1
|
Nigussie EW, Abera EG, Woldemariam MB. Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study. Medicine (Baltimore) 2024; 103:e39140. [PMID: 39058854 PMCID: PMC11272293 DOI: 10.1097/md.0000000000039140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.
Collapse
Affiliation(s)
| | - Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Jimma University Clinical Trial Unit, Jimma, Oromia, Ethiopia
| | | |
Collapse
|
2
|
Gimblet CJ, Kruse NT, Geasland K, Michelson J, Sun M, Mandukhail SR, Wendt LH, Eyck PT, Pierce GL, Jalal DI. Effect of Resveratrol on Endothelial Function in Patients with CKD and Diabetes: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2024; 19:161-168. [PMID: 37843843 PMCID: PMC10861109 DOI: 10.2215/cjn.0000000000000337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Patients with CKD and diabetes are at higher risk of developing cardiovascular disease, in part, because of impaired endothelial function. Cardioprotective compounds such as resveratrol could improve endothelial function and attenuate the cardiovascular burden in patients with CKD and diabetes. We hypothesized that resveratrol supplementation would improve endothelial function in patients with CKD and diabetes. METHODS Twenty-eight adults aged 68±7 years (84% men) with stage 3 CKD and diabetes were enrolled in a randomized, double-blind, placebo-controlled, crossover study to investigate the effects of 6-week resveratrol supplementation (400 mg/d) on endothelial function. Endothelial function was determined through brachial artery flow-mediated dilation. RESULTS The mean values for eGFR and hemoglobin A 1c were 40±9 ml/min per 1.73 m 2 and 7.36%±0.72%, respectively. Compared with placebo, resveratrol supplementation increased flow-mediated dilation (ratio of geometric mean changes and 95% confidence interval for between-group comparisons, 1.43 (1.15 to 1.77); P value = 0.001). eGFR, hemoglobin A 1c , BP, and nitroglycerin-mediated dilation were unchanged with resveratrol or placebo ( P = 0.15), suggesting the observed change in flow-mediated dilation was likely independent of changes in traditional cardiovascular risk factors. CONCLUSIONS Resveratrol supplementation improved endothelial function in patients with CKD and diabetes. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Resveratrol and Vascular Function in CKD, NCT03597568 . PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_11_20_CJN0000000000000337.mp3.
Collapse
Affiliation(s)
- Colin J. Gimblet
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Nicholas T. Kruse
- College of Health Professionals, Central Michigan University, Mount Pleasant, Michigan
| | - Katharine Geasland
- Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Jeni Michelson
- Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Mingyao Sun
- Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Safur Rehman Mandukhail
- Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Linder H. Wendt
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa
| | - Gary L. Pierce
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Diana I. Jalal
- Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
- Iowa City VA Medical Center, Iowa City, Iowa
| |
Collapse
|
3
|
Voicehovska JG, Trumpika D, Voicehovskis VV, Bormane E, Bušmane I, Grigane A, Moreino E, Lejnieks A. Cardiovascular Consequences of Acute Kidney Injury: Treatment Options. Biomedicines 2023; 11:2364. [PMID: 37760806 PMCID: PMC10526099 DOI: 10.3390/biomedicines11092364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Soon after haemodialysis was introduced into clinical practice, a high risk of cardiac death was noted in end-stage renal disease. However, only in the last decade has it become clear that any renal injury, acute or chronic, is associated with high overall and cardiovascular lethality. The need for early recognition of kidney damage in cardiovascular pathology to assess risk and develop tactics for patient management contributed to the emergence of the concept of the "cardiorenal syndrome" (CRS). CRS is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one of these organs leads to acute or chronic dysfunction of the other. The beneficial effect of ultrafiltration as a component of renal replacement therapy (RRT) is due to the elimination of hyperhydration, which ultimately affects the improvement in cardiac contractile function. This review considers the theoretical background, current status of CRS, and future potential of RRT, focusing on the benefits of ultrafiltration as a therapeutic option.
Collapse
Affiliation(s)
- Julija G. Voicehovska
- Department of Internal Diseases, Medical Faculty, Riga Stradins University, LV-1007 Riga, Latvia; (D.T.); (V.V.V.); (E.M.); (A.L.)
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.B.); (I.B.); (A.G.)
| | - Dace Trumpika
- Department of Internal Diseases, Medical Faculty, Riga Stradins University, LV-1007 Riga, Latvia; (D.T.); (V.V.V.); (E.M.); (A.L.)
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.B.); (I.B.); (A.G.)
| | - Vladimirs V. Voicehovskis
- Department of Internal Diseases, Medical Faculty, Riga Stradins University, LV-1007 Riga, Latvia; (D.T.); (V.V.V.); (E.M.); (A.L.)
| | - Eva Bormane
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.B.); (I.B.); (A.G.)
| | - Inara Bušmane
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.B.); (I.B.); (A.G.)
| | - Anda Grigane
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (E.B.); (I.B.); (A.G.)
| | - Eva Moreino
- Department of Internal Diseases, Medical Faculty, Riga Stradins University, LV-1007 Riga, Latvia; (D.T.); (V.V.V.); (E.M.); (A.L.)
| | - Aivars Lejnieks
- Department of Internal Diseases, Medical Faculty, Riga Stradins University, LV-1007 Riga, Latvia; (D.T.); (V.V.V.); (E.M.); (A.L.)
- Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| |
Collapse
|
4
|
Wang IK, Yen TH, Tsai CH, Sun Y, Chang WL, Chen PL, Lai TC, Yeh PY, Wei CY, Lin CL, Hsu KC, Li CY, Sung FC, Hsu CY. Renal function is associated with one-month and one-year mortality in patients with intracerebral hemorrhage. PLoS One 2023; 18:e0269096. [PMID: 36701340 PMCID: PMC9879419 DOI: 10.1371/journal.pone.0269096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/15/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with the glomerular filtration rate (eGFR) on admission for patients with intracerebral hemorrhage. METHODS From the Taiwan Stroke Registry data from April 2006 to December 2016, we identified and stratified patients with intracerebral hemorrhage into five subgroups by the eGFR level on admission: ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m2 or on dialysis. Risks for 1-month and 1-year mortality after intracerebral hemorrhage were compared by the eGFR levels. RESULTS Both the 1-month and 1-year mortality rates progressively increased with the decrease in eGFR levels. The 1-month mortality rate in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was approximately 5.5-fold greater than that in patients with eGFR ≥ 90 mL/min/1.73 m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 [95% confidence interval (CI) = 2.71-7.78]. Similarly, the 1-year mortality in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was 7.5 times that in patients with eGFR ≥ 90 mL/min/1.73 m2 (2.34 versus 0.31 per 1000 person-days), with an adjusted HR of 4.54 (95% CI 2.95-6.98). CONCLUSION Impairment of renal function is an independent risk factor for mortality in patients with intracerebral hemorrhage in a gradual way. The eGFR level is a prognostic indicator for patients with intracerebral hemorrhage.
Collapse
Affiliation(s)
- I-Kuan Wang
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chon-Haw Tsai
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Yu Sun
- Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chang Lai
- Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
- * E-mail:
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Science, China Medical University College of Medicine, Taichung, Taiwan
| | | |
Collapse
|
5
|
Luo H, Yang X, Chen K, Lan S, Liao G, Xu J. Blood creatinine and urea nitrogen at ICU admission and the risk of in-hospital death and 1-year mortality in patients with intracranial hemorrhage. Front Cardiovasc Med 2022; 9:967614. [PMID: 36440028 PMCID: PMC9685426 DOI: 10.3389/fcvm.2022.967614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background The relationship between renal function and clinical outcomes in patients with intracranial hemorrhage is controversial. Aims We investigated the associations of blood creatinine and urea nitrogen levels with hospital death and 1-year mortality in patients with intracranial hemorrhage treated in the intensive care unit (ICU). Methods A total of 2,682 patients with intracranial hemorrhage were included from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Clinical variables, including admission creatinine, urea nitrogen, type of intracranial hemorrhage, underlying diseases and other blood biochemistry parameters, were collected. Multivariable correction analysis was conducted of the relationships between blood creatinine and urea nitrogen levels on admission with hospital death and 1-year mortality in the included patients with intracranial hemorrhage. Smooth curve and subgroup analyses were also performed for these associations. Results A total of 2,682 patients had their blood creatinine and urea nitrogen levels measured within the first 24 h after ICU admission, with median values of 0.80 and 15.00 mg/dL, respectively. We observed steeply linear relationships between creatinine and urea nitrogen levels and the risk of in-hospital death and 1-year mortality, but the risk of in-hospital mortality and 1-year mortality increased little or only slowly above creatinine levels > 1.9 mg/dL or urea nitrogen > 29 mg/d (the inflection points). Consistently, conditional logistic regression analysis suggested that these inflection points had significant modification effects on the associations between blood creatinine levels, as well as blood urea nitrogen, and the risk of in-hospital death (interaction value < 0.001) and 1-year mortality (interaction value < 0.001). Conclusion Our results supported the hypothesis that elevated blood creatinine and urea nitrogen levels on admission are associated with an increased risk of in-hospital death and 1-year mortality in patients with intracranial hemorrhage. Interestingly, these independent relationships existed only for lower levels of serum creatinine (<1.9 mg/dL) and uric acid (<29 mg/dL).
Collapse
Affiliation(s)
- Hai Luo
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xuanyong Yang
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Kang Chen
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Shihai Lan
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Gang Liao
- Institute of Medicine, Nanchang University, Nanchang, China
| | - Jiang Xu
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
- *Correspondence: Jiang Xu
| |
Collapse
|
6
|
Wang IK, Yen TH, Chen CH, Hsu SP, Sun Y, Lien LM, Chang WL, Lai TC, Chen PL, Chen CC, Huang PH, Lin CH, Su YC, Lin MC, Li CY, Sung FC, Hsu CY. Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction. QJM 2022; 114:848-856. [PMID: 32770252 DOI: 10.1093/qjmed/hcaa237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction. DESIGN We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and <60 ml/min/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale ≥2) was calculated for patients with tPA treatment (N = 705), compared to those without tPA treatment (N = 2820), by eGFR levels, at 1, 3 and 6 months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels. RESULTS Among patients with eGFR levels of <60 ml/min/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42-0.87) at 6 months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment. CONCLUSIONS tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.
Collapse
Affiliation(s)
- I-K Wang
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - T-H Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - C-H Chen
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - S-P Hsu
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Y Sun
- Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - L-M Lien
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - W-L Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - T-C Lai
- Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - P-L Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-C Chen
- Department of Neurology, St Martin De Porres Hospital, Chiayi City, Taiwan
| | - P-H Huang
- Department of Neurology, Cathay General Hospital, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-H Lin
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Y-C Su
- Management Office for Health Data
| | - M-C Lin
- Management Office for Health Data
| | - C-Y Li
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- Department of Health Services Administration, China Medical University College of Public Health, Taichung 404, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Lioufeng Road, Wufeng, Taichung, Taiwan
| | - C Y Hsu
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| |
Collapse
|
7
|
Tanaka S, Nakano T, Hiyamuta H, Tsuruya K, Kitazono T. Association between Multimorbidity and Kidney Function among Patients with Non-Dialysis-Dependent CKD. J Atheroscler Thromb 2021; 29:1249-1264. [PMID: 34602524 PMCID: PMC9371752 DOI: 10.5551/jat.62900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: Individuals with chronic kidney disease (CKD) have a high prevalence of comorbidities, including cardiovascular disease (CVD) and its risk factors. However, epidemiological results to assess the association between multimorbidity and kidney function among the CKD population remains limited.
Methods: We performed a cross-sectional analysis of the association between 23 comorbid conditions and reduced kidney function in 4,476 patients with non-dialysis-dependent CKD enrolled in a multicenter cohort in Japan. Reduced kidney function was defined as an estimated glomerular filtration rate of ≤ 60 mL/min/1.73 m2.
Results: The mean age of patients was 67 years (male, 56.0%). The prevalence of hypertension, diabetes mellitus, dyslipidemia, prior CVD, cancer, and bone fracture, which are the major comorbidities, was 83.3%, 28.7%, 45.9%, 23.3%, 12.7%, and 6.3%, respectively. Multivariable-adjusted analyses revealed that age, male sex, hypertension, dyslipidemia, prior CVD, body mass index, urinary protein excretion, and underlying kidney disease were independent factors associated with reduced kidney function. Importantly, the odds ratios (ORs) for reduced kidney function increased linearly as the number of major comorbid conditions increased (OR for 1–2 conditions: 2.22, 95% confidence interval [CI]: 1.65–2.97; OR for 3–4 conditions: 3.04, 95% CI: 2.12–4.37; OR for ≥ 5 conditions: 4.37, 95% CI: 1.75–10.9). The upward trend in OR was more pronounced with cardiovascular comorbidities but not significant with non-cardiovascular comorbidities.
Conclusions: In conclusion, we observed an independent association between cardiovascular comorbidity and its risk factors and reduced kidney function. The results of this study highlight the importance of managing multimorbidity among patients with CKD.
Collapse
Affiliation(s)
- Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | |
Collapse
|
8
|
Tanaka S, Nakano T, Tsuruya K, Kitazono T. Clinical epidemiological analysis of cohort studies investigating the pathogenesis of kidney disease. Clin Exp Nephrol 2021; 26:1-12. [PMID: 34374903 PMCID: PMC8738501 DOI: 10.1007/s10157-021-02121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/05/2021] [Indexed: 12/01/2022]
Abstract
In recent years, large cohort studies of patients with chronic kidney disease (CKD) have been established all over the world. These studies have attempted to analyze the pathogenesis of CKD using a large body of published evidence. The design of cohort studies is characterized by the measurement of the exposure prior to the occurrence of the outcome, which has the advantage of clarifying the temporal relationship between predictors and outcomes and estimating the strength of the causal relationship between predictors and multiple outcomes. Recent advances in biostatistical analysis methods, such as propensity scores and risk prediction models, are facilitating causal inference using higher quality evidence with greater precision in observational studies. In this review, we will discuss clinical epidemiological research of kidney disease based on the analysis of observational cohort data sets, with a focus on our previous studies.
Collapse
Affiliation(s)
- Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
9
|
Palazzuoli A, Tecson KM, Ronco C, McCullough PA. Nomenclature for Kidney Function from KDIGO: Shortcomings of Terminology Oversimplification. Cardiorenal Med 2021; 11:119-122. [PMID: 34091445 DOI: 10.1159/000516615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
The recent Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference proposed a universal nomenclature calling for "Kidney Disease" (KD) to be applied to every form of kidney dysfunction, regardless of etiology. We recognize that the estimated glomerular filtration rate and urine albumin:creatinine ratio are limited in their application to the broad spectrum of KD. However, there are additional in vitro and advanced diagnostic options that can help identify the underlying cause of KD and inform about prognosis and management. While the overarching benefit of generalizing KD as a medical problem lies with screening and detection, the downsides attributable to a nonexact diagnosis (i.e., unclear prognosis and management strategy) are considerable. Finally, the terms "acute kidney injury" and "worsening renal function" are currently used interchangeably by nephrologists and cardiologists alike, and a universal adoption of one term will likely be a sizeable challenge. To be of greater benefit, we propose KD be used as a starting point and that the etiology and other epigenetic determinants of illness continue to be evaluated and characterized.
Collapse
Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital University of Siena, Siena, Italy
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA.,Department of Internal Medicine, Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
| | - Claudio Ronco
- Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Peter A McCullough
- Department of Internal Medicine, Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
| |
Collapse
|
10
|
Cancho B, Robles NR, Felix-Redondo FJ, Lozano L, Fernandez-Berges D. Study of the effect of chronic kidney disease on the incidence of cardiovascular events in a native Spanish population. Med Clin (Barc) 2021; 157:569-574. [PMID: 33632507 DOI: 10.1016/j.medcli.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the relationship between chronic kidney disease and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population. DESIGN AND METHODS The sample consisted of 2,668 subjects. Mean age was 50.6±14.5 years and 54.6% were female. In all, 3.5% of subjects had a glomerular filtration rate (GFR) below 60ml/min and 4.3% a urinary albumin excretion (UAE) above 30mg/g. GFR was estimated from serum creatinine using the CKD-EPI equation. UAE was measured in first morning urine sample as mg/g of creatinine. We examined the multivariable association between the estimated GFR and the risks of cardiovascular events and death. The median follow-up was 81 (75-89) months. RESULTS In CKD patients the hazard ratio (HR) was 1.36 (95% CI 0.97-1.91) (P=.079) for cardiovascular events and 1.62 (95% CI 0.53-4.91) (P=.396) for cardiovascular mortality. Increased UAE was also associated with higher cardiovascular risk (HR 2.38; 95% CI 1.51-3.74; P<.001) as well as increased cardiovascular mortality (HR 4.78; 95% CI 2.50-9.11; P<.001). For patients with UAE between 30 and 300mg/g HR for cardiovascular events was 2.09 (95% CI 1.34-3.50; P=.005) and 3.80 (95% CI 1.81-7.96; P<.001) for cardiovascular mortality. CONCLUSIONS An independent association was found between reduced GFR and cardiovascular event incidence and mortality. Increased UAE showed a higher prognostic value than decreased GFR. Our findings highlight the clinical and public health importance of routinely measuring UAE.
Collapse
Affiliation(s)
| | - Nicolás Roberto Robles
- Hospital Universitario de Badajoz, Badajoz, España; Cátedra de Riesgo Vascular, Facultad de Medicina, Universidad de Salamanca, Salamanca, España; Red de Investigación Renal, Instituto de Salud Carlos III (RENINRED), Madrid, España.
| | | | - Luis Lozano
- Centro de Salud Mérida, Mérida, Badajoz, España
| | - Daniel Fernandez-Berges
- Unidad de Investigación Don Benito-Villanueva de la Serena, Programa de Investigación en Enfermedades Cardiovasculares, FundeSalud, Villanueva de la Serena, Badajoz, España; Grupo de Investigadores Multidisciplinar de Extremadura (GRIMEX), Villanueva de la Serena, Badajoz, España; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Badajoz, España
| |
Collapse
|
11
|
Brunner FJ, Kröger F, Blaum C, Goßling A, Lorenz T, van Erckelens E, Brätz J, Westermann D, Blankenberg S, Zeller T, Waldeyer C, Seiffert M. Association of high-sensitivity troponin T and I with the severity of stable coronary artery disease in patients with chronic kidney disease. Atherosclerosis 2020; 313:81-87. [DOI: 10.1016/j.atherosclerosis.2020.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 01/18/2023]
|
12
|
Liu W, Tang Q, Jin J, Zhu T, Dai Y, Shi Y. Sex differences in cardiovascular risk factors for myocardial infarction. Herz 2020; 46:115-122. [PMID: 32377778 DOI: 10.1007/s00059-020-04911-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/23/2020] [Accepted: 02/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular disease is a leading cause of mortality worldwide. This study investigated the effects of sex on traditional cardiovascular risk factors for remote myocardial infarction in a community. METHODS A cross-sectional study was performed comprising 20,899 participants who underwent physical examination from 2013 to 2015, including systemic blood pressure and 12-lead electrocardiogram monitoring. Fasting blood samples were collected for blood cell counts and biochemistry tests. Remote myocardial infarction was diagnosed on the basis of electrocardiogram findings. RESULTS A total of 71 male and 21 female patients aged over 50 years were identified with remote myocardial infarction. In the female cohort, low-density lipoprotein (LDL), total cholesterol (TC), as well as high-density lipoprotein (HDL) were negatively correlated with myocardial infarction after adjusting for age. In the male cohort, after adjusting for age, serum levels of glycated hemoglobin (HbA1c) and fasting glucose were positively correlated with myocardial infarction, but the lipid profile, including low-density lipoprotein (LDL), total cholesterol (TC), and high-density lipoprotein (HDL), was negatively correlated with remote myocardial infarction. CONCLUSION In the male population, dyslipidemia and abnormal glucose metabolism play a role in myocardial infarction. In the female population, dyslipidemia is independent of glucose metabolism. This study highlights sex differences in the regulation of lipids and glucose metabolism in patients with remote myocardial infarction.
Collapse
Affiliation(s)
- Wenjie Liu
- Biomedical Research Center, Zhongshan Hospital Fudan University, Fenglin Road 180, CN-200032, Shanghai, China
| | - Qunye Tang
- Shanghai Key Laboratory of Transplantation, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Urology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jiangjun Jin
- Biomedical Research Center, Zhongshan Hospital Fudan University, Fenglin Road 180, CN-200032, Shanghai, China
| | - Tongyu Zhu
- Shanghai Key Laboratory of Transplantation, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Urology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yi Dai
- The Hospital Office, Tongji Hospital Branch, Tongji University, Chifeng Road 50, CN-200092, Shanghai, China.
| | - Yi Shi
- Biomedical Research Center, Zhongshan Hospital Fudan University, Fenglin Road 180, CN-200032, Shanghai, China.
- Shanghai Key Laboratory of Transplantation, Zhongshan Hospital Fudan University, Shanghai, China.
| |
Collapse
|
13
|
Péron J, Neven A, Collette L, Launay-Vacher V, Sprangers B, Marreaud S. Impact of acute kidney injury on anticancer treatment dosage and long-term outcomes: a pooled analysis of European Organisation for Research and Treatment of Cancer trials. Nephrol Dial Transplant 2020; 36:gfaa049. [PMID: 32337562 DOI: 10.1093/ndt/gfaa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The impact of kidney dysfunction on long-term outcomes of patients with advanced cancer remains unclear. METHODS Patients with advanced cancer included in trials conducted by the European Organisation for Research and Treatment of Cancer were eligible for this retrospective analysis. Acute kidney injury (AKI) was identified using serum creatinine levels and using adverse events reported by investigators. The impact of baseline estimated glomerular filtration rates (eGFRs) on progression-free survival (PFS) and overall survival (OS) was investigated. Pooled estimates of the impact of AKI on dose intensity, treatment duration, PFS and OS were obtained following a meta-analytic process. RESULTS Nine trials were included in this study, totalling 2872 metastatic patients with various tumour types and various systemic treatment types. Baseline eGFR had homogeneously no impact on PFS or OS. Most Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) events occurred early during the course of the treatment. AKI was not associated with an increased rate of treatment discontinuation, while it decreased the study treatment dose intensity. Occurrence of a first RIFLE event significantly and homogeneously reduced PFS (pooled hazard ratio = 1.18, 95% confidence interval 1.07-1.30; P = 0.0012), while its impact on OS was more heterogeneous across trials. CONCLUSION AKI is associated with reduced treatment dose intensity and reduced PFS. Therefore, close monitoring of the kidney function during the first months of treatment should be included in clinical trial protocols and probably also in daily practice to enable early AKI diagnosis and management. Collaboration between oncologists and nephrologists is needed to reduce the risk of undertreatment of patients experiencing AKI.
Collapse
Affiliation(s)
- Julien Péron
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
- Oncology Medical Unit, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Anouk Neven
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Ben Sprangers
- Department of Microbiology and Immunology, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals, UZGasthuisberg, Leuven, Belgium
| | - Sandrine Marreaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| |
Collapse
|
14
|
Banerjee S, Radak T. Association between food insecurity, cardiorenal syndrome and all-cause mortality among low-income adults. Nutr Health 2019; 25:245-252. [PMID: 31464165 DOI: 10.1177/0260106019869069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Food insecurity is known to be a major public health issue. There is limited data on food insecurity and chronic disease in the general population. AIM We aimed to assess effect of food insecurity on mortality of individuals with chronic disease like cardiorenal syndrome (CRS). METHODS The study was conducted on participants aged 20 years or older in the United States living below the 130% Federal Poverty Level. We assessed food insecurity utilizing the Household Food Security Survey Module in NHANES survey for the years 1999 to 2010 with mortality follow-up. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of food insecurity and CRS. RESULTS Prevalence of food insecurity among the low-income population was 16.1% among males and 21.7% among females. The mean follow-up was 6.5 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of food insecurity to no food insecurity was 1.28 (95% confidence interval [CI], 1.18-1.37, p < 0.001). Adjusted HR was elevated, 2.81 (CI 1.57-5.05, p < 0.001), among participants who were CRS-positive and food insecure but closer to 1.0 (2.48 CI 1.73-3.55, p < 0.001) among those who were CRS-positive and food secure, after controlling for medical and demographic risk factors. CONCLUSIONS Food insecurity is associated with higher mortality than food security. Food insecurity also may modify the effect of CRS on all-cause mortality in a representative general population. Social policy, when addressing food insecurity, should be inclusive among those with specific chronic diseases.
Collapse
Affiliation(s)
| | - Timothy Radak
- Walden University School of Health Sciences, Baltimore, MD, USA
| |
Collapse
|
15
|
Kluger AY, Tecson KM, Lee AY, Lerma EV, Rangaswami J, Lepor NE, Cobble ME, McCullough PA. Class effects of SGLT2 inhibitors on cardiorenal outcomes. Cardiovasc Diabetol 2019; 18:99. [PMID: 31382965 PMCID: PMC6683461 DOI: 10.1186/s12933-019-0903-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To summarize the four recent sodium-glucose cotransporter 2 inhibitor (SGLT2i) trials: Dapagliflozin Effect on CardiovascuLAR Events (DECLARE-TIMI 58), CANagliflozin CardioVascular Assessment Study (CANVAS) Program, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME), Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), and explore the potential determinants for their cardiovascular, renal, and safety outcomes. RESULTS The composite renal outcome event rates per 1000 patient-years for drug and placebo, as well as the corresponding relative risk reductions, were 3.7, 7.0, 47%; 5.5, 9.0, 40%; 6.3, 11.5, 46%; 43.2, 61.2, 30% for DECLARE-TIMI 58, CANVAS, EMPA-REG OUTCOME, and CREDENCE, respectively (event definitions varied across trials). The major adverse cardiovascular (CV) event rates per 1000 patient-years for drug and placebo, as well as the corresponding relative risk reductions, were 22.6, 24.2, 7%; 26.9, 31.5, 14%; 37.4, 43.9, 14%; 38.7, 48.7, 20% for DECLARE-TIMI 58, CANVAS, EMPA-REG OUTCOME, and CREDENCE, respectively. DECLARE-TIMI 58 had the fewest cardiorenal events and CREDENCE the most. These differences were presumably due to varying inclusion criteria resulting in DECLARE-TIMI 58 having the best baseline renal filtration function and CREDENCE the worst (mean estimated glomerular filtration rate 85.2, 76.5, 74, 56.2 mL/min/1.73 m2 for DECLARE-TIMI 58, CANVAS, EMPA-REG OUTCOME, and CREDENCE, respectively). Additionally, CREDENCE had considerably higher rates of albuminuria (median urinary albumin-creatinine ratios (UACR) were 927, 12.3, and 13.1 mg/g for CREDENCE, CANVAS, and DECLARE-TIMI 58, respectively; EMPA-REG OUTCOME had 59.4% UACR < 30, 28.6% UACR > 30-300, 11.0% UACR > 300 mg/g). CONCLUSIONS Dapagliflozin, empagliflozin, and canagliflozin have internally and externally consistent and biologically plausible class effects on cardiorenal outcomes. Baseline renal filtration function and degree of albuminuria are the most significant indicators of risk for both CV and renal events. Thus, these two factors also anticipate the greatest clinical benefit for SGLT2i.
Collapse
Affiliation(s)
- Aaron Y Kluger
- Baylor Heart and Vascular Institute, 621 N. Hall #H030, Dallas, TX, 75226, USA.
- Baylor Scott & White Research Institute, Dallas, TX, USA.
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, 621 N. Hall #H030, Dallas, TX, 75226, USA
- Baylor Scott & White Research Institute, Dallas, TX, USA
- Texas A&M College of Medicine Health Science Center, Dallas, TX, USA
| | - Andy Y Lee
- Baylor University Medical Center, Dallas, TX, USA
- Baylor Heart and Vascular Hospital, Dallas, TX, USA
| | - Edgar V Lerma
- UIC/Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Janani Rangaswami
- Einstein Medical Center, Philadelphia, PA, USA
- Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Norman E Lepor
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Peter A McCullough
- Baylor Heart and Vascular Institute, 621 N. Hall #H030, Dallas, TX, 75226, USA
- Texas A&M College of Medicine Health Science Center, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Baylor Heart and Vascular Hospital, Dallas, TX, USA
| |
Collapse
|
16
|
Obialo CI, Ofili EO, Norris KC. Statins and Cardiovascular Disease Outcomes in Chronic Kidney Disease: Reaffirmation vs. Repudiation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2733. [PMID: 30518032 PMCID: PMC6313800 DOI: 10.3390/ijerph15122733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) burden is several-fold higher in patients with chronic kidney disease (CKD). Although statins have been shown to provide significant CVD benefits in both the general population and patients with CKD, this has not translated into survival advantage in patients with advanced CKD or on dialysis. It has been reported that CVD risk continues to escalate as CKD progresses to end-stage kidney disease (ESKD); however, the CVD risk reduction by statins appears to decline as patients' progress from the early to later stages of CKD. Statins have also been associated with a higher incidence of stroke in ESKD patients. Thus, the CVD benefits of statins in ESKD remain questionable.
Collapse
Affiliation(s)
- Chamberlain I Obialo
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA.
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA.
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA.
| |
Collapse
|
17
|
Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke. Atherosclerosis 2018; 277:15-20. [PMID: 30170219 DOI: 10.1016/j.atherosclerosis.2018.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/11/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023]
|
18
|
Podzolkov VI, Bragina AE. Chronic kidney disease as a multidisciplinary problem of contemporary medicine. TERAPEVT ARKH 2018; 90:121-129. [PMID: 30701915 DOI: 10.26442/terarkh2018906121-129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A review deals with the problem of chronic kidney disease (CKD) from the position of a physician and cardiologist. The epidemiology of the disease was discussed both abroad and in Russia, including the most up-to-date data. In Russia CKD markers were detected in 49.4% of hypertensives. Authors describe risk factors and mechanisms of CKD at the most important pathogenetic conditions: hypertension, diabetes and obesity. The current classification and methods for calculating the glomerular filtration rate are given. The review disclose a paradigm of the renal continuum and its relation to cardiovascular diseases. It is well known fact that the final causes of the death of patients with CKD, as a rule, are cardiovascular complications. Based on the literature data, the necessity and expediency of screening for renal dysfunction is justified. In the example of use of an angiotensin receptor blocker II - irbesartan nephroprotective demonstrated possibilities of intervention in patients with renal dysfunction of varying severity.
Collapse
Affiliation(s)
- V I Podzolkov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A E Bragina
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| |
Collapse
|
19
|
Wang IK, Liu CH, Yen TH, Jeng JS, Sung SF, Huang PH, Li JY, Sun Y, Wei CY, Lien LM, Tsai IJ, Sung FC, Hsu CY, Liu CH, Tsai CH, Huang WS, Lu CT, Tsai TC, Tseng CH, Lin KH, Shyu WC, Yang YW, Liu YL, Cho DY, Chen CC, Jeng JS, Tang SC, Tsai LK, Yeh SJ, Chen CH, Tsai HH, Li JY, Chen HJ, Lu K, Hsu SP, Kuo HC, Tsou JC, Wang YT, Tai YC, Hsieh MT, Liliang PC, Liang CL, Wang HK, Tsai YT, Wang KW, Chen JS, Chen PY, Wang YC, Chen CH, Sung PS, Hsieh HC, Su HC, Chiu HC, Lien LM, Chen WH, Bai CH, Huang TH, Lau CI, Wu YY, Yeh HL, Chang A, Lin CH, Yen CC, Lin RT, Chen CH, Khor GT, Chao AC, Lin HF, Huang P, Lin HJ, Ke DS, Chang CY, Yeh PS, Lin KC, Cheng TJ, Chou CH, Yang CM, Shen HC, Chen AC, Tsai SJ, Lu TM, Kung SL, Lee MJ, Chou HH, Chang WL, Chiu PY, Hsu MH, Chan PC, Pan CH, Shoung HM, Lo YC, Wang FH, Chang WC, Lai TC, Yin JH, Wang CJ, Wang KC, Chen LM, Denq JC, Sun Y, Lu CJ, Lin CH, Huang CC, Liu CH, Chan HF, Lee SP, Sun MH, Ke LY, Chen PL, Lee YS, Sung SF, Ong CT, Wu CS, Hsu YC, Su YH, Hung LC, Lee JT, Lin JC, Hsu YD, Denq JC, Peng GS, Hsu CH, Lin CC, Yen CH, Cheng CA, Sung YF, Chen YL, Lien MT, Chou CH, Liu CC, Yang FC, Wu YC, Tso AC, Lai YH, Chiang CI, Tsai CK, Liu MT, Lin YC, Hsu YC, Chiang TR, Huang PH, Liao PW, Lee MC, Chen JT, Lie SK, Sun MC, Hsiao PJ, Chen WL, Chen TC, Chang CS, Lai CH, Chuang CS, Chen YY, Lin SK, Su YC, Shiao JL, Yang FY, Liu CY, Chiang HL, Chen GC, Hsu PJ, Chang CY, Lin IS, Chien CH, Chang YC, Chen PK, Chiu PY, Hsiao YJ, Fang CW, Chen YW, Lee KY, Lin YY, Li CH, Tsai HF, Hsieh CF, Yang CD, Liaw SJ, Liao HC, Yeh SJ, Wu LL, Hsieh LP, Lee YH, Chen CW, Hsu CS, Jhih YJ, Zhuang HY, Pan YH, Shih SA, Chen CI, Sung JY, Weng HY, Teng HW, Lee JE, Huang CS, Chao SP, Yuan RY, Sheu JJ, Yu JM, Ho CS, Lin TC, Yu SC, Chen JR, Tsai SY, Wei CY, Hung CH, Lee CF, Yang SK, Chen CL, Lin W, Tseng HP, Liu CH, Lin CL, Lin HC, Chen PT, Hu CJ, Chan L, Chi NF, Chern CM, Lin CJ, Wang SJ, Hsu LC, Wong WJ, Lee IH, Yen DJ, Tsai CP, Kwan SY, Soong BW, Chen SP, Liao KK, Lin KP, Chen C, Shan DE, Fuh JL, Wang PN, Lee YC, Yu YH, Huang HC, Tsai JY, Wu MH, Chiang SY, Wang CY, Hsu MC, Chen CC, Yeh PY, Tsai YT, Wang KY, Chen TS, Hsieh CY, Chen WF, Yip PK, Wang V, Wang KC, Tsai CF, Chen CC, Chen CH, Liu YC, Chen SY, Zhao ZH, Wei ZP, Wu SL, Liu CK, Lin RH, Chu CH, Yan SH, Lin YC, Chen PY, Hsiao SH, Yip BS, Tsai PC, Chou PC, Kuo TM, Lee YC, Chiu YP, Tsai KC, Liao YS, Tsai MJ, Kao HY. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke. Atherosclerosis 2018; 269:288-293. [PMID: 29254692 DOI: 10.1016/j.atherosclerosis.2017.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
|
20
|
Akashi N, Sakakura K, Watanabe Y, Noguchi M, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. The comparison of clinical outcomes in patients with acute myocardial infarction and advanced chronic kidney disease on chronic hemodialysis versus off hemodialysis. Heart Vessels 2018; 33:713-721. [DOI: 10.1007/s00380-018-1122-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/12/2018] [Indexed: 01/18/2023]
|
21
|
The prevalence and association of chronic kidney disease and diabetes in liver cirrhosis using different estimated glomerular filtration rate equation. Oncotarget 2017; 9:2236-2248. [PMID: 29416767 PMCID: PMC5788635 DOI: 10.18632/oncotarget.23368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) in cirrhosis is one of the dreaded complications associated with a steep rise in mortality and morbidity, including diabetes. There are limited data on the prevalence of CKD and the association with diabetes in outpatients with cirrhosis. Methodology This is a cross-sectional study of 7,440 adult liver cirrhosis patients enrolled from August 2001 to April 2010 in a medical center. Case control matching by age and sex with 1,967 pairs, and conditional logistic regression for odds of diabetes was analyzed using adjusted model. Results CKD was present in 46.0%, 45.7% and 45.6% of the study population using the MDRD-6, CKD-EPI and MDRD-4 estimated glomerular filtration rate (eGFR) equations, respectively. Using a conditional logistic regression model after adjusting for other risk factors, odds for diabetes increased significantly compared with non-CKD in CKD stage 3 to 5 (stage 3~5) based on MDRD-6–adjusted model, ORs were: stage 3~5, 2.34 (95% CI, 1.78-3.01); MDRD-4–adjusted model, ORs were: stage 3~5, 8.51 (95% CI, 5.63-11.4); CKD-EPI–adjusted model, ORs were: stage 3~5, 8.61 (95% CI, 5.13-13.9). Conclusion In cirrhosis patients, prevalence of diabetes was higher in patients with advanced stage of CKD. For patients with cirrhosis, patients with CKD stages 3~5 defined by MDRD-4, MDRD-6, and CKD-EPI eGFR equations had increased risk for diabetes. More severe cirrhosis, indicated by the Child-Turcott-Pugh classification was also accompanied by an increased risk for diabetes.
Collapse
|
22
|
Poggenburg S, Jeitler K, Semlitsch T, Stigler F, Krisper P, Rosenkranz A, Siebenhofer A. [Development of methods to evaluate nephrological screening and support measures, and lessons learned from the Styrian nephrological screening program "niere.schützen"]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 131-132:17-27. [PMID: 29217397 DOI: 10.1016/j.zefq.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 11/02/2017] [Accepted: 11/10/2017] [Indexed: 11/17/2022]
Abstract
Throughout the world, the incidence and prevalence of patients with chronic kidney disease have been steadily rising. In 2016, the Styrian nephrology awareness program "niere.schützen" ("Kidney Protection") was launched to early identify patients with renal insufficiency. The aim of this study was to search for existing international nephrological screening and support programs in order to identify possible evaluation parameters and concepts for niere.schützen. A search in MEDLINE® revealed five relevant international programs from four countries. These differed from one another with respect to the population to be screened, the screening method and the support measures. All the programs involved the transparent documentation of patient data, and allowed for disease monitoring, as well as the impact of specific measures on assessed parameters and variables (laboratory data, participation rates) to be determined. Depending on the data sources employed and the availability and comprehensiveness of additional documentation, three evaluation methods of different informative value were developed. The first method requires no participant labelling, while the second and third methods require the participants to be assigned to a particular program. With the third method, the documentation also needs to be conducted in line with a disease management program. Considering that the speedy implementation of the niere.schützen program is desired for political reasons, the only practical method is the first one as it does not entail patient documentation and only involves the evaluation of process parameters.
Collapse
Affiliation(s)
- Stephanie Poggenburg
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Österreich.
| | - Klaus Jeitler
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Österreich; Institut für Medizinische Informatik Statistik und Dokumentation, Medizinische Universität Graz, Österreich
| | - Thomas Semlitsch
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Österreich
| | - Florian Stigler
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Österreich
| | - Peter Krisper
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Nephrologie, Medizinische Universität Graz, Graz, Österreich
| | - Alexander Rosenkranz
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Nephrologie, Medizinische Universität Graz, Graz, Österreich
| | - Andrea Siebenhofer
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Österreich; Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt, Deutschland
| |
Collapse
|
23
|
Peng D, He ZS, Li XS, Tang Q, Zhang L, Yang KW, Yu XT, Zhang CJ, Zhou LQ. Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward? Int Braz J Urol 2017; 43:849-856. [PMID: 28792193 PMCID: PMC5678515 DOI: 10.1590/s1677-5538.ibju.2016.0598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN). Patients and Methods: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis. Results: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ between two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P <0.01) and RFS decreased with Furhman grade, positive surgical margin, and anemia (all P<0.01). Conclusions: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.
Collapse
Affiliation(s)
- Ding Peng
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Zhi-Song He
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Xue-Song Li
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Qi Tang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Lei Zhang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Kai-Wei Yang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Xiao-Teng Yu
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Cui-Jian Zhang
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| | - Li-Qun Zhou
- Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
| |
Collapse
|
24
|
Treweeke A, Hall J, Lambie S, Leslie SJ, Megson IL, MacRury SM. Preliminary study of hypoxia-related cardiovascular mediator-markers in patients with end-stage renal disease with and without diabetes and the effects of haemodialysis. PLoS One 2017; 12:e0178171. [PMID: 28542479 PMCID: PMC5441650 DOI: 10.1371/journal.pone.0178171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/08/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Evidence points to activation of pro-inflammatory and pro-thrombotic stimuli during the haemodialysis process in end-stage renal disease (ESRD) with potential to predispose to cardiovascular events. Diabetes is associated with a higher incidence of cardiovascular disease in haemodialysis patients. We tested the hypothesis that a range of mediators and markers that modulate cardiovascular risk are elevated in haemodialysis patients with diabetes compared to those without. METHODS Men and women with diabetes (n = 6) and without diabetes (n = 6) aged 18-90 years receiving haemodialysis were recruited. Blood samples were collected and analysed pre- and post-haemodialysis sessions for (platelet-monocyte conjugates (PMC), oxidised LDL (Ox-LDL), endothelin 1 (ET-1) and vascular endothelial growth factor (VEGF-A). RESULTS PMC levels significantly increased after haemodialysis in both groups (diabetes p = 0.047; non-diabetes p = 0.005). Baseline VEGF-A was significantly higher in people with diabetes (p = 0.009) and post-dialysis levels were significantly reduced in both groups (P = 0.002). Ox-LDL and CRP concentrations were not significantly different between groups nor affected in either group post-dialysis. Similarly, ET-1 concentrations were comparable in all patients at baseline, with no change post-dialysis in either group. CONCLUSIONS In this pilot study, we have confirmed that circulating PMCs are increased following dialysis irrespective of diabetes status. This is likely to be a mechanistic process and offers a potential explanation for high rates of vascular events associated with haemodialysis. The higher VEGF-A concentrations between patients with and without diabetes is a previously unreported finding in diabetic ESRD. Further research is merited to establish whether VEGF-A is a marker or mediator (or both) of cardiovascular risk in haemodialysis.
Collapse
Affiliation(s)
- A. Treweeke
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
| | - J. Hall
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
| | - S. Lambie
- Department of Medicine, Raigmore Hospital, Inverness, Scotland
| | - S. J. Leslie
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
- Department of Medicine, Raigmore Hospital, Inverness, Scotland
| | - I. L. Megson
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
| | - S. M. MacRury
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
- Department of Medicine, Raigmore Hospital, Inverness, Scotland
| |
Collapse
|
25
|
Jain RB. Trends in the levels of urine and serum creatinine: data from NHANES 2001-2014. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:10197-10204. [PMID: 28265873 DOI: 10.1007/s11356-017-8709-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/27/2017] [Indexed: 06/06/2023]
Abstract
Data from the National Health and Nutrition Examination Survey were used to study trends for urine and serum creatinine over 2001-2014 for those aged ≥20 years. In the absence of chronic kidney disease, levels of urine creatinine decreased for the total population, for those aged 20-29, 50-59, and ≥70 years, for males, and for Mexican Americans and other race/ethnicities. Levels of serum cotinine also exhibited a decreasing trend over 2001-2014 for the total population, for those aged 20-29 and 40-49 years, for females, and for non-Hispanic whites and Mexican Americans. In general, levels of serum creatinine and urine creatinine were positively correlated for chronic kidney disease stages 1-3 and negatively correlated for chronic kidney disease stages 4 and 5.
Collapse
Affiliation(s)
- Ram B Jain
- , 2959 Estate View Court, Dacula, GA, 30019, USA.
| |
Collapse
|
26
|
Mehta T, Buzkova P, Kizer JR, Djousse L, Chonchol M, Mukamal KJ, Shlipak M, Ix JH, Jalal D. Higher plasma transforming growth factor (TGF)-β is associated with kidney disease in older community dwelling adults. BMC Nephrol 2017; 18:98. [PMID: 28327102 PMCID: PMC5359982 DOI: 10.1186/s12882-017-0509-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/09/2017] [Indexed: 12/04/2022] Open
Abstract
Background TGF-β is induced in the vasculature with aging suggesting that high plasma TGF-β levels may be a risk factor for chronic kidney disease (CKD) in older adults. Methods We conducted a cross-sectional analysis of the association between plasma TGF-β levels and CKD including data for 1722 older adults who had participated in the 1996/97 visit of the Cardiovascular Health Study (CHS). Prevalent CKD was defined as eGFR < 60 mL/min/1.73 m2 or urinary albumin/creatinine ratio (ACR) ≥30 mg/g. We also evaluated whether baseline TGF-β levels predicted change in eGFR, cardiovascular (CV) events, or mortality in longitudinal analysis. Results Plasma TGF-β levels were significantly and independently associated with lower eGFR in cross-sectional analysis. Doubling of TGF-β was significantly associated with lower eGFR (β estimate after adjusting for CV risk factors = −1.18, 95% CI −2.03, −0.32). We observed no association with albuminuria. There was no association between baseline TGF-β and change in eGFR, but each doubling of TGF-β at baseline was associated with increased risk of a composite outcome of CV events and mortality, adjusted HR 1.10 (95% C.I. 1.02– 1.20, p = 0.006). Conclusion In this large cohort of community-dwelling older individuals, high plasma TGF-β levels are modestly, but independently associated with lower eGFR but not with albuminuria in cross-sectional analysis. In addition, TGF-β levels are associated with increased risk of CV events and mortality. Further research is needed to determine the direction of association between plasma TGF-β and the risk of CKD and CKD-associated morbidities in older adults. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0509-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tapan Mehta
- University of Colorado Anschutz Medical Center, Aurora, USA
| | | | | | - Luc Djousse
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | | | - Michael Shlipak
- University of California San Francisco School of Medicine, San Francisco, USA
| | | | - Diana Jalal
- University of Colorado Anschutz Medical Center, Aurora, USA. .,Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Campus Stop: C281, 12700 E. 19th Ave, Aurora, CO, 80015, USA.
| |
Collapse
|
27
|
Vascular inflammation and media calcification are already present in early stages of chronic kidney disease. Cardiovasc Pathol 2017; 27:57-67. [DOI: 10.1016/j.carpath.2017.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 02/01/2023] Open
|
28
|
Smilowitz NR, Gupta N, Guo Y, Mauricio R, Bangalore S. Management and outcomes of acute myocardial infarction in patients with chronic kidney disease. Int J Cardiol 2017; 227:1-7. [DOI: 10.1016/j.ijcard.2016.11.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
|
29
|
Lee GY, Lee YT, Yeh CM, Hsu P, Lin TW, Gau JP, Yu YB, Hsiao LT, Tzeng CH, Chiou TJ, Liu JH, Liu YC, Liu CJ. Risk of stroke in patients with newly diagnosed multiple myeloma: a retrospective cohort study. Hematol Oncol 2016; 35:726-733. [PMID: 27545592 DOI: 10.1002/hon.2340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022]
Abstract
Cerebrovascular events are a common complication among patients with cancer, increasing morbidity and mortality. However, the association between multiple myeloma and cerebrovascular events remains unclear. We therefore investigated multiple myeloma patients' risk factors for stroke to devise a better stroke-prevention strategy. This study includes consecutive patients 20 years and older who were newly diagnosed with symptomatic multiple myeloma at Taipei Veterans General Hospital, a tertiary medical center, between January 1, 2002 and December 31, 2014. The primary outcome was stroke development. Patients with head injuries, brain tumors, brain parenchymal invasions, or antecedent malignancies were excluded. Hazard ratios (HRs) of stroke risk factors for multiple myeloma patients were estimated by Cox proportional regression analysis. Overall, 395 patients with a median age of 70 years were investigated. In the median follow-up period of 18 months, cerebrovascular events occurred in 16 patients, including 10 ischemic strokes and 6 hemorrhagic strokes. The 5-year estimated cumulative incidence rate was 7.45%. In the multivariate analysis, the κ light chain isotype (adjusted HR, 8.37; 95% confidence interval [CI], 1.91-39.8), previous cerebrovascular accidents (adjusted HR, 5.16; 95% CI, 1.48-17.9), and serum creatinine > 2 mg/dL (adjusted HR, 4.21; 95% CI, 1.10-16.0) were identified as independent risk factors for stroke. Subgroup analysis showed that atrial fibrillation (adjusted HR, 8.07) and previous cerebrovascular accident (adjusted HR, 4.89) are significant risk factors for ischemic stroke. Serum creatinine > 2 mg/dL (adjusted HR, 30.6) and previous cerebrovascular accident (adjusted HR, 13.9) are significant for hemorrhagic stroke. Moreover, therapeutic strategies for multiple myeloma were not associated with stroke in our study. This study demonstrates that risk of stroke increases in myeloma patients with a κ light chain isotype, previous cerebrovascular events, and renal impairment. Further prospective clinical studies to clarify the relationship between multiple myeloma and stroke are warranted.
Collapse
Affiliation(s)
- Gin-Yi Lee
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Lee
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei Hsu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Wei Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Science, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
30
|
Neck Circumference as a Predictive Indicator of CKD for High Cardiovascular Risk Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:745410. [PMID: 26295050 PMCID: PMC4532819 DOI: 10.1155/2015/745410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/02/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
Background. Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients. Methods. A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1–4 CKD. A linear regression was performed using the Enter method to present an unadjusted R2, standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence. Results. Most anthropometric measurements from patients aged ≧65 were lower than those from patients aged <65, except for women's waist circumference (WC) and waist hip ratio. Female NC obtained the highest R2 values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine. Conclusions. NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future.
Collapse
|
31
|
Huang CW, Syed-Abdul S, Jian WS, Iqbal U, Nguyen PAA, Lee P, Lin SH, Hsu WD, Wu MS, Wang CF, Ma KL, Li YCJ. A novel tool for visualizing chronic kidney disease associated polymorbidity: a 13-year cohort study in Taiwan. J Am Med Inform Assoc 2015; 22:290-8. [PMID: 25814540 DOI: 10.1093/jamia/ocu044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study is to analyze and visualize the polymorbidity associated with chronic kidney disease (CKD). The study shows diseases associated with CKD before and after CKD diagnosis in a time-evolutionary type visualization. MATERIALS AND METHODS Our sample data came from a population of one million individuals randomly selected from the Taiwan National Health Insurance Database, 1998 to 2011. From this group, those patients diagnosed with CKD were included in the analysis. We selected 11 of the most common diseases associated with CKD before its diagnosis and followed them until their death or up to 2011. We used a Sankey-style diagram, which quantifies and visualizes the transition between pre- and post-CKD states with various lines and widths. The line represents groups and the width of a line represents the number of patients transferred from one state to another. RESULTS The patients were grouped according to their states: that is, diagnoses, hemodialysis/transplantation procedures, and events such as death. A Sankey diagram with basic zooming and planning functions was developed that temporally and qualitatively depicts they had amid change of comorbidities occurred in pre- and post-CKD states. DISCUSSION This represents a novel visualization approach for temporal patterns of polymorbidities associated with any complex disease and its outcomes. The Sankey diagram is a promising method for visualizing complex diseases and exploring the effect of comorbidities on outcomes in a time-evolution style. CONCLUSIONS This type of visualization may help clinicians foresee possible outcomes of complex diseases by considering comorbidities that the patients have developed.
Collapse
Affiliation(s)
- Chih-Wei Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Wen-Shan Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan Faculty of Health Sciences, Macau University of Science and Technology, Macau
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Alex Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Peisan Lee
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan
| | - Shen-Hsien Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Wen-Ding Hsu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan Department of Nephrology, New Taipei City Hospital, New Taipei City Government, Taipei, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Fu Wang
- Department of Computer Science, University of California-Davis, California, USA
| | - Kwan-Liu Ma
- Department of Computer Science, University of California-Davis, California, USA
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan Department of Dermatology, Wan-Fang Hospital, Taipei, Taiwan.
| |
Collapse
|
32
|
Deedwania PC. Statins in Chronic Kidney Disease: Cardiovascular Risk and Kidney Function. Postgrad Med 2015; 126:29-36. [DOI: 10.3810/pgm.2014.01.2722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
33
|
McCullough PA, Verrill TA. Cardiorenal Interaction: Appropriate Treatment of Cardiovascular Risk Factors to Improve Outcomes in Chronic Kidney Disease. Postgrad Med 2015; 122:25-34. [DOI: 10.3810/pgm.2010.03.2119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
34
|
McCullough PA, Roberts WC. Peter Andrew McCullough, MD, MPH: an interview with the editor. Am J Cardiol 2014; 114:1772-85. [PMID: 25439453 DOI: 10.1016/j.amjcard.2014.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/15/2014] [Indexed: 11/26/2022]
|
35
|
Hung CC, Yang ML, Lin MY, Lin HYH, Lim LM, Kuo HT, Hwang SJ, Tsai JC, Chen HC. Dipyridamole treatment is associated with improved renal outcome and patient survival in advanced chronic kidney disease. Kaohsiung J Med Sci 2014; 30:599-607. [PMID: 25476097 DOI: 10.1016/j.kjms.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 01/29/2023] Open
Abstract
Dipyridamole has been shown to decrease proteinuria and improve renal function progression especially in early chronic kidney disease (CKD) patients with glomerulonephropathy. A combination therapy of dipyridamole with aspirin could prevent second strokes in the general population. Whether these effects of dipyridamole are also true in advanced CKD patients and whether dipyridamole could improve renal outcomes or patient survival is unknown. We retrospectively analyzed an observational cohort of 3074 participants with CKD stage 3-5 from southern Taiwan, of whom 871 (28.3%) had received dipyridamole treatment ≥50 mg/d for ≥3 months and more than half of the observation period. The mean age was 63.6 ± 13.4 years and the mean estimated glomerular filtration rate (eGFR) was 25.5 mL/min/1.73 m(2). After inverse probability of treatment weighted adjustment by propensity score, there were no differences between the dipyridamole-treated and untreated groups. Dipyridamole treatment was associated with decreased odds for rapid eGFR decline [odds ratio, 0.755; 95% confidence interval (CI), 0.595-0.958; p = 0.007] and progression of urine protein-to-creatinine ratio (odds ratio, 0.655; 95% CI, 0.517-0.832; p = 0.002). In survival analysis, the dipyridamole-treated group was also associated with a decreased risk for end-stage renal disease (hazard ratio, 0.847; 95% CI, 0.733-0.980; p = 0.011) and all-cause mortality (hazard ratio, 0.765; 95% CI, 0.606-0.971; p = 0.001) but not for cardiovascular events. Our findings demonstrate that dipyridamole treatment is significantly associated with better renal outcomes and patient survival in patients with CKD stage 3-5. Further investigations are warranted to confirm these independent positive effects.
Collapse
Affiliation(s)
- Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Li Yang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hugo You-Hsien Lin
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lee-Moay Lim
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hung-Tien Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
36
|
Prospective Measurement of Urinary Microalbumin in Living Kidney Donor Nephrectomy: Toward Understanding the Renal Functional Recovery Period. J Urol 2014; 192:1172-7. [DOI: 10.1016/j.juro.2014.03.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
|
37
|
Creatinine, eGFR and association with myocardial infarction, ischemic heart disease and early death in the general population. Atherosclerosis 2014; 237:67-75. [PMID: 25222342 DOI: 10.1016/j.atherosclerosis.2014.08.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/15/2014] [Accepted: 08/16/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We tested the hypothesis that moderately elevated plasma creatinine levels and decreased levels of estimated glomerular filtration rate (eGFR) are associated with increased risk of myocardial infarction, ischemic heart disease, and early death in the general population. METHODS We studied 10,489 individuals with a plasma creatinine measurement and calculated eGFR from the Danish general population, of which 1498 developed myocardial infarction, 3001 ischemic heart disease, and 7573 died during 32 years follow-up. RESULTS Cumulative incidences of myocardial infarction and ischemic heart disease as a function of age increased with increasing levels of creatinine, and survival decreased (log-rank trends: <0.001). The median survival age was 78.7 (95%CI: 78.0-79.2) years for persons with creatinine levels <90th percentile, 78.1 (76.3-79.5) years for 90th-94th percentiles, and 74.8 (72.8-76.7) years for ≥95th percentile. Hazard ratios for myocardial infarction and plasma creatinine levels of 90th-94th percentiles and ≥95th percentile versus <50th percentile were 2.06 (95%CI: 1.67-2.56) and 1.90 (1.56-2.31) adjusted for gender and age, and 1.35 (1.09-1.68) and 1.11 (0.90-1.36) adjusted multifactorially, respectively. Corresponding estimates for creatinine and ischemic heart disease were 1.57 (1.33-1.85) and 1.64 (1.42-1.89) adjusted for gender and age, and 1.16 (0.98-1.37) and 1.11 (0.95-1.29) adjusted multifactorially. Finally, corresponding values for early death were 1.18 (1.06-1.32) and 1.43 (1.30-1.57), and 0.97 (0.87-1.09) and 1.13 (1.02-1.24), respectively. Low eGFR did not associate consistently with increased risk of these endpoints. CONCLUSION In the general population, moderately elevated plasma creatinine was associated with increased risk of myocardial infarction, ischemic heart disease, and early death, while low eGFR was not.
Collapse
|
38
|
Yang KW, Xiong GY, Li XS, Tang Y, Tang Q, Zhang CJ, He ZS, Zhou LQ. Prevalence of baseline chronic kidney disease in 2,769 Chinese patients with renal cancer: Nephron-sparing treatment is still underutilized. World J Urol 2013; 32:1027-31. [DOI: 10.1007/s00345-013-1178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022] Open
|
39
|
Hui X, Matsushita K, Sang Y, Ballew SH, Fülöp T, Coresh J. CKD and cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study: interactions with age, sex, and race. Am J Kidney Dis 2013; 62:691-702. [PMID: 23769137 PMCID: PMC3783539 DOI: 10.1053/j.ajkd.2013.04.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/24/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) and albuminuria are central for diagnosis, staging, and risk evaluation in chronic kidney disease (CKD). Universal thresholds regardless of age, sex, and race are recommended, but relatively little is known about how these demographic factors alter the relationship of eGFR and albuminuria to cardiovascular outcomes. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 11,060 whites and blacks aged 52-75 years in the Atherosclerosis Risk in Communities (ARIC) Study with median follow-up of 11.2 years. PREDICTORS eGFR by the CKD-EPI (CKD Epidemiology Collaboration) creatinine equation (reference, 95 mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (ACR; reference, 5 mg/g). OUTCOMES Cardiovascular events (coronary disease, stroke, and heart failure) and all-cause mortality. MEASUREMENTS Adjusted HRs associated with eGFR and ACR in subgroups according to age, sex, and race. RESULTS Cardiovascular risk significantly increased at eGFR <70 mL/min/1.73 m(2) in all subgroups according to age (<65 vs ≥65 years), sex, and race (P for interaction >0.2 for these subgroups; eg, at eGFR of 30 mL/min/1.73 m(2), the adjusted HR was 2.19 [95% CI, 1.10-4.35] at age 52-64 years vs 2.23 [95% CI, 1.33-3.72] at age 65-75 years). Results were similar for mortality. Log(ACR) was associated linearly with cardiovascular risk without threshold effects in all subgroups, with some quantitative interactions. HRs according to ACR tended to be lower in men versus women (eg, at ACR of 40 mg/g, 1.18 [95% CI, 0.98-1.41] vs 1.77 [95% CI, 1.45-2.15]) and in the older versus younger population (1.24 [95% CI, 1.04-1.49] vs 1.73 [95% CI, 1.42-2.12]; P for interaction <0.01 for sex and age). Less evident interactions were observed for mortality. LIMITATIONS Single measurement of eGFR with creatinine and ACR and relatively narrow age range. CONCLUSIONS The associations of eGFR and ACR with cardiovascular events were largely similar, with some quantitative interactions, in age, sex, and racial subgroups, generally supporting universal thresholds of GFR and ACR for CKD definition/staging.
Collapse
Affiliation(s)
- Xuan Hui
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yingying Sang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shoshana H. Ballew
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tibor Fülöp
- Department of Internal Medicine - Division of Nephrology, University of Mississippi Medical Center
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
40
|
Narala KR, Hassan S, LaLonde TA, McCullough PA. Management of coronary atherosclerosis and acute coronary syndromes in patients with chronic kidney disease. Curr Probl Cardiol 2013; 38:165-206. [PMID: 23590761 DOI: 10.1016/j.cpcardiol.2012.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis of the coronary arteries is common, extensive, and more unstable among patients with chronic renal impairment or chronic kidney disease (CKD). The initial presentation of coronary disease is often acute coronary syndrome (ACS) that tends to be more complicated and has a higher risk of death in this population. Medical treatment of ACS includes antianginal agents, antiplatelet therapy, anticoagulants, and pharmacotherapies that modify the natural history of ventricular remodeling after injury. Revascularization, primarily with percutaneous coronary intervention and stenting, is critical for optimal outcomes in those at moderate and high risk for reinfarction, the development of heart failure, and death in predialysis patients with CKD. The benefit of revascularization in ACS may not extend to those with end-stage renal disease because of competing sources of all-cause mortality. In stable patients with CKD and multivessel coronary artery disease, observational studies have found that bypass surgery is associated with a reduced mortality as compared with percutaneous coronary intervention when patients are followed for several years. This article will review the guidelines-recommended therapeutic armamentarium for the treatment of stable coronary atherosclerosis and ACS and give specific guidance on benefits, hazards, dose adjustments, and caveats concerning patients with baseline CKD.
Collapse
|
41
|
The prevalence of chronic kidney disease in a primary care setting: a Swiss cross-sectional study. PLoS One 2013; 8:e67848. [PMID: 23844110 PMCID: PMC3700872 DOI: 10.1371/journal.pone.0067848] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/21/2013] [Indexed: 12/22/2022] Open
Abstract
Chronic kidney disease (CKD) often remains clinically silent and therefore undiagnosed until a progressed stage is reached. Our aim was to estimate the prevalence of CKD in a primary care setting in Switzerland. A multicenter, cross-sectional study with randomly selected general practitioners was performed. Adults visiting their general physician’s cabinet during defined periods were asked to participate. Baseline information was reported on a questionnaire, urine and blood samples were analyzed in a central laboratory. Renal status was assessed using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. Extrapolation of results to national level was adjusted for age and gender. One thousand individuals (57% females) with a mean age of 57±17 years were included. Overall, 41% of the patients had normal estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR), whereas 36% of the subjects had slightly reduced excretory renal function with physiological albuminuria based on normal ACR. Almost one fourth of the subjects (23%) had either a substantially reduced eGFR or high levels of ACR. About 10% of the patients had a substantially reduced eGFR of <60 ml/min/1.73 m2, and 17% showed relevant proteinuria (ACR >30 mg/g creatinine). Extrapolation to national level suggests that about 18% of primary care patients may suffer from CKD. CKD prevalence in a primary care population is therefore high, and preventive interventions may be advisable, in particular as CKD prevalence is likely to rise over the next decades.
Collapse
|
42
|
Seck SM, Guéye S, Tamba K, Ba I. Prevalence of chronic cardiovascular and metabolic diseases in Senegalese workers: a cross-sectional study, 2010. Prev Chronic Dis 2013; 10:110339. [PMID: 23286359 PMCID: PMC3545700 DOI: 10.5888/pcd10.110339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are a major public health threat, particularly in developing countries. In sub-Saharan Africa, the scarcity of reliable data on NCDs in the general population makes it difficult to develop efficient prevention strategies. The objective of this cross-sectional study was to assess the prevalence of 4 cardiometabolic NCDs among 402 private-sector workers in Dakar, Senegal: high blood pressure (HBP), diabetes, obesity, and chronic kidney disease (CKD). Methods We collected demographic, clinical, and biological data for each worker during routine occupational health visits between September 1 and November 30, 2010. Multivariate analyses were performed to identify risk factors associated with NCDs. Results Among the 402 study participants, 24.1% had HBP, 9.7% had diabetes, 16.7% were obese, and 22.4% had CKD. About half of participants (48.5%) were not aware of their diseases before the screening. Univariate analysis showed that age was significantly associated with blood pressure, fasting blood glucose, and renal function. After adjusting for age and sex, systolic blood pressure was correlated with renal function, and physical inactivity was significantly associated with obesity. Conclusion Despite its small sample size, our study provides a perspective on the extent of cardiometabolic NCDs in Senegalese workers. Our study also suggests that targeted screening activities focusing on socio-professional groups may be helpful in the absence of national integrated prevention programs.
Collapse
Affiliation(s)
- Sidy Mohamed Seck
- Internal Medicine and Nephrology Department, Faculty of Health Sciences, University Gaston Berger, Route de Ngalléle, BP 234 Saint-Louis, Sénégal.
| | | | | | | |
Collapse
|
43
|
Whaley-Connell AT, Kurella Tamura M, Jurkovitz CT, Kosiborod M, McCullough PA. Advances in CKD detection and determination of prognosis: executive summary of the National Kidney Foundation-Kidney Early Evaluation Program (KEEP) 2012 annual data report. Am J Kidney Dis 2013; 61:S1-3. [PMID: 23507265 DOI: 10.1053/j.ajkd.2013.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 11/11/2022]
|
44
|
Sriharibabu M, Himabindu Y, Kabir Z. Cardiometabolic risk profile of rural South Indians undergoing coronary interventions. HEART ASIA 2012; 4:152-6. [PMID: 27326054 PMCID: PMC4832613 DOI: 10.1136/heartasia-2012-010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 11/03/2022]
Abstract
BACKGROUND According to projected estimates, India will bear 60% of the world's cardiovascular disease (CVD) burden by the year 2020. CVD mortality rates are high in South India compared with the rest of India. OBJECTIVE The objective of this study was to examine the prevalence of behavioural, biological and metabolic risk factors in different age groups of rural South Indians undergoing coronary interventions under a governmental health insurance scheme. METHODS This study includes 1294 patients who underwent coronary interventions. Age, gender and anthropometric measurements were recorded. History of hypertension, diabetes, smoking and family history of ischaemic heart disease was obtained from every subject. Physical activity was assessed using a General Practise physical activity questionnaire. Investigations like haemogram, blood urea, serum creatinine, fasting and postprandial blood glucose, lipid profile and echocardiography were carried out for all patients. RESULTS Hypertension was found in 65% patients, 32.38% had diabetes mellitus, 41.65% were smokers (current and former), 37.17% had dyslipidemia, 31.06% had body mass index more than 25 kg/m, 27.04% were physically active, 37% had left ventricular dysfunction, and 8.57% had renal impairment ( table 1). Statistically significant differences were seen in the prevalence rates of different risk factors in the compared age groups (p=<0.05) except for hypertension and dyslipidemia (p=0.596 and 0.306). CONCLUSIONS Risks to health, as an area of study, has recently begun to receive attention in developing countries including India. Population-based strategies aimed at bringing down risk factor levels in the community can translate into major public health benefits.
Collapse
Affiliation(s)
- Manne Sriharibabu
- Department of Medicine, GSL Medical College & General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Yalamanchali Himabindu
- Department of Obstetrics and Gynecology, GSL Medical College & General Hospital, Rajahmundry, Andhra Pradesh, India
| | - Zubair Kabir
- Department of Public Health & Epidemiology, University College Cork, Cork, Ireland
| |
Collapse
|
45
|
Perico N, Remuzzi G. Chronic kidney disease: a research and public health priority. Nephrol Dial Transplant 2012; 27:iii19-iii26. [DOI: 10.1093/ndt/gfs284] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
46
|
deFilippi C, Seliger SL, Kelley W, Duh SH, Hise M, Christenson RH, Wolf M, Gaggin H, Januzzi J. Interpreting Cardiac Troponin Results from High-Sensitivity Assays in Chronic Kidney Disease without Acute Coronary Syndrome. Clin Chem 2012; 58:1342-51. [DOI: 10.1373/clinchem.2012.185322] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Quantification and comparison of high-sensitivity (hs) cardiac troponin I (cTnI) and cTnT concentrations in chronic kidney disease (CKD) have not been reported. We examined the associations between hs cTnI and cTnT, cardiovascular disease, and renal function in outpatients with stable CKD.
METHODS
Outpatients (n = 148; 16.9% with prior myocardial infarction or coronary revascularization) with an estimated glomerular filtration rate (eGFR) of <60 mL · min−1 · (1.73 m2)−1 had serum cTnI (99th percentile of a healthy population = 9.0 ng/L), and cTnT (99th percentile = 14 ng/L) measured with hs assays. Left ventricular ejection fraction (LVEF) and mass were assessed by echocardiography, and coronary artery calcification (CAC) was determined by computed tomography. Renal function was estimated by eGFR and urine albumin/creatinine ratio (UACR).
RESULTS
The median (interquartile range) concentrations of cTnI and cTnT were 6.3 (3.4–14.4) ng/L and 17.0 (11.2–31.4) ng/L, respectively; 38% and 68% of patients had a cTnI and cTnT above the 99th percentile, respectively. The median CAC score was 80.8 (0.7–308.6), LV mass index was 85 (73–99) g/m2, and LVEF was 58% (57%–61%). The prevalences of prior coronary disease events, CAC score, and LV mass index were higher with increasing concentrations from both hs cardiac troponin assays (P < 0.05 for all). After adjustment for demographics and risk factors, neither cardiac troponin assay was associated with CAC, but both remained associated with LV mass index as well as eGFR and UACR.
CONCLUSIONS
Increased hs cTnI and cTnT concentrations are common in outpatients with stable CKD and are influenced by both underlying cardiac and renal disease.
Collapse
Affiliation(s)
| | | | - Walter Kelley
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Show-Hong Duh
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Myles Wolf
- Department of Medicine, University of Miami, Miami, FL
| | - Hanna Gaggin
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - James Januzzi
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
47
|
Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol 2012; 60:1031-42. [PMID: 22840531 DOI: 10.1016/j.jacc.2012.01.077] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/13/2012] [Indexed: 01/11/2023]
Abstract
Cardiorenal syndrome (CRS) type 1 is characterized as the development of acute kidney injury (AKI) and dysfunction in the patient with acute cardiac illness, most commonly acute decompensated heart failure (ADHF). There is evidence in the literature supporting multiple pathophysiological mechanisms operating simultaneously and sequentially to result in the clinical syndrome characterized by a rise in serum creatinine, oliguria, diuretic resistance, and in many cases, worsening of ADHF symptoms. The milieu of chronic kidney disease has associated factors including obesity, cachexia, hypertension, diabetes, proteinuria, uremic solute retention, anemia, and repeated subclinical AKI events all work to escalate individual risk of CRS in the setting of ADHF. All of these conditions have been linked to cardiac and renal fibrosis. In the hospitalized patient, hemodynamic changes leading to venous renal congestion, neurohormonal activation, hypothalamic-pituitary stress reaction, inflammation and immune cell signaling, systemic endotoxemic exposure from the gut, superimposed infection, and iatrogenesis all contribute to CRS type 1. The final common pathway of bidirectional organ injury appears to be cellular, tissue, and systemic oxidative stress that exacerbate organ function. This review explores in detail the pathophysiological pathways that put a patient at risk and then effectuate the vicious cycle now recognized as CRS type 1.
Collapse
Affiliation(s)
- Claudio Ronco
- Department of Nephrology, Dialysis, and Transplantation, St. Bortolo Hospital, Vicenza, Italy.
| | | | | |
Collapse
|
48
|
Tolstov SN, Mychka VB, Salov IA, Prokhorova YV, Vyshivanyuk VA. Cardiorenal disturbances in perimenopausal women. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-3-16-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To identify early signs of renal dysfunction; to investigate the associations between renal function and vascular remodelling; to evaluate the role of metabolic and hydrodynamic disturbances in the development of cardiorenal syndrome among perimenopausal women; and to assess the potential of hormone replacement therapy (17β-estradiol 1 mg and drospirenone 2 mg) for the correction of the above-mentioned disturbances. Material and methods. In total, 69 perimenopausal women were divided into two groups. Group I included 69 premenopausal women, while Group II consisted of 43 women in early postmenopause. Mean age in Group I was 49,0 years (95% CI 48,0-51,0 years); in Group II, it was 54,0 (50,0-56,0) years (p<0,01). Age at menopause reached 50,3 (48,0-52,0) years, with median duration of menopause of 3,5 (2,0-5,0) years. All participants underwent biochemical blood tests (creatinine (Cr), uric acid (UA), lipid profile, and glucose tolerance test (GTT)). Large elastic artery remodelling was assessed by intima-media thickness (IMT) of common carotid artery (CCA). Non-invasive assessment of endothelial vasoregulatory function involved the measurement of brachial artery (BA) endothelium-dependent vasodilatation (EDVD) in the reactive hyperemia test (RHT). Renal function was assessed by glomerular filtration rate (GFR) and Cr clearance (CrC). Monoalbuminuria (MAU) was qualitatively assessed with a urine strip test. Postmenopausal women were additionally divided into two groups: 23 patients were administered HRT (17β-estradiol 1 mg and drospirenone 2 mg; Angelique medication), while 20 women not receiving HRT comprised a control group. At the end of the study, after 12 months, the assessment of metabolic status, body mass dynamics, endothelial vasoregulatory function, and CCA IMT was repeated. Results. In most postmenopausal women, lipid and carbohydrate metabolism disturbances were observed, which were typical for metabolic syndrome (MS). Lipid metabolism disturbances were observed as early as in premenopause, but reached their maximum during early postmenopause. Postmenopausal women, compared to their peers in premenopause, had significantly higher fasting and postprandial levels of blood glucose. Structural and functional changes in vascular wall were more severe in postmenopausal vs. premenopausal women (p<0,001). While blood flow velocity in the RHT was comparable in both groups, postmenopausal women did not demonstrate a comparable increase in BA EDVD, in contrast to premenopausal females. This could point to the decrease in BA sensitivity to endothelial shear stress among women in postmenopause. Reduced GFR was observed only in postmenopausal women. MAU was registered in premenopausal women with normal GFR, as well as in postmenopausal females. These data on independent role of MAU and reduced GFR suggest an increase in the proportion of women with subclinical renal injury, as a manifestation of target organ damage. Conclusion. The associations between vascular structure and function, renal function, and main MS components were demonstrated. HRT (17β-estradiol 1 mg and drospirenone 2 mg) had beneficial effects on BP dynamics, visceral obesity, metabolic status, and arterial structure and function.
Collapse
Affiliation(s)
| | - V. B. Mychka
- A. L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Moscow
| | | | | | | |
Collapse
|
49
|
Saab G, Chen SC, Li S, Bomback AS, Whaley-Connell AT, Jurkovitz CT, Norris KC, McCullough PA. Association of physician care with mortality in Kidney Early Evaluation Program (KEEP) participants. Am J Kidney Dis 2012; 59:S34-9. [PMID: 22339900 DOI: 10.1053/j.ajkd.2011.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/04/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with or at high risk of chronic kidney disease (CKD) are at increased risk of premature morbidity and mortality. We sought to examine the effect of care provided by a primary care physician (PCP) on survival for all participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) and the effect of care provided by a nephrologist on survival for KEEP participants with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2). METHODS Provision of care by a PCP (n = 138,331) or nephrologist (n = 10,797) was defined using self-report of seeing that provider within the past year. Survival was ascertained by linking KEEP data to the Social Security Administration Death Master File. Multivariable Cox proportional hazards models examining the relationship between primary care and nephrologist provider status adjusted for age, sex, race, smoking status, education, health insurance, diabetes, cardiovascular disease, hypertension, cancer, albuminuria, body mass index, baseline eGFR, and hemoglobin level, with nephrology models further adjusting for calcium, phosphorus, and parathyroid hormone levels. RESULTS Of all participants, 70.9% (98,050 of 138,331) reported receiving PCP care; older age and female sex were associated with this care. During a median follow-up of 4.2 years, 4,836 deaths occurred. After multivariable adjustment, receiving PCP care and mortality were not associated (HR, 0.94; 95% CI, 0.86-1.03; P = 0.2). Of participants with eGFR <60 mL/min/1.73 m(2), 10.1% (1,095 of 10,797) reported receiving nephrology care; younger age and male sex were associated with receipt of nephrology care. During a mean follow-up of 2.2 years, 558 deaths occurred. After multivariable adjustment, nephrologist care was not associated with mortality (HR, 1.01; 95% CI, 0.75-1.36; P = 0.9). These associations were not modified by other specialist care (endocrinologist or cardiologist). CONCLUSIONS For all KEEP participants, neither PCP nor nephrology care was associated with improved survival. These results highlight the need to explore the connection between access to health care and outcomes in persons at high risk of or with CKD.
Collapse
Affiliation(s)
- Georges Saab
- Renal Division, Washington University School of Medicine, St Louis, MO 63110, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Jurkovitz CT, Elliott D, Li S, Saab G, Bomback AS, Norris KC, Chen SC, McCullough PA, Whaley-Connell AT. Physician utilization, risk-factor control, and CKD progression among participants in the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2012; 59:S24-33. [PMID: 22339899 DOI: 10.1053/j.ajkd.2011.11.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/03/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a well-known risk factor for cardiovascular mortality, but little is known about the association between physician utilization and cardiovascular disease risk-factor control in patients with CKD. We used 2005-2010 data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) to examine this association at first and subsequent screenings. METHODS Control of risk factors was defined as control of blood pressure, glycemia, and cholesterol levels. We used multinomial logistic regression to examine the association between participant characteristics and seeing a nephrologist after adjusting for kidney function and paired t tests or McNemar tests to compare characteristics at first and second screenings. RESULTS Of 90,009 participants, 61.3% had a primary care physician only, 2.9% had seen a nephrologist, and 15.3% had seen another specialist. The presence of 3 risk factors (hypertension, diabetes, and hypercholesterolemia) increased from 26.8% in participants with CKD stages 1-2 to 31.9% in those with stages 4-5. Target levels of all risk factors were achieved in 7.2% of participants without a physician, 8.3% of those with a primary care physician only, 9.9% of those with a nephrologist, and 10.3% of those with another specialist. Of up to 7,025 participants who met at least one criterion for nephrology consultation at first screening, only 12.3% reported seeing a nephrologist. Insurance coverage was associated strongly with seeing a nephrologist. Of participants who met criteria for nephrology consultation, 406 (5.8%) returned for a second screening, of whom 19.7% saw a nephrologist. The percentage of participants with all risk factors controlled was higher at the second screening (20.9% vs 13.3%). CONCLUSION Control of cardiovascular risk factors is poor in the KEEP population. The percentage of participants seeing a nephrologist is low, although better after the first screening. Identifying communication barriers between nephrologists and primary care physicians may be a new focus for KEEP.
Collapse
Affiliation(s)
- Claudine T Jurkovitz
- Christiana Care Health System, Center for Outcomes Research, Newark, DE 19713, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|