention. Here, we review the role of CysC in diagnosis, renal function evaluation, and prognosis outcomes for dialysis patients, so as to provide them with useful suggestions on evaluating renal function and predicting adverse outcomes in clinical practice.
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Affiliation(s)
- Dai-Yang Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China
| | - Wen-Jun Yin
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China
| | - Ling-Yun Zhou
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China
| | - Rong-Rong Ma
- Department of Clinical Pharmacy, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, PR China
| | - Kun Liu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China
| | - Can Hu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China
| | - Ge Zhou
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China
| | - Xiao-Cong Zuo
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, PR China.
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Bataille Y, Costerousse O, Bertrand OF, Moranne O, Pottel H, Delanaye P. One-year mortality of patients with ST-Elevation myocardial infarction: Prognostic impact of creatinine-based equations to estimate glomerular filtration rate. PLoS One 2018; 13:e0199773. [PMID: 29979700 PMCID: PMC6034802 DOI: 10.1371/journal.pone.0199773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Renal dysfunction is associated with worse outcomes after primary percutaneous coronary intervention (PCI). However, whether glomerular filtration rate (GFR) estimated with various equations can equally predict outcomes after ST-Elevation Myocardial Infarction (STEMI) is still debated. METHODS We compared the clinical impact of 3 different creatinine-based equations (Cockcroft and Gault (CG), CKD-epidemiology (CKD-EPI) and Full Age Spectrum (FAS)) to predict 1-year mortality in STEMI patients. RESULTS Among 1755 consecutive STEMI patients who had undergone primary PCI included between 2006 and 2011, median estimated GFR was 79 (61;96) with the CG, 81 (65;95) with CKD-EPI and 75 (60;91) mL/min/1.73 m2 with FAS equation. Reduced GFR values were independently associated with 1-year mortality risk with the 3 equations. Receiver operating curves (ROC) of CG and FAS equations were significantly superior to the CKD-EPI equation, p = 0.03 and p = 0.01, respectively. Better prediction with FAS and CG equations was confirmed by net reclassification index. CONCLUSIONS Our results suggest that in STEMI patients who have undergone primary PCI, 1-year mortality is better predicted by CG or FAS equations compared to CKD-EPI.
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Affiliation(s)
- Yoann Bataille
- Quebec Heart-Lung Institute, Quebec, Canada
- Department of Cardiology, Centre Hospitalier Régional la Citadelle, Liège, Belgium
| | | | | | - Olivier Moranne
- Department of Nephrology-Dialysis-Apheresis, CHU de Nîmes, Medical School, University Montpellier-Nimes, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, Kulak, University of Leuven, Kortrijk, Belgium
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (CHU ULg), Liège, Belgium
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Shouval R, de Jong CN, Fein J, Broers AEC, Danylesko I, Shimoni A, Reurs MR, Baars AE, van der Schaft N, Nagler A, Cornelissen JJ. Baseline Renal Function and Albumin are Powerful Predictors for Allogeneic Transplantation-Related Mortality. Biol Blood Marrow Transplant 2018; 24:1685-1691. [PMID: 29753163 DOI: 10.1016/j.bbmt.2018.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
Biomarkers measured in blood chemistry before allogeneic hematopoietic stem cell transplantation (HSCT) may reflect patients' physiological status. We hypothesized that selected markers are predictive for nonrelapse mortality (NRM) following transplantation and could contribute to risk assessment. We investigated the value of pre-HSCT albumin, estimated glomerular filtration rate (eGFR), and alkaline phosphatase (AlkP) in predicting NRM. We retrospectively analyzed clinical and laboratory data from 1217 patients receiving a first HSCT in 2 European centers between 2003 and 2015. Transplantation indications and conditioning regimens were diverse. Patients had a median age of 55 years and hematopoietic cell transplantation comorbidity index (HCT-CI) scores of 0 (24%), 1 to 2 (39%), and ≥3 (37%). Cutoffs of eGFR <60 mL/min, albumin <3.5 g/dL, and AlkP >180 IU/L corresponded with 8.8%, 8.3%, and 6.5% of the patients, respectively. eGFR and albumin were associated with increased risk and higher cumulative incidence of day-100, 1-year, and 2-year NRM, both as continuous or categorized variables. A similar pattern was observed for AlkP, except for day-100 NRM. In multivariable analyses, eGFR and albumin were consistently among the top risk factors for early and late-term NRM, abrogating the role of age. Prediction models for day-100, 1-year, and 2-year NRM based only on HCT-CI resulted in c-statistics of .565, .575, and .577, respectively. Addition of both biomarkers increased c-statistics for day-100, 1-year, and 2-year NRM to .651, .633, and .624, respectively. Albumin and eGFR are prognostic biomarkers for NRM after HSCT and improve the discriminative power of the HCT-CI.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Cornelis N de Jong
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Joshua Fein
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Annoek E C Broers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ivetta Danylesko
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avichai Shimoni
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marloes R Reurs
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Adája E Baars
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Niels van der Schaft
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Declercq P, Gijsen M, Meijers B, Schetz M, Nijs S, D'Hoore A, Wauters J, Spriet I. Reliability of serum creatinine-based formulae estimating renal function in non-critically ill surgery patients: Focus on augmented renal clearance. J Clin Pharm Ther 2018; 43:695-706. [PMID: 29733108 DOI: 10.1111/jcpt.12695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Formulae estimating glomerular filtration rate (GFR) are frequently used to guide drug dosing. The objectives of this prospective single-center study were to evaluate agreement between these equations and measured creatinine clearance (CrCl) in non-critically ill surgery patients with normal kidney function and augmented renal clearance (ARC, CrCl ≥ 130 mL/min/1.73 m²), to determine predictors for disagreement, define a GFR estimator cut-off value identifying ARC and determine the ARC prevalence and duration in non-critically ill surgical patients. METHODS Hospitalized adult non-critically ill abdominal and trauma surgery patients were eligible for inclusion. Measured CrCl based on an 8-hour urinary collection (CrCl8h ) was used as the primary method for determining kidney function. Agreement between equations and measured CrCl8h was assessed in terms of precision, defined as a bias within ±10 mL/min/1.73 m². Predictors for disagreement were identified for the most precise estimator using an ordinal logistic regression model with negative bias, agreement and positive bias as outcome variables. A receiver operating characteristic (ROC) analysis was performed to identify an estimator cut-off predicting ARC, which was subsequently applied for the daily proportion of patients displaying ARC and ARC duration. RESULTS AND DISCUSSION During the study period (14/11/2013 - 13/05/2014), in 232 adult non-critically ill abdominal and trauma surgery patients, all estimators tend to underestimate CrCl8h (mean bias ranging from 17 to 22 mL/min/1.73 m²), especially in patients displaying ARC (mean bias ranging from 44 to 56 mL/min/1.73 m²). eGFRCKD-EPI performed the best. Younger age and low ASA score independently predicted underestimation of CrCl8h . Three different eGFRCKD-EPI cut-offs with decreasing sensitivity and increasing specificity (84, 95 and 112 mL/min/1.73 m²) identified, respectively, 65%, 44% and 14% patients displaying ARC. The median ARC duration was 4, 4 and 3 days, respectively. WHAT IS NEW AND CONCLUSION In surgical patients, eGFR frequently underestimates measured CrCl, especially in young patients with low ASA score. eGFR cut-offs predicting ARC were identified.
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Affiliation(s)
- Peter Declercq
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Matthias Gijsen
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Björn Meijers
- Division of Internal Medicine, Nephrology Unit, UZ Leuven and Department of Immunology and Microbiology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marie Schetz
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Stefaan Nijs
- Faculty of Medicine, Department of Traumatology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - André D'Hoore
- Faculty of Medicine, Department of Abdominal Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Joost Wauters
- Faculty of Medicine, Department of General Internal Medicine, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Estimation et mesure du débit de filtration glomérulaire : en quête de précision. Nephrol Ther 2018; 14 Suppl 1:S59-S66. [DOI: 10.1016/j.nephro.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
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50
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Methods of Estimating Kidney Function for Drug Dosing in Special Populations. Clin Pharmacokinet 2018; 57:943-976. [DOI: 10.1007/s40262-018-0628-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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