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Zhu M, Bi Z, Wang Y, Li W. Serum hydroxycotinine was associated with chronic kidney disease (CKD): a cross-sectional study based on NHANES. Ren Fail 2024; 46:2356024. [PMID: 38832473 DOI: 10.1080/0886022x.2024.2356024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/12/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Smoking has been suggested as a modifiable and cardiovascular risk factor for chronic kidney disease (CKD). Although long-term smoking has been associated with CKD, the potential relationship between its metabolite hydroxycotinine and CKD has not been clarified. METHODS A total of 8,544 participants aged 20 years and above from the National Health and Nutrition Examination Survey (NHANES) 2017 - March 2020 were enrolled in our study. CKD was defined by estimated glomerular filtration rate (eGFR) < 60 mL/(min*1.73 m2). Serum hydroxycotinine was measured by an isotope-dilution high-performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometric (ID HPLC-APCI MS/MS) method with a lower limit of detections (LLOD) at 0.015 ng/mL. The non-linear relationship was explored with restricted cubic splines (RCS). Pearson's correlation coefficient and a multivariate logistic regression model were used for correlation analysis. RESULTS Serum hydroxycotinine and eGFR were negatively correlated in both non-CKD group (r= -0.05, p < 0.001) and CKD group (r= -0.04, p < 0.001). After serum hydoxycotinine dichotominzed with LLOD, serum hydroxycotinine ≥ 0.015 ng/mL was negatively correlated with eGFR not only in non-CKD group (r = -0.05, p < 0.001) but also in CKD group (r = -0.09, p < 0.001). After adjusting for comprehensive confounders, results from the multivariate logistic regression analysis showed that participants with serum hydroxycotinine ≥ 0.015 ng/mL had increased odds of CKD (OR = 1.505, p < 0.001). CONCLUSIONS Serum hydroxycotinine might be positively associated with CKD. Further study is warranted to find the right concentration of hydroxycotinine to measure the CKD.
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Affiliation(s)
- Meng'en Zhu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhimin Bi
- Department of Nephrology, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan University, Wuhan, P.R. China
| | - Yaoling Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ma X, Lv J, Zhang S, Zhang X, Lin X, Li S, Yang L, Xue F, Yi F, Zhang T. Habitual Iron Supplementation Associated with Elevated Risk of Chronic Kidney Disease in Individuals with Antihypertensive Medication. Nutrients 2024; 16:2355. [PMID: 39064798 PMCID: PMC11279651 DOI: 10.3390/nu16142355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to examine the effects of habitual iron supplementation on the risk of CKD in individuals with different hypertensive statuses and antihypertension treatment statuses. We included a total of 427,939 participants in the UK Biobank study, who were free of CKD and with complete data on blood pressure at baseline. Cox proportional hazards regression models were used to examine the adjusted hazard ratios of habitual iron supplementation for CKD risk. After multivariable adjustment, habitual iron supplementation was found to be associated with a significantly higher risk of incident CKD in hypertensive participants (HR 1.12, 95% CI 1.02 to 1.22), particularly in those using antihypertensive medication (HR 1.21, 95% CI 1.08 to 1.35). In contrast, there was no significant association either in normotensive participants (HR 1.06, 95% CI 0.94 to 1.20) or in hypertensive participants without antihypertensive medication (HR 1.02, 95% CI 0.90 to 1.17). Consistently, significant multiplicative and additive interactions were observed between habitual iron supplementation and antihypertensive medication on the risk of incident CKD (p all interaction < 0.05). In conclusion, habitual iron supplementation was related to a higher risk of incident CKD among hypertensive patients, the association might be driven by the use of antihypertensive medication.
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Affiliation(s)
- Xiaoyan Ma
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Jiali Lv
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Shuai Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Xiaofeng Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Xia Lin
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Shengxu Li
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN 55404, USA;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2V 0N5, Canada;
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2V 0N5, Canada
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Fan Yi
- The Key Laboratory of Infection and Immunity of Shandong Province, Department of Pharmacology, School of Basic Medical Sciences, Shandong University, Jinan 250012, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (X.M.); (J.L.); (S.Z.); (X.Z.); (X.L.); (F.X.)
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
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AlQashqri H. Renally Inappropriate Medications in the Old Population: Prevalence, Risk Factors, Adverse Outcomes, and Potential Interventions. Cureus 2023; 15:e49111. [PMID: 38125263 PMCID: PMC10732268 DOI: 10.7759/cureus.49111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Like most organs, the renal system decreases in function as we age. In the elderly, chronic kidney disease is common. When patients with chronic kidney disease take nephrotoxic medications, they are more likely to suffer adverse drug reactions, be hospitalized, and spend an extended period in the hospital. Calculating the renal clearance of a drug dose based on its glomerular filtration rate, or creatinine clearance, is necessary. Multiple tools are available for identifying renally inappropriate medications (RIMs). RIM prescriptions can be influenced by various factors, which vary according to the study. A higher number of medications means a higher likelihood of using RIMs. Numerous studies have investigated RIMs. The most contraindicated drug in renal insufficiency patients was a non-steroidal anti-inflammatory medication. A variety of interventions have been used to reduce RIM prescriptions to varying degrees of success.
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Affiliation(s)
- Hamsa AlQashqri
- Community and Family Medicine, Umm Al-Qura University, Makkah, SAU
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Fang Y, Lee H, Son S, Oh S, Jo SK, Cho W, Kim MG. Association between Consumption of Dietary Supplements and Chronic Kidney Disease Prevalence: Results of the Korean Nationwide Population-Based Survey. Nutrients 2023; 15:nu15040822. [PMID: 36839180 PMCID: PMC9967330 DOI: 10.3390/nu15040822] [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: 01/13/2023] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Despite the enormous global market of dietary supplements, the impact of dietary supplements on kidney disease is still unclear. Based on the National Health and Nutrition Examination Survey from 2015 to 2017, this study evaluated the association between dietary supplement and chronic kidney disease (CKD) in 13,271 Korean adults. Among the dietary supplements, vitamin and mineral intake was the highest at 61.41%, followed by omega-3 fatty acids at 11.85%, and ginseng at 7.99%. The prevalence of CKD was significantly higher in those who consumed amino acids and proteins, ginseng and red ginseng, and herbal medicine (plant extract)-berries than in those who did not. Conversely, patients who consumed probiotic supplements had a significantly lower prevalence of CKD than those who did not. In the population without CKD risk factors or history of CKD, the prevalence of CKD was high in the group consuming ginseng and red ginseng. After adjusting for covariates, the herbal medicine (plant extract)-berry group showed an independent association with CKD incidence. In conclusion, it is suggested that dietary supplements may affect kidney function. Further large-scale cohort studies are required to elucidate the exact effects of each dietary supplement on CKD.
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Affiliation(s)
- Yina Fang
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Hwasun Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul 02842, Republic of Korea
| | - Serhim Son
- Department of Biostatistics, Korea University College of Medicine, Seoul 02842, Republic of Korea
| | - Sewon Oh
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Wonyong Cho
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
- Correspondence: ; Tel.: +82-2-920-5475
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Associations between dietary patterns and stages of chronic kidney disease. BMC Nephrol 2022; 23:115. [PMID: 35317735 PMCID: PMC8939097 DOI: 10.1186/s12882-022-02739-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have revealed that patients with chronic kidney disease (CKD) have dietary patterns different from those of the general population. However, no studies have compared the dietary patterns of between patients with early-stages (stages 1-3a) and late-stages (stages 3b-5) of CKD. Our objective was to investigate the associations between dietary patterns in early and late-stage CKD. METHODS We analyzed 4480 participants with CKD at various stages based on the data recorded between 2007 and 2016 from the database of the American National Health and Nutrition Examination Survey. RESULTS In total, 3683 and 797 participants had early and late-stage CKD, respectively. Through principal components analysis, the dietary intake dimension was reduced from 63 variables to 3 dietary patterns. We adopted logistic regression for analysis. The three dietary patterns are as follows: (1) saturated fatty acids and mono-unsaturated fatty acids (MUFA); (2) vitamins and minerals; and (3) cholesterols and polyunsaturated fatty acids (PUFA). These 3 patterns explained > 50% of dietary nutrient intake. Results indicated that among participants with dietary patterns 2 (vitamins and minerals) and 3 (cholesterols and PUFA), those with low intakes were more likely to have late-stage CKD. The odds ratios for patterns 2 and 3 were 1.74 (95% CI: 1.21-2.50) and 1.66 (95% CI: 1.13-2.43), respectively. CONCLUSIONS This study revealed that intakes of vitamins and minerals and cholesterols and PUFA were associated with the stages of CKD.
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Dwyer JT, Saldanha LG, Bailen R. Dietary supplement databases: Public health tools. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2021.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Okuhara T, Yokota R, Shirabe R, Iye R, Okada H, Kiuchi T, Chiba T, Akamatsu R. Japanese newspaper advertisements for dietary supplements before and after COVID-19: a content analysis. BMJ Open 2021; 11:e050898. [PMID: 34815281 PMCID: PMC8611233 DOI: 10.1136/bmjopen-2021-050898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread. DESIGN Content analysis. PARTICIPANTS We analysed advertisements for dietary supplements in two major Japanese newspapers in February-July 2019 and February-July 2020. Our analysis covered 2167 advertisements. RESULTS The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as 'defence' and 'prevent' were used to promote the preventive effect. CONCLUSIONS False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rie Yokota
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ritsuko Shirabe
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Reina Iye
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroko Okada
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan
| | - Rie Akamatsu
- Natural Science Division, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
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A Content Analysis of Video Advertisements for Dietary Supplements in Japan. Healthcare (Basel) 2021; 9:healthcare9060742. [PMID: 34204421 PMCID: PMC8235716 DOI: 10.3390/healthcare9060742] [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: 05/17/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of video advertisements for dietary supplements and described the content of advertisements with high numbers and frequent views. We analyzed 82 video advertisements on YouTube that promoted fat-reduction effects. We extracted 22 themes and classified them into 10 categories. The categories with the highest numbers of advertisements were “Exemption” (i.e., consuming the product frees the audience from refraining from binge eating) (20 ads, 24.4%) and “Health Concerns” (i.e., the product intake solves the health concerns of the audience) (19 ads, 23.2%). These advertisements may stimulate negative audience attitudes toward appropriate health behaviors. The category with the most frequent views was “Lifestyle” (i.e., adding product intake to a healthy lifestyle) (3,035,298 views). “Lifestyle” advertisements portray physical activity in a positive light and may promote appropriate health behaviors in the audience. We discuss the possible effects of the advertisements on audiences and consider issues for future research and practice.
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Bigotte Vieira M, Magriço R, Viegas Dias C, Leitão L, Neves JS. Caffeine consumption and mortality in chronic kidney disease: a nationally representative analysis. Nephrol Dial Transplant 2020; 34:974-980. [PMID: 30215779 DOI: 10.1093/ndt/gfy234] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the association between caffeine consumption and mortality in patients with chronic kidney disease (CKD) remains uncertain. METHODS We analysed 4863 non-institutionalized USA adults with CKD [defined by an estimated glomerular filtration rate (eGFR) of 15-60 mL/min/1.73 m2 and/or a urinary albumin:creatinine ratio >30 mg/g] in a nationwide study using the National Health and Nutrition Examination Survey (NHANES) 1999-2010. Caffeine consumption was evaluated by 24-h dietary recalls at baseline and all-cause, cardiovascular and cancer mortality were evaluated until 31 December 2011. We also performed an analysis of caffeine consumption according to its source (coffee, tea and soft drinks). Quartiles of caffeine consumption were <28.2 mg/day (Q1), 28.2-103.0 (Q2), 103.01-213.5 (Q3) and >213.5 (Q4). RESULTS During a median follow-up of 60 months, 1283 participants died. Comparing with Q1 of caffeine consumption, the adjusted hazard ratio for all-cause mortality was 0.74 [95% confidence interval (CI) 0.60-0.91] for Q2, 0.74 (95% CI 0.62-0.89) for Q3 and 0.78 (95% CI 0.62-0.98) for Q4 (P = 0.02 for trend across quartiles). There were no significant interactions between caffeine consumption quartiles and CKD stages or urinary albumin:creatinine ratio categories regarding all-cause mortality. CONCLUSIONS We detected an inverse association between caffeine consumption and all-cause mortality among participants with CKD.
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Affiliation(s)
- Miguel Bigotte Vieira
- Nephrology and Renal Transplantation Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Rita Magriço
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Lia Leitão
- Neurology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Porto, Portugal.,Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
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Abstract
This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.
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Affiliation(s)
- Amita Jain
- HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Guzman JR, Paterniti DA, Liu Y, Tarn DM. Factors Related to Disclosure and Nondisclosure of Dietary Supplements in Primary Care, Integrative Medicine, and Naturopathic Medicine. ACTA ACUST UNITED AC 2019; 5. [PMID: 32051918 PMCID: PMC7015169 DOI: 10.23937/2469-5793/1510109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients’ disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice. Methods: Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California. Results: We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients’ convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001). Conclusions: When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.
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Affiliation(s)
- Jennifer R Guzman
- Department of Anthropology, State University of New York at Geneseo, USA
| | - Debora A Paterniti
- Department of Sociology, Sonoma State University, USA.,Departments of Internal Medicine and Sociology, University of California - Davis, USA
| | | | - Derjung M Tarn
- Department of Family Medicine, University of California - Los Angeles, USA
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Kurani S, Hickson LJ, Thorsteinsdottir B, Barreto EF, Haag JD, Shah ND, McCoy RG. Supplement Use by US Adults With CKD: A Population-Based Study. Am J Kidney Dis 2019; 74:862-865. [PMID: 31327533 DOI: 10.1053/j.ajkd.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/16/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Shaheen Kurani
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | - LaTonya J Hickson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Bjorg Thorsteinsdottir
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Erin F Barreto
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Pharmacy, Mayo Clinic, Rochester, MN
| | | | - Nilay D Shah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rozalina G McCoy
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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Tuot DS, Wong KK, Velasquez A, Crews DC, Zonderman AB, Evans MK, Powe NR. CKD Awareness in the General Population: Performance of CKD-Specific Questions. Kidney Med 2019; 1:43-50. [PMID: 32734184 PMCID: PMC7380399 DOI: 10.1016/j.xkme.2019.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rationale & Objective Data from patients in one delivery system have suggested that the prevalence of chronic kidney disease (CKD) awareness differs by how the question is asked. We examined the sensitivity and specificity of different CKD awareness questions among diverse community-dwelling adults who were not necessarily engaged in primary care to determine the generalizability of prior results. Study Design Cross-sectional study. Setting & Participants Participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study. Predictor CKD awareness, ascertained using 5 different questions. Outcome Sensitivity and specificity of each awareness question, using laboratory results as the gold standard. Analytic Approach Logistic regression was used to compare sensitivities of different awareness questions. Results Among 2,046 participants, mean (SD) age was 56.5 (9.1) years, 41.5% were men, and 61.3% were African American. More than 40% were poor, 35% reported not having health insurance, and 16.9% had low health literacy. More than 20% (n = 424) had CKD. Sensitivities of single CKD awareness questions ranged from 2.2% for “kidney damage” to 5.2% for “kidney problem.” Sensitivity of the compound question asking about “weak kidneys, failing kidneys, or kidney disease” was 19.5%. Sensitivity of this compound CKD awareness question was higher among study participants with more advanced CKD and low health literacy, and those who lived below the poverty level. Limitations Single measures of estimated glomerular filtration rate and albuminuria; study participants may have been more engaged in their health care than the average US adult, potentially limiting the generalizability of results. Conclusions CKD awareness is low among community-dwelling adults with kidney disease, though data using a sensitive compound question ascertaining awareness suggest that we have met the Healthy People 2020 goal related to CKD awareness of 13.4%. Understanding the phrases about kidney disease that are most understandable to patients with and at risk for CKD is important to further increase CKD awareness.
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Affiliation(s)
- Delphine S. Tuot
- Division of Nephrology, University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Address for Correspondence: Delphine S. Tuot, MDCM, MAS, Division of Nephrology, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Bldg 100, Rm 342, San Francisco, CA 94110.
| | - Karen K. Wong
- Touro University California College of Osteopathic Medicine, Vallejo, CA
| | - Alexandra Velasquez
- Division of Nephrology, University of California, San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Alan B. Zonderman
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Michele K. Evans
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Neil R. Powe
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco, CA
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Binns CW, Lee MK, Lee AH. Problems and Prospects: Public Health Regulation of Dietary Supplements. Annu Rev Public Health 2018; 39:403-420. [DOI: 10.1146/annurev-publhealth-040617-013638] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Colin W. Binns
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;,
| | - Mi Kyung Lee
- School of Health Professions, Murdoch University, Perth, Western Australia 6150, Australia
| | - Andy H. Lee
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;,
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Liu Y, Kuczmarski MF, Miller ER, Nava MB, Zonderman AB, Evans MK, Powe NR, Crews DC. Dietary Habits and Risk of Kidney Function Decline in an Urban Population. J Ren Nutr 2016; 27:16-25. [PMID: 27771303 DOI: 10.1053/j.jrn.2016.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/30/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore the association between following a Dietary Approaches to Stop Hypertension (DASH)-accordant diet and kidney end points among urban adults. DESIGN Prospective cohort study. SETTING Healthy Aging in Neighborhoods of Diversity across the Life Span study. SUBJECTS A total of 1,534 urban dwelling participants of the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.73 m2. INTERVENTION DASH diet accordance determined via a score based on nine target nutrients. MAIN OUTCOME MEASURE Rapid kidney function decline (eGFR decline >3 mL/minute/1.73 m2 per year), incident chronic kidney disease (CKD) (follow-up eGFR <60 mL/minute/1.73 m2), and eGFR decline >25%. RESULTS Participants' mean age was 48 years, and 59% were African-American. Median DASH score was 1.5 (range, 0-8). Over a median of 5 years, 13.4% experienced rapid eGFR decline, including 15.2% among participants not following a DASH-accordant diet (score ≤1) and 12.0% with higher accordance (score >1) (P = .08). Outcomes varied by hypertension status. In multinomial logistic regression models, following adjustment for sociodemographic and clinical factors, including total energy intake, low DASH diet accordance was associated with rapid eGFR decline among participants with hypertension (risk ratio, 1.68; 95% confidence interval: 1.17-2.42) but not among those without hypertension (risk ratio, 0.83; 95% confidence interval: 0.56-1.24; P interaction .001). There was no statistically significant association between DASH diet accordance and incident CKD or eGFR decline >25%. Results were similar when DASH diet accordance was analyzed in tertiles. CONCLUSIONS Among urban adults, low accordance to a DASH-type diet was not associated with incident CKD, but was associated with higher risk of rapid eGFR decline among those with hypertension, yet not among those without hypertension. Further study of dietary patterns as a potential target for improving kidney outcomes among high-risk populations is warranted.
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Affiliation(s)
- Yang Liu
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Edgar R Miller
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - M Berenice Nava
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Neil R Powe
- Department of Medicine, San Francisco General Hospital and University of California at San Francisco, San Francisco, California
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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Loquai C, Dechent D, Garzarolli M, Kaatz M, Kaehler KC, Kurschat P, Meiss F, Stein A, Nashan D, Micke O, Muecke R, Muenstedt K, Stoll C, Schmidtmann I, Huebner J. Risk of interactions between complementary and alternative medicine and medication for comorbidities in patients with melanoma. Med Oncol 2016; 33:52. [PMID: 27090799 DOI: 10.1007/s12032-016-0764-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
Complementary and alternative medicine (CAM) is used widely among cancer patients. Beside the risk of interaction with cancer therapies, interactions with treatment for comorbidities are an underestimated problem. The aim of this study was to assess prevalence of interactions between CAM and drugs for comorbidities from a large CAM usage survey on melanoma patients and to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers were asked to complete a standardized CAM questionnaire including questions to their CAM use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and complementary substances was evaluated for their potential of interaction. 1089 questionnaires were eligible for evaluation. From these, 61.6% of patients reported taking drugs regularly from which 34.4% used biological-based CAM methods. Risk evaluation for interaction was possible for 180 CAM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2% at risk of interaction of their co-consumption of conventional and complementary drugs. Almost all patients using Chinese herbs were at risk (88.6%). With a high rate of CAM usage at risk of interactions between CAM drugs and drugs taken for comorbidities, implementation of a regular assessment of CAM usage and drugs for comorbidities is mandatory in cancer care.
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Affiliation(s)
- Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dagmar Dechent
- Institute of Occupational Medicine, University Hospital, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marlene Garzarolli
- Department of Dermatology, University Medical Center Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Kaatz
- Department of Dermatology, Wald Klinikum Gera, Str. des Friedens 122, 07548, Gera, Germany
| | - Katharina C Kaehler
- Department of Dermatology, University Medical Center Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Peter Kurschat
- Practice of Dermatology, Bonner Str. 207, 50968, Cologne, Germany
| | - Frank Meiss
- Department of Dermatology, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Annette Stein
- Practice of Dermatology, Sachsenwerkstr. 71, 01257, Dresden, Germany
| | - Dorothee Nashan
- Department of Dermatology, Klinikum Dortmund gGmbH, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Oliver Micke
- Department of Radio-Oncology, St. Franziskus Hospital Bielefeld, Kiskerstraße 26, 33615, Bielefeld, Germany
| | - Ralph Muecke
- Department of Radio-Oncology, Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Karsten Muenstedt
- Department of Gynecology and Obstetrics, Clinic Offenburg, Ebertplatz 12, 77654, Offenburg, Germany
| | - Christoph Stoll
- Clinic Herzoghoehe Bayreuth, Kulmbacherstraße 103, 95445, Bayreuth, Germany
| | - Irene Schmidtmann
- Department of Medical Biometrie, Epidemiology and Informatics, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jutta Huebner
- Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Markovich JE, Freeman LM, Labato MA, Heinze CR. Survey of dietary and medication practices of owners of cats with chronic kidney disease. J Feline Med Surg 2015; 17:979-83. [PMID: 25535212 PMCID: PMC10816345 DOI: 10.1177/1098612x14563097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The objective of this study was to describe the dietary and medication patterns of cats with chronic kidney disease (CKD). In this prospective, cross-sectional descriptive study, owners of cats with CKD were asked to complete a web-based survey. The study was advertised on CKD-, pet-, veterinary- and breed-associated websites and list serves. Owners of 1089 cats with CKD participated in the study. The mean reported age of the cats with CKD was 13.7 ± 4.2 years. Forty percent (430/1089) of cats had concurrent diseases, with hyperthyroidism, heart disease and inflammatory bowel disease being the most common. Veterinarian recommendation was the most common reason reported (684/1032; 66%) for diet selection, and 51% (556/1089) of owners fed a veterinary therapeutic diet formulated for kidney disease as some component of the diet. Many owners (466/1079; 43%) reported that their cats had an abnormal appetite; of these owners, 52% responded that their cats had a poor appetite or required coaxing to eat 5-7 days per week. Forty-seven percent and 51% of cats were receiving subcutaneous fluids and oral medications, respectively; however, most cats (811/1036; 78%) were not receiving phosphorus-binding medications. Fifty-six percent and 38% of cats received commercial cat treats and dietary supplements, respectively. Anorexia or hyporexia is a common problem in cats with CKD and may lead to cats being fed suboptimal diets for their disease. This information may be useful for treating or designing nutritional studies for cats with CKD.
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Affiliation(s)
- Jessica E Markovich
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Lisa M Freeman
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Mary A Labato
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Cailin R Heinze
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
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Tangkiatkumjai M, Boardman H, Praditpornsilpa K, Walker DM. Association of herbal and dietary supplements with progression and complications of chronic kidney disease: A prospective cohort study. Nephrology (Carlton) 2015; 20:679-687. [PMID: 26040915 DOI: 10.1111/nep.12531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 11/30/2022]
Abstract
AIM To determine associations between herbal and dietary supplement (HDS) use and the progression of chronic kidney disease (CKD), and associations of HDS with uncontrolled hyperphosphataemia in patients with CKD. METHOD The cohort study recruited 406 Thai outpatients with stage 3-5 CKD from two kidney clinics of which 357 were followed up over 12 months. Patients receiving renal replacement therapy prior to recruitment were excluded. Participants were interviewed regarding their HDS use, dietary intake and conventional medication adherence using a questionnaire. The primary outcome was a composite of a decline of at least 5 mL/min per 1.73 m2 per year of estimated glomerular filtration rate and end stage renal disease. Serum creatinine, serum levels of potassium and phosphate were extracted from their medical notes over the 12 months. χ2 tests and multiple logistic regression analyses were performed to ascertain any associations. RESULTS Despite no association between HDS and the progression of CKD over a one-year period (adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 0.66-2.03), two patients had acute kidney injury, which may be related to an unknown Chinese herbal medicine, or river spiderwort combined with diclofenac reported in the medical notes. The use of HDS was associated with uncontrolled hyperphosphataemia (adjusted OR 3.53, 95%CI 1.20-10.43). CONCLUSIONS The findings suggest that HDS are likely to be related to acute kidney injury rather than the progression of CKD in Thai patients with CKD. The products were associated with uncontrolled hyperphosphataemia. Patients who have CKD and use HDS should be closely monitored regarding their kidney function and electrolytes.
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Affiliation(s)
| | - Helen Boardman
- Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dawn-Marie Walker
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Drawz PE, Archdeacon P, McDonald CJ, Powe NR, Smith KA, Norton J, Williams DE, Patel UD, Narva A. CKD as a Model for Improving Chronic Disease Care through Electronic Health Records. Clin J Am Soc Nephrol 2015; 10:1488-99. [PMID: 26111857 PMCID: PMC4527017 DOI: 10.2215/cjn.00940115] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Electronic health records have the potential to improve the care of patients with chronic medical conditions. CKD provides a unique opportunity to show this potential: the disease is common in the United States, there is significant room to improve CKD detection and management, CKD and its related conditions are defined primarily by objective laboratory data, CKD care requires collaboration by a diverse team of health care professionals, and improved access to CKD-related data would enable identification of a group of patients at high risk for multiple adverse outcomes. However, to realize the potential for improvement in CKD-related care, electronic health records will need to provide optimal functionality for providers and patients and interoperability across multiple health care settings. The goal of the National Kidney Disease Education Program Health Information Technology Working Group is to enable and support the widespread interoperability of data related to kidney health among health care software applications to optimize CKD detection and management. Over the course of the last 2 years, group members met to identify general strategies for using electronic health records to improve care for patients with CKD. This paper discusses these strategies and provides general goals for appropriate incorporation of CKD-related data into electronic health records and corresponding design features that may facilitate (1) optimal care of individual patients with CKD through improved access to clinical information and decision support, (2) clinical quality improvement through enhanced population management capabilities, (3) CKD surveillance to improve public health through wider availability of population-level CKD data, and (4) research to improve CKD management practices through efficiencies in study recruitment and data collection. Although these strategies may be most effectively applied in the setting of CKD, because it is primarily defined by laboratory abnormalities and therefore, an ideal computable electronic health record phenotype, they may also apply to other chronic diseases.
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Affiliation(s)
- Paul E. Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Patrick Archdeacon
- Office of Medical Policy, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Clement J. McDonald
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, Maryland
| | - Neil R. Powe
- Department of Medicine, University of California, San Francisco, California
| | - Kimberly A. Smith
- Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Jenna Norton
- National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Desmond E. Williams
- National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, Atlanta, Georgia; and
| | - Uptal D. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Andrew Narva
- National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Crews DC, Kuczmarski MF, Miller ER, Zonderman AB, Evans MK, Powe NR. Dietary habits, poverty, and chronic kidney disease in an urban population. J Ren Nutr 2015; 25:103-10. [PMID: 25238697 PMCID: PMC4339637 DOI: 10.1053/j.jrn.2014.07.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Poverty is associated with chronic kidney disease (CKD) in the United States and worldwide. Poor dietary habits may contribute to this disparity. STUDY DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 2,058 community-dwelling adults aged 30 to 64 years residing in Baltimore City, Maryland. PREDICTORS Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and nonpoverty (≥125% of guideline). OUTCOMES AND MEASUREMENTS CKD defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (CKD epidemiology collaboration equation). Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status. RESULTS Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (interquartile range, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, whereas higher education and regular health care were more prevalent among the highest DASH score tertile (P < .05 for all). Fiber, calcium, magnesium, and potassium intake were lower, and cholesterol higher, among the poverty compared with nonpoverty group (P < .05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the nonpoverty group had CKD (P = .05). The lowest DASH tertile (compared with the highest) was associated with more CKD among the poverty (AOR 3.15, 95% confidence interval 1.51-6.56), but not among the nonpoverty group (AOR 0.73, 95% confidence interval 0.37-1.43; P interaction = .001). CONCLUSIONS Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | | | - Edgar R Miller
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Neil R Powe
- Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California
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Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health 2015; 105:478-85. [PMID: 25602879 DOI: 10.2105/ajph.2014.302348] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Millions of people in the United States consume dietary supplements hoping to maintain or improve their health; however, extensive research has failed to demonstrate the efficacy of numerous supplements in disease prevention. In addition, concerns about the safety of routine and high-dose supplementation have been raised. The Food and Drug Administration regulates dietary supplement quality, safety, and labeling, and the Federal Trade Commission monitors advertisements and marketing; still, vast enforcement challenges remain, and optimal governmental oversight has not been achieved. If the composition and quality of ingredients cannot be reliably ensured, the validity of research on dietary supplements is questionable. Moreover, the health of the US public is put at risk.
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Affiliation(s)
- Ranjani R Starr
- Ranjani R. Starr, MPH, is with the Office of Public Health Studies, Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
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Vamenta-Morris H, Dreisbach A, Shoemaker-Moyle M, Abdel-Rahman EM. Internet claims on dietary and herbal supplements in advanced nephropathy: truth or myth. Am J Nephrol 2014; 40:393-8. [PMID: 25376340 DOI: 10.1159/000368724] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of complementary/alternative medicine has garnered rising interest in recent years. Natural products including herbs, vitamins, and minerals are the most popularly consumed. The Internet is a ubiquitous source of information/market for these supplements. AIM To systematically evaluate the dietary and herbal supplement recommended for patients with CKD and ESRD on the Internet, and try to distinguish between the claim of the manufacturer and proven scientific data. METHODS A questionnaire assessing each website was formulated. Each product ingredient was recorded in the questionnaire by two independent reviewers and statistically analyzed. RESULTS Of the 184 websites, 28% claimed to decrease CKD progression, 60% did not advise to consult a doctor before taking the supplement, and >90% did not mention any potential drug interaction, disease interaction, or caution in use during pregnancy or in children. The ten common plant ingredients claiming to be beneficial in kidney diseases were uva ursi, dandelion, parsley, corn silk, juniper, celery, buchu, horsetail, marshmallow, and stinging nettle. In contrast to their claims, these substances were not adequately studied in humans. The available animal studies showed detrimental effects and potential drug interactions with commonly used medications in the CKD/ESRD population. CONCLUSIONS Nephrologists need to be cognizant of the lack of substantiated proven benefits of these substances and of the potential adverse effects in the animal models that can translate to the patients. Most importantly, the policy needs to change regarding the regulation of these products to prevent patient harm and misinformation.
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Beto JA, Ramirez WE, Bansal VK. Medical Nutrition Therapy in Adults with Chronic Kidney Disease: Integrating Evidence and Consensus into Practice for the Generalist Registered Dietitian Nutritionist. J Acad Nutr Diet 2014; 114:1077-1087. [DOI: 10.1016/j.jand.2013.12.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 11/25/2013] [Indexed: 01/29/2023]
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