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Kim HJ, Hur KY, Lee YH, Kim JT, Lee YK, Baek KH, Choi EJ, Hwang WM, Bang KT, Lim JS, Chung YJ, Jo SR, Oh JS, Lee SH, Ko SH, Choi SH. Effect of Pravastatin on Kidney Function in Patients with Dyslipidemia and Type 2 Diabetes Mellitus: A Multicenter Prospective Observational Study. Adv Ther 2024; 41:3119-3137. [PMID: 38880822 PMCID: PMC11263229 DOI: 10.1007/s12325-024-02862-5] [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: 01/09/2024] [Accepted: 03/27/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Several studies have reported that pravastatin can mitigate the progression of kidney disease, but limited evidence exists regarding its effects on kidney function in Asian patients. This multicenter prospective observational study aimed to assess the effect of pravastatin on kidney function in Korean patients with dyslipidemia and type 2 diabetes mellitus (T2DM) in clinical practice. METHODS This 48-week prospective multicenter study included 2604 of 2997 eligible patients with dyslipidemia and T2DM who had available estimated glomerular filtration rate (eGFR) measurements. The primary endpoint was eGFR percent change at week 24 from baseline. We also assessed secondary endpoints, which included percent changes in eGFR at weeks 12 and 48 from baseline, as well as changes in eGFR, metabolic profiles (lipid and glycemic levels) at 12, 24, and 48 weeks from baseline, and safety. RESULTS We noted a significant improvement in eGFR, with mean percent changes of 2.5%, 2.5%, and 3.0% at 12, 24, and 48 weeks, respectively (all adjusted p < 0.05). The eGFR percent changes significantly increased in subgroups with baseline eGFR 30-90 mL/min/1.73 m2, glycated hemoglobin (HbA1c) ≥ 7 at baseline, no hypertension history, T2DM duration > 5 years, or previous statin therapy. Lipid profiles were improved and remained stable throughout the study, and interestingly, fasting glucose and HbA1c were improved at 24 weeks. CONCLUSION Our findings suggest that pravastatin may have potential benefits for improving eGFR in Korean patients with dyslipidemia and T2DM. This could make it a preferable treatment option for patients with reduced kidney function. TRIAL REGISTRATION NUMBER NCT05107063 submitted October 27, 2021.
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Affiliation(s)
- Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Taek Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Yong-Kyu Lee
- Division of Nephrology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea
| | - Ki-Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Euy Jin Choi
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Won Min Hwang
- Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Ki Tae Bang
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Jung Soo Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Yun Jae Chung
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Rae Jo
- Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea
| | - Joon Seok Oh
- Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Soon Hee Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea.
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Batsuuri B, Avirmed S, Batbold C, Lopez-Verdugo F, Nunez J, Togtokh A, Orgoi S. Risk factors for renal impairment after liver transplantation in Mongolia: a retrospective single-center study. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:128-135. [PMID: 38940688 PMCID: PMC11228376 DOI: 10.4285/ctr.24.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
Background Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. Methods We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Results Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58-5.91), Child-Turcotte-Pugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92-19.41 and OR, 7.68; 95% CI, 1.67-35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86; 95% CI, 1.1-31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23-9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Conclusions Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.
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Affiliation(s)
- Batsaikhan Batsuuri
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- The Transplantation Center, The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Shiirevnyamba Avirmed
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chuluunbileg Batbold
- Department of Internal Medicine, Health Development Center, Ulaanbaatar, Mongolia
| | | | - Jade Nunez
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ariunaa Togtokh
- Department of Nephrology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Sergelen Orgoi
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- The Transplantation Center, The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
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Jaimes Campos MA, Mavrogeorgis E, Latosinska A, Eder S, Buchwinkler L, Mischak H, Siwy J, Rossing P, Mayer G, Jankowski J. Urinary peptide analysis to predict the response to blood pressure medication. Nephrol Dial Transplant 2024; 39:873-883. [PMID: 37930730 PMCID: PMC11181870 DOI: 10.1093/ndt/gfad223] [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: 06/17/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The risk of diabetic kidney disease (DKD) progression is significant despite treatment with renin-angiotensin system (RAS) blocking agents. Current clinical tools cannot predict whether or not patients will respond to treatment with RAS inhibitors (RASi). We aimed to investigate whether proteome analysis could identify urinary peptides as biomarkers that could predict the response to angiotensin-converting enzyme inhibitor and angiotensin-receptor blockers treatment to avoid DKD progression. Furthermore, we investigated the comparability of the estimated glomerular filtration rate (eGFR), calculated using four different GFR equations, for DKD progression. METHODS We evaluated urine samples from a discovery cohort of 199 diabetic patients treated with RASi. DKD progression was defined based on eGFR percentage slope results between visits (∼1 year) and for the entire period (∼3 years) based on the eGFR values of each GFR equation. Urine samples were analysed using capillary electrophoresis-coupled mass spectrometry. Statistical analysis was performed between the uncontrolled (patients who did not respond to RASi treatment) and controlled kidney function groups (patients who responded to the RASi treatment). Peptides were combined in a support vector machine-based model. The area under the receiver operating characteristic curve was used to evaluate the risk prediction models in two independent validation cohorts treated with RASi. RESULTS The classification of patients into uncontrolled and controlled kidney function varies depending on the GFR equation used, despite the same sample set. We identified 227 peptides showing nominal significant difference and consistent fold changes between uncontrolled and controlled patients in at least three methods of eGFR calculation. These included fragments of collagens, alpha-1-antitrypsin, antithrombin-III, CD99 antigen and uromodulin. A model based on 189 of 227 peptides (DKDp189) showed a significant prediction of non-response to the treatment/DKD progression in two independent cohorts. CONCLUSIONS The DKDp189 model demonstrates potential as a predictive tool for guiding treatment with RASi in diabetic patients.
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Affiliation(s)
- Mayra Alejandra Jaimes Campos
- Mosaiques Diagnostics GmbH, Hannover, Germany
- University Hospital RWTH Aachen, Institute for Molecular Cardiovascular Research, Aachen, Germany
| | - Emmanouil Mavrogeorgis
- Mosaiques Diagnostics GmbH, Hannover, Germany
- University Hospital RWTH Aachen, Institute for Molecular Cardiovascular Research, Aachen, Germany
| | | | - Susanne Eder
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Buchwinkler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Complications Research, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Joachim Jankowski
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands
- Aachen-Maastricht Institute for Cardiorenal Disease (AMICARE), University Hospital RWTH Aachen, Aachen, Germany
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Wekiya E, Mujuzi GP, Nakiyingi J, Sanya J, Matovu M, Guido O, Nakaweesi J, Karamagi C, Nakayaga JK, Mutebi EI, Nakanjako D. The clinical utility of cystatin C based eGFR in assessing renal function among HIV/AIDs patients on ART at Mildmay Uganda. BMC Nephrol 2024; 25:144. [PMID: 38654183 PMCID: PMC11036554 DOI: 10.1186/s12882-024-03581-3] [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: 11/28/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In clinical practice, Measurement of estimated glomerular filtration rates (eGFR) is the gold standard assessing renal function the glomerular filtration rate often estimated from plasma creatinine. Several studies have shown Cystatin C based eGFR (Cys C) to be a better parameter for the diagnosis of impaired renal function. Cystatin C based eGFR has been proposed as a potential renal function marker but its use in HIV&AIDS patients has not been well evaluated. METHODS A cross sectional study was carried out on 914 HIV&AIDS patients on antiretroviral therapy (ART) attending Mildmay Uganda for care and treatment between January to March 2015. Serum Cystatin C based eGFR was measured using the particle enhanced immunoturbidimetric assay. Creatinine was analyzed using enzymatic Creatinine PAP method and creatinine clearance was calculated according to C&G. RESULTS The sensitivity of Cystatin C based eGFR was 15.1% (95% CI = 8.4, 24) with specificity 99.3% (95% CI = 98- 99.7). The positive and negative predictive values were 70.0% (95% CI 45.7-88.1) and 91.2% (95% CI 98.11-92.94) respectively. The positive likelihood ratio was 18.81 and negative likelihood ratio was 0.85. Cystatin C based eGFR had diagnostic accuracy of 90.7 and area under curve was 0.768. CONCLUSION Cystatin C based eGFR exhibited a high specificity and a high positive likelihood ratio in diagnosis of kidney disease among HIV&AIDS patients. Cystatin C based eGFR can be used as a confirmatory test.
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Affiliation(s)
- Enock Wekiya
- Mildmay Uganda, P.O Box 24985, Kampala, Uganda.
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Godfrey P Mujuzi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | | | - Moses Matovu
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ocung Guido
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Charles Karamagi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joan K Nakayaga
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Edrisa I Mutebi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Damalie Nakanjako
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Tang J, Zhang C, Hu W, Qu W. Evaluation of Six eGFR Equations in Predicting Acute Kidney Injury in Patients after Off-Pump Coronary Artery Bypass Grafting: A Case Control Study. Rev Cardiovasc Med 2024; 25:120. [PMID: 39076560 PMCID: PMC11264046 DOI: 10.31083/j.rcm2504120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 07/31/2024] Open
Abstract
Background There are six widely used equations to calculate the estimated glomerular filtration rate (eGFR) of patients. We aimed to assess the predictive power of preoperative eGFR calculated by these equations for the occurrence of postoperative acute kidney injury (AKI). Methods Patients who underwent isolated coronary surgery from January 2016 to January 2021 were continuously enrolled. Serum creatinine and cystatin C used to calculate eGFR were both measured within 1 week before surgery. The eGFR was calculated using six equations: Cockcroft Gault (CG) equation, Chinese abbreviated modification of diet in renal disease (MDRD) equation, chronic kidney disease-epidemiology (CKD-EPI) equation, and full age spectrum (FAS) equation. Postoperative AKI was diagnosed by Kidney Disease Improving Global Outcomes criteria (KDIGO) (① urine volume < 0.5 mL/kg/h for 6 h; ② an increase in serum creatinine by ≥ 26.5 µmol/L within 48 h; ③ an increase in serum creatinine to ≥ 1.5 times baseline levels, which is known or presumed to have occurred within the prior 7 days), and the occurrence of AKI within 7 days after surgery was followed. Results A total of 1428 patients were included, of which 319 patients (25.5%) developed postoperative AKI. After adjustment, all eGFRs (CG OR = 0.983, MDRD OR = 0.983, CKD-EPI crea OR = 0.97, CKD-EPI cys OR = 0.955, FAS crea OR = 0.978, FAS cys OR = 0. 941, all p < 0.001) were significantly associated with AKI. The area under the receiver operating characteristic curve (AUC) was 0.621 for CG, 0.614 for MDRD, 0.643 for CKD-EPI crea , 0.739 for CKD-EPI cys , 0.643 for FAS crea , 0.744 for FAS cys , respectively. There was no difference in predictive power between FAS cys and CKD-EPI cys (p = 0.33, DeLong's test). Conclusions Preoperative eGFR calculated by FAS cys and CKD-EPI cys equations have better performance in predicting AKI after off-pump coronary artery bypass grafting than other equations.
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Affiliation(s)
- Jiwen Tang
- Department of Cardiac Surgical Care Unit, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China
| | - Congcong Zhang
- Department of Cardiac Surgical Care Unit, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China
| | - Weiwei Hu
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China
| | - Weili Qu
- Department of Cardiac Surgical Care Unit, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China
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de Zoysa N, Haruhara K, Nikolic-Paterson DJ, Kerr PG, Ling J, Gazzard SE, Puelles VG, Bertram JF, Cullen-McEwen LA. Podocyte number and glomerulosclerosis indices are associated with the response to therapy for primary focal segmental glomerulosclerosis. Front Med (Lausanne) 2024; 11:1343161. [PMID: 38510448 PMCID: PMC10951056 DOI: 10.3389/fmed.2024.1343161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Corticosteroid therapy, often in combination with inhibition of the renin-angiotensin system, is first-line therapy for primary focal and segmental glomerulosclerosis (FSGS) with nephrotic-range proteinuria. However, the response to treatment is variable, and therefore new approaches to indicate the response to therapy are required. Podocyte depletion is a hallmark of early FSGS, and here we investigated whether podocyte number, density and/or size in diagnostic biopsies and/or the degree of glomerulosclerosis could indicate the clinical response to first-line therapy. In this retrospective single center cohort study, 19 participants (13 responders, 6 non-responders) were included. Biopsies obtained at diagnosis were prepared for analysis of podocyte number, density and size using design-based stereology. Renal function and proteinuria were assessed 6 months after therapy commenced. Responders and non-responders had similar levels of proteinuria at the time of biopsy and similar kidney function. Patients who did not respond to treatment at 6 months had a significantly higher percentage of glomeruli with global sclerosis than responders (p < 0.05) and glomerulosclerotic index (p < 0.05). Podocyte number per glomerulus in responders was 279 (203-507; median, IQR), 50% greater than that of non-responders (186, 118-310; p < 0.05). These findings suggest that primary FSGS patients with higher podocyte number per glomerulus and less advanced glomerulosclerosis are more likely to respond to first-line therapy at 6 months. A podocyte number less than approximately 216 per glomerulus, a GSI greater than 1 and percentage global sclerosis greater than approximately 20% are associated with a lack of response to therapy. Larger, prospective studies are warranted to confirm whether these parameters may help inform therapeutic decision making at the time of diagnosis of primary FSGS.
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Affiliation(s)
- Natasha de Zoysa
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia
| | - Kotaro Haruhara
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia
- Division of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - David J. Nikolic-Paterson
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
- Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Peter G. Kerr
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
- Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Jonathan Ling
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
- Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Sarah E. Gazzard
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia
| | - Victor G. Puelles
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - John F. Bertram
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies, Melbourne, VIC, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies, Brisbane, QLD, Australia
| | - Luise A. Cullen-McEwen
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia
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Mekkawy KL, Chaudhry YP, Rao SS, Raad M, Amin RM, Khanuja HS. Comparing five equations to calculate estimated glomerular filtration rate to predict acute kidney injury following total joint arthroplasty. ARTHROPLASTY 2023; 5:14. [PMID: 36899415 PMCID: PMC9999604 DOI: 10.1186/s42836-022-00161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/26/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) following total joint arthroplasty (TJA) is associated with increased morbidity and mortality. Estimated glomerular filtration rate (eGFR) is used as an indicator of renal function. The purpose of this study was (1) to assess each of the five equations that are used in calculating eGFR, and (2) to evaluate which equation may best predict AKI in patients following TJA. METHODS The National Surgical Quality Improvement Program (NSQIP) was queried for all 497,261 cases of TJA performed from 2012 to 2019 with complete data. The Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Cockcroft-Gault, Mayo quadratic, and Chronic Kidney Disease Epidemiology Collaboration equations were used to calculate preoperative eGFR. Two cohorts were created based on the development of postoperative AKI and were compared based on demographic and preoperative factors. Multivariate regression analysis was used to assess for independent associations between preoperative eGFR and postoperative renal failure for each equation. The Akaike information criterion (AIC) was used to evaluate predictive ability of the five equations. RESULTS Seven hundred seventy-seven (0.16%) patients experienced AKI after TJA. The Cockcroft-Gault equation yielded the highest mean eGFR (98.6 ± 32.7), while the Re-expressed MDRD II equation yielded the lowest mean eGFR (75.1 ± 28.8). Multivariate regression analysis demonstrated that a decrease in preoperative eGFR was independently associated with an increased risk of developing postoperative AKI in all five equations. The AIC was the lowest in the Mayo equation. CONCLUSIONS Preoperative decrease in eGFR was independently associated with increased risk of postoperative AKI in all five equations. The Mayo equation was most predictive of the development of postoperative AKI following TJA. The mayo equation best identified patients with the highest risk of postoperative AKI, which may help providers make decisions on perioperative management in these patients.
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Affiliation(s)
- Kevin L Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 19131, USA
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Raj M Amin
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, 94063, USA
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
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Antony MB, Gopal N, Kozel Z, Gurram S, Linehan WM, Ball MW. Comparison of Race-Based and Non-Race-Based Glomerular Filtration Rate Equations for the Assessment of Renal Functional Risk Before Nephrectomy. Urology 2023; 172:144-148. [PMID: 36495949 PMCID: PMC9925404 DOI: 10.1016/j.urology.2022.11.032] [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: 05/06/2022] [Revised: 11/08/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the performance of race-based and race-neutral estimated glomerular filtration rate (eGFR) calculators in patients undergoing kidney surgery. METHODS Analysis of institutional kidneys surgeries from 2006-2021 was conducted. Demographics, serum creatinine (SCr), protein dipstick, and creatinine clearance (CrCl) were assessed within 1 week prior to surgery. SCr was used to calculate eGFR using 3 models: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI 2009), and CKD-EPI 2021. Patients were classified based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria for CKD staging and prognosis, with urine CrCl treated as benchmark for analysis. Receiver operating characteristic (ROC) analysis evaluated accuracy of eGFR calculators' binary discrimination of eGFR less than 60 mL/min. CKD stage agreement between eGFR and urine CrCl was assessed. RESULTS A total of 554 kidney surgeries in 336 patients had necessary laboratory data for analysis. The cohort was 62% male, with a median age of 47. Within this cohort, 8.1% (n=45) were Black, and 80% (n=441) were White. glomerular filtration rate (GFR) from 24-hour urine CrCl normalized by BSA did not vary significantly from eGFR by SCr based calculators. The proportion of patients with eGFR <60 significantly differed when using Modification of Diet in Renal Disease, CKD-EPI 2009, and CKD-EPI 2021 equations when compared to CrCl (P<.001). Still, they performed equivalently in the staging of CKD, as well as in predicting GFR of less than 60, and classifying CKD prognosis of "moderately increased or higher". CONCLUSION A race-neutral eGFR calculator can perform equivalently to established eGFR calculators, with the added benefit of mitigating biases that account for racial disparities in nephrectomy decision making.
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Affiliation(s)
- Maria B Antony
- Urologic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Nikhil Gopal
- Urologic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Zachary Kozel
- Urologic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Mark W Ball
- Urologic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD.
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Pereira GC. Novel Nanotechnology-Driven Prototypes for AI-Enriched Implanted Prosthetics Following Organ Failure. Methods Mol Biol 2023; 2575:195-237. [PMID: 36301477 DOI: 10.1007/978-1-0716-2716-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Meeting medical challenges posed by global burdens is proven to be of primary interest. One example is the COVID-19 epidemic that humankind is currently experiencing, since around December 2019. Innovation is key to respond rapidly and effectively to sanitary and health emergencies, when human lives are severely threatened. In this scenery, medical devices that can be rapidly launched in the market and manufactured at scale are crucial for saving lives. One example is a lifesaving respiratory device launched in about 10 days (Mercedes F1 team's new device based on continuous positive airway pressure devices) and rapidly approved by international agencies responsible for assuring drug and medical devices safety, in response to the COVID-19 burden. Remarkably, it is the first time in history that mankind observes disease spread reaching such high proportions, globally, in such short time scale. However, while this epidemic had, in March 2020, reached the critical figures of about 38,000 deaths and c. 738,000 infected, organ donation and transplantation patients are suffering for years, accounting for an increasing number of affected, annually. These patients are invisible for the general public. Therefore, this chapter approaches the organ donation and transplantation burden, proposing effective solutions to leverage the suffering, improving life quality of patients enduring several underlying issues, from hemodialysis complications and critical organ failure to lacking compatible donors. This, on the basis of technology repurposing, to speed up approval processes followed by international agencies responsible for assuring drug and medical devices safety, while adding innovative methods to existing technology and reducing invasiveness.
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Coelho FUDA, Gadioli B, Freitas FFMD, Vattimo MDFF. Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort. Rev Esc Enferm USP 2023; 57:e20220299. [PMID: 37071796 PMCID: PMC10104527 DOI: 10.1590/1980-220x-reeusp-2022-0299en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/01/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To identify factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation. METHOD Retrospective cohort study conducted in an adult Intensive Care Unit with patients undergoing extracorporeal membrane oxygenation from 2012 to 2021. The research used the Kidney Disease Improving Global Outcomes as criteria for definition and classification of acute kidney injury. A multiple logistic regression model was developed to analyze the associated factors. RESULTS The sample was composed of 122 individuals, of these, 98 developed acute kidney injury (80.3%). In multiple regression, the associated factors found were vasopressin use, Nursing Activities Score, and glomerular filtration rate. CONCLUSION The use of vasopressin, the Nursing Activities Score, and the glomerular filtration rate were considered as factors related to the development of acute kidney injury in patients undergoing extracorporeal membrane oxygenation.
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Affiliation(s)
| | - Barbara Gadioli
- Hospital Israelita Albert Einstein, Departamento de pacientes graves, São Paulo, SP, Brazil
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11
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Khandpur S, Awasthi A, Behera MR, Purty AJ, Singh NP, Tiwari S. Kidney disease burden in an Asian Indian population: Effect of the new 2021 serum creatinine CKD-EPI equation. Diabetes Res Clin Pract 2022; 193:110120. [PMID: 36270433 DOI: 10.1016/j.diabres.2022.110120] [Citation(s) in RCA: 2] [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: 05/26/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
AIMS CKD-EPI (chronic kidney disease-epidemiological) serum creatinine equation is widely accepted for calculating estimated glomerular filtration rate (eGFR). The effect of transitioning from the older 2009 to the newer race-independent 2021 CKD-EPI equation on the estimated kidney disease burden (eKDB) was studied in an Asian-Indian population. METHODS The study included 1156 adults, the two equations were compared for agreement (Bland-Altman and Cohen's kappa) and concordance (Lin's correlation and test for proportions). RESULTS The 2021 CKD-EPI increased the eGFR (positive-bias), independent of age-group, gender or presence of type 2 diabetes mellitus (T2DM) and hypertension (HTN). Thus, the eKDB was significantly decreased by 2021 CKD-EPI equation. The agreement was highest for the age-group 31-40 years (95.8 % versus 87.5 % for > 50 years). Besides, the eGFR category was shifted from G3 to G1 in 8.2 % (95 % CI: 6.8-9.9) individuals by 2021 CKD-EPI. The effect of transition on eKDB was greater in individuals > 50 years (7.4 %) or with HTN (6.3 %). CONCLUSION In comparison to the old equation, the 2021 CKD-EPI equation increased the eGFR, lowering the eKDB in this Asian-Indian cohort. The degree of lowering was affected by age-group, and presence of T2DM /HTN, but independent of gender.
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Affiliation(s)
- Sukhanshi Khandpur
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ashish Awasthi
- Centre for Chronic Disease Control, C1/52, 2(nd) Floor, Safdarjung Development Area, New Delhi 110016, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram 122002, India
| | - Manas R Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | | | - Swasti Tiwari
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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12
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Dordunoo D, Abernethy P, Kayuni J, McConkey S, Aviles-G ML. Dismantling "Race" in Health Research. Can J Nurs Res 2022; 54:239-245. [PMID: 35060400 PMCID: PMC9379379 DOI: 10.1177/08445621221074849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this era of confronting racism in public space, it is critical to keep addressing the covert systemic racism in the healthcare system. We want to bring attention to the continued unscientific practice of race-based medicine and the absurdity of treating race as a biological indicator in the 21st century. We believe race is a social construct that does not qualify as a scientific biological indicator for predicting health outcomes. In this paper, we first present arguments for inappropriate use of race in health research and then discuss alternative explanations for health disparity findings that use race as a predictor. Our main concern centers on two specific aspects of the concept of "race": (1) its fundamental lack of scientific basis as a predictor for health outcomes, (2) the misguided narrative that the term creates, placing the onus of racial discrimination on the victim, instead of highlighting the act of discrimination and the role researchers play in actively reinforcing racism when using "race" as a variable. We conclude by proposing that "race" be replaced by the variable "racism" in health.
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Affiliation(s)
| | - Paivi Abernethy
- University of Victoria, Centre for Global Studies, Victoria, BC
- University of Waterloo, School of Environment, Resources and Sustainability, Waterloo, ON
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13
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Ram E, Beckerman P, Segev A, Shlomo N, Atlas-Lazar A, Sternik L, Raanani E. The predictive value of creatinine clearance for mortality in patients undergoing revascularization. J Cardiothorac Surg 2021; 16:120. [PMID: 33933109 PMCID: PMC8088555 DOI: 10.1186/s13019-021-01502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Renal function plays a significant role in the prognosis and management of patients with multi-vessel coronary artery disease (CAD) referred for revascularization. Current data lack precise risk stratification using estimated glomerular filtration rate (eGFR) and creatinine clearance. Methods This prospective study includes a three-year follow-up of 1112 consecutive patients with multi-vessel CAD enrolled in the 22 hospitals in Israel that perform coronary angiography. Results The Mayo formula yielded the highest mean eGFR (90 ± 26 mL/min per 1.73m2) and chronic kidney disease-epidemiology collaboration (CKD-EPI) the lowest (76 ± 24 mL/min per 1.73m2). Consequently, the Mayo formula classified more patients (56%) as having normal renal function. There was a significant and strong correlation between the values obtained from all five formulas using Cockcroft-Gault as the reference formula: Mayo: r = 0.80, p < 0.001; CKD-EPI: r = 0.87, p < 0.001; modification of diet in renal disease (MDRD): r = 0.84, p < 0.001; inulin clearance-based: r = 0.99, p < 0.001). Multivariable analysis demonstrated that decreased renal function is an independent predictor of 3-year mortality in all five formulas, with risk increasing by 15–25% for each 10-unit decrease in eGFR. Despite the similarities between the formulas, the ability to predict mortality was highest in the Mayo formula and lowest in MDRD. Conclusions Our data suggest that while the Mayo formula is not currently recommended by any nephrology guidelines, it may be an alternative formula to predict mortality among patients with multivessel CAD, including to the widely used MDRD formula. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01502-1.
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Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel. .,Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Pazit Beckerman
- Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel
| | - Amit Segev
- Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel
| | - Nir Shlomo
- Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel
| | | | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel.,Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel.,Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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