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Provenzano M, Hu L, Abenavoli C, Cianciolo G, Coppolino G, De Nicola L, La Manna G, Comai G, Baraldi O. Estimated glomerular filtration rate in observational and interventional studies in chronic kidney disease. J Nephrol 2024; 37:573-586. [PMID: 38347343 PMCID: PMC11150208 DOI: 10.1007/s40620-024-01887-x] [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: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2024]
Abstract
Estimated glomerular filtration rate is considered the principal measure of kidney function and, together with albuminuria, is a relevant prognostic factor for the development of end-stage kidney disease. Due to the strong association between estimated glomerular filtration rate and clinical events, such as commencement of dialysis, cardiovascular outcomes and all-cause death, estimated glomerular filtration rate is crucial for clinical decision-making in terms of scheduling follow-up and pharmacological interventions, and planning renal replacement therapies in advanced chronic kidney disease. In this review we discuss the available methods for measuring glomerular filtration rate and for estimating it through mathematical equations developed over the last few decades. We summarize the prognostic association of different percentages of estimated glomerular filtration rate decline and the main clinical outcomes, and how treatments modify estimated glomerular filtration rate decline and the risk of future endpoints. We also examine the role of pre-clinical trial slope and that of estimated glomerular filtration rate as a useful biomarker when evaluating patients for inclusion into both observational and interventional studies.
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Affiliation(s)
- Michele Provenzano
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, 40138, Bologna, Italy
| | - Lilio Hu
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, 40138, Bologna, Italy
| | - Chiara Abenavoli
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, 40138, Bologna, Italy
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy
| | - Giuseppe Coppolino
- Renal Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Luca De Nicola
- Renal Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, 40138, Bologna, Italy
| | - Giorgia Comai
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy.
| | - Olga Baraldi
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola, Bologna, Italy
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Okabe H, Muraoka Y, Naka Y, Setoyama K, Inoue K, Miura T, Shimizu A, Anai R, Miyamoto T, Tsuda Y, Araki M, Sonoda S, Kataoka M. Malnutrition leads to the progression of coronary artery calcification in hemodialysis patients. PLoS One 2023; 18:e0280383. [PMID: 36638132 PMCID: PMC9838858 DOI: 10.1371/journal.pone.0280383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Malnutrition is considered a risk factor for cardiovascular disease in patients with chronic kidney disease. However, no in vivo studies have reported on using optical coherence tomography to evaluate the effect of nutritional status on coronary atherosclerosis in hemodialysis patients. We aimed to conduct a detailed analysis of the effect of nutritional status on the coronary arteries in hemodialysis patients. METHODS Among 64 hemodialysis patients who underwent percutaneous coronary interventions, 41 that underwent optical coherence tomography imaging were included in this study. And, among them, 24 patients that could also be evaluated using OCT also at the 6-month follow-up were included in this study. The patients were divided into two groups based on nutritional evaluation using the geriatric nutritional risk index. Culprit and non-culprit lesions were evaluated at baseline and after 6 months. RESULTS In the culprit lesions at baseline, the length of the lipid plaque was significantly smaller in the malnutrition group. In contrast, the thickness and length of the calcified plaque and the angle of the calcified nodule were significantly larger (each p < 0.01). In the non-culprit lesions, the 6-month change in the angle of the calcified plaque was significantly greater in the malnutrition group (p = 0.02). The significant factors that affected the change in the angle of calcification were "malnutrition at geriatric nutritional risk index" [odds ratio, 8.17; 95% confidence interval, 1.79 to 37.33; p < 0.01] and "serum phosphorus level" (odds ratio, 3.73; 95% confidence interval, 1.42 to 9.81; p < 0.01). CONCLUSIONS Appropriate management of nutritional status is crucial for suppressing the progression of coronary artery disease in hemodialysis patients.
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Affiliation(s)
- Hiroki Okabe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshitaka Muraoka
- Division of cardiology, Japan Labor Health and Welfare Organization Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Yutaro Naka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koshi Setoyama
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Konosuke Inoue
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiya Miura
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akiyoshi Shimizu
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reo Anai
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tetsu Miyamoto
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuki Tsuda
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Araki
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- * E-mail:
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Yilmaz R, Yildirim T, Abudalal A, Erdem Y. Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients. Nefrologia 2022; 42:171-176. [PMID: 36153913 DOI: 10.1016/j.nefroe.2022.05.009] [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: 10/05/2020] [Accepted: 01/28/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Prevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. MATERIALS AND METHODS Twenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. RESULTS In donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. CONCLUSIONS After transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.
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Affiliation(s)
- Rahmi Yilmaz
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey.
| | - Tolga Yildirim
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Ayman Abudalal
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Yunus Erdem
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
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Yildirim F, Yildiz AB, Kanbay M. OUP accepted manuscript. Clin Kidney J 2022; 15:1653-1656. [PMID: 36003667 PMCID: PMC9394708 DOI: 10.1093/ckj/sfac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Lipid profile management is one of the crucial components to optimize outcomes in
patients with chronic kidney disease (CKD). CKD is associated with poor cardiovascular
outcomes due to both a direct cardiovascular impact of CKD and the presence of metabolic
comorbidities. Low-density lipoprotein cholesterol is the main target of current
lipid-lowering drugs. However, the derangement of lipid metabolism in CKD is more complex.
The recently described triglyceride–glucose index (TyG) is associated with cardiovascular
outcomes in the general population. In recent studies, the TyG was associated with CKD
progression in CKD patients and with cardiovascular death in patients on peritoneal
dialysis. Quiroga et al. now show that the TyG is associated with the
occurrence of major cardiovascular events in individuals free from diabetes with
non-dialysis-dependent CKD.
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Affiliation(s)
- Fatma Yildirim
- Department of Medicine, Koc University School of Medicine,
Istanbul, Turkey
| | - Abdullah B Yildiz
- Department of Medicine, Koc University School of Medicine,
Istanbul, Turkey
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Yilmaz R, Yildirim T, Abudalal A, Erdem Y. Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients. Nefrologia 2021; 42:S0211-6995(21)00111-9. [PMID: 34281748 DOI: 10.1016/j.nefro.2021.01.015] [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: 10/05/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Prevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. MATERIALS AND METHODS Twenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. RESULTS In donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. CONCLUSIONS After transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.
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Affiliation(s)
- Rahmi Yilmaz
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey.
| | - Tolga Yildirim
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Ayman Abudalal
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
| | - Yunus Erdem
- Hacettepe University Faculty of Medicine Nephrology Department, Ankara, Turkey
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Al Salmi I, Bieber B, Al Rukhaimi M, AlSahow A, Shaheen F, Al-Ghamdi SM, Al Wakeel J, Al Ali F, Al-Aradi A, Hejaili FA, Maimani YA, Fouly E, Robinson BM, Pisoni RL. Parathyroid Hormone Serum Levels and Mortality among Hemodialysis Patients in the Gulf Cooperation Council Countries: Results from the DOPPS (2012-2018). KIDNEY360 2020; 1:1083-1090. [PMID: 35368779 PMCID: PMC8815498 DOI: 10.34067/kid.0000772020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/06/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND The prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates). We report the relationship of PTH with mortality in this largest GCC cohort of patients on hemodialysis studied to date. METHODS Data were from randomly selected national samples of hemodialysis facilities in GCC-DOPPS phases 5 and 6 (2012-2018). PTH descriptive findings and case mix-adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly selected patients on hemodialysis, respectively. RESULTS Mean patient age was 55 years (median dialysis vintage, 2.1 years). Median PTH ranged from 259 pg/ml (UAE) to 437 pg/ml (Kuwait), with 22% having PTH <150 pg/ml, 24% with PTH of 150-300 pg/ml, 34% with PTH 301-700 pg/ml, and 20% with PTH >700 pg/ml. Patients with PTH >700 pg/ml were younger; on dialysis longer; less likely to be diabetic; have urine >200 ml/d; be prescribed 3.5 mEq/L dialysate calcium; had higher mean serum creatinine and phosphate levels; lower white blood cell counts; and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A U-shaped PTH/mortality relationship was observed with more than two- and 1.5-fold higher adjusted HR of death at PTH >700 pg/ml and <300 pg/ml, respectively, compared with PTH of 301-450 pg/ml. CONCLUSIONS Secondary hyperparathyroidism is highly prevalent among GCC patients on hemodialysis, with a strong U-shaped PTH/mortality relationship seen at PTH <300 and >450 pg/ml. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.
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Affiliation(s)
- Issa Al Salmi
- The Royal Hospital, Ministry of Health, Muscat, Oman
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | - Fayez Al Hejaili
- King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | | | - Essam Fouly
- Amgen United Arab Emirates, Dubai, United Arab Emirates
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Al Salmi I, Bieber B, Al Rukhaimi M, AlSahow A, Shaheen F, Al-Ghamdi SM, Al Wakeel J, Al Ali F, Al-Aradi A, Hejaili FA, Maimani YA, Fouly E, Robinson BM, Pisoni RL. Parathyroid Hormone Serum Levels and Mortality among Hemodialysis Patients in the Gulf Cooperation Council Countries: Results from the DOPPS (2012–2018). KIDNEY360 2020. [DOI: https://doi.org/10.34067/kid.0000772020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BackgroundThe prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates). We report the relationship of PTH with mortality in this largest GCC cohort of patients on hemodialysis studied to date.MethodsData were from randomly selected national samples of hemodialysis facilities in GCC-DOPPS phases 5 and 6 (2012–2018). PTH descriptive findings and case mix–adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly selected patients on hemodialysis, respectively.ResultsMean patient age was 55 years (median dialysis vintage, 2.1 years). Median PTH ranged from 259 pg/ml (UAE) to 437 pg/ml (Kuwait), with 22% having PTH <150 pg/ml, 24% with PTH of 150–300 pg/ml, 34% with PTH 301–700 pg/ml, and 20% with PTH >700 pg/ml. Patients with PTH >700 pg/ml were younger; on dialysis longer; less likely to be diabetic; have urine >200 ml/d; be prescribed 3.5 mEq/L dialysate calcium; had higher mean serum creatinine and phosphate levels; lower white blood cell counts; and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A U-shaped PTH/mortality relationship was observed with more than two- and 1.5-fold higher adjusted HR of death at PTH >700 pg/ml and <300 pg/ml, respectively, compared with PTH of 301–450 pg/ml.ConclusionsSecondary hyperparathyroidism is highly prevalent among GCC patients on hemodialysis, with a strong U-shaped PTH/mortality relationship seen at PTH <300 and >450 pg/ml. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.
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Li PKT, Chow KM. The Clinical and Epidemiological Aspects of Vascular Mortality in Chronic Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080502503s20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article reviews the clinical aspects of and epidemiological links between vascular mortality and the dialysis population, and emphasizes areas that warrant further clarification. In particular, we highlight potential pitfalls in interpretation of published observational and clinical studies, notably some of the issues related to reverse epidemiology of risk factors for cardiovascular disease. Recent published data from our own center in the Prince of Wales Hospital relating to the significance of residual renal function, inflammation, valvular calcification, as well as left ventricular hypertrophy were highlighted. Actions are needed to tackle both the traditional and the nontraditional factors for cardiovascular disease in order to treat this problem causing the highest mortality in peritoneal dialysis patients.
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Affiliation(s)
- Philip Kam-Tao Li
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kai Ming Chow
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
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Guo Y, Cui L, Ye P, Li J, Wu S, Luo Y. Change of Kidney Function Is Associated With All-Cause Mortality and Cardiovascular Diseases: Results From the Kailuan Study. J Am Heart Assoc 2019; 7:e010596. [PMID: 30608199 PMCID: PMC6404220 DOI: 10.1161/jaha.118.010596] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Current evaluation about the relationship of sequential change in estimated glomerular filtration rate (eGFR) and clinical outcomes are still inconsistent. We aimed to investigate the association between the change in kidney function over time and the risk of all‐cause mortality and cardiovascular disease. Methods and Results This prospective cohort including 37 691 participants aged ≥45 years used data from the Kailuan Health Registry. The relationship of the annual percentage and absolute change in eGFR and outcomes were analyzed with Cox proportional regression. The participants were stratified according to the quintiles distribution of the percentage annual change in eGFR (Q1–Q5). After adjusting for baseline covariates including initial eGFR, participants with annual eGFR decline were at significantly greater risk for all‐cause mortality (Q1: hazard ratio, 1.22 [95% confidence interval, 1.04–1.43]; Q2: 1.19 [1.01–1.40]) than noted for patients in Q3. Cardiovascular disease risk was also significantly higher in participants with annual eGFR decline (Q1 and Q2). No significantly increased risk of adverse outcomes was noted for patients with annual eGFR increased groups (Q4 and Q5). When considering the absolute eGFR annual change rate (no/mild/rapid decline), we obtained similar results in chronic kidney disease participants, whereas non–chronic kidney disease participants had less pronounced association of eGFR decline with cardiovascular disease, though not with mortality. Conclusions A decline in eGFR over time is associated with higher risk for all‐cause mortality and cardiovascular disease independent of initial eGFR and other known risk factors at baseline. Our data support the serial evaluation of change in kidney function as a better prognostic indicator than single eGFR assessments.
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Affiliation(s)
- Yidan Guo
- 1 Department of Nephrology Beijing Shijitan Hospital Capital Medical University Beijing China
| | - Liufu Cui
- 2 Department of Rheumatology and Immunology Kailuan General Hospital Hebei United University Tangshan China
| | - Pengpeng Ye
- 5 Division of Injury Prevention and Mental Health The National Center for Chronic and Non-communicable Disease Control and Prevention Beijing China
| | - Junjuan Li
- 3 Department of Nephrology Kailuan General Hospital Hebei United University Tangshan China
| | - Shouling Wu
- 4 Department of Cardiology Kailuan General Hospital Hebei United University Tangshan China
| | - Yang Luo
- 1 Department of Nephrology Beijing Shijitan Hospital Capital Medical University Beijing China
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Effects of Prevalent and Incident Chronic Kidney Disease on Cardiovascular Events in Patients with Atrial Fibrillation. J Clin Med 2019; 8:jcm8081184. [PMID: 31394871 PMCID: PMC6723547 DOI: 10.3390/jcm8081184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a well-known complication of atrial fibrillation (AF) but how the incident CKD affects the clinical outcomes amongst AF patients is not clear. Methods: Our study data were retrieved from National Health Insurance Research Data for the period from 1996 to 2013. Incident AF patients were classified as non-CKD group (n = 7272), prevalent CKD group (n = 2104), and incident CKD group (n = 1507) based on administrative codes. Patients with prevalent CKD were those participants who already had CKD ahead of the index date of AF, whereas patients with incident CKD were those who developed CKD after the index date and the remaining patients were designated as non-CKD. Multivariate-adjusted time-dependent Cox models were conducted to estimate the associations of CKD status with the outcomes of interest, including heart failure (HF), acute myocardial infarction (AMI), stroke or systemic thromboembolism, all-cause mortality, and cardiovascular (CV) mortality, expressed as hazard ratio (HR) and 95% confidence interval (CI). Results: The mean age was 70.8 ± 13.3 years, and 55.4% of the studied population were men. In Cox models, the adjusted rate of HF, AMI, all-cause mortality, and CV mortality was greater in the prevalent and incident CKD groups, ranging from 1.31-fold to 4.28-fold, compared with non-CKD group. Notably, incident CKD was associated with higher rates of HF (HR, 1.8; 95% CI, 1.67–1.93), stroke or systemic thromboembolism (HR, 1.33; 95% CI, 1.22–1.45), AMI (HR, 1.46; 95% CI, 1.25–1.71), all-cause mortality (HR, 1.76; 95% CI, 1.68–1.85), and CV mortality (HR, 2.13; 95% CI, 1.92–2.36) compared with prevalent CKD. Conclusion: The presence of CKD was associated with higher risks of subsequent adverse clinical outcomes in patients with AF. Our study was even highlighted by the finding that incident CKD was linked to higher risks of outcome events compared with prevalent CKD.
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Innate Immune Dysregulation in the Development of Cardiovascular Disease in Lupus. Curr Rheumatol Rep 2019; 21:46. [DOI: 10.1007/s11926-019-0842-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kim J, Lee J, Kim KN, Oh KH, Ahn C, Lee J, Kang D, Park SK. Association between Dietary Mineral Intake and Chronic Kidney Disease: The Health Examinees (HEXA) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061070. [PMID: 29795052 PMCID: PMC6025644 DOI: 10.3390/ijerph15061070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/11/2018] [Accepted: 05/11/2018] [Indexed: 01/20/2023]
Abstract
Few studies have explored the association between mineral intake and chronic kidney disease (CKD). A cross-sectional analysis investigated the association between mineral intake (calcium, phosphorus, sodium, potassium, iron, and zinc) and CKD using the Health Examinee (HEXA) cohort of the Korean Genome and Epidemiologic Study (KoGES). For 159,711 participants, mineral intake was assessed by a food frequency questionnaire. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. Dietary intake of each mineral was divided into quartiles and the quartile including recommended dietary allowance (RDA) or adequate intake (AI) of each mineral was used as a reference. We assessed the association between the quartile of mineral intakes and CKD using polytomous logistic regression models. The lowest quartiles of phosphorus (≤663.68 mg/day, odds ratio [OR] = 1.64, 95% confidence interval [CI]: 1.25–2.15), potassium (≤1567.53 mg/day, OR = 1.87, 95% CI: 1.27–2.75), iron (≤6.93 mg/day, OR = 1.53, 95% CI: 1.17–2.01), and zinc (≤5.86 mg/day, OR = 1.52, 95% CI: 1.02–2.26) were associated with higher odds for advanced CKD compared with the references. The present study suggests that an inadequate intake of some minerals may be associated with CKD occurrence in the general population. Due to the reverse causation issue in this cross-sectional study design, further longitudinal prospective studies are needed in order to prove the results.
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Affiliation(s)
- Jeewoo Kim
- Department of Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Juyeon Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Cancer Research Institute, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Kyoung-Nam Kim
- Division of Public Health and Preventive Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Curie Ahn
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Jongkoo Lee
- JW Lee Center for Global Medicine, College of Medicine, Seoul National University, IhwaJang-gil 71 Jongnogu, Seoul 03087, Korea.
- Department of Family Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Daehee Kang
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
| | - Sue K Park
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Department of Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
- Cancer Research Institute, Seoul National University, 103 Daehakro, Jongnogu, Seoul 03080, Korea.
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13
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Chin CY, Matsumura M, Maehara A, Zhang W, Lee CT, Yamamoto MH, Song L, Parviz Y, Jhalani NB, Mohan S, Ratner LE, Cohen DJ, Ben-Yehuda O, Stone GW, Shlofmitz RA, Kakuta T, Mintz GS, Ali ZA. Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography. Am J Cardiol 2017; 119:1313-1319. [PMID: 28279437 DOI: 10.1016/j.amjcard.2017.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/30/2022]
Abstract
Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, gender, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and 19 paired distal vessel lesions. Lesion length, minimum lumen area, and area stenosis were similar between groups. The HD-dependent group had greater mean calcium arcs in culprit (54.3° vs 26.4°, p = 0.004) and non-culprit lesions (34.3° vs 24.5°, p = 0.02) and greater maximum calcium arc in distal vessel segments (101.6° vs 0°, p = 0.03). There were no differences in lipid arcs between groups. There was a higher prevalence of thin intimal calcium, defined as an arc of calcium >30° within intima <0.5 mm thick, in patients in the HD-dependent group (41.9% vs 4.8%, p <0.001). There was a higher prevalence of calcified nodules in the HD-dependent group (24.2% vs 9.7%, p = 0.049) but no differences in medial calcification or thin-cap fibroatheroma. In conclusion, in this OCT study, HD-dependent patients, compared with matched patients without CKD, had more extensively distributed coronary calcium and uniquely, a higher prevalence of non-atherosclerotic thin intimal calcium. This thin intimal calcium may cause an overestimation of calcium burden by intravascular ultrasound and may contribute to the lack of correlation between increased coronary artery calcification scores with long-term outcomes in patients with CKD.
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Affiliation(s)
- Chee Yang Chin
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Wenbin Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Cheolmin Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Myong Hwa Yamamoto
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Lei Song
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Department of Cardiology, National Center for Cardiovascular Disease, China Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Yasir Parviz
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Nisha B Jhalani
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Sumit Mohan
- Division of Nephrology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Lloyd E Ratner
- Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - David J Cohen
- Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | | | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
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14
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Ateya AM, Sabri NA, El Hakim I, Shaheen SM. Effect of Omega-3 Fatty Acids on Serum Lipid Profile and Oxidative Stress in Pediatric Patients on Regular Hemodialysis: A Randomized Placebo-Controlled Study. J Ren Nutr 2017; 27:169-174. [PMID: 28110812 DOI: 10.1053/j.jrn.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We sought to evaluate the effects of omega-3 fatty acids supplementation on serum lipid profile and oxidative stress markers in pediatric patients with end-stage renal disease on regular hemodialysis (HD). DESIGN This study was a double-blinded, randomized, placebo-controlled trial conducted on 49 pediatric patients on regular HD for at least 6 months. INTERVENTION Patients were randomly divided into either omega-3 group (n = 25) who received 1-g oral omega-3 capsule once daily for 16 weeks or placebo group (n = 24) who received 1-g matching oral placebo capsule once daily for 16 weeks. MAIN OUTCOME MEASURE Lipid profile markers including: total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and oxidative stress markers including the following: malondialdehyde, glutathione peroxidase, and superoxide dismutase were measured at baseline and after 16 weeks of supplementation. RESULTS By the end of the study, children in omega-3 group showed a highly significant reduction in total cholesterol and a highly significant increase in glutathione peroxidase and superoxide dismutase levels. CONCLUSION The administration of omega-3 has a beneficial effect on serum lipid profile and oxidative stress in children undergoing HD.
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Affiliation(s)
- Areej Mohamed Ateya
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Nagwa Ali Sabri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ihab El Hakim
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sara M Shaheen
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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15
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Chin CY, Mintz GS, Saito S, Witzenbichler B, Metzger DC, Rinaldi MJ, Mazzaferri EL, Duffy PL, Weisz G, Stuckey TD, Brodie BR, Litherland C, Kirtane AJ, Stone GW, Maehara A. Relation Between Renal Function and Coronary Plaque Morphology (from the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Virtual Histology-Intravascular Ultrasound Substudy). Am J Cardiol 2017; 119:217-224. [PMID: 27814787 DOI: 10.1016/j.amjcard.2016.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
We sought to examine the relation between various degrees of renal function and coronary plaque morphology by grayscale and virtual histology intravascular ultrasound (IVUS). ADAPT-DES was a prospective, multicenter registry of 8,582 consecutive patients treated using coronary drug-eluting stents with a prespecified grayscale and virtual histology-IVUS substudy. A lesion-level analysis of study participants was performed by comparing IVUS parameters of culprit and nonculprit lesions across tertiles of estimated creatinine clearance (CrCl). Preintervention IVUS imaging of 762 patients identified 898 culprit and 752 nonculprit native coronary artery lesions. Patients in the lowest CrCl tertile were older, more often women, and more often presented with stable angina. Compared with the middle and upper tertiles, the lowest tertile was significantly associated with culprit lesion smaller mean external elastic membrane cross-sectional area (12.9 vs 14.2 mm3/mm vs 14.9 mm3/mm, p <0.0001), smaller mean lumen cross-sectional area (5.5 mm3/mm vs 5.8 mm3/mm vs 6.1 mm3/mm, p = 0.002), and more dense calcium volume (11.5% vs 10.2% vs 9.7%, p = 0.02). Similar trends were found in the nonculprit lesions. Plaque rupture was least common in patients in the lowest tertile. On multivariable analysis, independent predictors of greater dense calcium volume were lower CrCl, hyperlipidemia, female gender, and presentation without ST-segment elevation myocardial infarction. In conclusion, in the present large-scale IVUS study diminishing renal function was associated with increased coronary calcification and decreased coronary vessel and lumen sizes, with a graded response according to the reduction in CrCl. In addition, these patients were more likely to present with stable angina versus patients with normal renal function who were more likely to present with an acute coronary syndrome.
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16
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Cho EY, Myoung C, Park HS, Kim AJ, Ro H, Chang JH, Lee HH, Chung W, Jung JY. Efficacy of Statin Treatment in Early-Stage Chronic Kidney Disease. PLoS One 2017; 12:e0170017. [PMID: 28081262 PMCID: PMC5231363 DOI: 10.1371/journal.pone.0170017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022] Open
Abstract
Chronic kidney disease (CKD) represents a major medical challenge and frequently coexists with cardiovascular disease (CVD), which can be treated by statin trerapy. However, whether statin treatment affects renal progression and outcomes in CKD patients remains unclear. We retrospectively reviewed CKD patients at Gachon University Gil Medical Center from 2003–2013. From a total of 14,497 CKD patients, 858 statin users were paired with non-users and analyze with propensity score matching was performed. The outcomes of this study were creatinine doubling, renal death, all-cause mortality, and interactive factors for composite outcomes. Statins were prescribed to 13.5% of the study subjects. Hazard ratios (HRs) [95% confidence intervals (CIs)] for statin treatment for the doubling of serum creatinine levels were significant only in CKD patients with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, and were 0.744 (0.635–0.873) in the unmatched cohort and 0.767 (0.596–0.986) in the matched cohort. In analyses of secondary outcomes, the HRs (95% CIs) for all-cause mortality were 0.655 (0.502–0.855) in the unmatched cohort and 0.537 (0.297–0.973) in the matched cohort. The HRs (95% CIs) for statin therapy for composite outcomes among patients with and without an eGFR ≥30 mL/min/1.73 m2 were 0.764 (0.613–0.952) and 1.232 (0.894–1.697), respectively (P for interaction, 0.017). Thus, statin treatment may have beneficial effects on renal progression and all-cause mortality only for the patients with early- stage CKD.
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Affiliation(s)
- Eun Yeong Cho
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
| | - Chana Myoung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
| | - Hong-suk Park
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
| | - Ae Jin Kim
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Han Ro
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jae Hyun Chang
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Hyun Hee Lee
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Wookyung Chung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
- * E-mail:
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17
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Seminars in Dialysis: The 100 Most Highly Cited Papers. Semin Dial 2016; 29:518-520. [PMID: 27774673 DOI: 10.1111/sdi.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Hayashi M, Yasuda Y, Suzuki S, Tagaya M, Ito T, Kamada T, Yoshinaga M, Sugishita Y, Fujiwara W, Yokoi H, Ozaki Y, Izawa H. Brain natriuretic peptide as a potential novel marker of salt-sensitivity in chronic kidney disease patients without cardiac dysfunction. Heart Vessels 2016; 32:279-286. [PMID: 27385024 DOI: 10.1007/s00380-016-0867-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/01/2016] [Indexed: 01/13/2023]
Abstract
Although the renin-angiotensin system (RAS) is counter-balanced by a salt-sensitive mechanism in the hypertensive state, both are reported to be up-regulated in chronic kidney disease (CKD) patients. We conducted this study to evaluate the associations among the RAS, renal function, hypertension, and atherosclerosis, as well as to identify markers for salt-sensitivity. A total of 213 pre-dialysis CKD patients with preserved cardiac function (EF >50 %) were enrolled. Their renal and cardiac biochemical markers and plasma renin activity (PRA) were measured, and echocardiography and carotid artery ultrasound were performed. Their salt intake was estimated by the NaCl excretion from a 24-h collected urine sample. The PRA was higher in patients with hypertension (p = 0.018), and had a significant negative correlation with the eGFR (r = -0.23, p = 0.0067). Importantly, the PRA had a strong negative correlation with the brain natriuretic peptide (BNP) level (r = -0.28, p = 0.017) regardless of whether the patients were being treated with RAS inhibitors. The BNP level was related to the renal functions (eGFR: p = 0.001, ACR: p = 0.009). There was a significant positive correlation between the BNP level and carotid intima-media thickness (p < 0.001). A multivariate analysis revealed that older age and an excess of NaCl excretion were independent predictors of BNP elevation (p = 0.02 and 0.003, respectively). Our analysis revealed details of the counterbalance between BNP and PRA, as well as identifying that excess salt intake is a predictor of BNP elevation. These results indicate that the BNP could be a possible valuable marker for salt sensitivity, and that high salt sensitivity could facilitate atherosclerosis in CKD patients.
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Affiliation(s)
- Mutsuharu Hayashi
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan. .,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manaka Tagaya
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Takehiro Ito
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Tomohito Kamada
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Masataka Yoshinaga
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yoshinori Sugishita
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Wakaya Fujiwara
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Hiroatsu Yokoi
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
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19
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Rysz J, Gluba-Brzózka A, Banach M, Więcek A. Should we use statins in all patients with chronic kidney disease without dialysis therapy? The current state of knowledge. Int Urol Nephrol 2015; 47:805-13. [PMID: 25758011 DOI: 10.1007/s11255-015-0937-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/19/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this article was to present the most important matters associated with dyslipidemia treatment in CKD patients. Moreover, the most important recommendations of the current (2013) KDIGO clinical practice guideline for lipid management in chronic kidney disease are presented. METHODS Authors looked through the most recent large clinical trials and meta-analyses and presented their results. We searched using the electronic databases [MEDLINE, EMBASE, Scopus, DARE]. Additionally, abstracts from national and international cardiovascular meetings were studied. RESULTS Analysis results suggest that statins exert beneficial effects on kidney since they considerably reduce 24 h urinary protein excretion and are associated with a rise in GFR. Beneficial effects of statins may be influenced by kidney disease stage, doses of medicine and treatment duration. Data suggest that statins are effective and safe for secondary prevention of CV events in individuals with mild CKD. Patients treated with statins had decreased frequency of major atherosclerotic events compared with placebo, reduced risk of CV mortality and deaths from all causes. CONCLUSIONS Meta-analyses results suggest that statins are associated with lipid lowering, cardiovascular and anti-proteinuric benefits in CKD patients. However, their effects on overall and cardiovascular mortality are much less obvious. Bearing in mind the advantageous effects and low risk of adverse effects, it seems that mild renal impairment should not exclude these patients from receiving a statin. However, because CKD patients in stages III-V are underrepresented in clinical trials, administration of statins to these patients who have not yet had a vascular event remains controversial.
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Affiliation(s)
- Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Zeromskiego 113, 90-549, Lodz, Poland,
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20
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Association of renal function, estimated by four equations, with coronary artery disease. Int Urol Nephrol 2015; 47:663-71. [DOI: 10.1007/s11255-015-0935-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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21
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Rashid Khan M, Ahsan H, Siddiqui S, Siddiqui WA. Tocotrienols have a nephroprotective action against lipid-induced chronic renal dysfunction in rats. Ren Fail 2014; 37:136-43. [DOI: 10.3109/0886022x.2014.959433] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Zhu W, Dong C, Du H, Zhang H, Chen J, Hu X, Hu F. Effects of fish oil on serum lipid profile in dialysis patients: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis 2014; 13:127. [PMID: 25106703 PMCID: PMC4266905 DOI: 10.1186/1476-511x-13-127] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/15/2014] [Indexed: 01/16/2023] Open
Abstract
Background The effects of fish oil supplements on lipid profile in dialysis patients are
controversial. With increasing interest in the potential health benefits of fish
oil, it is important to explore its real effects. Objective We aimed to identify and quantify the effects of fish oil on triglyceride
(TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and
low-density lipoprotein cholesterol (LDL-C) in dialysis patients. Methods PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were
searched for relevant trials of fish oil and lipid profile in dialysis patients.
We identified 209 potential studies and included 13 randomized controlled trials.
Eligible studies, determined by consensus using predefined criteria, were reviewed
in accordance with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed. Results Compared with the control group, serum TG and TC levels in the fish oil group
were reduced by 0.23 mmol/L (95% CI, −0.31, −0.14, P <0.01) and 0.12 mmol/L (95% CI, −0.23, −0.01, P =0.03), respectively. HDL-C levels were increased by
0.20 mmol/L (95% CI, 0.01, 0.40, P <0.01)
attributable to fish oil. In contrast, fish oil did not influence serum LDL-C
levels. Subgroup analysis showed the effects of fish oil were stronger in subjects
with higher baseline TG levels, and the long-term intervention (>12w)
demonstrated a tendency towards greater improvement of serum HDL-C and LDL-C
levels compared with short-term intervention (≤12 w). However, both of the changes
were not statistically significant in meta-regression analysis. There were no
obvious difference in effects of different doses and components of fish oil on
lipid levels. Conclusion Fish oil supplements reduced serum TG and TC levels, and increased HDL-C
levels, without affecting LDL-C levels among dialysis patients. It should benefit
patients at risk of cardiovascular diseases. Based on randomized controlled
trials, we suggested a daily supplement dose of fish oil for dialysis patients of
>1 g, but a high dose might not be necessary. Electronic supplementary material The online version of this article (doi:10.1186/1476-511X-13-127) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Wei Zhu
- Department of Nephrology, The 150th Hospital of PLA, Luoyang, China.
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Shen YC, Weng SF, Wang JJ, Tien KJ. Erectile dysfunction and risk of end stage renal disease requiring dialysis: a nationwide population-based study. PLoS One 2014; 9:e102055. [PMID: 25013905 PMCID: PMC4094485 DOI: 10.1371/journal.pone.0102055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies have suggested that erectile dysfunction (ED) is an independent risk factor for macrovascular disease. Very few studies have evaluated the relationship between ED and risk of end stage renal disease (ESRD) requiring dialysis. Methods A random sample of 1,000,000 individuals from Taiwan's National Health Insurance database was collected. We selected the control group by matching the subjects and controls by age, diabetes, hypertension, coronary heart disease, hyperlipidemia, area of residence, monthly income and index date. We identified 3985 patients with newly-diagnosed ED between 2000 and 2008 and compared them with a matched cohort of 23910 patients without ED. All patients were tracked from the index date to identify which patients subsequently developed a need for dialysis. Results The incidence rates of dialysis in the ED cohort and comparison groups were 10.85 and 9.06 per 10000 person-years, respectively. Stratified by age, the incidence rate ratio for dialysis was greater in ED patients aged <50 years (3.16, 95% CI: 1.62–6.19, p = 0.0008) but not in aged 50–64 (0.94, 95% CI: 0.52–1.69, p = 0.8397) and those aged ≧65 (0.69, 95% CI: 0.32–1.52, p = 0.3594). After adjustment for patient characteristics and medial comorbidities, the adjusted HR for dialysis remained greater in ED patients aged <50 years (adjusted HR: 2.08, 95% CI: 1.05–4.11, p<0.05). The log-rank test revealed that ED patients <50-years-old had significantly higher cumulative incidence rates of dialysis than those without (p = 0.0004). Conclusion Patients with ED, especially younger patients, are at an increased risk for ESRD requiring dialysis later in life.
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Affiliation(s)
- Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Cheng Shiu University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Kai-Jen Tien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- The Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- * E-mail:
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24
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A population-based approach indicates an overall higher patient mortality with peritoneal dialysis compared to hemodialysis in Korea. Kidney Int 2014; 86:991-1000. [PMID: 24805104 DOI: 10.1038/ki.2014.163] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 03/07/2014] [Accepted: 03/13/2014] [Indexed: 11/08/2022]
Abstract
To date, only a few large-scale studies have measured the effect of dialysis modality on mortality in Asian populations. Here, we sought to compare survival between incident hemodialysis (HD) and peritoneal dialysis (PD) patients using the Korean Health Insurance Review & Assessment Service database. This enabled us to perform a population-based complete survey that included 32,280 incident dialysis patients and followed them for a median of 26.5 months. To reduce biases due to nonrandomization, we first matched 7049 patient pairs with similar propensity scores. Using the log-rank test, we found the mortality rate in PD patients was significantly higher than that in HD patients. Subsequent subgroup analyses indicated that in older patients (55 years and older), with the exception of the subgroup of patients with no comorbidities and the subgroup of patients with malignancy, PD was consistently associated with a higher mortality rate. In younger patients (under 55 years), regardless of the covariates, the survival rate of PD patients was comparable to that of HD patients. Thus, while the overall mortality rate was higher in incident PD patients, mortality rates of some incident PD and HD patients were comparable in Korea.
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Ronco C, Tetta C. Dialysis patients and cardiovascular problems: can technology solve the complex equation? Expert Rev Med Devices 2014; 2:681-7. [PMID: 16293095 DOI: 10.1586/17434440.2.6.681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with end-stage kidney disease undergoing chronic hemodialysis present higher mortality rates compared with the general population. Once patients are on hemodialysis, the risk of cardiovascular death is approximately 30-times higher than the general population, and still remains 10- to 20-times higher after stratification for age, gender and presence of diabetes. Approximately half of patient deaths on dialysis are attributed to cardiovascular causes, including coronary heart disease, cerebrovascular disease, peripheral vascular disease and heart failure. The cardiovascular burden of the hemodialysis patient arises from three different sources: risks inherent to the patient and the uremic syndrome, traditional risk factors and risk factors related to the dialysis therapy. Based on these considerations and the fact that several aspects of the dialysis procedure can cause either a cardiovascular burden or modify the burden already present, new technologies should be directed towards the approach of a possible 'cardioprotective dialysis therapy'. This approach may significantly contribute new techniques and new dialysis machines. Born to make dialysis easy and safe, the new machines feature several options that make monitoring and online hemodiafiltration a simple routine. These and other features could make dialysis better tolerated and more efficient in protecting from fatal cardiovascular events.
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Affiliation(s)
- Claudio Ronco
- St. Bortolo Hospital, Department of Nephrology, Viale Rodolfi, 36100, Vicenza, Italy.
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26
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Even Mild Kidney Dysfunction Is an Important Cardiovascular Risk Predictor: Implications and Challenges. Can J Cardiol 2013; 29:1371-3. [DOI: 10.1016/j.cjca.2013.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 09/14/2013] [Accepted: 09/15/2013] [Indexed: 01/13/2023] Open
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A meta-analysis of the role of statins on renal outcomes in patients with chronic kidney disease. Is the duration of therapy important? Int J Cardiol 2013; 168:5437-47. [PMID: 24016544 DOI: 10.1016/j.ijcard.2013.08.060] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/19/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The efficacy of statin treatment in chronic kidney disease (CKD) patients remains controversial. Therefore, we performed a meta-analysis to investigate whether statins modulate renal function in patients with CKD. METHODS Data from Scopus, PubMed, Web of Science, and the Cochrane Central Register of randomized controlled trials for years 1966-December 2012 were searched for appropriate studies. RESULTS Twenty trials with 6452 CKD subjects randomized to receive either statin or placebo were included. Statin therapy significantly influenced high sensitivity C-reactive protein levels in patients on or off dialysis [-0.28 mg/dl, 95%CI: -0.93 to -0.37; p<0.05 and -0.46 mg/dl, 95%CI: -0.87 to -0.05; p=0.03], respectively], urinary protein (-0.77 g/24 h, 95%CI: -1.24 to -0.29, p<0.02; this effect persisted for treatment ≤12 months), and serum creatinine but only for long-term therapy (3 years) (-0.65 mg/dl, 95%CI: -1.00 to -0.30; p=0.0003). The summary for standardized effect size of mean differences of glomerular filtration rate was 0.29 ml/min/1.73 m(2) (95%CI: 0.01 to 0.58; p=0.04), and depended on treatment duration - a significant increase was observed for between 1 and 3 years of statin therapy (0.50 ml/min/1.73 m(2), 95%CI: 0.40 to 0.60; p<0.0001), with no significant increase for both ≤1 and >3 years of the therapy. CONCLUSION Statins might exert significant renoprotective effects in CKD patients; however, benefit may depend on the duration of treatment. This is an issue that warrants more definitive investigation. More studies are necessary in dialysis patients to credibly evaluate the renal effects of statin therapy.
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Impact of Early Graft Function on 10-Year Graft Survival in Recipients of Kidneys From Standard- or Expanded-Criteria Donors. Transplantation 2013; 96:176-81. [DOI: 10.1097/tp.0b013e318297443b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duran M, Uysal OK, Gunebakmaz O, Baran O, Turfan M, Ornek E, Cetin M, Murat SN, Yarlioglues M, Karadeniz M, Kurtul A, Kaya MG. Glomerular filtration rate is associated with burden of coronary atherosclerosis in patients with acute coronary syndrome. Angiology 2013; 65:350-6. [PMID: 23636853 DOI: 10.1177/0003319713486536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to elucidate the relationship between mild to moderate renal impairements and burden of atherosclerosis in patients with acute coronary syndrome (ACS). A total of 380 patients with ACS were included in the study. Gensini and SYNTAX scores were also calculated. Kidney function was classified based on estimated glomerular filtration rate (eGFR) into stage 1: eGFR >90, stage 2: 60 to 89, and stage 3: 30 to 60 mL/min per 1.73 m(2). Gensini and SYNTAX scores were higher in stages 2 and 3 than in stage 1. Also, the number of diseased vessels, number of critical lesions (>50 and 70%), left main disease, and number of total occlusion vessels were higher in stages 2 and 3 than in stage 1. Multivariate linear regression analysis demonstrated that a decreased eGFR was an independent risk factor for SYNTAX and Gensini scores together with age and male gender.
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Affiliation(s)
- Mustafa Duran
- 1Ankara Research and Education Hospital, Ankara, Turkey
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30
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Rogacev KS, Pinsdorf T, Weingärtner O, Gerhart MK, Welzel E, van Bentum K, Popp J, Menzner A, Fliser D, Lütjohann D, Heine GH. Cholesterol Synthesis, Cholesterol Absorption, and Mortality in Hemodialysis Patients. Clin J Am Soc Nephrol 2012; 7:943-8. [DOI: 10.2215/cjn.05170511] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Kuwashiro T, Sugimori H, Ago T, Kamouchi M, Kitazono T. Risk Factors Predisposing to Stroke Recurrence within One Year of Non-Cardioembolic Stroke Onset: The Fukuoka Stroke Registry. Cerebrovasc Dis 2012; 33:141-9. [DOI: 10.1159/000334190] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 09/19/2011] [Indexed: 11/19/2022] Open
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32
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Tsai JP, Lai YH, Wang CH, Hsu BG, Fang TC. Clinical correlates of arterial stiffness assessed by the cardio-ankle vascular index in peritoneal dialysis patients. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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33
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Drury PL, Ting R, Zannino D, Ehnholm C, Flack J, Whiting M, Fassett R, Ansquer JC, Dixon P, Davis TME, Pardy C, Colman P, Keech A. Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetologia 2011; 54:32-43. [PMID: 20668832 DOI: 10.1007/s00125-010-1854-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/18/2010] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. METHODS Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years. RESULTS Lower estimated GFR (eGFR) vs eGFR ≥90 ml min⁻¹ 1.73 m⁻² was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01-1.29] for eGFR 60-89 ml min⁻¹ 1.73 m⁻²; 1.59 [1.28-1.98] for eGFR 30-59 ml min⁻¹ 1.73 m⁻²; p < 0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01-1.54] and 1.19 [0.76-1.85], respectively; p = 0.001 for trend) when eGFR ≥90 ml min⁻¹ 1.73 m⁻². CVD risk was further modified by renal status changes over the first 2 years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure. CONCLUSIONS/INTERPRETATION Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models.
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Affiliation(s)
- P L Drury
- Auckland Diabetes Centre, New Zealand.
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34
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Shen TW, Wang CH, Lai YH, Hsu BG, Liou HH, Fang TC. Use of cardio-ankle vascular index in chronic dialysis patients. Eur J Clin Invest 2011; 41:45-51. [PMID: 20735471 DOI: 10.1111/j.1365-2362.2010.02375.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Arterial stiffness is an independent predictor of all-cause and cardiovascular mortality, particularly in patients with chronic kidney disease and end-stage renal disease (ESRD). The objective of this study was to determine the risk factors for de novo arterial stiffness in long-term dialysis patients. MATERIALS AND METHODS A total of 59 dialysis patients without initial arterial stiffness were studied for 1 year. Cardio-ankle vascular index (CAVI) was measured and a CAVI value ≥ 9 at the end of 1 year was defined as de novo arterial stiffness. The initial baseline characteristics and laboratory parameters and final laboratory parameters after 1 year were analysed. RESULTS Dialysis patients with de novo arterial stiffness were significantly older than dialysis patients without de novo arterial stiffness. Initial serum phosphorus and calcium × phosphorus product of dialysis patients with de novo arterial stiffness were significantly greater than those of dialysis patients without de novo arterial stiffness. The haematocrit of dialysis patients with de novo arterial stiffness was significantly lower than that of dialysis patients without de novo arterial stiffness. Multivariate logistic regression analysis showed that age and initial serum phosphorus were independent risk factors for de novo arterial stiffness in dialysis patients. CONCLUSION After 1-year follow-up, de novo arterial stiffness in dialysis patients as determined by CAVI was significantly associated with age and initial serum phosphorus.
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Affiliation(s)
- Tsu-Wang Shen
- Department of Medical Informatics, Medical College, Tzu Chi University, Hualien, Taiwan
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35
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Charytan DM, Shelbert HR, Di Carli MF. Coronary microvascular function in early chronic kidney disease. Circ Cardiovasc Imaging 2010; 3:663-71. [PMID: 20851872 DOI: 10.1161/circimaging.110.957761] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND coronary microvascular dysfunction may underlie the high cardiovascular risk associated with chronic kidney disease (CKD), but the effects of CKD on coronary microvasculature function remain uncertain. METHODS AND RESULTS we assessed myocardial blood flow changes in mild-to-moderate CKD and analyzed the association between creatinine clearance (CrCl) and peak myocardial blood flow and coronary flow reserve (CFR) measured as the ratio of stress to rest perfusion at baseline and at 1 year in 435 nondiabetic individuals who underwent quantitative rest and pharmacological stress positron emission tomography imaging. At baseline, CFR was significantly associated with CrCl (β per 10 mL/min increase, 0.07; P=0.001). Factors such as age and blood pressure accounted for this association, and it was not significant in adjusted analyses (β=-0.02, P=0.53). Peak flow was not associated with CrCl in either crude or adjusted analyses (β per 10 mL/min=-0.02 mL/min per g, P=0.29). Although change in peak flow at 1 year was similar in patients with and without CKD, CrCl was a strong and independent predictor of a higher rate of change in CFR, with a loss of 0.11 CFR units/y (95% confidence interval, 0.01 to 0.20) for each 10 mL/min drop in CrCl (P=0.03). CONCLUSIONS these findings demonstrate that mild-to-moderate CKD is not independently associated with a reduction in peak myocardial flow or CFR and suggests that microvascular changes are unlikely to explain the high cardiovascular mortality in mild to moderate CKD. Loss of CFR, however, may accelerate in mild to moderate CKD. Further studies are needed to determine whether these changes lead to more significant reductions that may reduce peak flows and CFR and contribute to cardiovascular risk in more severe CKD.
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Affiliation(s)
- David M Charytan
- Department of Medicine, Renal Division, the Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, USA.
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36
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Sorrentino MJ. Early intervention strategies to lower cardiovascular risk in early nephropathy: focus on dyslipidemia. Cardiol Clin 2010; 28:529-39. [PMID: 20621255 DOI: 10.1016/j.ccl.2010.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with chronic kidney disease (CKD) are at high cardiovascular risk and we can consider them to have a risk equivalent to coronary heart disease, putting them into the high-risk category. A mixed dyslipidemia with high triglyceride levels; low high-density lipoprotein (HDL) levels; and small, dense low-density lipoprotein (LDL) particles is a common pattern in patients with CKD, contributing to their high cardiovascular disease (CVD) risk. A treatment strategy to reduce LDL cholesterol to the current high-risk category goals reduces risk similar to patients without CKD. Emerging evidence suggests that targeting non-HDL cholesterol can have the potential to bring about further CVD risk reduction. Non-HDL cholesterol should be a secondary target for all patients with CKD. Further studies are needed to determine the magnitude of the risk reduction we can expect to gain by targeting non-HDL cholesterol and the most effective way to treat this target.
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Affiliation(s)
- Matthew J Sorrentino
- Department of Medicine, University of Chicago Pritzker School of Medicine, IL 60637, USA.
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37
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Hakeem A, Bhatti S, Karmali KN, Dillie KS, Cook JR, Xu J, Samad Z, Chang SM. Renal Function and Risk Stratification of Diabetic and Nondiabetic Patients Undergoing Evaluation for Coronary Artery Disease. JACC Cardiovasc Imaging 2010; 3:734-45. [DOI: 10.1016/j.jcmg.2010.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 05/28/2010] [Accepted: 06/01/2010] [Indexed: 11/16/2022]
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Tsuchikura S, Shoji T, Shimomura N, Kakiya R, Emoto M, Koyama H, Ishimura E, Inaba M, Nishizawa Y. Serum C-reactive protein and thioredoxin levels in subjects with mildly reduced glomerular filtration rate. BMC Nephrol 2010; 11:7. [PMID: 20423474 PMCID: PMC2868841 DOI: 10.1186/1471-2369-11-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 04/27/2010] [Indexed: 12/15/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a newly recognized high-risk condition for cardiovascular disease (CVD), and previous studies reported the changes in inflammation and oxidative stress in advanced stages of CKD. We compared the levels of serum biomarkers for inflammation and oxidative stress between subjects with normal and mildly reduced glomerular filtration rate (GFR). Methods The subjects were 182 participants of a health check-up program including those with normal (≥ 90 mL/min/1.73 m2, N = 79) and mildly reduced eGFR (60-89 mL/min/1.73 m2, N = 103) which was calculated based on serum creatinine, age and sex. We excluded those with reduced eGFR < 60 mL/min/1.73 m2. No one had proteinuria. We measured serum levels of C-reactive protein (CRP) and thioredoxin (TRX) as the markers of inflammation and oxidative stress, respectively. Results As compared with subjects with normal eGFR, those with mildly reduced eGFR had increased levels of both CRP and TRX. Also, eGFR was inversely correlated with these biomarkers. The associations of eGFR with these biomarkers remained significant after adjustment for age and sex. When adjustment was done for eight possible confounders, CRP showed significant association with systolic blood pressure, high density lipoprotein cholesterol (HDL-C) and non-HDL-C, whereas TRX was associated with sex significantly, and with eGFR and systolic blood pressure at borderline significance. Conclusions We showed the increased levels of CRP and TRX in subjects with mildly reduced eGFR. The eGFR-CRP link and the eGFR-TRX link appeared to be mediated, at least partly, by the alterations in blood pressure and plasma lipids in these subjects.
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Affiliation(s)
- Shoko Tsuchikura
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Nakano T, Ninomiya T, Sumiyoshi S, Fujii H, Doi Y, Hirakata H, Tsuruya K, Iida M, Kiyohara Y, Sueishi K. Association of Kidney Function With Coronary Atherosclerosis and Calcification in Autopsy Samples From Japanese Elders: The Hisayama Study. Am J Kidney Dis 2010; 55:21-30. [DOI: 10.1053/j.ajkd.2009.06.034] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 06/22/2009] [Indexed: 01/01/2023]
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40
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Nuijten M, Andress DL, Marx SE, Sterz R. Chronic kidney disease Markov model comparing paricalcitol to calcitriol for secondary hyperparathyroidism: a US perspective. Curr Med Res Opin 2009; 25:1221-34. [PMID: 19335321 DOI: 10.1185/03007990902844097] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to determine the cost effectiveness of paricalcitol versus calcitriol for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease in the United States setting. METHODS A Markov process model was developed employing data sources from the published literature, paricalcitol clinical trials and observational studies, official US price/tariff lists and national population statistics. The comparator was calcitriol, a non-selective vitamin D receptor activator (VDRA) medication. The primary perspective of the study was that of the third-party payer in the US. The efficacy outcomes (reduction in secondary hyperparathyroidism (SHPT), reduction in proteinuria, complications and mortality) were extrapolated to: number of life-years gained (LYG) and number of quality-adjusted life-years (QALYs). Clinical and economic outcomes were discounted at 3.5%. RESULTS The reference case analysis was a 10-year time horizon based on a comparison of paricalcitol with calcitriol, which is started in chronic kidney disease (CKD) stage 3 and continued in CKD stage 4 and CKD stage 5. The use of paricalcitol leads to a cost saving of US$1941. The inclusion of indirect costs leads to a cost saving of US$2528. The use of paricalcitol leads to an increase in life-years gained (0.47 years) and a gain in QALYs (0.43). The use of paricalcitol results in a dominant outcome from the perspective of the third-party payer, as well as from the societal perspective. One-way sensitivity analyses and probabilistic sensitivity analyses confirmed the robustness of the model. CONCLUSION This model showed that the favorable clinical benefit of paricalcitol results in positive short and long-term health economic benefits. This study suggests that the use of paricalcitol in patients with early chronic kidney disease may be cost-effective from the third-party payer perspective in the US versus calcitriol. Additional comparative studies are necessary to validate these results.
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Ninomiya T, Kiyohara Y, Tokuda Y, Doi Y, Arima H, Harada A, Ohashi Y, Ueshima H. Impact of Kidney Disease and Blood Pressure on the Development of Cardiovascular Disease. Circulation 2008; 118:2694-701. [PMID: 19106392 DOI: 10.1161/circulationaha.108.792903] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Kidney disease is associated with an increased risk of cardiovascular disease (CVD); however, there have been few well-designed prospective studies of this issue in Asian populations. Recent epidemiological studies have suggested that a lower blood pressure level may be associated with an increased risk of CVD in individuals with kidney dysfunction.
Methods and Results—
Using data from 10 community-based cohort studies in Japan, we conducted follow-up on a total of 30 657 individuals 40 to 89 years of age without preexisting CVD or kidney failure and examined the relationship between reduced glomerular filtration rate (GFR) and the risk of CVD. During an average 7.4-year follow-up, 727 individuals experienced CVD. The age- and sex-adjusted incidence of CVD increased significantly in subjects with GFR of 60 to 89 mL · min
−1
· 1.73 m
−2
(4.3 per 1000 person-years,
P
=0.002) and in those with a GFR <60 mL · min
−1
· 1.73 m
−2
(6.5,
P
<0.001) compared with those with a GFR ≥90 mL · min
−1
· 1.73 m
−2
(2.9). Even after adjustment for potential confounding factors, subjects with a GFR <60 mL · min
−1
· 1.73 m
−2
had a 57% (95% CI 14% to 115%) greater risk of CVD than those with a GFR ≥90 mL · min
−1
· 1.73 m
−2
. The multivariate-adjusted hazard ratios of CVD increased in a log-linear manner with elevations in blood pressure levels, regardless of GFR levels (all
P
for trend <0.01).
Conclusions—
Our findings suggest that a reduced GFR is a significant risk factor for CVD in the general Japanese population. Additionally, a log-linear association of blood pressure level with CVD risk was observed, without evidence of a J-curve association, regardless of GFR levels.
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Affiliation(s)
- Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582 Japan
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K.D. Ephra R, K.B.A. Owi W, F. Laing E, Amidu N, A. Eghan J B, Ahenkorah L. Anaemia as a Risk Factor for Cardiovascular Disease in Patients with Chronic Kidney Disease. JOURNAL OF MEDICAL SCIENCES 2008. [DOI: 10.3923/jms.2008.707.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wada M, Nagasawa H, Iseki C, Takahashi Y, Sato H, Arawaka S, Kawanami T, Kurita K, Daimon M, Kato T. Cerebral small vessel disease and chronic kidney disease (CKD): Results of a cross-sectional study in community-based Japanese elderly. J Neurol Sci 2008; 272:36-42. [DOI: 10.1016/j.jns.2008.04.029] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 03/07/2008] [Accepted: 04/28/2008] [Indexed: 11/28/2022]
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Seiler S, Schlitt A, Jiang XC, Ulrich C, Blankenberg S, Lackner KJ, Girndt M, Werdan K, Buerke M, Fliser D, Heine GH. Cholesteryl ester transfer protein activity and cardiovascular events in patients with chronic kidney disease stage V. Nephrol Dial Transplant 2008; 23:3599-604. [PMID: 18503096 DOI: 10.1093/ndt/gfn296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have an increased risk for cardiovascular events (CVE). Uraemic dyslipidaemia, which is characterized by low HDL-cholesterol (HDL-C) and elevated triglycerides' levels, may contribute to this elevated cardiovascular risk. Cholesteryl ester transfer protein (CETP) lowers HDL-C by transferring cholesterol esters to LDL and VLDL particles. We tested the hypothesis that CETP activity is associated with CVE in patients with CKD stage V. METHODS We measured CETP activity and cholesterol levels in 69 haemodialysis patients. CVE and death were prospectively assessed over a follow-up period of 48 months. RESULTS CETP activity was negatively correlated with HDL-C levels in patients without lipid-lowering medication (r = -0.379, P = 0.005). We found no difference in CETP activity in patients with cardiovascular disease at baseline compared to patients without cardiovascular disease. The same was true for incident CVE during the follow-up. When stratifying patients by median CETP activity, patients with high CETP activity did not have an increased risk for CVE (P = 0.901 by the log-rank test) or death (P = 0.615). Similarly, after stratifying patients by median HDL-C no increased risk for CVE (P = 0.780) or death (P = 0.838) was found in patients with low HDL-C. CONCLUSIONS In summary, although CETP activity correlated with HDL-C levels, neither high CETP activity nor low HDL-C was associated with CVE in CKD stage V patients. Thus, pharmacological modification of HDL-C by CETP inhibitors seems to be of questionable value in these patients.
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Affiliation(s)
- Sarah Seiler
- Department of Medicine IV, Saarland University, Homburg/Saar, Germany.
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McFarlane SI, Chen SC, Whaley-Connell AT, Sowers JR, Vassalotti JA, Salifu MO, Li S, Wang C, Bakris G, McCullough PA, Collins AJ, Norris KC. Prevalence and associations of anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis 2008; 51:S46-55. [PMID: 18359408 DOI: 10.1053/j.ajkd.2007.12.019] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 12/28/2007] [Indexed: 12/29/2022]
Abstract
BACKGROUND Early identification of anemia of chronic kidney disease may be important for the development of preventive strategies. We compared anemia prevalence and characteristics in the National Kidney Foundation Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004 populations. METHODS Clinical, demographic, and laboratory data were collected from August 2000 to December 31, 2006, from participants in KEEP, a community-based health-screening program targeting individuals 18 years and older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. Anemia was defined as hemoglobin level less than 13.5 g/dL for men and less than 12.0 g/dL for women (Kidney Disease Outcomes Quality Initiative [KDOQI] 2006) or less than 13.0 g/dL for men and less than 12.0 g/dL for women (World Health Organization [WHO]). RESULTS In KEEP (n = 70,069), 68.3% of participants, and in NHANES (n = 17,061), 52% of participants, were women. African Americans represented 33.9% of the KEEP and 11.2% of the NHANES cohorts, and Hispanics comprised 12.4% of KEEP and 13.2% of NHANES. Using the KDOQI classification, anemia was present in 13.9% and 6.3% of KEEP and NHANES participants, whereas using the WHO classification, anemia was present in 11.8% and 5.3%, respectively. In adjusted analysis of KEEP data, KDOQI-defined anemia was significantly more likely in men (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23 to 1.37); this pattern was reversed when using WHO-defined anemia (OR, 0.68; 95% CI, 0.64 to 0.72). Adjusted odds of anemia were greater for African American than white KEEP participants (OR, 2.98; 95% CI, 2.80 to 3.16; OR, 3.00; 95% CI, 2.81 to 3.20 for KDOQI- and WHO-defined anemia, respectively). CONCLUSION Anemia was twice as common in the targeted KEEP chronic kidney disease screening program cohort than in the NHANES sample population. African Americans had a 3-fold increased likelihood of anemia compared with whites. Targeted screening can identify anemia in a high-risk population.
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Affiliation(s)
- Samy I McFarlane
- Division of Endocrinology, SUNY-Downstate and Kings County Hospital Centers, Brooklyn, NY 11203, USA.
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Svensson M, Schmidt EB, Jorgensen KA, Christensen JH. The effect of n-3 fatty acids on lipids and lipoproteins in patients treated with chronic haemodialysis: a randomized placebo-controlled intervention study. Nephrol Dial Transplant 2008; 23:2918-24. [DOI: 10.1093/ndt/gfn180] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Pasqualini L, Schillaci G, Pirro M, Vaudo G, Siepi D, Innocente S, Ciuffetti G, Mannarino E. Renal dysfunction predicts long-term mortality in patients with lower extremity arterial disease. J Intern Med 2007; 262:668-77. [PMID: 17908164 DOI: 10.1111/j.1365-2796.2007.01863.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with renal insufficiency tend to suffer from advanced atherosclerosis and exhibit a reduced life expectancy. OBJECTIVES AND DESIGN This prospective study investigated the relation between renal dysfunction and long-term all-cause and cardiovascular mortality in a population of nonsurgical patients with lower extremity arterial disease (LEAD). SUBJECTS AND METHODS A total of 357 patients with symptomatic LEAD underwent baseline glomerular filtration rate (GFR) estimation by the 4-variable Modification Diet in Renal Diseases equation, and were then followed for 4.2 years (range: 1-17). RESULTS During follow-up, 131 patients died (8.6 deaths per 100 patient-years), 79 of whom (60%) from cardiovascular causes. All-cause death rates were 3.8, 6.6, and 15.5 per 100 patient-years, respectively, in the groups with normal GFR, mild reduction in GFR (60-89 mL min(-1) per 1.73 m2) and chronic kidney disease (CKD; <60 mL min(-1) per 1.73 m2; P < 0.001 by log-rank test). Compared to patients with normal renal function, the risk of all-cause and cardiovascular death was significantly higher in patients with CKD [hazard ratio, respectively, 2.23, 95% confidence interval (CI): 1.16-4.34, P = 0.017; 2.15, 95% CI: 1.05-4.43, P = 0.03]. The association of CKD with all-cause and cardiovascular mortality were independent of age, LEAD severity, cardiovascular risk factors and treatment with angiotensin-converting enzyme (ACE)-inhibitors, hypolipidaemic and antiplatelet drugs. The power of GFR in predicting all-cause death was higher than that of ankle-brachial pressure index (P = 0.029) and Framingham risk score (P < 0.0001). CONCLUSION Chronic kidney disease strongly predicts long-term mortality in patients with symptomatic LEAD irrespective of disease severity, cardiovascular risk factors and concomitant treatments.
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Affiliation(s)
- L Pasqualini
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy.
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Reboredo MDM, Henrique DMN, Bastos MG, Paula RBD. Exercício físico em pacientes dialisados. REV BRAS MED ESPORTE 2007. [DOI: 10.1590/s1517-86922007000600014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pacientes portadores de doença renal crônica (DRC) submetidos a tratamento dialítico apresentam alterações físicas e psicológicas que predispõem ao sedentarismo. Nesta população, a prescrição rotineira de exercícios físicos não é uma prática freqüente, especialmente no nosso país. No entanto, alguns autores têm demonstrado que um programa de exercícios para estes pacientes contribui para o melhor controle da hipertensão arterial, da capacidade funcional, da função cardíaca, da força muscular e, conseqüentemente, da qualidade de vida. Além dos benefícios relacionados ao sistema cardiovascular, a realização do exercício traz benefícios secundários, pois quebra a monotonia do procedimento, melhora aderência e pode aumentar a eficácia da diálise. Na presente revisão, os autores discutem aspectos da realização de exercícios físicos em pacientes portadores de DRC em diálise e apresentam dados iniciais de sua experiência com a aplicação de exercícios supervisionados durante as sessões de hemodiálise.
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Noshad H, Ardalan MR, Mortazavi M, Tayebi H, Safa J, Nezami N. Kidney transplantation candidates and cardiovascular risk factors. Transplant Proc 2007; 39:871-4. [PMID: 17524836 DOI: 10.1016/j.transproceed.2007.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine the prevalence of cardiovascular disease and risk factors among chronic renal failure (CRF) patients on the transplantation waiting list. METHODS Fifty CRF patients on chronic hemodialysis who underwent evaluation for transplantation were compared with 60 hypertensive patients matched for age. We used Framingham scoring to calculate the absolute risk; relative risk was calculated based on the low-risk Framingham cohort. RESULTS According to traditional risk factors, a significant difference was observed in systolic blood pressure and total cholesterol (greater in the hypertensive group), and in the prevalence of the male gender, smoking, and diabetes, which were greater in the CRF group. The latter had a greater degree of left ventricular hypertrophy, lower diastolic blood pressure, and a lower prevalence of familial history of cardiovascular disease and obesity. Patients with CRF had a greater relative risk compared with the Framingham control population, but it did not differ from that observed in the group of hypertensive individuals. CONCLUSION The prevalence of cardiovascular disease and traditional risk factors is high among renal transplantation candidates. The Framingham equations do not adequately quantify the real cardiovascular risk; other risk factors specific for that population probably contribute to their greater cardiovascular risk.
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Affiliation(s)
- H Noshad
- Nephrology Division, Department of Internal Medicine, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran.
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Schlitt A, Heine GH, Jiang XC, Messow M, Blankenberg S, Rupprecht HJ, Ulrich C, Buerke M, Werdan K, Lackner KJ, Köhler H, Girndt M. Phospholipid transfer protein in hemodialysis patients. Am J Nephrol 2007; 27:138-43. [PMID: 17308375 DOI: 10.1159/000099943] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 01/19/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Phospholipid transfer protein (PLTP) is mainly involved in high-density lipoprotein (HDL) metabolism. The role of PLTP in atherogenesis is still controversial. We aimed to investigate PLTP activity in hemodialysis (HD) patients, a population which has an increased risk for the development of atherosclerosis. METHODS PLTP activity and other markers were analyzed in blood samples from 68 HD patients and in a matched group of 68 healthy controls. RESULTS Serum PLTP activity was nearly doubled in HD patients in comparison to healthy controls (median 43.0 vs. 22.4 pmol/mul/h, p < 0.001). In HD patients, PLTP activity correlated with HDL-C (r = 0.342, p = 0.004), but not with CRP (r = -0.057, p = 0.644) or leukocyte count (r = 0.116, p = 0.345). After a follow-up of 2 years, 26 HD patients had died. Kaplan-Meier analyses showed that low CRP (p = 0.047) but neither high HDL-C (p = 0.071) nor low PLTP activity (p = 0.853) were relevantly related to survival of HD patients. CONCLUSION An elevated PLTP activity in HD patients may be considered as a further aspect of uremic dyslipidemia in HD patients. However, PLTP activity was not related to markers of inflammation or to survival of HD patients, even though it correlated with HDL-C. Thus, we conclude that PLTP does not influence the prognostically relevant inflammatory process in HD patients although it does influence the composition of HDL particles.
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Affiliation(s)
- Axel Schlitt
- Department of Medicine III, Martin Luther University, Halle-Wittenberg, Germany.
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