1
|
Choi JY, Yang YM. Association between high-sensitivity C-reactive protein and renal function in Korean adults: A sex-specific analysis of Korea National Health and Nutrition Examination Survey 2015 to 2018 data. Medicine (Baltimore) 2024; 103:e38769. [PMID: 39093734 PMCID: PMC11296482 DOI: 10.1097/md.0000000000038769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
This study aimed to investigate the association between high-sensitivity C-reactive protein (hs-CRP) levels, as a surrogate marker of systemic inflammation, and renal function among Korean adults grouped by age, sex, and body mass index. This study analyzed data obtained from the Korea National Health and Nutrition Examination Survey 2015 to 2018, a cross-sectional and nationally representative survey conducted by the Korean Centers for Disease Control and Prevention. Of the 22,451 subjects included in this study, 19,607 (87.3%) and 2844 (12.7%) had normal kidney function and incident chronic kidney disease, respectively. Reduced renal function was more frequently observed in subjects with high hs-CRP levels than in those with low hs-CRP levels (odds ratio [OR], 1.438; 95% confidence interval [CI], 1.234-1.674). In the group aged ≥ 65 years, the odds of reduced renal function were higher among subjects with a high hs-CRP level compared to those with a low hs-CRP level (OR, 1.528; 95% CI, 1.191-1.960). The association between hs-CRP level and renal function was observed only in women (OR, 2.485; 95% CI, 1.779-3.470) and further stratified by age and sex, the odds of reduced renal function were likely higher in women aged ≥ 65 years with a high hs-CRP level (OR, 2.338; 95% CI, 1.622-3.369). Moreover, reduced renal function was more observed in subjects aged ≥ 65 years and those with a body mass index < 25 kg/m2 (OR, 1.502; 95% CI, 1.087-2.075). This study showed that a high hs-CRP level likely contributes to the increased prevalence of reduced renal function. This association may aid the identification of individuals at high risk for reduced renal function, especially elderly women, in clinical or public health practice.
Collapse
Affiliation(s)
- Ji-Young Choi
- Department of Food and Nutrition, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, Republic of Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, Republic of Korea
| |
Collapse
|
2
|
Kim E, Huh H, Mo Y, Park JY, Jung J, Lee H, Kim S, Kim DK, Kim YS, Lim CS, Lee JP, Kim YC, Kim H. Long-term ozone exposure and mortality in patients with chronic kidney disease: a large cohort study. BMC Nephrol 2024; 25:74. [PMID: 38418953 PMCID: PMC10900590 DOI: 10.1186/s12882-024-03500-6] [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: 12/19/2022] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Epidemiologic studies on the effects of long-term exposure to ozone (O3) have shown inconclusive results. It is unclear whether to O3 has an effect on chronic kidney disease (CKD). We investigated the effects of O3 on mortality and renal outcome in CKD. METHODS We included 61,073 participants and applied Cox proportional hazards models to examine the effects of ozone on the risk of end-stage renal disease (ESRD) and mortality in a two-pollutants model adjusted for socioeconomic status. We calculated the concentration of ozone exposure one year before enrollment and used inverse distance weighting (IDW) for interpolation, where the exposure was evenly distributed. RESULTS In the single pollutant model, O3 was significantly associated with an increased risk of ESRD and all-cause mortality. Based on the O3 concentration from IDW interpolation, this moving O3 average was significantly associated with an increased risk of ESRD and all-cause mortality. In a two-pollutants model, even after we adjusted for other measured pollutants, nitrogen dioxide did not attenuate the result for O3. The hazard ratio (HR) value for the district-level assessment is 1.025 with a 95% confidence interval (CI) of 1.014-1.035, while for the point-level assessment, the HR value is 1.04 with a 95% CI of 1.035-1.045. The impact of ozone on ESRD, hazard ratio (HR) values are, 1.049(95%CI: 1.044-1.054) at the district unit and 1.04 (95%CI: 1.031-1.05) at the individual address of the exposure assessment. The ozone hazard ratio for all-cause mortality was 1.012 (95% confidence interval: 1.008-1.017) for administrative districts and 1.04 (95% confidence interval: 1.031-1.05) for individual addresses. CONCLUSIONS This study suggests that long-term ambient O3 increases the risk of ESRD and mortality in CKD. The strategy to decrease O3 emissions will substantially benefit health and the environment.
Collapse
Affiliation(s)
- Ejin Kim
- Institute of Health and Environment and Graduate School of Public Health, Seoul National University, Room 708, Building 220, Gwanak-Ro Gwanak-Gu, Seoul, 08826, Republic of Korea
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hyuk Huh
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yongwon Mo
- Department of Landscape Architecture, Yeungnam University, Gyeongsan, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-Do, Republic of Korea
| | - Jiyun Jung
- Data Management and Statistics Institute, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Daehak-Ro, Jongno-Gu, 101, Seoul, Republic of Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Daehak-Ro, Jongno-Gu, 101, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Daehak-Ro, Jongno-Gu, 101, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Daehak-Ro, Jongno-Gu, 101, Seoul, Republic of Korea.
| | - Ho Kim
- Institute of Health and Environment and Graduate School of Public Health, Seoul National University, Room 708, Building 220, Gwanak-Ro Gwanak-Gu, Seoul, 08826, Republic of Korea.
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Yan J, Yang X, Wang J, Cai H, Che X, Ying L, Zhang T, Chen Q, Xia J, Gu L, Yuan X, Chen R, Li D, Liu Z, Dong K, He L, Zhang M, Mou S. Metabolic Risk Profile and Graft Function Deterioration 2 Years After Kidney Transplant. JAMA Netw Open 2023; 6:e2349538. [PMID: 38150251 PMCID: PMC10753396 DOI: 10.1001/jamanetworkopen.2023.49538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Studies exploring the association of body weight and metabolic status with graft function deterioration (GFD) after kidney transplantation have produced inconsistent findings. Few studies have examined whether metabolically healthy overweight or obesity (MHO) may contribute to GFD. Objective To evaluate associations of overweight or obesity and metabolic disorders with GFD in recipients of kidney transplant. Design, Setting, and Participants This multicenter retrospective cohort study was conducted from January 1, 2020, through June 30, 2021, with a follow-up period of 2 years after kidney transplantation. Participants included adult recipients of cadaveric kidney transplant in 4 transplantation centers in China. Participants were classified as 4 metabolic phenotypes according to their BMI and metabolic status. Data were analyzed from July to August 2023. Exposures Overweight and obesity were characterized by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater. Metabolic disorder was identified by existence of a minimum of 2 of 4 conditions: hypertension, hyperglycemia, increased triglyceride, and decreased high-density lipoprotein cholesterol. Main Outcome and Measures The main outcome was GFD, defined as a decrease in estimated glomerular filtration rate of at least 25% within 6 months to 2 years after transplant. Results A total of 1260 adult recipients of cadaveric kidney transplant (mean [SD] age, 43.97 [11.51] years; 755 [59.92%] male) were included in the study, and 127 (10.08%) participants experienced the primary outcome of GFD during follow-up. After accounting for confounding factors in multivariable analyses, overweight or obesity (odds ratio [OR], 1.64; 95% CI, 1.10-2.44; P = .02) and metabolic disorder (OR, 1.71; 95% CI, 1.12-2.63; P = .01) were associated with increased risk of GFD. The MHO subgroup exhibited a greater risk for GFD (OR, 2.37; 95% CI, 1.01-5.57; P = .048) compared with participants who did not have overweight or obesity or metabolic disorder. All components of metabolic disorder, with the exception of elevated triglyceride, were associated with GFD. There was a dose-response association of number of metabolic disorder components (OR per 1 additional condition, 1.40; 95% CI, 1.20-1.63; P < .001) and BMI (OR per 1-unit increase, 1.90; 95% CI, 1.03-1.15; P = .002) with increased risk for GFD. A nonlinear association was observed between BMI and risk of GFD. Conclusions and Relevance In this cohort study of recipients of cadaveric kidney transplant, individuals with overweight or obesity or metabolic disorder had a significantly higher risk of experiencing GFD. Individuals with MHO had an elevated risk for graft function deterioration. Additional studies with larger sample size and longer follow-up are necessary to validate our findings.
Collapse
Affiliation(s)
- Jiayi Yan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoqian Yang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieying Wang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Cai
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiajing Che
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Ying
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Chen
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Xia
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leyi Gu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Yuan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyang Chen
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawei Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Liu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Dong
- Organ Transplantation Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Long He
- Organ Transplantation Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Zhang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
4
|
Kim EJ, Cho A, Kim DH, Park HC, Yoon JY, Shon K, Kim E, Koo JR, Lee YK. Geriatric Nutritional Risk Index as a Prognostic Factor for Renal Progression in Patients with Type 2 Diabetes Mellitus. Nutrients 2023; 15:4636. [PMID: 37960289 PMCID: PMC10649929 DOI: 10.3390/nu15214636] [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: 10/03/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to evaluate whether the geriatric nutritional risk index (GNRI) is associated with chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (DM). In total, 1100 patients with type 2 DM with a follow-up duration > 1 year were included in this longitudinal study. The risk of CKD progression was assessed according to GNRI quartiles. Patients in the lowest GNRI quartile exhibited a significantly lower estimated glomerular filtration rate (eGFR), compared with those in quartile four. Moreover, these patients had poorer glycemic control and lower hemoglobin levels, body mass index, and albumin levels. Additionally, they exhibited a greater annual decline in eGFR. Multivariate logistic regression analysis showed that old age (>60 years), baseline eGFR, the presence of proteinuria, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and low GNRI were significantly associated with CKD progression. GNRI may serve as a valuable predictive tool for identifying the risk of adverse renal outcomes in patients with type 2 DM. It may potentially serve as a more feasible measure for assessing the nutritional status of these patients, as well as for predicting their clinical outcomes.
Collapse
Affiliation(s)
- Eun Jung Kim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Graduate School of Kangwon National University, Kangwon 24341, Republic of Korea
| | - Ajin Cho
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Do Hyoung Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Hayne Cho Park
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Joo Yeon Yoon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Kyungjun Shon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Eunji Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
| | - Young-Ki Lee
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| |
Collapse
|
5
|
Chen CH, Wang CK, Wang CY, Chang CF, Chu TW. Roles of biochemistry data, lifestyle, and inflammation in identifying abnormal renal function in old Chinese. World J Clin Cases 2023; 11:7004-7016. [PMID: 37946770 PMCID: PMC10631406 DOI: 10.12998/wjcc.v11.i29.7004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/01/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The incidence of chronic kidney disease (CKD) has dramatically increased in recent years, with significant impacts on patient mortality rates. Previous studies have identified multiple risk factors for CKD, but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors. AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate (L-eGFR < 60 mL/min per 1.73 m2) in a cohort of 1236 Chinese people aged over 65. METHODS Twenty risk factors were divided into three models. Model 1 consisted of demographic and biochemistry data. Model 2 added lifestyle data to Model 1, and Model 3 added inflammatory markers to Model 2. Five machine learning methods were used: Multivariate adaptive regression splines, eXtreme Gradient Boosting, stochastic gradient boosting, Light Gradient Boosting Machine, and Categorical Features + Gradient Boosting. Evaluation criteria included accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), F-1 score, and balanced accuracy. RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance. Model 3 selected uric acid as the most important risk factor, followed by age, hemoglobin (Hb), body mass index (BMI), sport hours, and systolic blood pressure (SBP). CONCLUSION Among all the risk factors including demographic, biochemistry, and lifestyle risk factors, along with inflammation markers, UA is the most important risk factor to identify L-eGFR, followed by age, Hb, BMI, sport hours, and SBP in a cohort of elderly Chinese people.
Collapse
Affiliation(s)
- Chao-Hung Chen
- Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chun-Kai Wang
- Department of Obstetrics and Gynecology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung 813, Taiwan
| | - Chen-Yu Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chun-Feng Chang
- Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ta-Wei Chu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Chief Executive Officer's Office, MJ Health Research Foundation, Taipei 114, Taiwan
| |
Collapse
|
6
|
Li X, Wang L, Zhou H, Xu H. Association between weight-adjusted-waist index and chronic kidney disease: a cross-sectional study. BMC Nephrol 2023; 24:266. [PMID: 37691097 PMCID: PMC10494374 DOI: 10.1186/s12882-023-03316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS We aimed to investigate the potential association between weight-adjusted-waist index (WWI) and chronic kidney disease (CKD). DESIGN AND METHODS This research examined data collected from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2020. CKD was defined as the low estimated glomerular filtration rate (eGFR) or the existence of albuminuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30mg/g). Low-eGFR was described as eGFR < 60 mL/min/1.73m2. The associations between WWI with CKD, albuminuria, and low-eGFR were examined using generalized additive models and weighted multivariable logistic regression models. We also analyzed the associations of other obesity indicators with CKD, albuminuria, and low-eGFR, including body mass index (BMI), waist-to-height ratio (WHtR), waist circumference(WC), height, and weight. The receiver operating characteristic (ROC) curves were used to assess and compare their diagnostic abilities. RESULTS Males made up 48.26% of the total 40,421 individuals that were recruited. The prevalences of CKD, albuminuria, and low-eGFR were 16.71%, 10.97%, and 7.63%, respectively. WWI was found to be positively linked with CKD (OR = 1.42; 95% CI: 1.26, 1.60). A nonlinear connection between WWI and CKD was found using smooth curve fitting. Additionally, a higher prevalence of albuminuria is linked to a higher level of WWI (OR = 1.60; 95% CI: 1.40, 1.82). Different stratifications did not substantially influence the connection between WWI and CKD, albuminuria, and low-eGFR, according to subgroup analysis and interaction tests. We observed higher height was related to higher low-eGFR prevalence (OR = 1.05; 95% CI: 1.03, 1.06). ROC analysis revealed that WWI had the best discrimination and accuracy for predicting CKD and albuminuria compared to other obesity indicators (BMI, WHTR, WC, height and weight). In addition, height had the highest area under the curve (AUC) value for predicting low-eGFR. CONCLUSION WWI is the best obesity indicator to predict CKD and albuminuria compared to other obesity indicators (BMI, WHTR, WC, height, and weight). WWI and CKD and albuminuria were found to be positively correlated. Furthermore, height had the strongest ability to predict low-eGFR. Therefore, the importance of WWI and height in assessing kidney health in US adults should be emphasized.
Collapse
Affiliation(s)
- Xiaowan Li
- Department of Critical Care Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Nanjing, China
| | - Lanyu Wang
- Department of Urology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Nanjing, China
| | - Hongyi Zhou
- Department of Urology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Nanjing, China
| | - Hongyang Xu
- Department of Critical Care Medicine, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Nanjing, China.
| |
Collapse
|
7
|
Kim B, Kim GM, Han K, Maki N, Taniguchi K, Oh S. The Triglyceride-Glucose Index is Independently Associated with Chronic Kidney Disease in the Geriatric Population, Regardless of Obesity and Sex. Ann Geriatr Med Res 2023; 27:258-265. [PMID: 37673691 PMCID: PMC10556718 DOI: 10.4235/agmr.23.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) negatively affects several risk factors of chronic kidney disease (CKD). This cross-sectional study investigated whether the triglyceride-glucose (TyG) index, which reflects IR, was independently associated with CKD in a geriatric population, regardless of obesity and sex. METHODS The analysis included 7,326 individuals (2,864 males and 4,462 females) aged ≥60 years. Non-obesity or obesity was evaluated using a body mass index cutoff of 25 kg/m2. The TyG index was calculated as ln [triglyceride concentration (mg/dL)×fasting plasma glucose concentration (mg/dL)]/2. All participants were categorized into three groups according to TyG tertiles. Moderate-to-severe CKD (MSCKD) was defined as an estimated glomerular filtration rate (eGFR) of <45.0 mL/min/1.73 m2. RESULTS In males and females with or without obesity, a trend test showed a decreasing tendency in the eGFR from the lowest to highest TyG tertiles. Males without obesity and females with obesity in the middle and highest tertiles of the TyG index were 2.342 and 2.393, and were 2.313 and 3.516 times more likely to have MSCKD, respectively. Those with or without obesity in the highest tertile of the TyG index were 1.736 and 2.374 times more likely to have MSCKD, respectively. CONCLUSION Geriatric populations with an increased TyG index have a high risk of MSCKD regardless of obesity and sex. Our findings suggest that increased IR is associated with CKD in the geriatric population independent of obesity and sex.
Collapse
Affiliation(s)
- Bokun Kim
- Future Convergence Research Institute, Changwon National University, Changwon, Korea
- Human Community Renovation Research Center, R Professional University of Rehabilitation, Tsuchiura, Japan
| | - Gwon-Min Kim
- Human Community Renovation Research Center, R Professional University of Rehabilitation, Tsuchiura, Japan
- Medical Research Institute, Pusan National University, Busan, Korea
| | - Kihoon Han
- Department of Physical Education, Pusan National University, Busan, Korea
| | - Naoki Maki
- Human Community Renovation Research Center, R Professional University of Rehabilitation, Tsuchiura, Japan
- Faculty of Rehabilitation, R Professional University of Rehabilitation, Tsuchiura, Japan
| | - Keisuke Taniguchi
- Human Community Renovation Research Center, R Professional University of Rehabilitation, Tsuchiura, Japan
- Faculty of Rehabilitation, R Professional University of Rehabilitation, Tsuchiura, Japan
| | - Sechang Oh
- Human Community Renovation Research Center, R Professional University of Rehabilitation, Tsuchiura, Japan
- Faculty of Rehabilitation, R Professional University of Rehabilitation, Tsuchiura, Japan
| |
Collapse
|
8
|
Bullen AL, Katz R, Kumar U, Gutierrez OM, Sarnak MJ, Kramer HJ, Shlipak MG, Ix JH, Judd SE, Cushman M, Garimella PS. Lipid accumulation product, visceral adiposity index and risk of chronic kidney disease. BMC Nephrol 2022; 23:401. [PMID: 36522626 PMCID: PMC9753382 DOI: 10.1186/s12882-022-03026-9] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lipid accumulation product (LAP) and visceral adiposity index (VAI) are novel, non-imaging markers of visceral adiposity that are calculated by using body mass index (BMI), waist circumference (WC) and serum lipid concentrations. We hypothesized that LAP and VAI are more strongly associated with adverse kidney outcomes than BMI and WC. METHODS Using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we used multivariable logistic regression to evaluate associations of LAP, VAI, BMI and WC with incident chronic kidney disease (CKD), (incident eGFR < 60 ml/min/1.73m2 and > 25% decline). RESULTS Among the overall cohort of 27,550 participants, the mean baseline age was 65 years; 54% were women; and 41% were African American. After a median of 9.4 years (IQR 8.6, 9.9) of follow-up, a total of 1127 cases of incident CKD were observed. Each two-fold higher value of VAI (OR 1.12, 95% CI 1.04, 1.20), LAP (OR 1.21, 95% CI 1.13, 1.29), WC (OR 2.10, 95% CI 1.60, 2.76) and BMI (OR: 2.66, 95% CI 1.88, 3.77), was associated with greater odds of incident CKD. CONCLUSIONS LAP and VAI as measures of visceral adiposity are associated with higher odds of incident CKD but may not provide information beyond WC and BMI.
Collapse
Affiliation(s)
- Alexander L Bullen
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.
- Division of Nephrology & Hypertension, University of California San Diego, 200 W Arbor Dr.. M/C 8409 MPF L030, San Diego, CA, 92103, USA.
| | - Ronit Katz
- Division of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Ujjala Kumar
- Division of Nephrology & Hypertension, University of California San Diego, 200 W Arbor Dr.. M/C 8409 MPF L030, San Diego, CA, 92103, USA
| | - Orlando M Gutierrez
- Division of Nephrology, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Holly J Kramer
- Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
- Division of Nephrology & Hypertension, University of California San Diego, 200 W Arbor Dr.. M/C 8409 MPF L030, San Diego, CA, 92103, USA
| | - Suzanne E Judd
- Department of Biostatistics, UAB School of Public Health, Birmingham, AL, USA
| | - Mary Cushman
- Division of Hematology and Oncology, University of Vermont, Colchester, VT, USA
| | - Pranav S Garimella
- Division of Nephrology & Hypertension, University of California San Diego, 200 W Arbor Dr.. M/C 8409 MPF L030, San Diego, CA, 92103, USA
| |
Collapse
|
9
|
Kim B, Kim GM, Oh S. Use of the Visceral Adiposity Index as an Indicator of Chronic Kidney Disease in Older Adults: Comparison with Body Mass Index. J Clin Med 2022; 11:6297. [PMID: 36362525 PMCID: PMC9659218 DOI: 10.3390/jcm11216297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 12/27/2023] Open
Abstract
The visceral adiposity index (VAI) was recently introduced to quantify visceral fat accumulation and dysfunction. This cross-sectional study explored whether the VAI is associated with chronic kidney disease (CKD) in older adults and compared its utility with that of body mass index (BMI) for predicting CKD. In total, 7736 older adults (3479 men and 4257 women) aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups. Associations of the VAI and BMI with CKD were compared among the groups, and cut-off points for moderate-to-severe CKD (MSCKD) were established. While the VAI could discriminate among all of the groups, the BMI could not. The severity of CKD was more strongly associated with the VAI than BMI. The odds ratios indicated that, in the fully adjusted model, the VAI was a significant predictor of MSCKD in both men and women, while the BMI was a significant predictor only in men. For the VAI, the area under the receiver operating characteristic curve values for men and women were 0.631 (cut-off point: ≥2.993) and 0.588 (≥4.001), compared with 0.555 (≥25.335) and 0.533 (≥24.096) for BMI, respectively. Taken together, the findings suggest that the VAI is associated with CKD and represents a better indicator for the disease than BMI.
Collapse
Affiliation(s)
- Bokun Kim
- Department of Anti-Ageing Health Care, Changwon National University, Changwon 51140, Korea
- Future Convergence Research Institute, Changwon National University, Changwon 51140, Korea
- Department of Sports Healthcare, In-Je University, Gimhae 50834, Korea
| | - Gwon-Min Kim
- Medical Research Institute, Pusan National University, Busan 46241, Korea
| | - Sechang Oh
- Faculty of Rehabilitation, R Professional University of Rehabilitation, Tsuchiura 300-0032, Japan
| |
Collapse
|
10
|
Lin CH, Li YH, Wang YY, Chang WD. Higher Neutrophil-To-Lymphocyte Ratio Was Associated with Increased Risk of Chronic Kidney Disease in Overweight/Obese but Not Normal-Weight Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138077. [PMID: 35805736 PMCID: PMC9265888 DOI: 10.3390/ijerph19138077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
Background: Inflammation has been proposed to play potential roles in the development and progression of chronic kidney disease (CKD). We evaluated the relationship of neutrophil-to-lymphocyte ratio (NLR), a systemic inflammation marker, with CKD in normal-weight and overweight/obese adults. Methods: This cross-sectional study included 2846 apparently healthy adults who underwent a health examination between August 2000 and April 2002. Normal-weight was defined as a body mass index (BMI, kg/m2) of 18.5−24, while overweight/obesity was defined as a BMI of ≥24. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Logistic and linear regression analysis was performed to explore the NLR−CKD relationship. Results: Of the 2846 participants (1777 men and 1069 women), there were 348 CKD individuals (12.3%), with 262 (14.7%) men and 86 (8%) women. A total of 1011 men (56.9%) and 408 women (38.2%) were overweight or obese. Compared with the normal-weight participants, CKD prevalence was higher in the overweight/obese women (6.1% vs. 11.3%, p = 0.002), but not in the overweight/obese men (14.5% vs. 14.9%, p = 0.793). CKD percentages in the NLR quartile groups were 9.4%, 11.5%, 15.4%, and 22.7% in men (p < 0.0001) and 6.4%, 7.1%, 10.5%, and 8.2% in women (p = 0.2291). After adjustment for confounders, each increment of one unit of NLR was associated with a higher CKD risk in the overweight/obese men (adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.03−1.82, p = 0.03) and women (adjusted OR = 1.77, 95% CI = 1.08−2.90, p = 0.023), whereas NLR was not associated with CKD in normal-weight men or women. Further, in the overweight/obese participants with an eGFR of 50−70 mL/min/1.73 m2, univariable linear regression analysis revealed a significant negative correlation between NLR and eGFR for men (p = 0.004) and women (p = 0.009). Conclusions: It was found that higher NLR was associated with an increased CKD risk in overweight/obese but not in normal-weight men and women in an adult health examination dataset. Our study suggests a role of NLR for CKD prediction in overweight/obese individuals.
Collapse
Affiliation(s)
- Chia-Ho Lin
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Ya-Yu Wang
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung 40705, Taiwan;
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Wen-Dau Chang
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung 40705, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Correspondence:
| |
Collapse
|
11
|
Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes. J Clin Med 2022; 11:jcm11102787. [PMID: 35628912 PMCID: PMC9144670 DOI: 10.3390/jcm11102787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity-related nephropathy is associated with renal function progression. However, some studies have associated a high body mass index (BMI) with improved renal outcomes—this is referred to as the obesity paradox for renal outcomes, especially in relation to advanced chronic kidney disease (CKD). Central obesity can explain the obesity paradox in all-cause mortality. However, whether obesity or central obesity is associated with renal outcomes (renal replacement therapy or a 50% decline in the estimated glomerular filtration rate) in patients with advanced CKD remains unclear. Our study included 3605 Asian patients with CKD stages 1−5 divided into six groups according to their BMI (between 15 and 35 kg/m2). Through linear regression, BMI was positively associated with hemoglobin and albumin at CKD stages 4 and 5. In the competing risk Cox regression model, a high BMI (27.5−35 kg/m2) was associated with renal outcomes at CKD stages 1−3, but not stages 4 and 5. A high BMI was associated with renal outcomes in patients with hemoglobin ≥11 g/dL, but not <11 g/dL. A high waist-to-hip ratio was not associated with renal outcomes. We conclude that the CKD stage and anemia may explain the obesity paradox in renal outcomes in patients with CKD.
Collapse
|
12
|
Steele C, Nowak K. Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease. KIDNEY AND DIALYSIS 2022; 2:106-122. [PMID: 35350649 PMCID: PMC8959086 DOI: 10.3390/kidneydial2010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an increased risk for rapid kidney disease progression. Autosomal dominant polycystic kidney disease causes growth and proliferation of kidney cysts resulting in a reduction in kidney function in the majority of adults. An accumulation of adipose tissue may further exacerbate the metabolic defects that have been associated with ADPKD by affecting various cell signaling pathways. Lifestyle interventions inducing weight loss might help delay disease progression by reducing adipose tissue and systematic inflammation. Further research is needed to determine the mechanistic influence of adipose tissue on disease progression.
Collapse
Affiliation(s)
- Cortney Steele
- Division of Renal Diseases and Hypertension, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Kristen Nowak
- Division of Renal Diseases and Hypertension, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| |
Collapse
|
13
|
Xu L, Liu J, Li D, Yang H, Zhou Y, Yang J. Association between metabolic syndrome components and chronic kidney disease among 37,533 old Chinese individuals. Int Urol Nephrol 2021; 54:1445-1454. [PMID: 34671893 PMCID: PMC9085695 DOI: 10.1007/s11255-021-03013-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023]
Abstract
Background Chronic kidney disease (CKD) has become a worldwide health problem among aging populations. However, epidemiological information on Chinese elderly people with CKD is still lacking. This study aimed to investigate the epidemiological features and associated risk factors of CKD in aging population in China. Methods In this cross-sectional study, a total of 37,533 individuals aged ≥ 65 years were enrolled in Binhai from January to December 2018. The crude and standardized prevalence of CKD were calculated. Associations of metabolism-related indicators with CKD were examined using univariate and multivariate analyses. Results The overall prevalence of CKD was 17.7% (95% confidence interval 17.3–18.1%) in this Chinese elderly population. The prevalence was 17.5% among men (95% CI 17.0–18.1%) and 17.8% among women (95% CI 17.3–18.4%). The mean eGFR was 84.22 (SD ± 12.87) mL/min/1.73 m2, with the median value higher for women than for men. Conclusion Our study shows a high prevalence of CKD among Chinese elderly population. Aging, pre-HTN, HTN, elevated triglyceride, and FBG were associated with the risk of CKD. More attention should be paid to metabolic diseases to prevent CKD in the elderly.
Collapse
Affiliation(s)
- Lingling Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China
| | - Jin Liu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China
| | - Dongling Li
- Department of Nephrology, People's Hospital of Binhai County, Yancheng, 224500, Jiangsu, China
| | - Hua Yang
- Department of Nephrology, People's Hospital of Binhai County, Yancheng, 224500, Jiangsu, China
| | - Yang Zhou
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China.
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China.
| |
Collapse
|
14
|
Sánchez‐Navarro A, Martínez‐Rojas MÁ, Caldiño‐Bohn RI, Pérez‐Villalva R, Zambrano E, Castro‐Rodríguez DC, Bobadilla NA. Early triggers of moderately high-fat diet-induced kidney damage. Physiol Rep 2021; 9:e14937. [PMID: 34291592 PMCID: PMC8295594 DOI: 10.14814/phy2.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
Most of the obesity murine models inducing renal injury use calorie-enriched foods, where fat represents 60% of the total caloric supply, however, this strategy doubles the standard proportion of fat ingestion in obese patients. Therefore, it is crucial to study the impact of a high-fat intake on kidney physiology that resembles common obesity in humans to understand the trigger mechanisms of the long-term consequences of overweight and obesity. In this study, we analyzed whether chronic feeding with a moderately high fat diet (MHFD) representing 45% of total calories, may induce kidney function and structural injury compared to C57BL/6 mice fed a control diet. After 14 weeks, MHFD induced significant mice obesity. At the functional level, obese mice showed signs of kidney injury characterized by increased albuminuria/creatinine ratio and higher excretion of urinary biomarkers of kidney damage. While, at the structural level, glomerular hypertrophy was observed. Although, we did not detect renal fibrosis, the obese mice exhibited a significant elevation of Tgfb1 mRNA levels. Kidney damage caused by the exposure to MHFD was associated with greater oxidative stress, renal inflammation, higher endoplasmic reticulum (ER)-stress, and disruption of mitochondrial dynamics. In summary, our data demonstrate that obesity induced by a milder fat content diet is enough to establish renal injury, where oxidative stress, inflammation, ER-stress, and mitochondrial damage take relevance, pointing out the importance of opportune interventions to avoid the long-term consequences associated with obesity and metabolic syndrome.
Collapse
Affiliation(s)
- Andrea Sánchez‐Navarro
- Molecular Physiology UnitInstituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoMexico CityMexico
- Department of NephrologyInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
| | - Miguel Ángel Martínez‐Rojas
- Molecular Physiology UnitInstituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoMexico CityMexico
- Department of NephrologyInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
| | - Rebecca I. Caldiño‐Bohn
- Molecular Physiology UnitInstituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoMexico CityMexico
- Department of NephrologyInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
| | - Rosalba Pérez‐Villalva
- Molecular Physiology UnitInstituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoMexico CityMexico
- Department of NephrologyInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
| | - Elena Zambrano
- Department of Biology of ReproductionInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
| | - Diana C. Castro‐Rodríguez
- Department of Biology of ReproductionInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
- CONACyT‐CátedrasMexico CityMexico
| | - Norma A. Bobadilla
- Molecular Physiology UnitInstituto de Investigaciones BiomédicasUniversidad Nacional Autónoma de MéxicoMexico CityMexico
- Department of NephrologyInstituto Nacional de Ciencias Médicas y NutriciónSalvador ZubiránMexico CityMexico
| |
Collapse
|
15
|
Population Pharmacokinetic Analysis and Dosing Optimization Based on Unbound Daptomycin Concentration and Cystatin C in Nonobese Elderly Patients with Hypoalbuminemia and Chronic Kidney Disease. Pharm Res 2021; 38:1041-1055. [PMID: 34013390 DOI: 10.1007/s11095-021-03058-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study evaluated the population pharmacokinetics of daptomycin in nonobese elderly patients with hypoalbuminemia and chronic kidney disease (CKD) using the glomerular filtration rate estimated from cystatin C (eGFRcys) and estimated its optimal dose. METHODS We performed population pharmacokinetic analysis of the unbound concentrations of daptomycin. The probability of target attainment of 90% for achieving an area under the concentration-time curve of unbound daptomycin at steady state/ minimum inhibitory concentration ratio of ≥66.6 was stochastically simulated. RESULTS In the population pharmacokinetic analysis of 25 patients aged ≥65 years, the two-compartment model using eGFRcys and age as covariates of clearance in central compartment of unbound daptomycin were optimal. The unbound fraction rate (fu) was 0.05-0.14. According to the Monte Carlo simulation, the optimal doses for patients with eGFRcys of 20-60 mL/min and aged 65-95 years were calculated as 200-500 mg q24h. CONCLUSION These results suggest that establishing the dose using total concentrations may result in under- or overestimation caused by alterations in fu. The optimal dose for nonobese elderly patients with hypoalbuminemia and CKD depends on eGFRcys and age, and a standard dose may be insufficient for some patients.
Collapse
|
16
|
Ngo-Bitoungui VJ, Belinga S, Mnika K, Masekoameng T, Nembaware V, Essomba RG, Ngo-Sack F, Awandare G, Mazandu GK, Wonkam A. Investigations of Kidney Dysfunction-Related Gene Variants in Sickle Cell Disease Patients in Cameroon (Sub-Saharan Africa). Front Genet 2021; 12:595702. [PMID: 33790942 PMCID: PMC8005585 DOI: 10.3389/fgene.2021.595702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background Renal dysfunctions are associated with increased morbidity and mortality in sickle cell disease (SCD). Early detection and subsequent management of SCD patients at risk for renal failure and dysfunctions are essential, however, predictors that can identify patients at risk of developing renal dysfunction are not fully understood. Methods In this study, we have investigated the association of 31 known kidney dysfunctions-related variants detected in African Americans from multi-ethnic genome wide studies (GWAS) meta-analysis, to kidney-dysfunctions in a group of 413 Cameroonian patients with SCD. Systems level bioinformatics analyses were performed, employing protein-protein interaction networks to further interrogate the putative associations. Results Up to 61% of these patients had micro-albuminuria, 2.4% proteinuria, 71% glomerular hyperfiltration, and 5.9% had renal failure. Six variants are significantly associated with the two quantifiable phenotypes of kidney dysfunction (eGFR and crude-albuminuria): A1CF-rs10994860 (P = 0.02020), SYPL2-rs12136063 (P = 0.04208), and APOL1 (G1)-rs73885319 (P = 0.04610) are associated with eGFR; and WNT7A-rs6795744 (P = 0.03730), TMEM60-rs6465825 (P = 0.02340), and APOL1 (G2)-rs71785313 (P = 0.03803) observed to be protective against micro-albuminuria. We identified a protein-protein interaction sub-network containing three of these gene variants: APOL1, SYPL2, and WNT7A, connected to the Nuclear factor NF-kappa-B p105 subunit (NFKB1), revealed to be essential and might indirectly influence extreme phenotypes. Interestingly, clinical variables, including body mass index (BMI), systolic blood pressure, vaso-occlusive crisis (VOC), and haemoglobin (Hb), explain better the kidney phenotypic variations in this SCD population. Conclusion This study highlights a strong contribution of haematological indices (Hb level), anthropometric variables (BMI, blood pressure), and clinical events (i.e., vaso-occlusive crisis) to kidney dysfunctions in SCD, rather than known genetic factors. Only 6/31 characterised gene-variants are associated with kidney dysfunction phenotypes in SCD samples from Cameroon. The data reveal and emphasise the urgent need to extend GWAS studies in populations of African ancestries living in Africa, and particularly for kidney dysfunctions in SCD.
Collapse
Affiliation(s)
- Valentina J Ngo-Bitoungui
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon-Accra, Ghana.,Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Microbiology Haematology and Immunology, University of Dschang, Yaoundé, Cameroon
| | | | - Khuthala Mnika
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tshepiso Masekoameng
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon-Accra, Ghana
| | - René G Essomba
- National Public Health Laboratory, Yaoundé, Cameroon.,Department of Microbiology, Parasitology, Haematology, Immunology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Francoise Ngo-Sack
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Gordon Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon-Accra, Ghana
| | - Gaston K Mazandu
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,African Institute for Mathematical Sciences, Muizenberg, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
17
|
Miller AC, Tuiz E, Shaw L, Flood D, Garcia P, Dhaenens E, Thomson DR, Barnoya J, Montano CM, Rohloff P. Population Estimates of GFR and Risk Factors for CKD in Guatemala. Kidney Int Rep 2021; 6:796-805. [PMID: 33732994 PMCID: PMC7938058 DOI: 10.1016/j.ekir.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America's most populous country, are limited, especially for rural communities. METHODS We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. RESULTS We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4-6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2. Most individuals with an eGFR below 60 ml/min per 1.73 m2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28-38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05-217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01-1.19). CONCLUSIONS In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.
Collapse
Affiliation(s)
- Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Tuiz
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Leah Shaw
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - David Flood
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Pablo Garcia
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Eloin Dhaenens
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Dana R. Thomson
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | | | - Peter Rohloff
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Kulathunga MRDL, Wijayawardena MAA, Naidu R, Wimalawansa SJ, Wijeratne AW. Association between body mass index and estimated glomerular filtration rate in patients with chronic kidney disease of unknown aetiology in Sri Lanka. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:2645-2653. [PMID: 32020376 DOI: 10.1007/s10653-019-00472-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/08/2019] [Indexed: 05/24/2023]
Abstract
Chronic kidney disease of unknown aetiology (CKDu), which is widespread in the North Central Province (NCP) of Sri Lanka, is not associated with commonly known factors such as diabetes, hypertension, and glomerulonephritis. The pathogenicity of CKDu is not well understood, but people with a low body mass index (BMI) and mineral and nutrient deficiencies are more vulnerable to develop CKDu. To understand this situation, the relationship between BMI and the estimated glomerular filtration rate (eGFR) was investigated in people with CKDu in comparison with unaffected age-matched control groups in disease-endemic areas of the NCP. This community-based cross-sectional study was performed in Medirigiriya in the Polonnaruwa district of Sri Lanka, which has one of the highest densities of patients with CKDu. The data for identifying demographic factors and the relationship between CKDu and BMI were investigated by using a validated survey questionnaire. Findings indicated that the group with the highest number of people affected with CKDu (i.e. eGFR of less than 60 mL/min/1.73 m2) had the lowest BMI compared to those with normal eGFR. The majority affected were male farmers. The severity of the disease was inversely associated with BMI values and had a higher prevalence of smoking and alcohol consumption. In addition, those who consume water from household dug wells had significantly lower eGFR (p < 0.0001). A linear regression analysis revealed a significant positive association between lower eGFR and lower BMI (p < 0.001). We hypothesised that the low BMI in those with CKDu may have increased susceptibility to develop CKDu, in the presence of exposure to multiple nephrotoxins and adverse conditions.
Collapse
Affiliation(s)
- M R D L Kulathunga
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
- Fruit Research and Development Institute, Kananwila, Horana, Sri Lanka
| | - M A A Wijayawardena
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia.
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Ravi Naidu
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia
| | | | - A W Wijeratne
- Faculty of Agricultural Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka
| |
Collapse
|
19
|
Abdullah Bawazir LA, Sianipar W, Buntaran S, Kekalih A. The relationship between body mass index and blood pressure in patients undergoing chronic hemodialysis: A reverse epidemiology in Jakarta, Indonesia. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:62-69. [PMID: 32129198 DOI: 10.4103/1319-2442.279962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In the general population, obesity is positively correlated with hypertension. On the other hand, there was hypothesis of "reverse epidemiology" in the relationship between body mass index (BMI) and blood pressure (BP) of hemodialysis (HD) patients. This study aimed to investigate the "reverse epidemiology" of the relationship between the two variables in Jakarta, Indonesia. Cross-sectional study was conducted at Cipto Mangunkusumo Hospital, Koja District Hospital, and Cengkareng District Hospital in July 2018. Total sampling was performed with a total of 525 HD patients aged >18 years. All data were analyzed from the medical records. Of 525 patients, 27.4% were obese. The post hoc analyses showed that obese patients had significantly lower post-HD systolic BP (P = 0.006) and diastolic BP (P = 0.004) than the normal-weight patients. The Chi-square analyses showed that the overweight group [odds ratio (OR) = 0.53; 95% confidence interval (CI) 0.31-0.87; P = 0.011] and the obese group (OR = 0. 63; 95% CI 0.400.97; P= 0.038) had significant protective effect (OR <1) on the post-HD hypertension. Being obese was a strong predictor for reduced BP (coefficient β = -0.02; P = 0.031). BMI is inversely associated with BP in patients undergoing chronic HD.
Collapse
Affiliation(s)
- Lucky Aziza Abdullah Bawazir
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | - Aria Kekalih
- Department of Community Occupational and Family Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
20
|
Kurniawan AL, Hsu CY, Rau HH, Lin LY, Chao JCJ. Association of kidney function-related dietary pattern, weight status, and cardiovascular risk factors with severity of impaired kidney function in middle-aged and older adults with chronic kidney disease: a cross-sectional population study. Nutr J 2019; 18:27. [PMID: 31010424 PMCID: PMC6477746 DOI: 10.1186/s12937-019-0452-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/28/2019] [Indexed: 01/30/2023] Open
Abstract
Background Chronic Kidney Disease (CKD), characterized by impaired kidney function, affects over 1.5 million individuals in Taiwan. Cardiovascular disease (CVD) is commonly found in patients with CKD, and the increased prevalence of obesity can have some implications for the risk of both CKD and CVD. Since diet plays an important role in the development of obesity, CVD and CKD, our study was designed to investigate the association of kidney function-related dietary pattern with weight status, cardiovascular risk factors, and the severity of impaired kidney function in middle-aged and older adults in Taiwan. Methods A total of 41,128 participants aged 40 to 95 years old with an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m2 and proteinuria were recruited from Mei Jau Health Institute between 2008 and 2010. The kidney function-related dietary pattern was identified using reduced rank regression (RRR) and was known as high consumption of preserved or processed food, meat, organ meats, rice/flour products, and, low consumption of fruit, dark-colored vegetables, bread, and beans. A multivariable logistic regression analysis was used to identify the association of weight status and cardiovascular risk factors with moderately/severely impaired kidney function (eGFR < 60 mL/min/1.73 m2) and the association of dietary pattern with the outcomes aforementioned. Results Moderately/severely impaired kidney function participants were heavier and had higher abnormality of cardiovascular risk factors compared with those with mildly impaired kidney function. Weight status (OR = 1.28, 95% CI 1.12–1.45, P < 0.001 for obesity) and cardiovascular risk factors (OR = 1.52, 95% CI 1.31–1.77, P < 0.001 for high total cholesterol/HDL-C ratio and OR = 1.56, 95% CI 1.41–1.72, P < 0.001 for hypercalcemia) were positively associated with increased risk of moderately/severely impaired kidney function. The kidney function-related dietary pattern was correlated with overweight or obese (OR = 2.07, 95% CI 1.89–2.27, P < 0.01) weight status, increased cardiovascular risk by 10–31%, and the risk of moderately/severely impaired kidney function (OR = 1.15, 95% CI 1.02–1.29, P < 0.05). Conclusions The RRR-derived kidney function-related dietary pattern, characterized by high intake of processed and animal foods and low intake of plant foods, predicts the risks for developing cardiovascular disease and moderately/severely impaired kidney function among middle-aged and older adults. Electronic supplementary material The online version of this article (10.1186/s12937-019-0452-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Adi Lukas Kurniawan
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, 365 Ming-Te Road, Peitou District, Taipei, 112, Taiwan.,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
| | - Hsiao-Hsien Rau
- Joint Commission of Taiwan. 31 Sec.2 Sanmin Road, Banqiao District, New Taipei City, 220, Taiwan
| | - Li-Yin Lin
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
| | - Jane C-J Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan. .,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan. .,Nutrition Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei, 110, Taiwan.
| |
Collapse
|