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Jiang Y, Cao Q, Hong W, Xu T, Tang M, Li Y, Xu R. Age and estimated glomerular filtration rate in Chinese older adults: a cohort study from 2014 to 2020. Front Public Health 2024; 12:1392903. [PMID: 38983263 PMCID: PMC11231386 DOI: 10.3389/fpubh.2024.1392903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024] Open
Abstract
Objectives This study aimed to fill the data gap of the course of renal function decline in old age and explore changes in renal function across different health states with increasing age. Methods This observational, retrospective, single-center cohort study included 5,112 Chinese older adults (3,321 men and 1,791 women, range 60-104 years). The individual rate of estimated glomerular filtration rate (eGFR) decline was analyzed using linear mixed-effects model to account for repeated measures over the years. Results The median age was 66 years, median BMI was 24.56 kg/m2, and median eGFR was 89.86 mL/min.1.73 m2. For every 1-year increase in age, women's eGFR decreased by 1.06 mL/min/1.73 m2 and men's by 0.91 mL/min/1.73 m2. We observed greater age-related eGFR decline in men and women with high systolic blood pressure (SBP). Men with high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C), had greater age-related eGFR decline. In women, different BMI groups showed significant differences in age-related eGFR decline, with the highest decline in those with obesity. Additionally, participants with normal baseline eGFR had a faster age-related decline than those with low baseline eGFR. Conclusion The eGFR declined linearly with age in Chinese older adults, with women exhibiting a slightly faster decline than men. Both men and women should be cautious of SBP. Older adults with normal baseline renal function experienced a faster eGFR decline. Men with high TG, LDL-C, and low HDL-C levels, as well as obese women, should be vigilant in monitoring renal function.
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Affiliation(s)
- Ying Jiang
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Cao
- Health Management Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqi Hong
- Shanghai Pudong New Area Caolu Community Health Center, Shanghai, China
| | - Tianwei Xu
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Molian Tang
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nutrition, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yoon Y, Kim YM, Lee S, Shin BC, Kim HL, Chung JH, Son M. Association between Neck Circumference and Chronic Kidney Disease in Korean Adults in the 2019-2021 Korea National Health and Nutrition Examination Survey. Nutrients 2023; 15:5039. [PMID: 38140298 PMCID: PMC10745966 DOI: 10.3390/nu15245039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic kidney disease (CKD) is a major public health problem and a leading cause of cardiovascular disease and death. Early recognition and management of CKD risk factors are necessary to prevent its onset and progression. Neck circumference (NC) is a non-invasive and easily accessible anthropometric measure associated with central obesity and subcutaneous fat accumulation in the upper body. Our study aimed to explore the relationship between NC and the prevalence of CKD using data from the nationally representative Korea National Health and Nutrition Examination Survey (2019-2021). We analyzed data from 10,219 subjects (age > 19 years, no missing values). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Logistic regression analysis was performed, which revealed a significant association between NC and CKD prevalence even after adjusting for confounding factors, both when NC was considered a continuous variable (OR [95% CI], 1.11 [1.03-1.19]) and in quartiles (Q1 as reference; Q2 OR [95% CI], 1.23 [0.91-1.67]; Q3 OR [95% CI], 1.59 [1.16-2.18]; Q4 OR [95% CI], 1.70 [1.16-2.50]). Our findings suggest that NC could be a simple and effective anthropometric measurement for identifying individuals at risk for CKD.
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Affiliation(s)
- Youngmin Yoon
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Yoo-min Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Gwang-myung Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si 14353, Republic of Korea;
| | - Somin Lee
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Byung-Chul Shin
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Hyun-Lee Kim
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Jong-Hoon Chung
- Division of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Republic of Korea; (Y.Y.); (S.L.); (B.-C.S.); (H.-L.K.); (J.-H.C.)
| | - Minkook Son
- Department of Physiology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
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Harhay MN, Kim Y, Moore K, Harhay MO, Katz R, Shlipak MG, Mattix-Kramer HJ. Modifiable kidney disease risk factors among nondiabetic adults with obesity from the Multi-Ethnic Study of Atherosclerosis. Obesity (Silver Spring) 2023; 31:3056-3065. [PMID: 37766596 DOI: 10.1002/oby.23883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE It is unknown whether weight change or physical fitness is associated with chronic kidney disease (CKD) risk among nondiabetic adults with obesity. METHODS This was a prospective, longitudinal cohort study of adults with obesity without baseline CKD or diabetes enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Linear mixed-effects and multistate models were adjusted for demographics, time-varying covariates including blood pressure, and comorbidities these were used to examine associations of weight change and slow walking pace (<2 miles/h) with (i) rate of annual estimated glomerular filtration rate (eGFR) decline and (ii) incident CKD, defined as eGFRCr-Cys < 60 mL/min/1.73 m2 , and tested for interaction by baseline hypertension status. RESULTS Among 1208 included MESA participants (median BMI 33.0 kg/m2 [interquartile range 31.2-35.9]), 15% developed CKD. Slow walking pace was associated with eGFR decline (-0.27 mL/min/1.73 m2 /year; 95% CI: -0.42 to -0.12) and CKD risk (adjusted hazard ratio 1.48; 95% CI: 1.08 to 2.01). Weight gain was associated with CKD risk (adjusted hazard ratio 1.34; 95% CI: 1.02 to 1.78 per 5 kg weight gain from baseline). There was no significant interaction by baseline hypertension status. CONCLUSIONS Slow walking pace and weight gain were associated with CKD risk among adults with obesity who did not have diabetes at baseline.
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Affiliation(s)
- Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Nephrology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Yuna Kim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Kari Moore
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco VA Healthcare System and University of California, San Francisco, California, USA
| | - Holly J Mattix-Kramer
- Departments of Public Health Science and Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA
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Xu F, Shen L, Yang Y, Kong L, Zu W, Tian D, Cao X, Huang G. Association Between Plasma Levels of ANGPTL3, 4, 8 and the Most Common Additional Cardiovascular Risk Factors in Patients with Hypertension. Diabetes Metab Syndr Obes 2023; 16:1647-1655. [PMID: 37309506 PMCID: PMC10257919 DOI: 10.2147/dmso.s411483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023] Open
Abstract
Background ANGPTL3, 4 and 8 have been reported to be involved in the regulation of lipid and glucose metabolism. The aim of this study was to investigate the expression of ANGPTL3, 4, 8 in hypertensive patients with or without overweight/obesity, T2D, and hyperlipidemia, and the possible association between their expression and the status of the aforementioned comorbidities. Methods Plasma levels of ANGPTL3, 4, and 8 in 87 hospitalized patients with hypertension were measured using ELISA kits. Associations between circulating ANGPTLs levels and the most common additional cardiovascular risk factors were assessed using multivariate linear regression analyses. Pearson's correlation analysis was used to examine the association between ANGPTLs and clinical parameters. Results In the context of hypertension, (1) although not statistically significant, circulating ANGPTL3 levels were higher in the overweight/obese group than in the normal weight group; (2) circulating levels of ANGPTL3 and ANGPTL8 were significantly lower in patients with T2D than in non-diabetic patients; (3) circulating ANGPTL3 levels were significantly higher in the hyperlipidemic group than in the non-hyperlipidemic group. ANGPTL3 was associated with T2D and hyperlipidemia status, whereas ANGPTL8 was independently associated with T2D status. In addition, circulating ANGPTL3 levels were positively correlated with TC, TG, LDL-C, HCY, and ANGPTL8, and circulating ANGPTL4 levels were positively correlated with UACR and BNP. Conclusion Changes in circulating ANGPTL3 and ANGPTL8 levels have been observed in hypertensive patients with the most common additional cardiovascular risk factors, suggesting a role in the common comorbidities of hypertension and cardiovascular disease. Hypertensive patients with overweight/obesity or hyperlipidemia may benefit from therapies targeting ANGPTL3.
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Affiliation(s)
- Fangfang Xu
- Key Laboratory of Geriatrics, Institute of Geriatrics, Department of Geriatric Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Lijun Shen
- Department of Clinical Medical Research Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yongguang Yang
- Department of Clinical Medical Research Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Limin Kong
- Department of General Medicine, Xinxiang Medical University, the Sixth People’s Hospital of Zhengzhou, Zhengzhou, People’s Republic of China
| | - Wufan Zu
- Department of Immunology, School of Basic Medical Science, Xinxiang Medical University, Xinxiang, People’s Republic of China
| | - Dandan Tian
- Department of Hypertension, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Xuanchao Cao
- Key Laboratory of Geriatrics, Institute of Geriatrics, Department of Geriatric Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Gairong Huang
- Key Laboratory of Geriatrics, Institute of Geriatrics, Department of Geriatric Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Guiney H, Walker R, Broadbent J, Caspi A, Goodin E, Kokaua J, Moffitt TE, Robertson S, Theodore R, Poulton R, Endre Z. Kidney-Function Trajectories From Young Adulthood to Midlife: Identifying Risk Strata and Opportunities for Intervention. Kidney Int Rep 2023; 8:51-63. [PMID: 36644353 PMCID: PMC9831942 DOI: 10.1016/j.ekir.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Understanding normative patterns of change in kidney function over the life course may allow targeting of early interventions to slow or prevent the onset of kidney disease, but knowledge about kidney functional change before middle age is limited. This study used prospective longitudinal data from a representative birth cohort to examine common patterns of change from young to midadulthood and to identify risk factors and outcomes associated with poorer trajectories. Methods We used group-based trajectory modeling in the Dunedin study birth cohort (n = 857) to identify the following: (i) common kidney function trajectories between the ages 32 and 45 years, (ii) early-life factors associated with those trajectories, (iii) modifiable physical and psychosocial factors across adulthood associated with differences in trajectory slope, and (iv) links between trajectories and kidney-related outcomes at age 45 years. Results Three trajectory groups were identified and could be differentiated by age 32 years as follows: normal (58% of participants), low-normal (36%), and high-risk (6%) groups. Those from low socioeconomic backgrounds had higher odds of following a high-risk (vs. normal) trajectory. Modifiable factors (blood pressure, body mass index, inflammation, glycated hemoglobin, smoking, and socioeconomic status) across adulthood were associated with steeper age-related declines in kidney function, particularly among those in the low-normal and high-risk groups. Those in the low-normal and high-risk groups also had more adverse kidney-related outcomes at age 45 years. Conclusion The current findings could be used to inform the development of early interventions and point to socioeconomic conditions across the life course and health-related risk factors and behaviors in adulthood as kidney health promotion targets.
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Affiliation(s)
- Hayley Guiney
- Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | | | - Avshalom Caspi
- Social, Genetic, and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Elizabeth Goodin
- Department of Women’s and Children’s Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Jesse Kokaua
- Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
- Centre for Pacific Health, Va’a O Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Terrie E. Moffitt
- Social, Genetic, and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Stephen Robertson
- Department of Women’s and Children’s Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Reremoana Theodore
- Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- Department of Psychology, Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Zoltan Endre
- Department of Nephrology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Zhang Y, Gao W, Ren R, Liu Y, Li B, Wang A, Tang X, Yan L, Luo Z, Qin G, Chen L, Wan Q, Gao Z, Wang W, Ning G, Mu Y. Body roundness index is related to the low estimated glomerular filtration rate in Chinese population: A cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1148662. [PMID: 37056676 PMCID: PMC10086436 DOI: 10.3389/fendo.2023.1148662] [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: 01/20/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Kidney disease is related to visceral obesity. As a new indicator of obesity, body roundness index (BRI) has not been fully revealed with kidney disease. This study's objective is to assess the relationship between estimated glomerular filtration rate (eGFR) and BRI among the Chinese population. METHODS This study enrolled 36,784 members over the age of 40, they were from 7 centers in China by using a random sampling method. BRI was computed using height and waist circumference, eGFR ≤ 90 mL/min/1.73 m2 was considered to indicate low eGFR. To lessen bias, propensity score matching was employed, multiple logistic regression models were utilized to examine the connection between low eGFR and BRI. RESULTS The age, diabetes and coronary heart disease rates, fasting blood glucose, and triglycerides were all greater in participants with low eGFR. The BRI quartile was still positively connected with low eGFR after controlling for confounding variables, according to multivariate logistic regression analysis. (OR [95%CI] Q2:1.052 [1.021-1.091], OR [95%CI] Q3:1.189 [1.062-1.284], OR [95%CI] Q4:1.283 [1.181-1.394], P trend < 0.001). Stratified research revealed that the elders, women, habitual smokers, and those with a history of diabetes or hypertension experienced the connection between BRI level and low eGFR. According to ROC, BRI was able to detect low eGFR more accurately. CONCLUSION Low eGFR in the Chinese community is positively connected with BRI, which has the potential to be used as an effective indicator for screening kidney disease to identify high-risk groups and take appropriate measures to prevent subsequent complications.
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Affiliation(s)
- Yue Zhang
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Wenxing Gao
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Rui Ren
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Yang Liu
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese People’s Liberation Army, Beijing, China
| | - Binqi Li
- Medical School of Chinese People’s Liberation Army, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Anping Wang
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Li Yan
- Zhongshan University Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zuojie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guijun Qin
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Wuhan, Hubei, China
| | - Qin Wan
- Department of Endocrinology, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, China
| | - Zhengnan Gao
- Department of Endocrinology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Weiqing Wang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Department of Endocrinology, the First Clinical Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
- *Correspondence: Yiming Mu,
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Jaques DA, Vollenweider P, Bochud M, Ponte B. Aging and hypertension in kidney function decline: A 10 year population-based study. Front Cardiovasc Med 2022; 9:1035313. [PMID: 36277793 PMCID: PMC9582457 DOI: 10.3389/fcvm.2022.1035313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Aging is associated with a physiological decline in kidney function (KFD). In this study, we aimed to describe the impact of age on the rate of KFD and its interplay with risk factors for chronic kidney disease (CKD), considering mainly hypertension (HT), in the general population. Materials and methods Participants of European descent, aged 35-75, were recruited from a populational cohort in Lausanne, Switzerland. Participants with a 10 year follow-up were selected. KFD was defined as the difference in estimated glomerular filtration rate (eGFR) between baseline and follow-up, divided by the observation period. Multivariate linear regressions were used with KFD as the outcome and age as the main predictor. HT was tested as a modifying factor. Results We included 4,163 participants with mean age 52.2 ± 10.4, 44.7% men, 31.9% HT, and 5.0% diabetics. Mean baseline eGFR was 85.9 ± 14.6 ml/min/1.73 m2. Mean KFD was -0.49 ± 1.08 ml/min/1.73 m2 per year with 70% of participants decreasing their eGFR during follow-up. The relationship between age and KFD was non-linear and age was divided in tertiles. Old participants had faster rates of KFD as compared to young and middle-age participants (p < 0.001). A significant interaction was found between age and HT on KFD prediction (p < 0.001). In HT participants, KFD was significantly different across tertiles of age (p < 0.001). On contrary, KFD was not different across tertiles of age in non-HT participants. Conclusion A physiological KFD is present over time in the general population. Age contributes non-linearly to the rate of this decline with older subjects declining the fastest. The presence of HT is a major contributing factor in this setting as KFD worsened with age only in hypertensive participants. Thus, HT represents an important pathological factor aggravating the age-related physiological decline in eGFR in the general population.
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Affiliation(s)
- David A. Jaques
- Division of Nephrology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland,*Correspondence: David A. Jaques,
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Belen Ponte
- Division of Nephrology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland,Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland,Belen Ponte,
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8
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Munagala KK, Nanda S, Chowdhary Z, Pathivada L, Vivekanandan G, Bodhi S. Severity of Periodontal Disease in Chronic Kidney Disease Patients: A Hospital-Based Study. Cureus 2022; 14:e25646. [PMID: 35795522 PMCID: PMC9251445 DOI: 10.7759/cureus.25646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Periodontal disease is a chronic inflammatory condition of multifactorial origin. The inflammatory mediators released during the progression of disease may affect all the organs of the body. Renal disease is a chronic systemic disease which may influence the progression of periodontal disease. Therefore, this study was conducted to evaluate and compare the prevalence of periodontal disease among individuals with chronic kidney disease undergoing maintenance hemodialysis with healthy individuals. Methodology In this cross-sectional study including 150 participants, 75 patients with different renal diseases undergoing hemodialysis (Group I) and 75 healthy controls (Group II) were included. The general examination of the patients was done. Blood pressure, pulse, and body mass index were recorded, followed by biochemical investigations, in which serum urea, serum creatinine, and random blood sugar were evaluated for each participant. Plaque Index (PI) and Gingival Index (GI) scores were recorded. Probing pocket depth (PPD) and gingival recession GR were measured, and clinical attachment level (CAL) was calculated based on the obtained values. The subjects were then categorized into three groups, namely, no/mild, moderate, and severe periodontitis. Results Out of the total study participants, 68% were men and 32% were women, with a mean age of 47 years. Serum markers were significantly elevated in Group I compared to Group II. Poor oral hygiene and periodontitis were observed to be much higher in dialysis patients compared to the control group. The two groups also significantly differed in PI, GI, PPD, GR, and CAL, all of which were higher in Group I. Conclusions The results suggest that patients with renal disease must be screened for periodontal disease.
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Steele C, Nowak K. Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease. KIDNEY AND DIALYSIS 2022; 2:106-122. [PMID: 35350649 PMCID: PMC8959086 DOI: 10.3390/kidneydial2010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an increased risk for rapid kidney disease progression. Autosomal dominant polycystic kidney disease causes growth and proliferation of kidney cysts resulting in a reduction in kidney function in the majority of adults. An accumulation of adipose tissue may further exacerbate the metabolic defects that have been associated with ADPKD by affecting various cell signaling pathways. Lifestyle interventions inducing weight loss might help delay disease progression by reducing adipose tissue and systematic inflammation. Further research is needed to determine the mechanistic influence of adipose tissue on disease progression.
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Lau LHY, Nano J, Prehn C, Cecil A, Rathmann W, Zeller T, Lechner A, Adamski J, Peters A, Thorand B. Associations of endogenous androgens and sex hormone-binding globulin with kidney function and chronic kidney disease. Front Endocrinol (Lausanne) 2022; 13:1000650. [PMID: 36601008 PMCID: PMC9807167 DOI: 10.3389/fendo.2022.1000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The role of endogenous androgens in kidney function and disease has not been extensively explored in men and women. RESEARCH DESIGN AND METHODS We analyzed data from the observational KORA F4 study and its follow-up examination KORA FF4 (median follow-up time 6.5 years) including 1293 men and 650 peri- and postmenopausal women, not using exogenous sex hormones. We examined the associations between endogenous androgens (testosterone [T], dihydrotestosterone [DHT], free T [fT], free DHT [fDHT], and T/DHT), with estimated glomerular filtration rate (eGFR) at baseline and follow-up, prevalent, and incident chronic kidney disease (CKD) adjusting for common CKD risk factors. RESULTS At baseline, 73 men (5.7%) and 54 women (8.4%) had prevalent CKD. Cross-sectionally, no significant associations between androgens and kidney function were observed among men. In women, elevated T (β=-1.305, [95% CI -2.290; -0.320]) and fT (β=-1.423, [95% CI -2.449; -0.397]) were associated with lower eGFR. Prospectively, 81 men (8.8%) and 60 women (15.2%) developed incident CKD. In women, a reverse J-shaped associations was observed between DHT and incident CKD (Pnon-linear=0.029), while higher fDHT was associated with lower incident CKD risk (odds ratio per 1 standard deviation=0.613, [95% CI 0.369; 0.971]. Among men, T/DHT (β=-0.819, [95% CI -1.413; -0.226]) and SHBG (Pnon-linear=0.011) were associated with eGFR at follow-up but not with incident CKD. Some associations appeared to be modified by type 2 diabetes (T2D). CONCLUSION Suggestive associations are observed of androgens and SHBG with kidney impairment among men and women. However, larger well-phenotyped prospective studies are required to further elucidate the potential of androgens, SHBG, and T2D as modifiable risk factors for kidney function and CKD.
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Affiliation(s)
- Lina Hui Ying Lau
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- International Helmholtz Research School for Diabetes, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jana Nano
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Cornelia Prehn
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Alexander Cecil
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Partner Site Düsseldorf, Düsseldorf, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine Universität, Düsseldorf, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Department of Cardiology, University Medical Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andreas Lechner
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, München, Germany
- German Center for Diabetes Research (DZD), Partner Site Munich-Neuherberg, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Munich-Neuherberg, Neuherberg, Germany
- *Correspondence: Barbara Thorand,
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11
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van der Burgh AC, Rizopoulos D, Ikram MA, Hoorn EJ, Chaker L. Determinants of the Evolution of Kidney Function With Age. Kidney Int Rep 2021; 6:3054-3063. [PMID: 34901574 PMCID: PMC8640542 DOI: 10.1016/j.ekir.2021.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Kidney function declines with age, but its determinants in the general population remain incompletely understood. We investigated the rate and determinants of kidney function decline in the general population. Methods Participants with information on kidney function were selected from a population-based cohort study. Joint models were used to investigate the evolution of the estimated glomerular filtration rate (eGFR, expressed in ml/min per 1.73 m2 per year) and the urine albumin-to-creatinine ratio (ACR, expressed in mg/g per year) with age. We stratified for 8 potential determinants of kidney function decline, including sex, cardiovascular risk factors, and cardiovascular disease. Results We included 12,062 participants with 85,922 eGFR assessments (mean age 67.0 years, 58.7% women) and 3522 participants with 5995 ACR measurements. The annual eGFR decline was 0.82 and the ACR increase was 0.05. All determinants appeared detrimental for eGFR and ACR, except for prediabetes and higher body mass index which proved only detrimental for ACR. In participants without the determinants, eGFR decline was 0.75 and ACR increase was 0.002. Higher baseline eGFR but faster eGFR decline with age was detected in men (0.92 vs. 0.75), smokers (0.90 vs. 0.75), and participants with diabetes (1.07 vs. 0.78). Conclusion We identify prediabetes, smoking, and blood pressure as modifiable risk factors for kidney function decline. As with diabetes, hyperfiltration seems important in accelerated kidney function decline in men and smokers. The interpretation of kidney function decline may require adjustment for age and sex to prevent overdiagnosis of chronic kidney disease in aging populations.
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Affiliation(s)
- Anna C van der Burgh
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Fotheringham AK, Solon-Biet SM, Bielefeldt-Ohmann H, McCarthy DA, McMahon AC, Ruohonen K, Li I, Sullivan MA, Whiddett RO, Borg DJ, Cogger VC, Ballard WO, Turner N, Melvin RG, Raubenheimer D, Le Couteur DG, Simpson SJ, Forbes JM. Kidney disease risk factors do not explain impacts of low dietary protein on kidney function and structure. iScience 2021; 24:103308. [PMID: 34820603 PMCID: PMC8602032 DOI: 10.1016/j.isci.2021.103308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/29/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
The kidneys balance many byproducts of the metabolism of dietary components. Previous studies examining dietary effects on kidney health are generally of short duration and manipulate a single macronutrient. Here, kidney function and structure were examined in C57BL/6J mice randomized to consume one of a spectrum of macronutrient combinations (protein [5%–60%], carbohydrate [20%–75%], and fat [20%–75%]) from weaning to late-middle age (15 months). Individual and interactive impacts of macronutrients on kidney health were modeled. Dietary protein had the greatest influence on kidney function, where chronic low protein intake decreased glomerular filtration rates and kidney mass, whereas it increased kidney immune infiltration and structural injury. Kidney outcomes did not align with cardiometabolic risk factors including glucose intolerance, overweight/obesity, dyslipidemia, and hypertension in mice with chronic low protein consumption. This study highlights that protein intake over a lifespan is an important determinant of kidney function independent of cardiometabolic changes. Chronic high macronutrient intake from any source increases kidney function (GFR) Low protein intake led to greater kidney tubular structural injury and inflammation Lower protein intake decreased kidney mass and glomerular filtration capacity Kidney outcomes did not align with longevity or cardiometabolic outcomes
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Affiliation(s)
- Amelia K Fotheringham
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia
| | - Samantha M Solon-Biet
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,School of Medical Sciences, University of Sydney, Sydney 2006, NSW, Australia
| | - Helle Bielefeldt-Ohmann
- School of Veterinary Science, University of Queensland, Gatton Campus, Gatton 4343, QLD, Australia.,School of Chemistry & Molecular Biosciences, University of Queensland, Brisbane 4067, QLD, Australia
| | - Domenica A McCarthy
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia
| | - Aisling C McMahon
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,Centre for Education and Research on Aging, and Aging and Alzheimer's Institute, Concord Hospital, Sydney 2139, NSW, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney 2139, NSW, Australia
| | - Kari Ruohonen
- Animal Nutrition and Health, Cargill, Sandnes, Norway
| | - Isaac Li
- Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia
| | - Mitchell A Sullivan
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia
| | - Rani O Whiddett
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia
| | - Danielle J Borg
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia
| | - Victoria C Cogger
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,Centre for Education and Research on Aging, and Aging and Alzheimer's Institute, Concord Hospital, Sydney 2139, NSW, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney 2139, NSW, Australia
| | - William O Ballard
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney 2052, NSW, Australia
| | - Nigel Turner
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, NSW 2052, Australia
| | - Richard G Melvin
- Department of Biomedical Sciences, University of Minnesota Medical School, 1035 University Drive, Duluth 55812, MN, USA
| | - David Raubenheimer
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,Centre for Education and Research on Aging, and Aging and Alzheimer's Institute, Concord Hospital, Sydney 2139, NSW, Australia.,ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney 2139, NSW, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, University of Sydney, Sydney 2006, NSW, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, Australia
| | - Josephine M Forbes
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane 4072, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane 4067, QLD, Australia.,Department of Medicine, University of Melbourne, Heidelberg, VIC 3084, Australia
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13
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Xu L, Liu J, Li D, Yang H, Zhou Y, Yang J. Association between metabolic syndrome components and chronic kidney disease among 37,533 old Chinese individuals. Int Urol Nephrol 2021; 54:1445-1454. [PMID: 34671893 PMCID: PMC9085695 DOI: 10.1007/s11255-021-03013-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023]
Abstract
Background Chronic kidney disease (CKD) has become a worldwide health problem among aging populations. However, epidemiological information on Chinese elderly people with CKD is still lacking. This study aimed to investigate the epidemiological features and associated risk factors of CKD in aging population in China. Methods In this cross-sectional study, a total of 37,533 individuals aged ≥ 65 years were enrolled in Binhai from January to December 2018. The crude and standardized prevalence of CKD were calculated. Associations of metabolism-related indicators with CKD were examined using univariate and multivariate analyses. Results The overall prevalence of CKD was 17.7% (95% confidence interval 17.3–18.1%) in this Chinese elderly population. The prevalence was 17.5% among men (95% CI 17.0–18.1%) and 17.8% among women (95% CI 17.3–18.4%). The mean eGFR was 84.22 (SD ± 12.87) mL/min/1.73 m2, with the median value higher for women than for men. Conclusion Our study shows a high prevalence of CKD among Chinese elderly population. Aging, pre-HTN, HTN, elevated triglyceride, and FBG were associated with the risk of CKD. More attention should be paid to metabolic diseases to prevent CKD in the elderly.
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Affiliation(s)
- Lingling Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China
| | - Jin Liu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China
| | - Dongling Li
- Department of Nephrology, People's Hospital of Binhai County, Yancheng, 224500, Jiangsu, China
| | - Hua Yang
- Department of Nephrology, People's Hospital of Binhai County, Yancheng, 224500, Jiangsu, China
| | - Yang Zhou
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China.
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, 262N Zhongshan Road, Nanjing, 210003, Jiangsu, China.
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14
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Association between socioeconomic position and cystatin C in the Heinz Nixdorf Recall Study. Sci Rep 2021; 11:19387. [PMID: 34588554 PMCID: PMC8481271 DOI: 10.1038/s41598-021-98835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
Social inequalities in health and disease are well studied. Less information is available on inequalities in biomarker levels indicating subclinical stages of disease such as cystatin C, an early diagnostic marker of renal dysfunction and predictor for cardiovascular disease. We evaluated the relationship between cystatin C, socioeconomic position (SEP) and established cardiovascular risk factors in a population-based study. In 4475 men and women aged 45–75 years participating in the baseline examination of the Heinz Nixdorf Recall Study cystatin C was measured from serum samples with a nephelometric assay. SEP was assessed by education and household income. Linear regression models were used to analyse the association between SEP and cystatin C as well as the impact of cardiovascular risk factors (i.e., body mass index, blood pressure, blood glucose, diabetes mellitus, blood lipids, C-reactive protein, smoking) on this association. After adjustment for age and sex cystatin C decreased by 0.019 mg/l (95% confidence interval (CI) − 0.030 to − 0.008) per five years of education. While using a categorical education variable cystatin C presented 0.039 mg/l (95% CI 0.017–0.061) higher in men and women in the lowest educational category (≤ 10 years of education) compared to the highest category (≥ 18 years). Concerning income, cystatin C decreased by 0.014 mg/l (95% CI − 0.021 to − 0.006) per 1000 € after adjustment for age and sex. For men and women in the lowest income quartile cystatin C was 0.024 mg/l (95% CI 0.009–0.038) higher compared to the highest income quartile. After adjusting for established cardiovascular risk factors the observed associations were substantially diminished. Social inequalities seem to play a role in subclinical stages of renal dysfunction, which are also related to development of cardiovascular disease. Adjustment for traditional cardiovascular risk factors showed that these risk factors largely explain the association between SEP and cystatin C.
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15
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Uchiyama K, Mochizuki T, Shimada Y, Nishio S, Kataoka H, Mitobe M, Tsuchiya K, Hanaoka K, Ubara Y, Suwabe T, Sekine A, Nutahara K, Tsuruya K, Ishimura E, Nakatani S, Sofue T, Tanaka S, Narita I, Maruyama S, Horie S, Muto S. Factors predicting decline in renal function and kidney volume growth in autosomal dominant polycystic kidney disease: a prospective cohort study (Japanese Polycystic Kidney Disease registry: J-PKD). Clin Exp Nephrol 2021; 25:970-980. [PMID: 33928479 DOI: 10.1007/s10157-021-02068-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/22/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Factors affecting decline in renal function and cyst growth in patients with autosomal polycystic kidney disease (ADPKD) are not fully described, particularly in Japan. METHODS This was the first multi-facility, prospective, observational cohort study conducted in ADPKD patients at 14 centers in Japan. Patients in the J-PKD registry were assessed from December 2009 to June 2012 (follow-up until June 2017). Patients' data including estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) were assessed initially and a maximum of five times annually. Contributing factors to eGFR decline and TKV growth were identified using multiple linear regression analysis. RESULTS Of the 340 patients in the J-PKD registry, data analysis was performed for 192 patients in whom serial changes for both eGFR and TKV were obtained. eGFR slope, eGFR change, and TKV change values were as follows: - 2.7 (- 4.2 to - 1.5) (ml/min/1.73 m2/year), - 5.0 (- 9.6 to - 2.3) (%/year), and 4.78 (0.86-8.22) (%/year), respectively. Lower high-density lipoprotein (HDL) cholesterol was an independent predictor of eGFR decline, using both eGFR slope and change (P = 0.04, P = 0.02, respectively), whereas lower hemoglobin and higher uric acid were significantly associated with greater eGFR change only (P = 0.02, P = 0.002, respectively). Younger age and higher fasting blood sugar were independent predictors of greater TKV change (P = 0.01, P = 0.02, respectively). CONCLUSIONS This real-world study in Japan identified risk factors for renal function decline in ADPKD patients. These included lower HDL cholesterol, lower hemoglobin and higher uric acid for eGFR decline, and youth and higher blood sugar levels for TKV growth.
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Affiliation(s)
- Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Mochizuki
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Shimada
- Intelligent Systems Laboratory, SECOM CO., LTD., Mitaka, Tokyo, Japan.,Department of Medical Electronic Intelligence Management, Juntendo University Graduate School, Bunkyo, Tokyo, Japan
| | - Saori Nishio
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Hiroshi Kataoka
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michihiro Mitobe
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Woman's Medical University, Tokyo, Japan
| | - Kazushige Hanaoka
- Department of General Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | | | - Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Kikuo Nutahara
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Eiji Ishimura
- Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - Satoshi Tanaka
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Horie
- Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan.,Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Satoru Muto
- Department of Advanced Informatics for Genetic Disease, Juntendo University, Tokyo, Japan. .,Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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16
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Is trimethoprim/sulfamethoxazole-associated increase in serum creatinine a pseudo-elevation or true nephrotoxicity? J Infect Chemother 2021; 27:1193-1197. [PMID: 33832848 DOI: 10.1016/j.jiac.2021.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to determine the rates of trimethoprim/sulfamethoxazole (TMP/SMX)-associated pseudo-elevation and true nephrotoxicity by comparison of creatinine-estimated and cystatin C-estimated GFRs (glomerular filtration rates) before and after TMP/SMX administrations. METHODS Patients in whom serum creatinine and cystatin C were simultaneously measured are the cohort of this study. A decreasing of creatinine-estimated GFR posterior to TMP/SMX by ≥ 20% and a decreasing of cystatine C-estimated GFR posterior to TMP/SMX by ≥ 20% were defined as true nephrotoxicity. A decreasing of creatinine-estimated GFR posterior to TMP/SMX by ≥ 20% and a decreasing of cystatine C-estimated GFR posterior to TMP/SMX by < 20% were defined as pseudo-elevation. RESULTS A total of 66 patients were enrolled. Within the 19 patients in whom serum creatinine and cystatin C were measured simultaneously both before and after TMP/SMX administrations, 10 patients (52.6%) had nephrotoxicity. Fewer random error and systematic bias between creatinine- and cystatine C-estimated GFR were observed after TMP/SMX than before TMP/SMX by Bland-Altman analysis. CONCLUSIONS Using cystatin C, we reveled TMP/SMX-associated nephrotoxicity is not uncommon. We should equally pay attention to TMP/SMX-associated nephrotoxicity and pseudo-elevation. In spite of pseudo-elevation, creatinine-estimated GFR after receiving TMP/SMX is ironically reliable as surrogate maker for renal clearance.
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17
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Friedman AN, Kaplan LM, le Roux CW, Schauer PR. Management of Obesity in Adults with CKD. J Am Soc Nephrol 2021; 32:777-790. [PMID: 33602674 PMCID: PMC8017542 DOI: 10.1681/asn.2020101472] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Obesity is a leading public health problem that currently affects over 650 million individuals worldwide. Although interest in the adverse effects of obesity has grown exponentially in recent years, less attention has been given to studying its management in individuals with CKD. This relatively unexplored area should be considered a high priority because of the rapid growth and high prevalence of obesity in the CKD population, its broad impact on health and outcomes, and its modifiable nature. This article begins to lay the groundwork in this field by providing a comprehensive overview that critically evaluates the available evidence related to obesity and kidney disease, identifies important gaps in our knowledge base, and integrates recent insights in the pathophysiology of obesity to help provide a way forward in establishing guidelines as a basis for managing obesity in CKD. Finally, the article includes a kidney-centric algorithm for management of obesity that can be used in clinical practice.
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Affiliation(s)
- Allon N. Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Carel W. le Roux
- Diabetes Complications Research Center, University College Dublin, Dublin, Ireland
| | - Philip R. Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
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18
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Association between Neck Circumference and the Risk of Decreased Estimated Glomerular Filtration Rate in the General Population of China: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3496328. [PMID: 33299866 PMCID: PMC7707937 DOI: 10.1155/2020/3496328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/05/2020] [Accepted: 11/07/2020] [Indexed: 12/16/2022]
Abstract
Background The burden of chronic kidney disease is increasing substantially worldwide. Neck circumference (NC), an anthropometric index for upper-body adiposity, has been recognized as an indicator of cardiometabolic diseases. However, the association between NC and renal dysfunction has not been fully disclosed. Objectives The aim of this study was to investigate the association between NC and estimated glomerular filtration rate (eGFR) in the general population in China. Methods A total of 8805 participants (3322 men and 5483 women) were enrolled in this study. Logistic regression analysis was conducted to examine the association between NC and eGFR. The male and female subjects were divided into four groups according to the NC quartiles. The primary outcome was defined as an eGFR ≤ 90 mL/min/1.73 m2. Results Logistic regression analysis revealed that in both sexes, higher NC was significantly associated with a higher risk of decreased eGFR even after fully adjusting for age, other anthropometric indexes, traditional risk factors for chronic kidney diseases, and sociologic risk factors (quartile 1 as a reference; the odds ratios [95% confidence intervals] were as follows: quartile 2, 1.26 [0.99-1.59]; quartile 3, 1.40 [1.07-1.83]; and quartile 4, 1.71 [1.22-2.38], in men; quartile 2, 1.14 [0.95-1.37]; quartile 3, 1.31 [1.03-1.66]; and quartile 4, 1.32 [1.04-1.68], in women). Stratified analyses suggested that the association was significant among subjects with prediabetes or normal serum uric acid levels and those without cardiovascular diseases (CVD). Among subjects with CVD, the association persisted only in males. When the subjects were stratified according to blood pressure or BMI, the association persisted among male subjects with abnormal blood pressure and was strengthened among male subjects who were overweight/obese, while the association disappeared among female subjects. Conclusions NC is independently associated with the risk of decreased eGFR in the general population in China, indicating that NC could contribute to renal dysfunction risk assessment.
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Surachman A, Daw J, Bray BC, Alexander LM, Coe CL, Almeida DM. Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study. BMC Nephrol 2020; 21:188. [PMID: 32429854 PMCID: PMC7236129 DOI: 10.1186/s12882-020-01846-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background There is a lack of empirical effort that systematically investigates the clustering of comorbidity among known risk factors (obesity, hypertension, diabetes, hypercholesterolemia, and elevated inflammation) of chronic kidney disease (CKD) and how different types of comorbidity may link differently to kidney function among healthy adult samples. This study modeled the clustering of comorbidity among risk factors, examined the association between the clustering of risk factors and kidney function, and tested whether the clustering of risk factors was associated with childhood SES. Methods The data were from 2118 participants (ages 25–84) in the Midlife in the United States (MIDUS) Study. Risk factors included obesity, elevated blood pressure (BP), high total cholesterol levels, poor glucose control, and increased inflammatory activity. Glomerular filtration rate (eGFR) was estimated from serum creatinine, calculated with the CKD-EPI formula. The clustering of comorbidity among risk factors and its association with kidney function and childhood SES were examined using latent class analysis (LCA). Results A five-class model was optimal: (1) Low Risk (class size = 36.40%; low probability of all risk factors), (2) Obese (16.42%; high probability of large BMI and abdominally obese), (3) Obese and Elevated BP (13.37%; high probability of being obese and having elevated BP), (4) Non-Obese but Elevated BP (14.95%; high probability of having elevated BP, hypercholesterolemia, and elevated inflammation), and (5) High Risk (18.86%; high probability for all risk factors). Obesity was associated with kidney hyperfiltration, while comorbidity between obesity and hypertension was linked to compromised kidney filtration. As expected, the High Risk class showed the highest probability of having eGFR < 60 ml/min/1.73 m2 (P = .12; 95%CI = .09–.17). Finally, higher childhood SES was associated with reduced probability of being in the High Risk rather than Low Risk class (β = − 0.20, SE = 0.07, OR [95%CI] = 0.82 [0.71–0.95]). Conclusion These results highlight the importance of considering the impact of childhood SES on risk factors known to be associated with CKD.
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Affiliation(s)
- Agus Surachman
- Department of Human Development and Family Studies/ Center for Healthy Aging, The Pennsylvania State University, 405 Biobehavioral Health (BBH) Building, University Park, PA, 16802, USA. .,Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA.
| | - Jonathan Daw
- Department of Sociology, The Pennsylvania State University, University Park, PA, USA
| | - Bethany C Bray
- The Methodology Center, The Pennsylvania State University, University Park, PA, USA.,Center for Dissemination and Implementation Science, UIC, Chicago, IL, USA
| | - Lacy M Alexander
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA.,Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin - Madison, Madison, WI, USA.,Harlow Center for Biological Psychology, University of Wisconsin - Madison, Madison, WI, USA
| | - David M Almeida
- Department of Human Development and Family Studies/ Center for Healthy Aging, The Pennsylvania State University, 405 Biobehavioral Health (BBH) Building, University Park, PA, 16802, USA.,Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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20
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Anti-inflammatory action of β-hydroxybutyrate via modulation of PGC-1α and FoxO1, mimicking calorie restriction. Aging (Albany NY) 2020; 11:1283-1304. [PMID: 30811347 PMCID: PMC6402511 DOI: 10.18632/aging.101838] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/17/2019] [Indexed: 01/22/2023]
Abstract
β-Hydroxybutyrate (HB) is a ketone body used as an energy source that has shown anti-inflammatory effects similar to calorie restriction (CR); Here, PGC-1α, an abundantly expressed co-factor in the kidney, was reported to interact with both FoxO1 and NF-κB although the definitive interactive mechanism has not yet been reported. In this study, we investigated whether renal aging-related inflammation is modulated by HB. We compared aged rats administered with HB to calorie restricted rats and examined the modulation of FoxO1 and the NF-κB pathway through interactions with PGC-1α. We found that in aged rats treated with HB, pro-inflammatory signaling changes were reversed and showed effects comparable to CR. As FoxO1 and its target genes catalase/MnSOD were upregulated by HB treatment and PGC-1α selectively interacted with FoxO1, not with NF-κB, and ameliorated the renal inflammatory response. These findings were further confirmed using FoxO1 overexpression and siRNA transfection in vitro. Our findings suggest that HB suppressed aging-related inflammation as a CR mimetic by enabling the co-activation and selective interaction between FoxO1 and PGC-1α. This study demonstrates the potential therapeutic role of HB as a CR mimetic, which ameliorates inflammation by a novel mechanism where FoxO1 outcompetes NF-κB by interacting with PGC-1α in aging kidneys.
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21
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Callcott ET, Blanchard CL, Snell P, Santhakumar AB. The anti-inflammatory and antioxidant effects of pigmented rice consumption in an obese cohort. Food Funct 2020; 10:8016-8025. [PMID: 31750484 DOI: 10.1039/c9fo02261a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of lifestyle diseases in the obese has been attributed to higher levels of inflammation and free radical mediated oxidative stress. The antioxidant and anti-inflammatory properties of polyphenols in pigmented rice varieties could have potential to neutralize oxidative stress and modulate inflammatory responses in the obese. A cross-over dietary intervention human clinical trial was conducted with three pigmented rice varieties chosen from previous chemical and in vitro antioxidant and anti-inflammatory screening. Obese (n = 22, BMI > 30) sedentary participants consumed one cup of pigmented rice (Reiziq (brown), Purple (purple) and Yunlu29 (red)). Blood samples were collected prior consumption (baseline) and at set time points of 30 minutes, 1 hour, 2 hours and 4 hours post rice consumption. The collected blood samples were analysed for antioxidant and inflammatory biomarkers. Total antioxidant activity increased (p < 0.001) at the 1 hour time point by 40.3% post purple rice consumption. The red rice variety, Yunlu29 increased antioxidant activity at the 30 minute (p < 0.001) and 1 hour (p < 0.01) time point by 29.5% and 21.2% respectively. Lipid peroxidation biomarker, malondialdehyde (MDA), decreased (p < 0.05) at the 30 minute time point by 6.8% post purple rice consumption. At the 4 hour time point MDA levels was significantly reduced (p < 0.001) by the red rice variety Yunlu29, by 9.6%. Pro-inflammatory cytokine, interleukin-10 (IL-10), was significantly (p < 0.0001) reduced by 3.1% 30 minutes post purple rice consumption. In contrast, Yunlu29 (red) reduced interleukin-6 levels by 13.6% and 11.0% at the 30 minute and 1 hour time points respectively. Both the purple (p < 0.01) and red (p < 0.001) varieties significantly reduced interleukin-12p70 concentrations at 30 minutes by 8.7% and 10.3% respectively. Reiziq (brown) did not affect any of the biomarkers analysed in this study. The outcomes of this study highlight that polyphenols found in pigmented rice may play a key role in targeting specific therapeutic pathways in obesity-related oxidative stress and inflammation.
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Affiliation(s)
- Esther T Callcott
- Australian Research Council (ARC) Industrial Transformation Training Centre for Functional Grains, Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia
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22
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Duan Y, Wang X, Zhang J, Ye P, Cao R, Yang X, Bai Y, Wu H. Body mass index is an independent predictive factor for kidney function evaluated by glomerular filtration rate in a community-dwelling population. Eat Weight Disord 2019; 24:731-738. [PMID: 28871501 DOI: 10.1007/s40519-017-0434-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The effects of overweight and obesity on kidney function have since been identified and become a subject of increased study and concern. But the association between body mass index (BMI) and estimated glomerular filtration rate (eGFR) is not well characterized. The aim of this study was to determine the relationship between BMI and eGFR. METHODS To better understand the relationship between BMI and kidney function, we investigated the association between BMI and eGFR using both the baseline BMI level and the follow-up eGFR level and investigated the relationship between the change in BMI and the change in eGFR in 1447 patients from a 4.8-year prospective study in Beijing, People's Republic of China. RESULTS In multiple linear regression analysis, age, antihypertensive treatment, and BMI were negatively associated with the follow-up eGFR levels in all participants (R = -0.622, -0.926, and -0.266, respectively; P < 0.05), or in the elderly (R = -0.883, -1.035, and -0.630, respectively; P < 0.05); sex was found to be associated with the follow-up eGFR levels independently not only in all participants (R = 6.783; P < 0.001), but also in the elderly (R = 3.518; P < 0.05). In addition, the change in eGFR levels was positively related to age, the change in LDL-C, the change in TC, and the change in SBP, but negatively related to the change in BMI and the change in HDL-C (all P < 0.05). CONCLUSIONS The present study clearly indicated that BMI is an independent predictive factor for kidney function evaluated by the eGFR level during a median 4.8 years of follow-up in Chinese population. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- Yuanyuan Duan
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaona Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jiao Zhang
- Department of Cardiology, Chinese People's Armed Police Forces General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
| | - Ruihua Cao
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xu Yang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hongmei Wu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
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23
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Choi JI, Cho YH, Lee SY, Jeong DW, Lee JG, Yi YH, Tak YJ, Lee SH, Hwang HR, Park EJ. The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes. Korean J Fam Med 2019; 40:176-181. [PMID: 31072076 PMCID: PMC6536908 DOI: 10.4082/kjfm.18.0139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes. Methods We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation. Results Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009– 3.236) and 1.834 (95% confidence interval, 1.162–2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline. Conclusion In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.
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Affiliation(s)
- Jung In Choi
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Yeoup Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Wook Jeong
- Department of Family Medicine, Dongmasan Hospital, Masan, Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea.,Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea.,Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea.,Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Seung Hun Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Hye Rim Hwang
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Eun Ju Park
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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24
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Freise J, Tavakol M, Gao Y, Klein O, Lee BK, Freise C, Park M. The Effect of Enlarged Kidneys on Calculated Body Mass Index Categorization in Transplant Recipients With ADPKD. Kidney Int Rep 2019; 4:606-609. [PMID: 30993236 PMCID: PMC6451113 DOI: 10.1016/j.ekir.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jonathan Freise
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mehdi Tavakol
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ying Gao
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Oana Klein
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brian K Lee
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Chris Freise
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Meyeon Park
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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25
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Liu Y, Wang L, Luo M, Chen N, Deng X, He J, Zhang L, Luo P, Wu J. Inhibition of PAI-1 attenuates perirenal fat inflammation and the associated nephropathy in high-fat diet-induced obese mice. Am J Physiol Endocrinol Metab 2019; 316:E260-E267. [PMID: 30532990 DOI: 10.1152/ajpendo.00387.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Plasminogen activator inhibitor-1 (PAI-1) is increasingly recognized as a mediator in extracellular matrix (ECM) accumulation in diabetic nephropathy. Previous studies have implicated PAI-1 in adipose tissue (AT) expansion, while also contributing to insulin resistance. As inflammation is also known to occur in perirenal AT during obesity, we hypothesized that in a high-fat diet (HFD)-induced obese mouse model, PAI-1 contributes to macrophage-mediated inflammation and diabetic nephropathy. The HFD mice showed increased expression of PAI-1 in perirenal fat and also displayed increased fat weight and macrophage numbers. We found that the macrophage polarization, proinflammatory macrophage-M1-phenotype, including CD11c, IL-6, and monocyte chemoattractant protein-1, were increased by an HFD and decreased by either the genetic depletion of PAI-1 or treatment with the PAI-1 inhibitor, PAI-039. Similarly, an enhanced anti-inflammatory M2-phenotype, including CD206 and IL-10, was accompanied by either the genetic deletion of PAI-1 or PAI-039 treatment. Furthermore, the inhibition of PAI-1 reduced HFD-induced renal histological lesions and abated profibrotic/extracellular-matrix protein. Collectively, our findings provide support that PAI-1 contributes to the development of inflammation in perirenal fat and correlates with the development of diabetic nephropathy in HFD-induced obesity.
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Affiliation(s)
- Yong Liu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, People's Republic of China
- State Key Laboratory of Quality Research in Chinese Medicine (Macau University of Science and Technology), Taipa, Macau, People's Republic of China
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Lin Wang
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Mao Luo
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Ni Chen
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Xin Deng
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Jing He
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Liping Zhang
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
| | - Pei Luo
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, People's Republic of China
- State Key Laboratory of Quality Research in Chinese Medicine (Macau University of Science and Technology), Taipa, Macau, People's Republic of China
| | - Jianbo Wu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, People's Republic of China
- State Key Laboratory of Quality Research in Chinese Medicine (Macau University of Science and Technology), Taipa, Macau, People's Republic of China
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Laboratory for Cardiovascular Pharmacology of the Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan , People's Republic of China
- Department of Medicine and Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine and Research Service , Columbia, Missouri
- Harry S. Truman Memorial Veterans Hospital , Columbia, Missouri
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Callcott ET, Thompson K, Oli P, Blanchard CL, Santhakumar AB. Coloured rice-derived polyphenols reduce lipid peroxidation and pro-inflammatory cytokines ex vivo. Food Funct 2019; 9:5169-5175. [PMID: 30255188 DOI: 10.1039/c8fo01531g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rice-derived polyphenols have been demonstrated to alleviate obesity-related oxidative stress and inflammation. The aim of the study was to investigate if coloured rice polyphenol extracts (PE) reduce malondialdehyde, interleukin-6 and tumour necrosis factor-α (TNF-α) levels in obese individuals ex vivo. Malondialdehyde and pro-inflammatory cytokines were quantified using high-performance liquid chromatography and flow cytometry respectively. Fasting blood samples were treated with PE from three coloured rice varieties (purple, red and brown rice) at varying concentrations (10, 20, 50, 100, 200 and 500 μg mL-1). PE treatment demonstrated a dose-dependent reduction in malondialdehyde and TNF-α levels. Purple PE reduced plasma malondialdehyde concentration by 59% compared to red (21%) and brown (25.5%) rice PE. Brown rice PE at 50 μg mL-1 reduced TNF-α levels by 98% compared to red (80%) and purple rice PE (74%). Rice PE did not modulate plasma interleukin-6 concentrations. Coloured rice may be of therapeutic benefit as a potential functional food alternative in targeting specific pathways associated with obesity.
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Affiliation(s)
- Esther T Callcott
- Australian Research Council (ARC) Industrial Transformation Training Centre for Functional Grains, Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia.
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Changes of Percent Body Fat as a Useful Surrogate for Risk of Declined Renal Function. Sci Rep 2018; 8:17289. [PMID: 30470784 PMCID: PMC6251878 DOI: 10.1038/s41598-018-35601-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022] Open
Abstract
The association between anthropometric indices with chronic kidney disease (CKD) was examined previously. However, the effect of body fat on renal function was not determined clearly. Our aim was to investigate the association of percent body fat (PBF) and renal function in adult population from health examination in Tri-Service General Hospital (2010–2016). 35087 participants aged 20 years and older were enrolled in the study. PBF was measured by bioelectrical impedance analysis (BIA). Estimation of renal function was performed by Taiwanese MDRD equation. Optimal cut-off values of PBF was accessed by a receiver–operator characteristic (ROC) curve analysis. Multivariate regression models were used in the relationship among changes of PBF, renal function, and future CKD. In terms of baseline PBF for CKD, optimal cut-off values of PBF in males and females were 21.55 and 40.75. The changes of PBF were more closely associated with renal function decline than waist circumference (WC) with β values of −0.173 (95% CI: −0.233, −0.112) and −0.077 (95% CI: −0.104, −0.049), respectively. After stratified by gender, this relationship remained significant in male population with β values of −0.276 (95% CI: −0.371, −0.181) and −0.159 (95% CI: −0.207, −0.112), respectively. Female subjects with increased baseline PBF over cut-off values had increased risk for predicting the future CKD with odd ratios (ORs) of 2.298 (95% CI: 1.006–5.252). Body fat had detrimental impact on renal function and development of CKD in adult population. Measurement of PBF for surveillance of renal function impairment was warranted.
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Yarnoff BO, Hoerger TJ, Shrestha SS, Simpson SK, Burrows NR, Anderson AH, Xie D, Chen HY, Pavkov ME. Modeling the impact of obesity on the lifetime risk of chronic kidney disease in the United States using updated estimates of GFR progression from the CRIC study. PLoS One 2018; 13:e0205530. [PMID: 30339684 PMCID: PMC6195263 DOI: 10.1371/journal.pone.0205530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
Abstract
Rationale & objective As the prevalence of obesity continues to rise in the United States, it is important to understand its impact on the lifetime risk of chronic kidney disease (CKD). Study design The CKD Health Policy Model was used to simulate the lifetime risk of CKD for those with and without obesity at baseline. Model structure was updated for glomerular filtration rate (GFR) decline to incorporate new longitudinal data from the Chronic Renal Insufficiency Cohort (CRIC) study. Setting and population The updated model was populated with a nationally representative cohort from National Health and Nutrition Examination Survey (NHANES). Outcomes Lifetime risk of CKD, highest stage and any stage. Model, perspective, & timeframe Simulation model following up individuals from current age through death or age 90 years. Results Lifetime risk of any CKD stage was 32.5% (95% CI 28.6%–36.3%) for persons with normal weight, 37.6% (95% CI 33.5%–41.7%) for persons who were overweight, and 41.0% (95% CI 36.7%–45.3%) for persons with obesity at baseline. The difference between persons with normal weight and persons with obesity at baseline was statistically significant (p<0.01). Lifetime risk of CKD stages 4 and 5 was higher for persons with obesity at baseline (Stage 4: 2.1%, 95% CI 0.9%–3.3%; stage 5: 0.6%, 95% CI 0.0%–1.1%), but the differences were not statistically significant (stage 4: p = 0.08; stage 5: p = 0.23). Limitations Due to limited data, our simulation model estimates are based on assumptions about the causal pathways from obesity to CKD, diabetes, and hypertension. Conclusions The results of this study indicate that obesity may have a large impact on the lifetime risk of CKD. This is important information for policymakers seeking to set priorities and targets for CKD prevention and treatment.
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Affiliation(s)
- Benjamin O. Yarnoff
- RTI International, Research Triangle Park, North Carolina, United States of America
- * E-mail:
| | - Thomas J. Hoerger
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Sundar S. Shrestha
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Siobhan K. Simpson
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Nilka R. Burrows
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Dawei Xie
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Hsiang-Yu Chen
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Meda E. Pavkov
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Schrauben SJ, Hsu JY, Rosas SE, Jaar BG, Zhang X, Deo R, Saab G, Chen J, Lederer S, Kanthety R, Hamm LL, Ricardo AC, Lash JP, Feldman HI, Anderson AH. CKD Self-management: Phenotypes and Associations With Clinical Outcomes. Am J Kidney Dis 2018; 72:360-370. [PMID: 29580660 PMCID: PMC6109611 DOI: 10.1053/j.ajkd.2018.01.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/12/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND To slow chronic kidney disease (CKD) progression and its complications, patients need to engage in self-management behaviors. The objective of this study was to classify CKD self-management behaviors into phenotypes and assess the association of these phenotypes with clinical outcomes. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. 3,939 participants in the CRIC Study recruited between 2003 and 2008 served as the derivation cohort and 1,560 participants recruited between 2013 and 2015 served as the validation cohort. PREDICTORS CKD self-management behavior phenotypes. OUTCOMES CKD progression, atherosclerotic events, heart failure events, death from any cause. MEASUREMENTS Latent class analysis stratified by diabetes was used to identify CKD self-management phenotypes based on measures of body mass index, diet, physical activity, blood pressure, smoking status, and hemoglobin A1c concentration (if diabetic); Cox proportional hazards models. RESULTS 3 identified phenotypes varied according to the extent of implementation of recommended CKD self-management behaviors: phenotype I characterized study participants with the most recommended behaviors; phenotype II, participants with a mixture of recommended and not recommended behaviors; and phenotype III, participants with minimal recommended behaviors. In multivariable-adjusted models for those with and without diabetes, phenotype III was strongly associated with CKD progression (HRs of 1.82 and 1.49), death (HRs of 1.95 and 4.14), and atherosclerotic events (HRs of 2.54 and 1.90; each P < 0.05). Phenotype II was associated with atherosclerotic events and death among those with and without diabetes. LIMITATIONS No consensus definition of CKD self-management; limited to baseline behavior data. CONCLUSIONS There are potentially 3 CKD self-management behavior phenotypes that distinguish risk for clinical outcomes. These phenotypes may inform the development of studies and guidelines regarding optimal self-management.
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Affiliation(s)
- Sarah J Schrauben
- Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, PA.
| | - Jesse Y Hsu
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Bernard G Jaar
- Division of Nephrology, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Rajat Deo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Division of Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Georges Saab
- Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Jing Chen
- Department of Medicine, Tulane University, New Orleans, LA
| | - Swati Lederer
- Department of Medicine, University of Texas Southwestern, Dallas, TX
| | | | - L Lee Hamm
- Department of Medicine, Tulane University, New Orleans, LA
| | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Harold I Feldman
- Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Amanda H Anderson
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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30
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Dias RSC, Calado IL, Alencar JDD, Hortegal EV, Santos EJF, Brito DJDA, Lages JS, Santos AMD, Salgado Filho N. Abdominal obesity and reduction of glomerular filtration. ACTA ACUST UNITED AC 2018; 64:346-353. [PMID: 30133614 DOI: 10.1590/1806-9282.64.04.346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/09/2017] [Indexed: 11/21/2022]
Abstract
The objective was to evaluate the association between nutritional status and the glomerular filtration rate (GFR) in remaining quilombolas. Cross-sectional study carried out on 32 remaining quilombola communities in the municipality of Alcântara-MA. The nutritional indicators (IN) used were: body mass index (BMI); Waist circumference (WC); Waist-to-hip ratio (WHR); Waist-to-height ratio (WHtR); conicity index (CI) and estimated visceral adipose tissue (VAT). GFR was estimated from the CKD-EPI creatinine-cystatin C formula. The Shapiro Wilk test was used to evaluate the normality of the quantitative variables. In order to compare the second IN sex, the chi-square test was applied. The Anova or Kruskal-Wallis tests were used to verify the association between IN and GFR. Of the 1,526 remaining quilombolas studied, 89.5% were black or brown, 51.2% were women, 88.6% belonged to economic classes D and E and 61.2% were farmers or fishermen. Clinical investigation revealed 29.2% of hypertensive patients, 8.5% of diabetics and 3.1% with reduced GFR. The BMI revealed 45.6% of the remaining quilombolas with excess weight. When compared to men, women presented a higher prevalence of overweight by BMI (56.6% vs 33.8%, p <0.001) and abdominal obesity CC (52.3% vs 4.3%), WHR (76,5% vs 5.8%), WHtR (82.3% vs 48.9%) and VAT (27.1% vs 14.5%) (p <0.001). Comparing the means of IN according to the GFR, it was observed that the higher the mean value of the IN lower the GFR (p <0.05). The GFR reduced with increasing mean values of nutritional indicators of abdominal obesity, regardless of sex.
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Affiliation(s)
- Raimunda Sheyla Carneiro Dias
- Center of prevention of renal diseases of the university hospital at Brazilian university Universidade Federal do Maranhão
| | - Isabela Leal Calado
- Department of physiological sciences at Brazilian university Universidade Federal do Maranhão
| | - Janete Daniel de Alencar
- Postgraduation program in health sciences at Brazilian university Universidade Federal do Maranhão
| | - Elane Viana Hortegal
- Department of physiological sciences at Brazilian university Universidade Federal do Maranhão
| | - Elton Jonh Freitas Santos
- Center of prevention of renal diseases of the university hospital at Brazilian university Universidade Federal do Maranhão
| | - Dyego José de Araújo Brito
- Center of prevention of renal diseases of the university hospital at Brazilian university Universidade Federal do Maranhão
| | - Joyce Santos Lages
- Center of prevention of renal diseases of the university hospital at Brazilian university Universidade Federal do Maranhão
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31
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Metabolic syndrome but not obesity measures are risk factors for accelerated age-related glomerular filtration rate decline in the general population. Kidney Int 2018; 93:1183-1190. [DOI: 10.1016/j.kint.2017.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023]
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32
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Chung KW, Lee EK, Lee MK, Oh GT, Yu BP, Chung HY. Impairment of PPAR α and the Fatty Acid Oxidation Pathway Aggravates Renal Fibrosis during Aging. J Am Soc Nephrol 2018; 29:1223-1237. [PMID: 29440279 DOI: 10.1681/asn.2017070802] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/03/2018] [Indexed: 01/07/2023] Open
Abstract
Defects in the renal fatty acid oxidation (FAO) pathway have been implicated in the development of renal fibrosis. Although, compared with young kidneys, aged kidneys show significantly increased fibrosis with impaired kidney function, the mechanisms underlying the effects of aging on renal fibrosis have not been investigated. In this study, we investigated peroxisome proliferator-activated receptor α (PPARα) and the FAO pathway as regulators of age-associated renal fibrosis. The expression of PPARα and the FAO pathway-associated proteins significantly decreased with the accumulation of lipids in the renal tubular epithelial region during aging in rats. In particular, decreased PPARα protein expression associated with increased expression of PPARα-targeting microRNAs. Among the microRNAs with increased expression during aging, miR-21 efficiently decreased PPARα expression and impaired FAO when ectopically expressed in renal epithelial cells. In cells pretreated with oleic acid to induce lipid stress, miR-21 treatment further enhanced lipid accumulation. Furthermore, treatment with miR-21 significantly exacerbated the TGF-β-induced fibroblast phenotype of epithelial cells. We verified the physiologic importance of our findings in a calorie restriction model. Calorie restriction rescued the impaired FAO pathway during aging and slowed fibrosis development. Finally, compared with kidneys of aged littermate controls, kidneys of aged PPARα-/- mice showed exaggerated lipid accumulation, with decreased activity of the FAO pathway and a severe fibrosis phenotype. Our results suggest that impaired renal PPARα signaling during aging aggravates renal fibrosis development, and targeting PPARα is useful for preventing age-associated CKD.
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Affiliation(s)
- Ki Wung Chung
- Molecular Inflammation Research Center for Aging Intervention and.,Department of Pharmacy, College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Eun Kyeong Lee
- Molecular Inflammation Research Center for Aging Intervention and.,Department of Pharmacy, College of Pharmacy, Pusan National University, Busan, Republic of Korea.,Korea Institute of Toxicology, Yuseong-gu, Daejeon, Republic of Korea
| | - Mi Kyung Lee
- Department of Pathology, Ilsin Christian Hospital, Busan, Republic of Korea
| | - Goo Taeg Oh
- Department of Life Sciences, Ewha Womans University, Seoul, Republic of Korea; and
| | - Byung Pal Yu
- Department of Physiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hae Young Chung
- Molecular Inflammation Research Center for Aging Intervention and .,Department of Pharmacy, College of Pharmacy, Pusan National University, Busan, Republic of Korea
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33
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Brown A, Taheri S. Very-low-energy diets for weight loss in patients with kidney disease. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/jokc.2018.3.1.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Adrian Brown
- Researcher, Department of Diabetes, Endocrinology and Metabolism, Imperial College, London
| | - Shahrad Taheri
- Researcher, Department of Medicine and Clinical Research Core, Weill Cornell Medical College, New York
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Nowak KL, You Z, Gitomer B, Brosnahan G, Torres VE, Chapman AB, Perrone RD, Steinman TI, Abebe KZ, Rahbari-Oskoui FF, Yu ASL, Harris PC, Bae KT, Hogan M, Miskulin D, Chonchol M. Overweight and Obesity Are Predictors of Progression in Early Autosomal Dominant Polycystic Kidney Disease. J Am Soc Nephrol 2017; 29:571-578. [PMID: 29118087 DOI: 10.1681/asn.2017070819] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/08/2017] [Indexed: 01/12/2023] Open
Abstract
The association of overweight/obesity with disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD) remains untested. We hypothesized that overweight/obesity associates with faster progression in early-stage ADPKD. Overall, 441 nondiabetic participants with ADPKD and an eGFR>60 ml/min per 1.73 m2 who participated in the Halt Progression of Polycystic Kidney Disease Study A were categorized on the basis of body mass index (BMI; calculated using nonkidney and nonliver weight) as normal weight (18.5-24.9 kg/m2; reference; n=192), overweight (25.0-29.9 kg/m2; n=168), or obese (≥30 kg/m2; n=81). We evaluated the longitudinal (5-year) association of overweight/obesity with change in total kidney volume (TKV) by magnetic resonance imaging using linear regression and multinomial logistic regression models. Among participants, mean±SD age was 37±8 years, annual percent change in TKV was 7.4%±5.1%, and BMI was 26.3±4.9 kg/m2 The annual percent change in TKV increased with increasing BMI category (normal weight: 6.1%±4.7%, overweight: 7.9%±4.8%, obese: 9.4%±6.2%; P<0.001). In the fully adjusted model, higher BMI associated with greater annual percent change in TKV (β=0.79; 95% confidence interval [95% CI], 0.18 to 1.39, per 5-unit increase in BMI). Overweight and obesity associated with increased odds of annual percent change in TKV ≥7% compared with <5% (overweight: odds ratio, 2.02; 95% CI, 1.15 to 3.56; obese: odds ratio, 3.76; 95% CI, 1.81 to 7.80). Obesity also independently associated with greater eGFR decline (slope) versus normal weight (fully adjusted β =-0.08; 95% CI, -0.15 to -0.02). In conclusion, overweight and, particularly, obesity are strongly and independently associated with rate of progression in early-stage ADPKD.
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Affiliation(s)
- Kristen L Nowak
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Berenice Gitomer
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Godela Brosnahan
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Ronald D Perrone
- Division of Nephrology, Tufts University Medical Center, Boston, Massachusetts
| | - Theodore I Steinman
- Department of Medicine and Renal Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kaleab Z Abebe
- Center for Clinical Trials & Data Coordination, Division of General Internal Medicine, and
| | | | - Alan S L Yu
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marie Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Dana Miskulin
- Division of Nephrology, Tufts University Medical Center, Boston, Massachusetts
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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35
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Motie M, Evangelista LS, Lombardo D, Hoi J, Horwich TB, Hamilton M, Fonarow GC. Effect of weight loss on renal function in overweight and obese patients with heart failure. Diabetes Metab Syndr 2017; 11:95-98. [PMID: 27381968 PMCID: PMC5182197 DOI: 10.1016/j.dsx.2016.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/19/2016] [Indexed: 11/17/2022]
Abstract
AIMS The effect of intentional weight loss on glomerular filtration rate (GFR) in overweight and obese patients with heart failure (HF), diabetes mellitus (DM) and/or metabolic syndrome (MS) has not been studied. The purpose of the present study is to assess the short term effects of intentional weight loss on renal function in this population. MATERIALS AND METHODS Fifty nine patients were recruited to participate in a 3-month intensive behavioral weight management intervention and received one of two standard structured energy-restricted meal plans (1200 or 1500kcal/day) based on their computed calorie deficit. Weight and renal function (serum creatinine, BUN and estimated glomerular filtration rate based on two formulas - Modification in Renal Disease Study (MDRD), and modified version of Cockcroft-Gault formula reported by Salazar Corcoran for obese patients (absolute and relative formulas) - were evaluated at baseline and at 3 months. RESULTS Participants had eGFR in the normal range at baseline and lost an average of 7.56±14.9 pounds (p<0.0001) over 3 months; however, there was no significant reduction in serum creatinine, BUN or eGFR. CONCLUSION This study provides evidence that intentional weight loss in overweight and obese patients with HF along with DM, and/or MS and normal baseline renal function does not adversely affect renal function overtime.
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Affiliation(s)
- Marjan Motie
- Program in Nursing Science, University of California Irvine, Irvine, CA, United States.
| | | | - Dawn Lombardo
- Clinical Heart Failure Program, Department of Medicine, University of California Irvine Medical Center, Irvine, CA, United States
| | - Josiah Hoi
- Program in Nursing Science, University of California Irvine, Irvine, CA, United States
| | - Tamara B Horwich
- Cardiology University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Michele Hamilton
- Medicine/Cardiology UCLA, Heart Failure Program, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Cardiology David Geffen School of Medicine, Los Angeles, CA, United States
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36
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Affiliation(s)
- Morgan E. Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- Departments of Epidemiology and
| | - Josef Coresh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- Departments of Epidemiology and
- Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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37
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Yoon HE, Choi SS, Kim Y, Shin SJ. The Clinical Usefulness of Measurement of Visceral Fat Area Using Multi-Frequency Bioimpedance: The Association with Cardiac and Renal Function In General Population with Relatively Normal Renal Function. Int J Med Sci 2017; 14:1375-1381. [PMID: 29200951 PMCID: PMC5707754 DOI: 10.7150/ijms.21393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background: This study was performed to determine the clinical usefulness of measurement of visceral fat area (VFA) using bioimpedance analysis in relation with left ventricular hypertrophy (LVH), diastolic dysfunction parameters, and decreased estimated glomerular filtration rate (eGFR). Methods: A cross-sectional analysis was performed on 1028 patients with eGFR≥60 ml/min/1.73m2, aged 40 - 64 years, and who underwent routine health check-ups. Subjects were divided into tertiles based on their VFA. Associations of VFA with echocardiographic parameters and eGFR were evaluated. Results: Across the VFA teriltes, there was a significant trend for increasing left ventricular mass index (LVMi), left atrial diameter (LAD), and ratio of early mitral inflow velocity to peak mitral annulus velocity (E/E' ratio) and that for decreasing ratio of early to late mitral inflow peak velocities (E/A ratio) and eGFR. In multivariate linear regression analysis, log-transformed VFA was significantly associated with increased LVMi, LAD, and E/E' ratio, and with decreased E/A ratio and eGFR. After adjustment for body mass index, log-transformed VFA remained as a significant determinant for E/A ratio. Conclusion: VFA may be associated with LV structure and diastolic function, and decreased eGFR in middle-aged adults with normal or mildly impaired renal function.
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Affiliation(s)
- Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Su Choi
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yaeni Kim
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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38
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Ouyang Y, Xie J, Yang M, Zhang X, Ren H, Wang W, Chen N. Underweight Is an Independent Risk Factor for Renal Function Deterioration in Patients with IgA Nephropathy. PLoS One 2016; 11:e0162044. [PMID: 27611091 PMCID: PMC5017745 DOI: 10.1371/journal.pone.0162044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/16/2016] [Indexed: 11/18/2022] Open
Abstract
Studies on the relationship between body mass index (BMI) and renal progression in IgA Nephropathy (IgAN) were limited, especially for underweight patients with IgAN. To elucidate the clinical features and effect of underweight on renal function deterioration in this disease, we recruited IgAN patients with diagnostic age ≥18 years old and a baseline estimated glomerular filtration rate (eGFR) ≥15 ml/min/1.73m2 from our center between 1985 and 2014. Patients secondary to systemic diseases or follow-up less than 6 months were excluded. All patients’ clinical data at renal biopsy and during follow-up were recorded. Renal outcome was defined as end-stage kidney disease (ESRD). Baseline body mass index (BMI) was calculated by weight (kg) over squared height (m2). According to WHO Asian guideline, BMI was categorized as follows: <18.5kg/m2 (underweight), 18.5–22.99kg/m2 (normal weight), 23–27.49kg/m2 (overweight) and obese (≥27.5 kg/m2). Of 930 primary IgAN patients enrolled in this study, mean age at renal biopsy was 37.6 years and 49.2% were men. Totally, 114 (12.3%) ESRD occurred after a mean follow-up of 47.1 months. More ESRD happened in underweight patients (17.3%) compared to patients with normal weight (13.2%), overweight (11.0%) or obesity (9.5%). By multivariate Cox regression analysis, underweight was independently associated with a higher risk of ESRD after adjustment for demographic characteristics and clinical variables (HR: 3.5, 95% CI: 1.3–9.5, P = 0.01) comparing to normal weight. Underweight patients had lower hemoglobin, serum uric acid, triglycerides, cholesterol and lymphocyte counts than patients with normal weight. Furthermore, BMI was positively correlated with serum C3 (r = 0.25, p <0.001). Our research finds that underweight is an independent risk factor for kidney disease progression in IgAN, which might be associated with malnutrition status and decreased C3 levels.
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Affiliation(s)
- Yan Ouyang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Meng Yang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaoyan Zhang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weiming Wang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- * E-mail:
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Young BA, Katz R, Boulware LE, Kestenbaum B, de Boer IH, Wang W, Fülöp T, Bansal N, Robinson-Cohen C, Griswold M, Powe NR, Himmelfarb J, Correa A. Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS). Am J Kidney Dis 2016; 68:229-239. [PMID: 27066930 PMCID: PMC5445065 DOI: 10.1053/j.ajkd.2016.02.046] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/02/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Racial differences in rapid kidney function decline exist, but less is known regarding factors associated with rapid decline among African Americans. Greater understanding of potentially modifiable risk factors for early kidney function loss may help reduce the burden of kidney failure in this high-risk population. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,653 African American participants enrolled in the Jackson Heart Study (JHS) with kidney function data from 2 of 3 examinations (2000-2004 and 2009-2013). Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI creatinine equation. PREDICTORS Demographics, socioeconomic status, lifestyle, and clinical risk factors for kidney failure. OUTCOMES Rapid decline was defined as a ≥30% decline in eGFR during follow-up. We quantified the association of risk factors with rapid decline in multivariable models. MEASUREMENTS Clinical (systolic blood pressure and albuminuria [albumin-creatinine ratio]) and modifiable risk factors. RESULTS Mean age was 54±12 (SD) years, 37% were men, average body mass index was 31.8±7.1kg/m(2), 19% had diabetes mellitus (DM), and mean eGFR was 96.0±20mL/min/1.73m(2) with an annual rate of decline of 1.27mL/min/1.73m(2). Those with rapid decline (11.5%) were older, were more likely to be of low/middle income, and had higher systolic blood pressures and greater DM than those with nonrapid decline. Factors associated with ≥30% decline were older age (adjusted OR per 10 years older, 1.51; 95% CI, 1.34-1.71), cardiovascular disease (adjusted OR, 1.53; 95% CI, 1.12-2.10), higher systolic blood pressure (adjusted OR per 17mmHg greater, 1.22; 95% CI, 1.06-1.41), DM (adjusted OR, 2.63; 95% CI, 2.02-3.41), smoking (adjusted OR, 1.60; 95% CI, 1.10-2.31), and albumin-creatinine ratio > 30mg/g (adjusted OR, 1.55; 95% CI, 1.08-1.21). Conversely, results did not support associations of waist circumference, C-reactive protein level, and physical activity with rapid decline. LIMITATIONS No midstudy creatinine measurement at examination 2 (2005-2008). CONCLUSIONS Rapid decline heterogeneity exists among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.
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Affiliation(s)
- Bessie A Young
- Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
| | - Ronit Katz
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | | | - Bryan Kestenbaum
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - Ian H de Boer
- Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Tibor Fülöp
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | | | - Michael Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Neil R Powe
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Jonathan Himmelfarb
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Yu S, Yang H, Guo X, Zheng L, Sun Y. Association between Obese Phenotype and Mildly Reduced eGFR among the General Population from Rural Northeast China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060540. [PMID: 27240390 PMCID: PMC4923997 DOI: 10.3390/ijerph13060540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/15/2016] [Accepted: 05/19/2016] [Indexed: 01/26/2023]
Abstract
Obesity contributes to reduced kidney function; however, whether this is due to obesity itself or the metabolic abnormalities that accompany it is unclear. Besides, most previous studies enrolled participants with moderate or severe stage of chronic kidney disease. In the present study, we aim to investigate the possible relationship between obesity, metabolic abnormalities and mildly reduced estimated glomerular filtration rate (eGFR). A total of 11,127 Chinese participants (age ≥ 35 years) were enrolled in a survey conducted from January 2012 to August 2013. eGFR 60–90 mL/min/1.73 m2 was defined as mildly reduced eGFR. Obese phenotype was divided into four types: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically abnormal non-obese (MANO) and metabolically abnormal obese (MAO). Among all participants, 1941 (17.4%) of them had mildly reduced eGFR (16.7% for men and 18.1% for women, p = 0.025). The prevalence of obese phenotype was 22.5% for MHNO, 9.1% for MHO, 32.1% for MANO and 36.4% for MAO. The prevalence of mildly reduced eGFR was 9.0% among MHNO, 7.0% among MHO, 22.6% among MANO and 20.7% among MAO (p < 0.001). Multivariate logistic regression analysis revealed that obese phenotype did not statically contributed to mildly reduced eGFR (MHO: OR = 1.107, p = 0.662; MANO: OR = 0.800, p = 0.127; MAO: OR = 1.119, p = 0.525). However, gender (OR = 1.475, p < 0.001), aging (OR = 1.283, p < 0.001), dyslipidemia (OR = 1.544, 95%CI: 1.315, 1.814, p < 0.001) and hyperglycemia (OR = 1.247, 95%CI: 1.068, 1.455, p = 0.005) was associated with increased risk of mild reduced eGFR. Among the general population from rural Northeast China, mildly reduced eGFR was associated with metabolic disorders like dyslipidemia and hyperglycemia, but not obesity.
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Affiliation(s)
- Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shenjing Hospital of China Medical University, Shenyang 110003, China.
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
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Rebholz CM, Anderson CAM, Grams ME, Bazzano LA, Crews DC, Chang AR, Coresh J, Appel LJ. Relationship of the American Heart Association's Impact Goals (Life's Simple 7) With Risk of Chronic Kidney Disease: Results From the Atherosclerosis Risk in Communities (ARIC) Cohort Study. J Am Heart Assoc 2016; 5:e003192. [PMID: 27053058 PMCID: PMC4859292 DOI: 10.1161/jaha.116.003192] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND As part of its 2020 Impact Goals, the American Heart Association developed the Life's Simple 7 metric for cardiovascular health promotion. The relationship between the Life's Simple 7 metric and incident chronic kidney disease (CKD) is unknown. METHODS AND RESULTS We estimated the association between Life's Simple 7 and incident CKD in 14 832 Atherosclerosis Risk in Communities study participants. Ideal levels of Life's Simple 7 health factors were the following: nonsmoker or quit >1 year ago; body mass index <25 kg/m(2); ≥150 minutes/week of physical activity; healthy dietary pattern (high in fruits and vegetables, fish, and fiber-rich whole grains; low in sodium and sugar-sweetened beverages); total cholesterol <200 mg/dL; blood pressure <120/80 mm Hg; and fasting blood glucose <100 mg/dL. At baseline, mean age was 54 years, 55% were women, and 26% were African American. There were 2743 incident CKD cases over a median follow-up of 22 years. Smoking, body mass index, physical activity, blood pressure, and blood glucose were associated with CKD risk (all P<0.01), but diet and blood cholesterol were not. CKD risk was inversely related to the number of ideal health factors (P-trend<0.001). A model containing the Life's Simple 7 health factors was more predictive of CKD risk than the base model including only age, sex, race, and estimated glomerular filtration rate (Life's Simple 7 health factors area under the ROC curve: 0.73, 95% CI: 0.72, 0.74 versus base model area under the ROC curve: 0.68, 95% CI: 0.67, 0.69; P<0.001). CONCLUSIONS The AHA's Life's Simple 7 metric, developed to measure and promote cardiovascular health, predicts a lower risk of CKD.
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Affiliation(s)
- Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Cheryl A M Anderson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA
| | - Morgan E Grams
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alex R Chang
- Division of Nephrology, Geisinger Health System, Danville, PA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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AMADOR VAG, FREITAS ATVDS, NAGHETTINI AV, PEREIRA ERS, PEIXOTO MDRG. Anthropometric measurements and markers of renal function in adults and older adults. REV NUTR 2016. [DOI: 10.1590/1678-98652016000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: To determine whether anthropometric indicators are associated with markers of renal function in adults and older adults. Methods: This cross-sectional study included 279 adults and older adults attending eight primary healthcare units in eastern Goiânia, Góias. Sociodemographic, lifestyle, and clinical data were collected using a standard questionnaire. Body mass index was categorized as overweight (≥25 kg/m²) or non-overweight. Waist circumference was classified as normal or high; chronic kidney disease was defined as a glomerular filtration rate below 60 mL/minutes/1.73 m²; micro/macroalbuminuria was defined as an albumin/creatinine ratio above 30 mg/g. The association between anthropometric indicators and renal function markers was assessed by multiple linear regression analysis. Results: Chronic kidney disease was present in 8.9% and micro/macroalbuminuria in 34.8% of the sample. The prevalence of overweight was 57.0%. Waist circumference and body mass index were positively associated with glomerular filtration rate, characterized as glomerular hyperfiltration. Microalbuminuria was positively associated with body mass index in women. Conclusion: The prevalences of chronic kidney disease and overweight were high in the study population. Overweight was positively associated with glomerular filtration rate.
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Li L, Hongwei S, Ying Q, Jianzhong L, Zhifang W, Ling G, Sijin L. Influence of Weight-Age Normalization on Glomerular Filtration Rate Values of Renal Patients: A STROBE-Compliant Article. Medicine (Baltimore) 2016; 95:e2492. [PMID: 26817886 PMCID: PMC4998260 DOI: 10.1097/md.0000000000002492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To explore whether weight-age (W-A) could be applied in clinical practice, this study was designed to verify the normalization ability of W-A by the data from another medical center, and to access the influence of the normalization on glomerular filtration rate (GFR) values in renal patients.Both plasma clearance (pGFR) and camera-based (gGFR), which were separately scaled to W-A and body surface area (BSA), were measured for patients with diffuse renal diseases. The patients (n = 298) were stratified according to the Chinese body mass index (BMI) criteria and were staged according to the Kidney Disease Outcome Quality Initiatives guideline based on gGFR and pGFR separately.The indices of intraclass correlation coefficient (ICC), concordance correlation coefficient (CCC), and ratio of residual standard deviation to pooled standard deviation (RSD/PSD) suggested that, for all patients and each BMI stratum, W-A was obviously better than BSA in scaling GFR. Both under pGFR or gGFR renal stages, only small amount of the patients encountered stage migrations from BSA to W-A scaled stages. The differences between any 2 of the unscaled, BSA scaled, and W-A scaled gGFR (or pGFR) were not obviously changed. Additionally, in some strata, W-A normalization is better than BSA normalization in decreasing the median bias between pGFR and gGFR.W-A is better than BSA in scaling GFR without obvious modifying GFR values and can be applied in routine clinical practice.
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Affiliation(s)
- Li Li
- From the Department of Nuclear Medicine, the First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi Province (LL, SH, QY, GL, LJ, WZ, LS)
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Obesity-Related Chronic Kidney Disease-The Role of Lipid Metabolism. Metabolites 2015; 5:720-32. [PMID: 26690487 PMCID: PMC4693192 DOI: 10.3390/metabo5040720] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/01/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Obesity is an independent risk factor for chronic kidney disease (CKD). The mechanisms linking obesity and CKD include systemic changes such as high blood pressure and hyperglycemia, and intrarenal effects relating to lipid accumulation. Normal lipid metabolism is integral to renal physiology and disturbances of renal lipid and energy metabolism are increasingly being linked with kidney disease. AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) are important regulators of fatty acid oxidation, which is frequently abnormal in the kidney with CKD. A high fat diet reduces renal AMPK activity, thereby contributing to reduced fatty acid oxidation and energy imbalance, and treatments to activate AMPK are beneficial in animal models of obesity-related CKD. Studies have found that the specific cell types affected by excessive lipid accumulation are proximal tubular cells, podocytes, and mesangial cells. Targeting disturbances of renal energy metabolism is a promising approach to addressing the current epidemic of obesity-related kidney disease.
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Maleki A, Montazeri M, Rashidi N, Montazeri M, Yousefi-Abdolmaleki E. Metabolic syndrome and its components associated with chronic kidney disease. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:465-9. [PMID: 26487875 PMCID: PMC4590201 DOI: 10.4103/1735-1995.163969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: There is limited information on the relationship between metabolic syndrome (MetS) and chronic kidney disease (CKD) in the Iranian population, a group that has a high prevalence of CKD and obesity. The aim of present study was to determine the relationship between MetS and CKD in West of Iran. Materials and Methods: A total of 800 subjects aged more than 35 years admitted from 2011 to 2013 were enrolled in the study. MetS was defined based on the Adult Treatment Panel III criteria, and CKD was defined from the Kidney Disease Outcomes Quality Initiative practice guidelines. Waist circumference and body mass index were calculated, as well, blood samples were taken and lipid profile, plasma glucose levels, and serum creatinine were measured. Data were analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA). Results: CKD was seen in 14.8% patients with MetS and 8.3% individuals without MetS. MetS was associated with an increased odds ratio (OR) for a glomerular filtration rate <60 ml/min/1.73 m2 (OR: 1.91; 95% confidence interval [CI]: 1.22-2.99; P = 0.004). Individuals with 2, 3, 4, and 5 components of the MetS had an increased OR for CKD: 2.19 (95% CI: 0.95-3.62), 2.65 (95% CI: 1.03-4.71), 2.86 (95% CI: 1.08-5.53), and 5.03 (95% CI: 1.80-8.57), respectively, compared with individuals with none of the components. Conclusion: We found a high prevalence of CKD in patients with MetS compared with the subject without MetS. Our observations raised major clinical and public health concerns in Iran, where both the MetS and kidney diseases are becoming common.
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Affiliation(s)
- Ali Maleki
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mahdi Montazeri
- Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Rashidi
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Montazeri
- Young Researchers Club, Islamic Azad University, Babol Branch, Babol, Iran
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Eppenga WL, Kramers C, Derijks HJ, Wensing M, Wetzels JFM, De Smet PAGM. Individualizing pharmacotherapy in patients with renal impairment: the validity of the Modification of Diet in Renal Disease formula in specific patient populations with a glomerular filtration rate below 60 ml/min. A systematic review. PLoS One 2015; 10:e0116403. [PMID: 25741695 PMCID: PMC4351004 DOI: 10.1371/journal.pone.0116403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/09/2014] [Indexed: 01/20/2023] Open
Abstract
Background The Modification of Diet in Renal Disease (MDRD) formula is widely used in clinical practice to assess the correct drug dose. This formula is based on serum creatinine levels which might be influenced by chronic diseases itself or the effects of the chronic diseases. We conducted a systematic review to determine the validity of the MDRD formula in specific patient populations with renal impairment: elderly, hospitalized and obese patients, patients with cardiovascular disease, cancer, chronic respiratory diseases, diabetes mellitus, liver cirrhosis and human immunodeficiency virus. Methods and Findings We searched for articles in Pubmed published from January 1999 through January 2014. Selection criteria were (1) patients with a glomerular filtration rate (GFR) < 60 ml/min (/1.73m2), (2) MDRD formula compared with a gold standard and (3) statistical analysis focused on bias, precision and/or accuracy. Data extraction was done by the first author and checked by a second author. A bias of 20% or less, a precision of 30% or less and an accuracy expressed as P30% of 80% or higher were indicators of the validity of the MDRD formula. In total we included 27 studies. The number of patients included ranged from 8 to 1831. The gold standard and measurement method used varied across the studies. For none of the specific patient populations the studies provided sufficient evidence of validity of the MDRD formula regarding the three parameters. For patients with diabetes mellitus and liver cirrhosis, hospitalized patients and elderly with moderate to severe renal impairment we concluded that the MDRD formula is not valid. Limitations of the review are the lack of considering the method of measuring serum creatinine levels and the type of gold standard used. Conclusion In several specific patient populations with renal impairment the use of the MDRD formula is not valid or has uncertain validity.
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Affiliation(s)
- Willemijn L. Eppenga
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
- * E-mail:
| | - Cornelis Kramers
- Radboud University Medical Center, Department of Pharmacology and Toxicology, Nijmegen, The Netherlands
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Hieronymus J. Derijks
- Hospital Pharmacy ‘ZANOB’, ‘s-Hertogenbosch, The Netherlands
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Jack F. M. Wetzels
- Radboud University Medical Center, Department of Nephrology, Nijmegen, The Netherlands
| | - Peter A. G. M. De Smet
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, The Netherlands
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Tsirigoti L, Kontogianni MD, Darema M, Iatridi V, Altanis N, Poulia KA, Zavos G, Boletis J. Exploring associations between anthropometric indices and graft function in patients receiving renal transplant. J Hum Nutr Diet 2014; 29:52-8. [PMID: 25522813 DOI: 10.1111/jhn.12289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to identify indicators of malnutrition, as obtained by anthropometric measurements, that might be potential predictors of transplant outcomes. METHODS One hundred and three patients receiving a graft from a living or a deceased donor were included in this prospective study. Body mass index (BMI) based on pretransplant dry body weight, triceps skinfold, mid-arm muscle circumference and corrected mid-arm muscle area were measured. Post-transplant data on delayed graft function (DGF) and glomerular filtration rate (GFR) at discharge were collected until patient discharge. RESULTS Delayed graft function developed in 36.9% of the patients. BMI was the only anthropometric variable associated with a higher likelihood of DGF (odds ratio = 1.25, 95% confidence interval = 1.07-1.47) after adjusting for age, gender, donor group, donor age and years of dialysis before transplantation. Obesity was associated with a higher frequency of DGF (83.3% versus 31.1%, P = 0.001) compared to normal weight. GFR at discharge was negatively associated with BMI [β = -0.014 (0.005), P = 0.004], being overweight [β = -0.151 (0.041), P < 0.001] and obesity [β = -0.188 (0.053), P = 0.001], after adjusting for age, gender, donor group, donor age and years of dialysis, but was not associated with indices of muscle reserves. CONCLUSIONS The likelihood of DGF was higher among obese patients, whereas GFR at discharge was negatively associated with being overweight and obesity.
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Affiliation(s)
- L Tsirigoti
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - M D Kontogianni
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - M Darema
- Department of Nephrology & Transplantation Unit, Laiko Hospital, Athens, Greece
| | - V Iatridi
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - N Altanis
- Department of Nephrology & Transplantation Unit, Laiko Hospital, Athens, Greece
| | - K A Poulia
- Department of Nutrition & Dietetics, Laiko Hospital, Athens, Greece
| | - G Zavos
- Transplantation Unit, Laiko Hospital, Athens, Greece
| | - J Boletis
- Department of Nephrology & Transplantation Unit, Laiko Hospital, Athens, Greece
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Ricardo AC, Anderson CA, Yang W, Zhang X, Fischer MJ, Dember LM, Fink JC, Frydrych A, Jensvold NG, Lustigova E, Nessel LC, Porter AC, Rahman M, Wright Nunes JA, Daviglus ML, Lash JP. Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2014; 65:412-24. [PMID: 25458663 DOI: 10.1053/j.ajkd.2014.09.016] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/24/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND In general populations, healthy lifestyle is associated with fewer adverse outcomes. We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease (CKD). STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS 3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. PREDICTORS 4 lifestyle factors (regular physical activity, body mass index [BMI] of 20-<25kg/m(2), nonsmoking, and "healthy diet"), individually and in combination. OUTCOMES CKD progression (50% decrease in estimated glomerular filtration rate or end-stage renal disease), atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease), and all-cause mortality. MEASUREMENTS Multivariable-adjusted Cox proportional hazards. RESULTS During a median follow-up of 4 years, we observed 726 CKD progression events, 355 atherosclerotic events, and 437 deaths. BMI≥25kg/m(2) and nonsmoking were associated with reduced risk of CKD progression (HRs of 0.75 [95% CI, 0.58-0.97] and 0.61 [95% CI, 0.45-0.82] for BMIs of 25 to <30 and ≥30kg/m(2), respectively, versus 20 to <25kg/m(2); HR for nonsmoking of 0.68 [95% CI, 0.55-0.84] compared to the current smoker reference group) and reduced risk of atherosclerotic events (HRs of 0.67 [95% CI, 0.46-0.96] for BMI of 25-<30 vs 20-<25kg/m(2) and 0.55 [95% CI, 0.40-0.75] vs current smoker). Factors associated with reduced all-cause mortality were regular physical activity (HR, 0.64 [95% CI, 0.52-0.79] vs inactive), BMI≥30kg/m(2) (HR, 0.64 [95% CI, 0.43-0.96] vs 20-<25kg/m(2)), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI<20kg/m(2) was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-<25kg/m(2)). Adherence to all 4 lifestyle factors was associated with a 68% lower risk of all-cause mortality compared to adherence to no lifestyle factors (HR, 0.32; 95% CI, 0.11-0.89). LIMITATIONS Lifestyle factors were measured only once. CONCLUSIONS Regular physical activity, nonsmoking, and BMI≥25kg/m(2) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.
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Affiliation(s)
- Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL.
| | - Cheryl A Anderson
- Department of Family and Preventive Medicine, University of California, San Diego, CA
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Michael J Fischer
- Department of Medicine, University of Illinois at Chicago, Chicago, IL; Center for Management of Complex Chronic Care, Jesse Brown VA Medical Center, Chicago, IL
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Anne Frydrych
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Nancy G Jensvold
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Eva Lustigova
- Department of Epidemiology, Tulane University, New Orleans, LA
| | - Lisa C Nessel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Anna C Porter
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mahboob Rahman
- Case Western Reserve University, University Hospitals Case Medical Center and Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | | | - Martha L Daviglus
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
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Shah AD, Schmidt H, Sen S, Shlipak MG, Kanaya AM. The association between body composition and cystatin C in South Asians: results from the MASALA study. Obes Res Clin Pract 2014; 9:180-3. [PMID: 25465493 DOI: 10.1016/j.orcp.2014.10.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/26/2022]
Abstract
While South Asians have high rates of obesity and kidney disease, little is known about the effect of regional body composition on kidney function. We investigated the association between body composition measures and cystatin C-based estimated glomerular filtration rate (eGFRcysC) in 150 immigrant South Asians. The inverse association between overall adiposity and eGFRcysC was attenuated by C-reactive protein (CRP), while the association of ectopic fat was completely attenuated by metabolic covariates and CRP. In immigrant South Asians, the associations between overall adiposity and ectopic fat with decreased kidney function are largely explained by metabolic alterations and inflammation.
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Affiliation(s)
- Arti D Shah
- Division of Endocrinology and Metabolism, University of California, San Francisco, United States.
| | - Heidi Schmidt
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, United States
| | - Saunak Sen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
| | - Michael G Shlipak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States; Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, United States
| | - Alka M Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
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50
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Malkina A, Scherzer R, Shlipak MG, Bacchetti P, Tien PC, Grunfeld C, Kosmiski L, Peralta CA. The association of adiposity with kidney function decline among HIV-infected adults: findings from the Fat Redistribution and Metabolic Changes in HIV Infection (FRAM) study. HIV Med 2014; 16:184-90. [PMID: 25251910 DOI: 10.1111/hiv.12196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the association of adiposity with longitudinal kidney function change in 544 HIV-infected persons in the Study of Fat Redistribution and Metabolic Change in HIV infection (FRAM) cohort over 5 years of follow-up. METHODS The regional distribution of muscle and adipose tissue was quantified by whole-body magnetic resonance imaging (MRI), and total adiponectin and leptin levels were measured in serum. Kidney function was assessed using the estimated glomerular filtration rate from serum cystatin C (eGFRCys), obtained at baseline and follow-up. Rapid kidney function decline was defined as annual loss of eGFRCys ≥ 3 mL/min/1.73 m(2) , and incident chronic kidney disease (CKD) was defined as eGFRCys <60 mL/min/1.73 m(2) . Multivariate regression analysis was adjusted for age, race, gender, glucose, antihypertensive use, serum albumin, baseline and change in HIV viral load. RESULTS At baseline, mean age was 43 years, mean eGFRCys was 86 mL/min/1.73 m(2) , and 21% of patients had albuminuria. The mean (± standard deviation) eGFRCys decline was -0.11 ± 4.87 mL/min/1.73 m(2) per year; 23% of participants had rapid kidney function decline, and 10% developed incident CKD. The lowest tertile of visceral adipose tissue and the highest tertile of adiponectin were both marginally associated with annual kidney function decline of -0.5 mL/min/1.73 m(2) each, but these associations were not statistically significant after adjustment. We found no statistically significant associations of MRI-measured regional adiposity or serum adipokines with rapid kidney function decline or incident CKD (all P-values>0.1 in adjusted models). CONCLUSIONS Contrary to findings in the general population, adiposity did not have a substantial association with longitudinal change in kidney function among HIV-infected persons.
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Affiliation(s)
- A Malkina
- University of California San Francisco Division of Nephrology, San Francisco, CA, USA; Veterans Affairs Medical Center Department of Medicine, San Francisco, CA, USA
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