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Mahadevappa K, Nayak SB, Maharaj RG, Bhaktha G. Using eGFR and Albumin Creatinine Ratio as an Initial Screening Tool in Trinidadian Primary Care to Identify High-risk Population for CKD: A Cross-Sectional Study. Indian J Nephrol 2024; 34:332-337. [PMID: 39156845 PMCID: PMC11328054 DOI: 10.25259/ijn_451_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/08/2023] [Indexed: 08/20/2024] Open
Abstract
Background Chronic kidney disease (CKD) is a major public health burden and is often undiagnosed in the primary care setting. Untested and untreated, this often leads to renal failure and dialysis. Materials and Methods This was a cross-sectional study of adults aged 20 years and over, diagnosed with type 2 diabetes mellitus and/or hypertension, with no previous history or record of CKD, and attending three chronic disease clinics in the Eastern Regional Health Authority (ERHA). Patients were screened for risk of CKD by using the albumin creatinine ratio. The eGFR was calculated based on serum creatinine by using the CKD Epidemiology Collaboration (EPI) 2009 equation. Results In total, 430 patients agreed to participate with 61.2% of response rate. Of the 385 with complete data, 357 (92%) were detected as having a high risk for CKD; older patients (>66 years) and those with both diabetes and hypertension had high proportions of risk for CKD. There were significant associations between age, systolic hypertension, and the severity of risk for CKD. Conclusion CKD is common at the primary care level among adults with NCDs in Trinidad, with many patients having been left out without being tested for CKD. Primary care physicians must take this into consideration in caring for NCD patients.
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Affiliation(s)
| | - Shivananda B. Nayak
- Department of Preclinical Sciences, The University of the West Indies, Faculty of Medical Sciences, EWMSC, Mount Hope, Trinidad and Tobago
| | - Rohan G. Maharaj
- Unit of Public Health and Primary Care, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Geetha Bhaktha
- Multidisciplinary Research Unit, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
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2
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Oosting IJ, Colombijn JM, Kaasenbrood L, Liabeuf S, Laville SM, Hooft L, Bots ML, Verhaar MC, Vernooij RW. Polypharmacy in Patients with CKD: A Systematic Review and Meta-Analysis. KIDNEY360 2024; 5:841-850. [PMID: 38661553 PMCID: PMC11219116 DOI: 10.34067/kid.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Key Points The prevalence of polypharmacy in patients with CKD was over 80%. Polypharmacy was highest in patients with a kidney transplant and those receiving dialysis. Polypharmacy is associated with worse clinical outcomes, lower quality of life, and medication-related problems in patients with CKD. Background Despite the high prevalence of polypharmacy in patients with CKD, the extent of polypharmacy across patients with (different stages of) CKD, as well as the association with clinical outcomes remains unknown. This systematic review aimed to evaluate the prevalence of polypharmacy in (different subgroups of) patients with CKD and assess the association between polypharmacy and patient-important outcomes. Methods MEDLINE, Embase, and the Cochrane Library were searched from inception until July 2022. Studies that reported the prevalence of polypharmacy, medication use, or pill burden in patients with CKD (including patients receiving dialysis and kidney transplant recipients) and their association with patient-important outcomes (i.e ., mortality, kidney failure, quality of life [QoL], and medication nonadherence) were included. Two reviewers independently screened title and abstract and full texts, extracted data, and assessed risk of bias. Data were pooled in a random-effects single-arm meta-analysis. Results In total, 127 studies were included (CKD 3–5 n =39, dialysis: n =38, kidney transplant n =13, different CKD stages n =37). The pooled prevalence of polypharmacy, based on 63 studies with 484,915 patients, across all patients with CKD was 82% (95% confidence interval, 76% to 86%), and the pooled mean number of prescribed medications was 9.7 (95% confidence interval, 8.4 to 11.0). The prevalence of polypharmacy was higher in patients who received dialysis or a kidney transplant compared with patients with CKD 3–5 but did not differ between studies with regards to region or patients' mean age or sex. In patients with CKD, polypharmacy was associated with a higher risk of all-cause mortality, kidney failure, faster eGFR decline, lower QoL, and higher medication nonadherence, adverse drug reactions, and potentially inappropriate medications. Conclusions The prevalence of polypharmacy in patients with CKD was over 80%, and highest in patients with a kidney transplant and those receiving dialysis. No causes of heterogeneity were identified, indicating that polypharmacy is an issue for all patients with CKD. Polypharmacy is associated with worse clinical outcomes, lower QoL, and medication-related problems in patients with CKD. Clinical Trial registry name and registration number: PROSPERO (CRD42022331941).
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Affiliation(s)
- Ilse J. Oosting
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julia M.T. Colombijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lotte Kaasenbrood
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sophie Liabeuf
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
| | - Solène M. Laville
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robin W.M. Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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3
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Liu M, Cheng L, Ye Q, Liu H, Shu C, Gao H, Liu X, Zhang X, Chen G. Hypericin Alleviates Chronic Kidney Disease-induced Left Ventricular Hypertrophy by Regulation of FGF23-FGFR4 Signaling Pathway. J Cardiovasc Pharmacol 2024; 83:588-601. [PMID: 38547517 DOI: 10.1097/fjc.0000000000001559] [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: 08/19/2023] [Accepted: 02/25/2024] [Indexed: 06/15/2024]
Abstract
ABSTRACT Chronic kidney disease (CKD) is a significant global health threat that imposes a substantial burden on both individuals and societies. CKD frequently correlates with cardiovascular events, particularly left ventricular hypertrophy (LVH), which contributes to the high mortality rate associated with CKD. Fibroblast growth factor 23 (FGF23), a hormone primarily involved in regulating calcium and phosphorus metabolism, has been identified as a major risk factor for LVH in CKD patients. Elevated serum FGF23 levels are known to induce LVH and myocardial fibrosis by activating the fibroblast growth factor receptor 4 (FGFR4) signal pathway. Therefore, targeting FGFR4 and its downstream signaling pathways holds potential as a treatment strategy for cardiac dysfunction in CKD. In our current study, we have discovered that Hypericin, a key component derived from Hypericum perforatum , has the ability to alleviate CKD-related LVH by targeting the FGFR4/phospholipase C gamma 1 (PLCγ1) signaling pathway. Through in vitro experiments using rat cardiac myocyte H9c2 cells, we observed that Hypericin effectively inhibits FGF23-induced hypertrophy and fibrosis by suppressing the FGFR4/PLCγ1/calcineurin/nuclear factor of activated T-cell (NFAT3) signaling pathway. In addition, our in vivo studies using mice on a high-phosphate diet and rat models of 5/6 nephrectomy demonstrated that Hypericin has therapeutic effects against CKD-induced LVH by modulating the FGFR4/PLCγ1/calcineurin/NFAT3 signaling pathway. In conclusion, our research highlights the potential of Hypericin as a candidate for the treatment of CKD-induced cardiomyopathy. By suppressing the FGFR4/PLCγ1 signaling pathway, Hypericin shows promise in attenuating LVH and myocardial fibrosis associated with CKD.
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MESH Headings
- Animals
- Perylene/analogs & derivatives
- Perylene/pharmacology
- Signal Transduction/drug effects
- Fibroblast Growth Factors/metabolism
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/drug therapy
- Receptor, Fibroblast Growth Factor, Type 4/metabolism
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/metabolism
- Hypertrophy, Left Ventricular/prevention & control
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/drug therapy
- Fibrosis
- Disease Models, Animal
- Fibroblast Growth Factor-23
- Rats
- Male
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Cell Line
- Mice, Inbred C57BL
- Anthracenes/pharmacology
- Ventricular Function, Left/drug effects
- Ventricular Remodeling/drug effects
- Phospholipase C gamma/metabolism
- NFATC Transcription Factors/metabolism
- Mice
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Affiliation(s)
- Min Liu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linting Cheng
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qianru Ye
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huamin Liu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China ; and
| | - Cong Shu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haocheng Gao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China ; and
| | - Xin Liu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiuhua Zhang
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China ; and
| | - Gaozhi Chen
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Chronic Kidney Disease, Wenzhou Medical University, Wenzhou, Zhejiang, China
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4
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Wong TS, Chen Q, Zhong Q, Hu B, Feng G, Huang F, Lu J, Yin L, Yu Z, Akinwunmi BO, Huang J, Zhang CJ, Ming WK. Cost-effectiveness analysis of autogenous arteriovenous fistula, arteriovenous graft, and tunneled-cuffed catheter for hemodialysis in patients with end-stage kidney disease in Southern China. J Vasc Access 2024; 25:953-962. [PMID: 36540049 DOI: 10.1177/11297298221143010] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of three permanent vascular accesses for maintenance hemodialysis patients from a hospital perspective throughout 5 years, which is the average life expectancy of patients with end-stage kidney disease. SUBJECTS AND METHODS We conducted a EuroQol(EQ-5D) questionnaire survey between January 2021 and March 2021 with 250 patients to estimate the health utility of various states in patients under different hemodialysis vascular access. We designed a Markov model and conducted a cost-effectiveness analysis to compare the cost-effectiveness of three hemodialysis vascular access in Guangzhou throughout 5 years. RESULTS The mean costs were US$44,481 with tunneled-cuffed catheter (TCC), and US$68,952 and US$59,247 with arteriovenous graft (AVG) and autogenous arteriovenous fistula (AVF), respectively. The mean quality-adjusted life-years (QALYs) was 1.41 with TCC, and 2.37 and 2.73 with AVG and AVF, respectively. AVG had an incremental cost-effectiveness ratio (ICER) of US$25,491 per QALY over TCC; AVF had an ICER of -US$26,958 per QALY over AVG. At a willingness to pay below US$10,633.8 per QALY, TCC is likely the most cost-effective vascular access. At any willingness to pay between US$10,633.8 and US$30,901.4 per QALY, AVF is likely the most cost-effective vascular access. CONCLUSION These findings illustrate the value of AVF given its relative cost-effectiveness to other hemodialysis modalities. Although AVG costs much more than TCC for slightly higher QALYs than TCC, AVG still has a greater advantage over TCC for patients with longer life expectancy due to its lower probability of death.
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Affiliation(s)
- Tak-Sui Wong
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Qian Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Qiongqiong Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Bo Hu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Guanrui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Fengqiu Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jian Lu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Lianghong Yin
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Zongchao Yu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | | | - Jian Huang
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Casper Jp Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong
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5
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Guo J, Liu C, Wang Y, Shao B, Fong TL, Lau NC, Zhang H, Li H, Wang J, Lu X, Wang A, Leung CL, Chia XW, Li F, Meng X, He Q, Chen H. Dose-response association of diabetic kidney disease with routine clinical parameters in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102482. [PMID: 38374967 PMCID: PMC10875261 DOI: 10.1016/j.eclinm.2024.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/21/2024] Open
Abstract
Background Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease and is associated with high mortality rates. The influence of routine clinical parameters on DKD onset in patients with type 2 diabetes mellitus (T2DM) remains uncertain. Methods In this systematic review and meta-analysis, we searched multiple databases, including PubMed, Embase, Scopus, Web of Science, and Cochrane Library, for studies published from each database inception until January 11, 2024. We included cohort studies examining the association between DKD onset and various clinical parameters, including body mass index (BMI), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and serum uric acid (UA). Random-effect dose-response meta-analyses utilizing one-stage and/or cubic spline models, were used to estimate correlation strength. This study is registered in PROSPERO (CRD42022326148). Findings This analysis of 46 studies involving 317,502 patients found that in patients with T2DM, the risk of DKD onset increased by 3% per 1 kg/m2 increase in BMI (relative risk (RR) = 1.03, confidence interval (CI) [1.01-1.04], I2 = 70.07%; GRADE, moderate); a 12% increased risk of DKD onset for every 1% increase in HbA1c (RR = 1.12, CI [1.07-1.17], I2 = 94.94%; GRADE, moderate); a 6% increased risk of DKD onset for every 5 mmHg increase in SBP (RR = 1.06. CI [1.03-1.09], I2 = 85.41%; GRADE, moderate); a 2% increased risk of DKD onset per 10 mg/dL increase in TG (RR = 1.02, CI [1.01-1.03], I2 = 78.45%; GRADE, low); an 6% decreased risk of DKD onset per 10 mg/dL increase in HDL (RR = 0.94, CI [0.92-0.96], I2 = 0.33%; GRADE, high), and a 11% increased risk for each 1 mg/dL increase in UA (RR = 1.11, CI [1.05-1.17], I2 = 79.46%; GRADE, moderate). Subgroup analysis revealed a likely higher risk association of clinical parameters (BMI, HbA1c, LDL, and UA) in patients with T2DM for less than 10 years. Interpretation BMI, HbA1c, SBP, TG, HDL and UA are potential predictors of DKD onset in patients with T2DM. Given high heterogeneity between included studies, our findings should be interpreted with caution, but they suggest monitoring of these clinical parameters to identify individuals who may be at risk of developing DKD. Funding Shenzhen Science and Innovation Fund, the Hong Kong Research Grants Council, and the HKU Seed Funds, and Scientific and technological innovation project of China Academy of Chinese Medical Sciences.
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Affiliation(s)
- Jianbo Guo
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Yifan Wang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Baoyi Shao
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tung Leong Fong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ngai Chung Lau
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hui Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haidi Li
- School of Pharmacy, Anhui Medical University, Hefei, China
| | - Jianan Wang
- School of Pharmacy, Anhui Medical University, Hefei, China
| | - Xinyu Lu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Anqi Wang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Cheuk Lung Leung
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xin Wei Chia
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Fei Li
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoming Meng
- School of Pharmacy, Anhui Medical University, Hefei, China
| | - Qingyong He
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haiyong Chen
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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6
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Cacciapuoti N, Lonardo MS, Di Lauro M, Di Lorenzo M, Aurino L, Pacella D, Guida B. Effects of Dietary Intervention on Nutritional Status in Elderly Individuals with Chronic Kidney Disease. Nutrients 2024; 16:632. [PMID: 38474760 DOI: 10.3390/nu16050632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence of chronic kidney disease (CKD) is rising, especially in elderly individuals. The overlap between CKD and aging is associated with body composition modification, metabolic abnormalities, and malnutrition. Renal care guidelines suggest treating CKD patient with a low-protein diet according to the renal disease stage. On the other hand, geriatric care guidelines underline the need for a higher protein intake to prevent malnutrition. The challenge remains of how to reconcile a low dietary protein intake with insuring a favorable nutritional status in geriatric CKD populations. Therefore, this study aims to evaluate the effect of a low-protein adequate energy intake (LPAE) diet on nutritional risk and nutritional status among elderly CKD (stage 3-5) patients and then to assess its impact on CKD metabolic abnormalities. To this purpose, 42 subjects [age ≥ 65, CKD stage 3-5 in conservative therapy, and Geriatric Nutritional Risk Index (GNRI) ≥ 98] were recruited and the LPAE diet was prescribed. At baseline and after 6 months of the LPAE diet, the following data were collected: age, sex, biochemical parameters, anthropometric measurements, body composition, and the GNRI. According to their dietary compliance, the subjects were divided into groups: compliant and non-compliant. For the compliant group, the results obtained show no increased malnutrition risk incidence but, rather, an improvement in body composition and metabolic parameters, suggesting that the LPAE diet can provide a safe tool in geriatric CKD patients.
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Affiliation(s)
- Nunzia Cacciapuoti
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Maria Serena Lonardo
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Mariastella Di Lauro
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Mariana Di Lorenzo
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Laura Aurino
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Bruna Guida
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
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7
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Lee CL, Liu WJ, Tsai SF. Effects of AST-120 on mortality in patients with chronic kidney disease modeled by artificial intelligence or traditional statistical analysis. Sci Rep 2024; 14:738. [PMID: 38184721 PMCID: PMC10771424 DOI: 10.1038/s41598-024-51498-6] [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: 08/05/2023] [Accepted: 01/05/2024] [Indexed: 01/08/2024] Open
Abstract
Chronic kidney disease (CKD) imposes a substantial burden, and patient prognosis remains grim. The impact of AST-120 (AST-120) on the survival of CKD patients lacks a consensus. This study aims to investigate the effects of AST-120 usage on the survival of CKD patients and explore the utility of artificial intelligence models for decision-making. We conducted a retrospective analysis of CKD patients receiving care in the pre-end-stage renal disease (ESRD) program at Taichung Veterans General Hospital from 2000 to 2019. We employed Cox regression models to evaluate the relationship between AST-120 use and patient survival, both before and after propensity score matching. Subsequently, we employed Deep Neural Network (DNN) and Extreme Gradient Boosting (XGBoost) models to assess their performance in predicting AST-120's impact on patient survival. Among the 2584 patients in our cohort, 2199 did not use AST-120, while 385 patients received AST-120. AST-120 users exhibited significantly lower mortality rates compared to non-AST-120 users (13.51% vs. 37.88%, p < 0.0001) and a reduced prevalence of ESRD (44.16% vs. 53.17%, p = 0.0005). Propensity score matching at 1:1 and 1:2 revealed no significant differences, except for dialysis and all-cause mortality, where AST-120 users exhibited significantly lower all-cause mortality (p < 0.0001), with a hazard ratio (HR) of 0.395 (95% CI = 0.295-0.522). This difference remained statistically significant even after propensity matching. In terms of model performance, the XGBoost model demonstrated the highest accuracy (0.72), specificity (0.90), and positive predictive value (0.48), while the logistic regression model showed the highest sensitivity (0.63) and negative predictive value (0.84). The area under the curve (AUC) values for logistic regression, DNN, and XGBoost were 0.73, 0.73, and 0.69, respectively, indicating similar predictive capabilities for mortality. In this cohort of CKD patients, the use of AST-120 is significantly associated with reduced mortality. However, the performance of artificial intelligence models in predicting the impact of AST-120 is not superior to statistical analysis using the current architecture and algorithm.
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Grants
- TCVGH-1093605D, TCVGH-1097316C, TCVGH-1097327D, TCVGH-1103502C, TCVGH-1107305D, TCVGH-1117308C, TCVGH-1117305D, TCVGH-1113602C, TCVGH-1113602D and TCVGH-1103601D Taichung Veterans General Hospital
- TCVGH-1093605D, TCVGH-1097316C, TCVGH-1097327D, TCVGH-1103502C, TCVGH-1107305D, TCVGH-1117308C, TCVGH-1117305D, TCVGH-1113602C, TCVGH-1113602D and TCVGH-1103601D Taichung Veterans General Hospital
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Affiliation(s)
- Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Intelligent Data Mining Laboratory, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wei-Ju Liu
- Intelligent Data Mining Laboratory, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shang-Feng Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Division of Nephrology, Taichung Veterans General Hospital, Taiwan, 160, Sec. 3, Taiwan Boulevard, Taichung, 407, Taiwan.
- Department of Life Science, Tunghai University, Taichung, Taiwan.
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8
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Thanachayanont T, Chanpitakkul M, Saetie A, Lekagul S, Tungsanga K. Correlation of the Dietary Protein Intake between Those Estimated from a Short Protein Food-Recall Questionnaire and from 24-Hour Urinary Urea-Nitrogen Excretion in Stages 3-4 Chronic Kidney Disease Patients. Int J Nephrol 2023; 2023:9713045. [PMID: 38033373 PMCID: PMC10686714 DOI: 10.1155/2023/9713045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction High protein intake may accelerate progression of chronic kidney disease (CKD). Estimation of dietary protein intake (DPI) is indispensable for management of CKD, but to achieve optimum DPI is quite challenging in routine clinical practice. We recently studied a beneficial effect of utilizing integrated care on the management of CKD at the rural community level. In that study, we created a short protein food-recall questionnaire (S-PFRQ) as a working tool to estimate DPI of the CKD patients during home visit by community health personnel. Herein, we reported the initial evaluation of the reliability of S-PFRQ from our previous study. Objective We compared the amount of DPI obtained from S-PFRQ with that obtained from protein-equivalent of total nitrogen appearance (PNA). Methods In the previous ESCORT-2 study, 914 patients with CKD stage 3 or 4, who were living in the rural area of Thailand, were prospectively followed while receiving integrated care for 36 consecutive months. During home visits by community nurses from subdistrict health centers, dietary food recall was made, recorded in S-PFRQ, and DPI was obtained. Among these, sixty patients were randomly selected, and 24-h urine was collected for urinary urea-N and estimation of PNA. A correlation was made between DPI obtained from S-PFRQ and PNA. Results The DPIs derived from S-PFRQ and PNA were 28.8 ± 14.8 and 39.26 ± 17.79 g/day, respectively. The mean difference and 95% CI between the 2 methods was -10.43 (-7.1 to -13.8) g/day, respectively (P < 0.001). Interclass correlation between these 2 methods was 0.24, P = 0.007. The difference between the 2 methods remained constant across different amounts of DPI. Conclusion The DPI estimated from S-PFRQ significantly correlated to that from PNA. However, the S-PFRQ method yielded a DPI value which was about 10 g of protein or 25% less than the PNA method. Despite this amount of difference, this S-PFRQ is user-friendly and could be used during field work as an easy and simple tool for DPI estimation in resource-limiting condition.
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Affiliation(s)
- Teerawat Thanachayanont
- Bhumirajanagarindra Kidney Institute, 8/99 Phayathai Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Bangkok 10400, Thailand
| | - Methee Chanpitakkul
- Bhumirajanagarindra Kidney Institute, 8/99 Phayathai Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Bangkok 10400, Thailand
| | - Akhathai Saetie
- Bhumirajanagarindra Kidney Institute, 8/99 Phayathai Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Bangkok 10400, Thailand
| | - Salyaveth Lekagul
- Bhumirajanagarindra Kidney Institute, 8/99 Phayathai Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Bangkok 10400, Thailand
| | - Kriang Tungsanga
- Bhumirajanagarindra Kidney Institute, 8/99 Phayathai Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Bangkok 10400, Thailand
- Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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Lin HYH, Chang YH, Wang YT, Liang PI, Hung CC, Chang JM, Dai DF, Lin CS, Chang KT. Thiazide and thiazide-like diuretics are associated with improved cardiovascular and renal outcomes in patients with chronic kidney disease. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:510-521. [PMID: 38920202 DOI: 10.47102/annals-acadmedsg.202359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Hypervolemia is a prevalent comorbidity of chronic kidney disease (CKD) patients. Thiazide diuretics (THZ) are the most common treatment for volume overload and hypertension (HTN). This study examines the association between THZ usage and clinical outcomes among CKD patients in a nationwide cohort. Method The total number of patients in the study was 24,312. After matching with one non-user randomly selected from the CKD population, we identified 8501 patients in the THZ and the comparison cohorts. Cox proportional hazards regression analysis was conducted to estimate the associations of THZ on the incidence of all-cause mortality, end-stage renal disease (ESRD), congestive heart failure (CHF), acute myocardial infarction (AMI), peripheral arterial occlusive disease (PAOD), and stroke. Results The all-cause mortality rate was significantly lower in THZ users than in non-users (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.60- 0.71). The THZ usage was associated with a lower incidence of ESRD, AMI, PAOD, and stroke (P<0.05). In subgroup analysis, some significant clinical outcomes were related with CKD stages 3 and 4 (P<0.05); however, there were no clinical associations in CKD stage 5. In further THZ subtype analysis, there were clinical associations with fewer deaths, ESRD, AMI, and PAOD accompanying chlorthalidone treatment. Moreover, the indapamide prescription was linked to lower mortality, ESRD, AMI, and PAOD prevalence. However, there were significantly greater incidences of ESRD, CHF, and AMI in the metolazone users. Conclusion THZ usage is associated with lower mortality and incidence of ESRD, AMI, PAOD, and stroke s in patients with CKD stages 3 and 4.
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Affiliation(s)
- Hugo Y-H Lin
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Yu-Han Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan
| | - Yu-Tsang Wang
- Management Office, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Dao-Fu Dai
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Chang-Shen Lin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Kai-Ting Chang
- Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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10
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Sharma S, Kalra D, Rashid I, Mehta S, Maity MK, Wazir K, Gupta S, Ansari SA, Alruqi OS, Khan R, Khan I, Anwar S. Assessment of Health-Related Quality of Life in Chronic Kidney Disease Patients: A Hospital-Based Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1788. [PMID: 37893506 PMCID: PMC10608694 DOI: 10.3390/medicina59101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023]
Abstract
Background: Health-related quality of life is rapidly becoming recognized as an important indicator of how a disease affects patient lives and for evaluating the quality of care, especially for chronic conditions such as chronic kidney disease (CKD). Objectives: This study is an attempt to assess the quality of life in patients with chronic kidney disease at MMIMSR and also identify characteristics that may be associated with their worsening quality of life. Materials and Methods: This cross-sectional investigation was conducted at the in-patient department (IPD) of the MMIMSR hospital. This study included 105 CKD patients and used a systematic random sampling method for quantitative analysis. This study utilized a 36-item short-form SF-36 (v1.3) questionnaire to assess HRQoL in CKD patients. Descriptive statistics were employed at the baseline. Chi square and ANOVA were used to draw comparisons between two groups or more than two groups, respectively. Logistic regression analysis was utilized to identify the potential QoL determinants. A p value of 0.05 or lower was used to determine statistical significance. Results: Among a total of 105 participants, the mean (±standard deviation) age was found to be 54.53 ± 13.47 years; 48 were male patients, and 57 were female patients. Diabetes Mellitus (61.9%), hypertension (56.2%), chronic glomerulonephritis (7.6%), chronic pyelonephritis (6.7%), and polycystic kidney disease (5.7%) were identified to be the most frequent disorders associated with CKD. The current study also demonstrated that the HRQoL score domains such as symptom problem list, the effect of kidney disease, and the burden of kidney disease decline significantly and progressively as the patient advances into higher stages of CKD (p = 0.005). A similar pattern was observed in work status, sleep, and general health (p < 0.005). Additionally, a statistically significant difference was noted for cognitive function, quality of social interaction, overall health, dialysis staff encouragement, patient satisfaction, social support, physical functioning, role of physical health, pain, emotional well-being, role of emotional health, social functioning, and energy fatigue (p < 0.005). The mean difference for PCS and MCS based on CKD stages was found to be statistically significant (p < 0.005). The PCS and MCS showed a positive correlation with GFR (r = 0.521), and Hb (r = 0.378), GFR (r = 0.836), and Hb (r = 0.488), respectively. Conclusions: The findings of this study demonstrated that a significant decrease in HRQoL was observed among CKD patients, with a progressive deterioration of HRQoL dimensions as the patient advances to end-stage renal disease. This study also revealed that CKD imposes various restrictions on patients' day-to-day lives, particularly in terms of their physical and mental functioning, even in the initial stages of the disease.
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Affiliation(s)
- Shivam Sharma
- Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, India; (S.S.); (D.K.)
| | - Darpan Kalra
- Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, India; (S.S.); (D.K.)
| | - Ishfaq Rashid
- Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, India; (S.S.); (D.K.)
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, 30S 2000E, Salt Lake City, UT 84112, USA
| | - Sudhir Mehta
- Department of Nephrology, M.M. Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Ambala 133207, India
| | - Manish Kumar Maity
- Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, India; (S.S.); (D.K.)
| | - Khushi Wazir
- Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, India; (S.S.); (D.K.)
| | - Sumeet Gupta
- Department of Pharmacology, M.M. College of Pharmacy, Maharishi Markandeshwar University, Ambala 133207, India;
| | - Siddique Akber Ansari
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.A.)
| | - Obaid S. Alruqi
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.A.)
| | - Roohi Khan
- Department of General Medicine, King Khaled Hospital, Hail 55421, Saudi Arabia
| | - Imran Khan
- Department of General Medicine, King Khaled Hospital, Hail 55421, Saudi Arabia
| | - Sirajudheen Anwar
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia
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11
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Bhandari S, Parfrey P, White C, Anker SD, Farrington K, Ford I, Kalra PA, McMurray JJV, Robertson M, Tomson CRV, Wheeler DC, Macdougall IC. Predictors of quality of life in patients within the first year of commencing haemodialysis based on baseline data from the PIVOTAL trial and associations with the study outcomes. J Nephrol 2023; 36:1651-1662. [PMID: 36995528 PMCID: PMC10061401 DOI: 10.1007/s40620-023-01571-6] [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: 08/12/2022] [Accepted: 01/01/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Impaired quality of life is common in patients with end-stage kidney disease. We report the baseline quality of life measures in participants from the PIVOTAL randomized controlled trial and the potential relationship with the primary outcome (all-cause mortality, myocardial infarction, stroke, and heart failure hospitalisation), and associations with key baseline characteristics. METHODS This was a post hoc analysis of 2141 patients enrolled in the PIVOTAL trial. Quality of life was measured using EQ5D index, Visual Analogue Scale, and the KD-QoL [Physical Component Score and Mental Component Score]. RESULTS Mean baseline EQ5D index and visual analogue scale scores were 0.68 and 60.7 and 33.7 (Physical Component Score) and 46.0 (Mental Component Score), respectively. Female sex, higher Body Mass Index, diabetes mellitus, history of myocardial infarction, stroke or heart failure were associated with significantly worse EQ5D index and visual analogue scale. Higher C-reactive protein levels and lower transferrin saturation were associated with worse quality of life. Haemoglobin was not an independent predictor of quality of life. A lower transferrin saturation was an independent predictor of worse physical component score. A higher C-reactive protein level was associated with most aspects of worse quality of life. Impaired functional status was associated with mortality. CONCLUSION Quality of life was impaired in patients starting haemodialysis. A higher C-reactive protein level level was a consistent independent predictor of the majority of worse quality of life. Transferrin saturation ≤ 20% was associated with worse physical component score of quality of life. Baseline quality of life was predictive of all-cause mortality and the primary outcome measure. EUDRACT REGISTRATION NUMBER 2013-002267-25.
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Affiliation(s)
- Sunil Bhandari
- Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull, HU3 2JZ, UK.
| | - Patrick Parfrey
- Divison of Nephrology, Health Sciences Centre, St Johns, NL, Canada
| | - Claire White
- Department of Renal Medicine, King's College Hospital, London, UK
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - John J V McMurray
- Department of Cardiology, University of Glasgow, Glasgow, Scotland, UK
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - David C Wheeler
- University College London, London, UK
- George Institute for Global Health, Sydney, Australia
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12
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Liu X, Gao W, Yang J, Mao G, Lu H, Xing W. Association between probiotic, prebiotic, and yogurt consumption and chronic kidney disease: The NHANES 2010-2020. Front Nutr 2022; 9:1058238. [PMID: 36618701 PMCID: PMC9822650 DOI: 10.3389/fnut.2022.1058238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Previous studies suggested that gut dysbacteriosis may promote the occurrence of chronic kidney disease (CKD), and probiotic, prebiotic, or yogurt supplements may alleviate CKD progression. This study aims to examine the association between probiotic, prebiotic, or yogurt supplements and the risk of CKD using the data from NHANES. Methods This study was designed to prospectively search data from the National Health and Nutrition Examination Survey (NHANES) (2011-2020). We examined dietary supplements and prescription medication labels to identify probiotic, or prebiotic product, and yogurt consumption during the dietary interview. The diagnosis of CKD was determined by the value of glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR). Results The study enrolled a total of 6,522 individuals. The prevalence of CKD was lower in the probiotic, prebiotic, or yogurt consumption group [age-adjusted odds ratio (OR): 0.77, 95% CI: 0.62-0.95, P = 0.02; multivariable-adjusted OR: 0.86, 95% CI: 0.69-1.07, P = 0.05]. Furthermore, 32% reduced risk was observed in the older group aged 55 years or older, and 32% reduced risk was also observed in the female population. Probiotic, or prebiotic, or yogurt supplements was associated a 12% reduction in moderate risk of CKD and an 11% reduction in very high risk of CKD. Conclusion Our results suggest that probiotic, prebiotic, or yogurt supplements may contribute to the prevention of CKD and relieve its progression risk, especially in the female population and older population who were aged 55 years or older.
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Affiliation(s)
- Xiaoxian Liu
- Department of Nephrology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenyan Gao
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Jie Yang
- Department of Nephrology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Genxiang Mao
- Zhejiang Provincial Key Laboratory of Geriatrics, Department of Geriatrics, Zhejiang Hospital, Hangzhou, China,Genxiang Mao,
| | - Hong Lu
- School of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China,Hong Lu,
| | - Wenmin Xing
- Zhejiang Provincial Key Laboratory of Geriatrics, Department of Geriatrics, Zhejiang Hospital, Hangzhou, China,*Correspondence: Wenmin Xing,
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Impact of Hospitalization on the Quality of Life of Patients with Chronic Kidney Disease in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159718. [PMID: 35955072 PMCID: PMC9368667 DOI: 10.3390/ijerph19159718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) is a global health problem. CKD causes patients to be hospitalized for a longer time to treat the disease. The impact of the hospitalization brings major changes and affects the quality of life (QoL) of the patients. In this study, we aimed to evaluate the impact of hospitalization on the QoL of patients with CKD. A cross-sectional study was conducted at the inpatient departments (IPDs) and outpatient departments (OPDs) of selected hospitals, in the eastern region of Saudi Arabia. The kidney disease quality of life (KDQOL) scale was used for the data collection and the findings were analyzed. The hospitalized patients had a poorer QoL than the OPD patients. The physical component summary (PCS) and mental component summary (MCS) mean scores were 52.82 ± 2.32 and 52.57 ± 2.93 in IPD patients, respectively, and 63.46 ± 3.65 and 66.39 ± 0.91 in OPD patients, respectively, which was significant (p < 0.0001). The QoL of patients decreased in the end stages of CKD. A significant association was observed between gender, occupation, smoking, and the stages of CKD with the QoL of the hospitalized patients. Measures must be taken to improve the QoL of these patients at all levels.
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Lee CL, Liu WJ, Tsai SF. Development and Validation of an Insulin Resistance Model for a Population with Chronic Kidney Disease Using a Machine Learning Approach. Nutrients 2022; 14:nu14142832. [PMID: 35889789 PMCID: PMC9319821 DOI: 10.3390/nu14142832] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is a complex syndrome without a definitive treatment. For these patients, insulin resistance (IR) is associated with worse renal and patient outcomes. Until now, no predictive model using machine learning (ML) has been reported on IR in CKD patients. Methods: The CKD population studied was based on results from the National Health and Nutrition Examination Survey (NHANES) of the USA from 1999 to 2012. The homeostasis model assessment of IR (HOMA-IR) was used to assess insulin resistance. We began the model building process via the ML algorithm (random forest (RF), eXtreme Gradient Boosting (XGboost), logistic regression algorithms, and deep neural learning (DNN)). We compared different receiver operating characteristic (ROC) curves from different algorithms. Finally, we used SHAP values (SHapley Additive exPlanations) to explain how the different ML models worked. Results: In this study population, 71,916 participants were enrolled. Finally, we analyzed 1,229 of these participants. Their data were segregated into the IR group (HOMA IR > 3, n = 572) or non-IR group (HOMR IR ≤ 3, n = 657). In the validation group, RF had a higher accuracy (0.77), specificity (0.81), PPV (0.77), and NPV (0.77). In the test group, XGboost had a higher AUC of ROC (0.78). In addition, XGBoost also had a higher accuracy (0.7) and NPV (0.71). RF had a higher accuracy (0.7), specificity (0.78), and PPV (0.7). In the RF algorithm, the body mass index had a much larger impact on IR (0.1654), followed by triglyceride (0.0117), the daily calorie intake (0.0602), blood HDL value (0.0587), and age (0.0446). As for the SHAP value, in the RF algorithm, almost all features were well separated to show a positive or negative association with IR. Conclusion: This was the first study using ML to predict IR in patients with CKD. Our results showed that the RF algorithm had the best AUC of ROC and the best SHAP value differentiation. This was also the first study that included both macronutrients and micronutrients. We concluded that ML algorithms, particularly RF, can help determine risk factors and predict IR in patients with CKD.
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Affiliation(s)
- Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Public Health, College of Public Health, China Medical University, Taichung 406040, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402204, Taiwan
| | - Wei-Ju Liu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Shang-Feng Tsai
- School of Medicine, National Yang-Ming University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402204, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- Correspondence: ; Tel.: +88-(64)-23592525 (ext. 3046); Fax: +88-(64)-23594980
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Meng P, Huang J, Ling X, Zhou S, Wei J, Zhu M, Miao J, Shen W, Li J, Ye H, Niu H, Zhang Y, Zhou L. CXC Chemokine Receptor 2 Accelerates Tubular Cell Senescence and Renal Fibrosis via β-Catenin-Induced Mitochondrial Dysfunction. Front Cell Dev Biol 2022; 10:862675. [PMID: 35592244 PMCID: PMC9110966 DOI: 10.3389/fcell.2022.862675] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/14/2022] [Indexed: 01/10/2023] Open
Abstract
Renal fibrosis is a common feature of various chronic kidney diseases (CKD). However, its underlying mechanism has not been totally clarified. C-X-C motif chemokine receptor (CXCR) family plays a role in renal fibrosis, however, detailed mechanisms have not been elucidated. Here, we report that CXCR2 has a potential role in tubular cell senescence and renal fibrosis, and is associated with β-catenin-activated mitochondrial dysfunction. CXCR2 is one of most increased members among CXCR family in unilateral ureteral obstruction (UUO) mice. CXCR2 was expressed primarily in tubules and co-localized with p16INK4A, a cellular senescence marker, and β-catenin. Administration of SB225002, a selective CXCR2 antagonist, significantly inhibited the activation of β-catenin signaling, restored mitochondrial function, protected against tubular cell senescence and renal fibrosis in unilateral ureteral obstruction (UUO) mice. In unilateral ischemia-reperfusion injury (UIRI) mice, treatment with interlukin-8 (IL-8), the ligand of CXCR2, further aggravated β-catenin activation, mitochondrial dysfunction, tubular cell senescence and renal fibrosis, whereas knockdown of p16INK4A inhibited IL-8-induced these effects. In vitro, SB225002 inhibited mitochondrial dysfunction and tubular cell senescence. Furthermore, ICG-001, a β-catenin signaling blocker, significantly retarded CXCR2-induced cellular senescence and fibrotic changes. These results suggest that CXCR2 promotes tubular cell senescence and renal fibrosis through inducing β-catenin-activated mitochondrial dysfunction.
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Affiliation(s)
- Ping Meng
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
- Department of Central Laboratory, Huadu District People’s Hospital, Southern Medical University, Guangzhou, China
| | - Jiewu Huang
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Xian Ling
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Shan Zhou
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Jingyan Wei
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingsheng Zhu
- Department of Nephrology, The People’s Hospital of Gaozhou, Maoming, China
| | - Jinhua Miao
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Weiwei Shen
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Jiemei Li
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Huiyun Ye
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
| | - Hongxin Niu
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Lili Zhou, ; Yunfang Zhang, ; Hongxin Niu,
| | - Yunfang Zhang
- Department of Nephrology, Huadu District People’s Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Lili Zhou, ; Yunfang Zhang, ; Hongxin Niu,
| | - Lili Zhou
- Division of Nephrology, Nanfang Hospital, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou, China
- *Correspondence: Lili Zhou, ; Yunfang Zhang, ; Hongxin Niu,
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Animaw Z, Walle Ayehu G, Abdu H. Prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221089442. [PMID: 35465636 PMCID: PMC9019378 DOI: 10.1177/20503121221089442] [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: 07/20/2021] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: The main aim of this systematic review and meta-analysis is to provide summarized evidence on the prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia. Method: Databases of MEDLINE/PubMed, Embase, Google Scholar, CINAHL, Cochrane library, and ScienceDirect were searched. In addition, gray literatures were searched manually from university repositories. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to select potential studies. Microsoft Excel 2013 sheet template was used to extract data. The quality of included studies was assessed by utilizing the Newcastle-Ottawa Scale. STATA software version 14.0 is used to compute the estimated pooled prevalence and associated factors of chronic kidney disease. Result: Twelve articles that fulfilled the inclusion criteria were included. The pooled estimate of chronic kidney disease among patients with chronic illnesses in Ethiopia is 21.71% (95% confidence interval: 17.67, 25.74). The highest prevalence of chronic kidney disease among patients with chronic illnesses is from Oromia (32.55% (confidence interval: 19.91, 45.19)). Glomerular filtration rate showed a comparable pooled prevalence from Cockroft-Gault and MDRD methods; 22.38% (confidence interval: 15.83, 28.92), 22.18 (confidence interval: 18.01, 26.34), respectively. Hypertensives become more likely to have chronic kidney disease compared with normotensive patients, (odds ratio = 3.01, 95% confidence interval: 1.33, 6.81). Conclusion: Prevalence of chronic kidney disease among chronic illness patients was significantly high. Hypertension is significantly associated with chronic kidney disease. Hence, we recommend that continuous screening of possible risk factors and proper follow-up and management strategies should be designed.
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Affiliation(s)
- Zelalem Animaw
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hussen Abdu
- School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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17
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Chen WT, Chiu CC, Tsai DJ, Ko PS, Lee MC, Lin HT, Chen YK, Su W, Lin YF, Su SL. The Effect of PPARγ rs1801282 Variant on Mortality Risk Among Asians With Chronic Kidney Disease: A Cohort Study and Meta-Analysis. Front Genet 2022; 13:705272. [PMID: 35265101 PMCID: PMC8898960 DOI: 10.3389/fgene.2022.705272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a public health issue, and an independent risk factor for cardiovascular disease. The peroxisome proliferator-activated receptor gamma (PPARG) plays an important role in the cardiovascular system. Previous studies have examined one important exon polymorphism, Pro12Ala, in PPARG with respect to mortality of CKD patients, but the results were inconsistent and current evidence is insufficient to support a strong conclusion. This study aimed to examine the correlation between Pro12Ala gene polymorphism and mortality among Asians with CKD by trial sequential analysis (TSA). Methods: The research was divided into observational research and meta-analysis. For the cohort study, 767 subjects from dialysis centers in Taipei were selected as samples, and tracked from December 2015 to February 2017. For the meta-analysis, relevant literature from “PubMed” and “Embase” databases (until December 2016), was searched and TSA was used to verify the results. In order to achieve the best evidence hierarchies, our retrospective cohort study was added to the meta-analysis and the TSA. Results: The combined sample size for Asian was 1,685 after adding our cohort study, and there was no significant correlation between PPARG Pro12Ala and mortality by the allele model (RR: 0.85, 95% CI: 0.39–1.83, I2 = 79.3%). Under the parameter setting with the RR value of 1.5, TSA estimation presented that the cumulative sample size entered into the futility area, and it confirmed the conclusion in this study. Conclusion: We found that PPARG Pro12Ala gene polymorphism was not related to mortality in CKD Asians patients, and validated our conclusion using TSA after adding our sample.
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Affiliation(s)
- Wei-Teing Chen
- Division of Chest Medicine, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.,National Defense Medical Center, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Chien Chiu
- Division of Infectious Diseases, National Defense Medical Center, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Dung-Jang Tsai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan
| | - Pi-Shao Ko
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan
| | - Meng-Chang Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hsiao-Ting Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ying-Kai Chen
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Wen Su
- National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan
| | - Yuh-Feng Lin
- Division on Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Nephrology, National Defense Medical Center, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
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18
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Shen Y, Shen Y, Li J, Ding F, Wang Y. Polyethyleneimine-anchored liposomes as scavengers for improving the efficiency of protein-bound uremic toxin clearance during dialysis. J Biomed Mater Res A 2021; 110:976-983. [PMID: 34908219 DOI: 10.1002/jbm.a.37346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 12/12/2022]
Abstract
Protein-bound uremic toxins (PBUTs) are significant toxins that are closely related to the prognosis of chronic kidney disease. They cannot be effectively removed by conventional dialysis therapies due to their high albumin binding affinity. Our previous research revealed that cationic liposomes (i.e., polyethyleneimine [PEI]-decorated liposomes) could enhance the clearance of PBUTs via electrostatic interactions. However, the poor biocompatibility (hemolysis) restricted their applications in clinical dialysis treatment. Herein, we produced PEI-anchored, linoleic acid-decorated liposomes (CP-LA liposomes) via the conjugation of PEI to cholesterol chloroformate (Chol-PEI, CP), and linoleic acid (LA) was added to provide liposomal colloidal stability. The CP-LA liposomes outperformed the plain liposomes, demonstrating significantly higher PBUT binding rates and removal rates. In addition, in vitro dialysis simulation verified that the CP-LA liposomes had a better capacity for PBUT clearance than the plain liposomes, especially for PBUTs with a strong negative net charge. Hemolysis and cytotoxicity tests revealed that the biocompatibility of the CP-LA liposomes was better than that of the physically-decorated PEI-liposome. CP-LA liposomes possess great potential for PBUT clearance in clinical dialysis therapy.
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Affiliation(s)
- Yuqi Shen
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Shen
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaolun Li
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yifeng Wang
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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19
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Maeda T, Yokota S, Nishi T, Funakoshi S, Tsuji M, Satoh A, Abe M, Kawazoe M, Yoshimura C, Tada K, Takahashi K, Ito K, Yasuno T, Yamanokuchi T, Iwanaga K, Morinaga A, Maki K, Ueno T, Masutani K, Mukoubara S, Arima H. Association between pulse pressure and progression of chronic kidney disease. Sci Rep 2021; 11:23275. [PMID: 34857861 PMCID: PMC8640028 DOI: 10.1038/s41598-021-02809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate the association between pulse pressure (PP) and chronic kidney disease (CKD) progression among the general population in Japan. We conducted a population-based cohort study of the residents of Iki Island, Nagasaki, Japan, from 2008 to 2018. We identified 1042 participants who had CKD (estimated glomerular filtration rate(eGFR) < 60 mL/min/1.73 m2 or the presence of proteinuria) at baseline. Cox's proportional hazard model was used to evaluate the association between PP and progression of CKD. During a 4.66-year mean follow-up, there were 241 cases of CKD progression (incident rate: 49.8 per 1000 person-years). A significant increase existed in CKD progression per 10 mmHg of PP elevation, even when adjusted for confounding factors [adjusted hazard ratio 1.17 (1.06-1.29) p < 0.001]. Similar results were obtained even after dividing PP into quartiles [Q2: 1.14 (0.74-1.76), Q3: 1.35 (0.88-2.06), Q4: 1.87 (1.23-2.83) p = 0.003 for trend]. This trend did not change significantly irrespective of baseline systolic or diastolic blood pressures. PP remained a potential predictive marker, especially for eGFR decline. In conclusion, we found a significant association between PP and CKD progression. PP might be a potential predictive marker for CKD progression.
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Affiliation(s)
- Toshiki Maeda
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Soichiro Yokota
- Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takumi Nishi
- Department of Research Planning and Information Management, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
| | - Shunsuke Funakoshi
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Masayoshi Tsuji
- Department of Lifestyle and Welfare Information, Kindai University Kyushu Junior College, Fukuoka, Japan
| | - Atsushi Satoh
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Chikara Yoshimura
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazuhiro Tada
- Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Koji Takahashi
- Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenji Ito
- Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tetsuhiko Yasuno
- Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshitaka Yamanokuchi
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Kazuyo Iwanaga
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Akiko Morinaga
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kaori Maki
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tamami Ueno
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kousuke Masutani
- Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigeaki Mukoubara
- Department of Internal Medicine, Nagasaki Prefecture Iki Hospital, Nagasaki, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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20
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Lived Experiences of Patients with Chronic Kidney Disease Receiving Hemodialysis in Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Int J Nephrol 2021; 2021:6637272. [PMID: 34484835 PMCID: PMC8410445 DOI: 10.1155/2021/6637272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Chronic kidney disease is a challenging disease and global public health problem. The burden of chronic kidney disease and hemodialysis is increasing in Ethiopia, but few studies explored the lived experiences of chronic kidney disease patients receiving hemodialysis. This study explored the lived experiences of chronic kidney disease patients receiving hemodialysis, in the Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar City, Northwest Ethiopia, 2019. Methods A phenomenological study design was conducted with 12 chronic kidney disease patients receiving hemodialysis between September 1 and October 30, 2019. A purposive sampling technique was used to select participants, and a semistructured in-depth interview guide was used to collect the data. The investigators audio-taped the interviews and then transcribed them verbatim. Finally, the transcribed data were imported to Atlas.ti™-7 software for coding, and then, thematic analysis was done. Transferability, dependability, credibility, and conformability were embedded to ensure data quality. Results In this study, six major themes were emerged: (1) the seriousness of the disease, (2) challenges to get hemodialysis, (3) financial constraint, (4) restricted life, (5) feeling of dependency, and (6) psychological impacts. Conclusion The restrictive nature of the disease affects a participant's financial status which makes it challenging to obtain the service and increases feelings of dependency. These circumstances impact the psychology of the participants. We would recommend that every patient with hemodialysis needs social and psychological support. We would also recommend the need to extend the study to other areas of the country to confirm or disconfirm the findings.
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21
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Filipska A, Bohdan B, Wieczorek PP, Hudz N. Chronic kidney disease and dialysis therapy: incidence and prevalence in the world. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e65501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Сhronic kidney disease (CKD) is the important public and medical problem in the world because of a large burden on health care systems. The prevalence of CKD and number of dialysis patients are increasing in the world. The prevalence and incidence of CKD depends on age, race, and gender of patients, region, and the presence of the CKD registry in a country. Diabetes mellitus (DM) and arterial hypertension (AH) are the most common causes of end stage renal disease (ESRD). It is projected that the number of dialysis patients will reach 5.5 million in 2030. Specific strategies and interventions should be urgently aimed at reducing in the burden of CKD by means of the prevention, detection and treatment of DM, AH, and early stages of CKD. One more strategy is the organization of own domestic manufacture of solutions for dialysis therapy.
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22
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Talbot B, Athavale A, Jha V, Gallagher M. Data Challenges in Addressing Chronic Kidney Disease in Low- and Lower-Middle-Income Countries. Kidney Int Rep 2021; 6:1503-1512. [PMID: 34169191 PMCID: PMC8207309 DOI: 10.1016/j.ekir.2021.03.901] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022] Open
Abstract
The burden of chronic kidney disease (CKD) is growing globally, particularly in low- and lower-middle-income countries (LLMICs) where access to treatment is poor and the largest increases in disease burden will occur. The individual and societal costs of kidney disease are well recognized, especially in developed health care systems where treatments for the advanced stages of CKD are more readily available. The consequences of CKD are potentially more catastrophic in developing health care systems where such resources are often lacking. Central to addressing this challenge is the availability of data to understand disease burden and ensure that investments in treatments and health resources are effective at a local level. Use of routinely collected administrative data is helpful in this regard, however, the barriers to developing a more systematic focus on data collection should not be underestimated. This article reviews the current tools that have been used to measure the burden of CKD and considers limitations regarding their use in LLMICs. A review of the literature investigating the use of registries, disease specific databases and administrative data to identify populations with CKD in LLMICs, which indicate these to be underused resources, is included. Suggestions regarding the potential use of administrative data for measuring CKD burden in LLMICs are explored.
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Affiliation(s)
- Benjamin Talbot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Concord Clinical School, University of Sydney, New South Wales, Australia
| | - Akshay Athavale
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India.,Manipal Academy of Higher Education (MAHE), Manipal, India.,School of Public Health, Imperial College, London, UK
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Concord Clinical School, University of Sydney, New South Wales, Australia
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23
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Ayat Ali AS, Lim SK, Tang LY, Rashid AA, Chew BH. The effectiveness of nurse-led self-management support program for people with chronic kidney disease stage 3-4 (CKD-NLSM): Study protocol for a randomized controlled trial. Sci Prog 2021; 104:368504211026159. [PMID: 34143698 PMCID: PMC10455029 DOI: 10.1177/00368504211026159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The complexity of chronic kidney disease (CKD) and its treatments have made self-management behaviors inevitably challenging. However, supplementing education with self-management skills may improve numerous health outcomes in people with nondialysis CKD. This study protocol describes a randomized controlled trial (RCT) aimed to evaluate the effects of a nurse-led self-management support program as an intervention for kidney disease knowledge and CKD self-management behaviors among people with pre-dialysis CKD. In Phase 1, people with CKD stage 3-4 and their family members are involved in co-designing, development and pilot testing of a theory-based self-management intervention. In Phase 2, we perform a cross-cultural adaptation of the Kidney Disease Knowledge Survey, CKD Self-Management and Self-efficacy for Managing Chronic Disease questionnaires. In Phase 3, a parallel RCT will be conducted to evaluate the intervention where 154 participants with CKD stage 3-4 will be randomly assigned to either the intervention (n = 77) or control group (n = 77). The intervention group will receive 6-week self-management program from a nurse-coach in addition to standard usual care, while the control group will receive only standard usual care. Outcome measures include kidney disease knowledge, CKD self-management behavior, self-efficacy, quality of life, blood pressure control and adherence to CKD diet as indicated by 24-h urine urea nitrogen, 24-h urine sodium and net endogenous acid production. Data will be collected at baseline and 12-week post-baseline. The between- and within-group intervention effects will be estimated using the Generalized Estimating Equations. The self-management intervention offers strategies to delay CKD progression and to encourage motivation to better self-manage at home. This study integrates self-management education and psychosocial support with culturally relevant scenarios, and evaluates important self-reported and objective outcomes.Clinical Trials Registration: www.ClinicalTrials.gov, identifier: NCT03974646.
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Affiliation(s)
- Al Sawad Ayat Ali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Department of Nursing, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Soo Kun Lim
- Department of Medicine (Nephrology), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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24
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Shahat AA, Ullah R, Alqahtani AS, Hassanein HM, Husseiny HA, Mohammed NM, Herqash RN. Nephroprotective effect of persimmon leaves ( Diospyros kaki L.f.) against CCl 4-induced renal toxicity in Swiss Albino rats. Drug Chem Toxicol 2021; 45:1578-1586. [PMID: 33522322 DOI: 10.1080/01480545.2020.1849269] [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] [Indexed: 10/22/2022]
Abstract
Diospyros kaki L.f. fruit and leaves are traditionally used for the treatment of hypertension, angina, internal hemorrhage, antithrombotic and anti-inflammatory effects.In the current study, the protective effects of ethyl acetate (Per-1), n-butanol (Per-2), and aqueous (Per-3) fractions of Diospyros kaki leaves against carbon tetrachloride (CCl4) induced nephrotoxicity in Swiss albino rats were tested. Animal were divided into nine groups; each group consists of six animals. The groups were : group I was untreated and kept as control, group II was treated with CCl4 only, group III (silymarin with CCl4); group IV (Per-1 100 mg/kg with CCl4);group V (Per-1 200 mg/kg with CCl4); group VI (Per-2 100 mg/kg with CCl4); group VII (Per-2 200 mg/kg with CCl4); group VIII (Per-3 100 mg/kg with CCl4); and group IX (Per-3 200 mg/kg with CCl4). Silymarin was used as standard drug. All tested fractions were found active (except Per-1 at low dose of 100 mg/kg) with significant value (p < 0.001) compared to CCl4 only group. Serum creatinine, malondialdehyde (MDA), and uric acid were significantly (p < 0.001) lowered in group VII-IX as compared to CCl4 only group. Similarly, total protein (TP) and non-protein sulfhydryls(NP-SH) level in kidney tissues were significantly (p < 0.001) elevated in the same groups compared to CCl4 only group. Further to check the cardio-protective potential, biochemical parameters such as LDH, creatine kinase, TP, MDA, and NP-SH levels in myocardial tissues were also estimated.These findings confirmed that the n-butanol and aqueous fractions are active and recommended for further bioactive phytoconstituents screening. Repeated column chromatography on silica gel G and sephadex-LH-20 of the active n-butanol fraction, four flavonoids were isolated. Based on the spectroscopic NMR data, compounds were identified as kaempferol (1), quercetin (2), astragalin (3), and rutin (4).
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Affiliation(s)
- Abdelaaty A Shahat
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Chemistry of Medicinal Plants Department, National Research Centre, Giza, Egypt
| | - Riaz Ullah
- College of Pharmacy, Medicinal, Aromatic and Poisonous Plants Research Centre (MAPRC), King Saud University, Riyadh, Saudi Arabia.,Department of Chemistry, Government College Ara Khel FR, Kohat, Pakistan
| | - Ali S Alqahtani
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,College of Pharmacy, Medicinal, Aromatic and Poisonous Plants Research Centre (MAPRC), King Saud University, Riyadh, Saudi Arabia
| | - Heba M Hassanein
- Chemistry of Medicinal Plants Department, National Research Centre, Giza, Egypt
| | - Husseiny A Husseiny
- Faculty of Pharmacy, Misr University for Science and Technology (MUST), Giza, Egypt
| | - Nahla M Mohammed
- Department of Chemistry, College of Science and Arts, Shaqra University, Riyadh, Saudi Arabia.,Department of Biochemistry, College of Medicine, University of Technological Science, Khartoum, Sudan
| | - Rashed N Herqash
- College of Pharmacy, Medicinal, Aromatic and Poisonous Plants Research Centre (MAPRC), King Saud University, Riyadh, Saudi Arabia
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25
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Gonçalves JG, Canale D, de Bragança AC, Seguro AC, Shimizu MHM, Volpini RA. The Blockade of TACE-Dependent EGF Receptor Activation by Losartan-Erlotinib Combination Attenuates Renal Fibrosis Formation in 5/6-Nephrectomized Rats Under Vitamin D Deficiency. Front Med (Lausanne) 2021; 7:609158. [PMID: 33469545 PMCID: PMC7813781 DOI: 10.3389/fmed.2020.609158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) has been considered a major public health issue. In addition to cardiovascular diseases and infections, hypovitaminosis D has been considered a non-traditional aggravating factor for CKD progression. Interstitial fibrosis is a hallmark of CKD strongly correlated with deterioration of renal function. Transforming growth factor β (TGF-β) is the major regulatory profibrotic cytokine in CKD. Many injurious stimuli converge on the TGF-β pathway, which has context-dependent pleiotropic effects and interacts with several related renal fibrosis formation (RFF) pathways. Epidermal growth factor receptor (EGFR) is critically involved in CKD progression, exerting a pathogenic role in RFF associated with TGF-β-related fibrogenesis. Among others, EGFR pathway can be activated by a disintegrin and a metalloproteinase known as tumor necrosis factor α-converting enzyme (TACE). Currently no effective therapy is available to completely arrest RFF and slow the progression of CKD. Therefore, we investigated the effects of a double treatment with losartan potassium (L), an AT1R antagonist, and the tyrosine kinase inhibitor erlotinib (E) on the alternative pathway of RFF related to TACE-dependent EGFR activation in 5/6-nephrectomized rats under vitamin D deficiency (D). During the 90-day protocol, male Wistar rats under D, were submitted to 5/6 nephrectomy (N) on day 30 and randomized into four groups: N+D, no treatment; N+D+L, received losartan (50 mg/kg/day); N+D+E, received erlotinib (6 mg/kg/day); N+D+L+E received losartan+erlotinib treatment. N+D+L+E data demonstrated that the double treatment with losartan+erlotinib not only blocked the TACE-dependent EGF receptor activation but also prevented the expression of TGF-β, protecting against RFF. This renoprotection by losartan+erlotinib was corroborated by a lower expression of ECM proteins and markers of phenotypic alteration as well as a lesser inflammatory cell infiltrate. Although erlotinib alone has been emerging as a renoprotective drug, its association with losartan should be considered as a potential therapeutic strategy on the modulation of RFF.
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Affiliation(s)
- Janaína Garcia Gonçalves
- Laboratorio de Investigacao Medica 12, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Carolina de Bragança
- Laboratorio de Investigacao Medica 12, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Wang CY, Lin TA, Ho MY, Yeh JK, Tsai ML, Hung KC, Hsieh IC, Wen MS. Regulation of autophagy in leukocytes through RNA N 6-adenosine methylation in chronic kidney disease patients. Biochem Biophys Res Commun 2020; 527:953-959. [PMID: 32439179 DOI: 10.1016/j.bbrc.2020.04.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
Patients with chronic kidney diseases have multiple cellular dysfunctions leading to increased atherosclerosis, impaired immunity, and disturbed metabolism. However, it is unclear what is the fundamental signaling served as a marker or as a mediator for the dysregulated function in their leukocytes or tissues. Here we hypothesized that the N6-Methyladenosine (m6A) modification of the RNA in the leukocytes is responsible for the cellular dysfunction in chronic kidney diseases. Patients with chronic kidney diseases had significantly less m6A abundances in leukocytes and elevated RNA demethylase FTO proteins. The uremic toxin, indoxyl sulfate, activated the autophagy flux through modulation of FTO and m6A modifications in RNA. Notably, knockdown of FTO or inhibit the m6A by 3-deazaadenosine blocks the effects of indoxyl sulfate on autophagy activation in cells. These findings provide new insights into the mechanisms underlying chronic kidney disease-associated cellular dysfunction. Targeting RNA m6A modification may be a novel strategy for the treatment of chronic kidney diseases and autophagy.
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Affiliation(s)
- Chao-Yung Wang
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan; Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, 350, Taiwan.
| | - Tien-An Lin
- Department of General Surgery, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
| | - Ming-Yun Ho
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
| | - Jih-Kai Yeh
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
| | - Ming-Lung Tsai
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
| | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
| | - I-Chang Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
| | - Ming-Shien Wen
- Department of Cardiology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan
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Neale EP, Middleton J, Lambert K. Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review. BMC Nephrol 2020; 21:83. [PMID: 32160886 PMCID: PMC7066820 DOI: 10.1186/s12882-020-01731-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care. Methods A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework. Results A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the ‘Environmental context and resources’ domain (n = 16 studies). Overall, the most common barrier identified was a lack of time (n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD (n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team (n = 5 studies). Conclusion This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently co-morbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.
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Affiliation(s)
- Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Health Impacts Research Cluster, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Justin Middleton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.,Health Impacts Research Cluster, University of Wollongong, Wollongong, NSW, 2522, Australia.,Department of Clinical Nutrition, Wollongong Hospital, Level 5, Block C, Crown St, Wollongong, NSW, 2500, Australia
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Zhu Y, Cui H, Lv J, Li G, Li X, Ye F, Zhong L. Angiotensin II triggers RIPK3-MLKL-mediated necroptosis by activating the Fas/FasL signaling pathway in renal tubular cells. PLoS One 2020; 15:e0228385. [PMID: 32134954 PMCID: PMC7058379 DOI: 10.1371/journal.pone.0228385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/14/2020] [Indexed: 01/08/2023] Open
Abstract
Our earlier studies proved that RIPK3-mediated necroptosis might be an important mode of renal tubular cell death in rats with chronic renal injury and the necroptotic cell death can be triggered by tumor necrosis factor-α (TNF-α) in vitro, but the triggering role of angiotensin II (AngII), which exerts notable effects on renal cells for the initiation and progression of renal tubulointerstitial fibrosis, is largely unknown. Here, we identified the presence of necroptotic cell death in the tubular cells of AngII-induced chronic renal injury and fibrosis mice and assessed the percentage of necroptotic renal tubular cell death with the disruption of this necroptosis by the addition of necrostatin-1 (Nec-1). Furthermore, the observation was further confirmed in HK-2 cells treated with AngII and RIPK1/3 or MLKL inhibitors. The detection of Fas and FasL proteins led us to investigate the contribution of the Fas/FasL signaling pathway to AngII-induced necroptosis. Disruption of FasL decreased the percentage of necroptotic cells, suggesting that Fas and FasL are likely key signal molecules in the necroptosis of HK-2 cells induced by AngII. Our data suggest that AngII exposure might trigger RIPK3-MLKL-mediated necroptosis in renal tubular epithelial cells by activating the Fas/FasL signaling pathway in vivo and in vitro.
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Affiliation(s)
- Yongjun Zhu
- Department of Nephrology, the First Affiliated Hospital of Hainan Medical University, Haikou, China
- * E-mail: (YZ); (LZ)
| | - Hongwang Cui
- Department of Orthopedics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jie Lv
- The First Clinical College of Hainan Medical University, Hainan, China
| | - Guojun Li
- Department of Orthopedics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xiaoyan Li
- Department of Nephrology, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Feng Ye
- Department of Nephrology, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Liangbao Zhong
- Department of Nephrology, the First Affiliated Hospital of Hainan Medical University, Haikou, China
- * E-mail: (YZ); (LZ)
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Alemu H, Hailu W, Adane A. Prevalence of Chronic Kidney Disease and Associated Factors among Patients with Diabetes in Northwest Ethiopia: A Hospital-Based Cross-Sectional Study. CURRENT THERAPEUTIC RESEARCH 2020; 92:100578. [PMID: 32190131 PMCID: PMC7068620 DOI: 10.1016/j.curtheres.2020.100578] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/06/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is increasingly recognized as a global health issue and it affects 10% to 15% of the world population. Diabetes mellitus is the leading cause of end-stage renal disease. More than 422 million adults in the world populations are living with diabetes mellitus, 40% of whom will develop CKD. CKD in diabetes increases the risk of early death and cardiovascular morbidity and mortality. There is a paucity of published data on the prevalence of CKD and its associated factors among patients with diabetes in northwest Ethiopia. OBJECTIVE The aim of this study is to determine the prevalence and factors associated with CKD among patients with diabetes at University of Gondar Hospital, Northwest Ethiopia. METHODS A hospital-based cross-sectional study was conducted from April 2 to July 31, 2018. Using convenience sampling, a total of 272 consecutive patients with diabetes were recruited for the study. Data regarding the patients' sociodemographic information, clinical characteristics, and laboratory parameters were collected using patient interview and review of medical records. Serum creatinine was measured and used to calculate estimated glomerular filtration rate using modification of diet in renal disease and chronic kidney disease epidemiology equations. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analyses were used to identify predictors of CKD in patients with diabetes. RESULT The prevalence of CKD, defined by estimated glomerular filtration rate <60 mL/min/1.73 m2, was found to be 17.3% and 14.3% by modification of diet in renal disease and chronic kidney disease epidemiology equations, respectively. The proportion of stage 3 CKD by modification of diet in renal disease equation was 14.7%, whereas the proportions of stage 4 and stage 5 CKD were 2.2% and 0.4%, respectively. Among those who were diagnosed with CKD, 85.1% had pre-existing hypertension. Multivariate logistic regression analysis revealed that the presence of retinopathy (adjusted odds ratio = 14; 95% CI, 4-36; p < 0.001), pre-existing hypertension (adjusted odds ratio = 8.2; 95% CI, 2-23; P < 0.001), current systolic blood pressure >140 mm Hg (adjusted odds ratio = 6; 95% CI, 4-22; P = 0.001), and duration of diabetes >10 years (adjusted odds ratio = 3.2; 95% CI, 2-7; P = 0.004) were significantly associated with CKD in patients with diabetes. CONCLUSIONS The prevalence of CKD in patients with diabetes is high and comparable with previous studies from low- and middle-income countries. Pre-existing hypertension, current systolic blood pressure >140 mm Hg, duration of diabetes >10 years, and presence of retinopathy were significantly associated with CKD. Regular screening for CKD, retinopathy, and optimal blood pressure management should be practiced.
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Affiliation(s)
| | - Workagegnehu Hailu
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar City, Ethiopia
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30
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Wu H, Li Q, Cai Y, Zhang J, Cui W, Zhou Z. Economic burden and cost-utility analysis of three renal replacement therapies in ESRD patients from Yunnan Province, China. Int Urol Nephrol 2020; 52:573-579. [PMID: 32009220 DOI: 10.1007/s11255-020-02394-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/16/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To compare the economic burden and cost-utility analysis of the renal replacement therapies, including hemodialysis (HD), peritoneal dialysis (PD), and allograft kidney transplantation (KT) among end-stage renal disease (ESRD) patients from Yunnan Province, China. METHODS Multistage stratified random sampling method was used to select presentative sample of 298 patients from four hospitals in Yunnan Province. The two-step model was applied to calculate a direct economic burden; the human capital approach was used to analyze the indirect economic burden. SF-36 scale was applied to assess the quality of life, while the improving score of quality of life was used to evaluate the cost-utility score. RESULTS A total of 298 patients were analyzed, including 108 HD patients, 91 PD patients and 99 KT patients. The mean unit economic expenses of HD, PD, and KT were $11,783.6 ± 402.63, $11,059.8 ± 709.51, and $21,151.1 ± 11,419.57, respectively. Based on the cost-utility analysis, the cost of improving one unit of quality of life in KT, PD, and HD was $599.86, $1373.89 and $2021.20, respectively; a significant difference was observed between the KT group and the HD or PD group (P < 0.05). CONCLUSIONS The economic burden of ESRD in Yunnan was substantial. The cost-utility was the best in the renal transplantation group. Kidney transplantation is still recommended as the first approach for patients with ESRD, followed by PD.
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Affiliation(s)
- Huixin Wu
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.,School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Qing Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.
| | - Yaping Cai
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Junlin Zhang
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wenlong Cui
- School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Zhu Zhou
- The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
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Anupama YJ, Kiran SK, Hegde SN. Heavy Metals and Pesticides in Chronic Kidney Disease - Results from a Matched Case-Control Study from a Rural Population in Shivamogga District in South India. Indian J Nephrol 2019; 29:402-409. [PMID: 31798222 PMCID: PMC6883862 DOI: 10.4103/ijn.ijn_325_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION There is a high prevalence of chronic kidney disease (CKD) in the rural agrarian population of South India and it often appears unrelated to major known causes such as diabetes or glomerulonephritis. METHODS In a matched case-control study conducted in a rural population in Shivamogga district in South India, the association of heavy metals - lead (Pb), arsenic (As), cadmium (Cd) - and pesticides in CKD was studied. Blood and spot urine samples were tested quantitatively for heavy metals and qualitatively for pesticides. RESULTS In all, 69 matched pairs (40 female, 58%) were recruited. The mean estimated glomerular filtration rate (mL/min/1.73 m2) was 60.1 (14.2) in cases and 83.4 (13.4) in controls. Elevated blood lead level >5 μg/dL was seen in 15 cases and 25 controls, respectively [P = 0.035, matched odds ratio (MOR) 0.5, 95% confidence interval (CI) 0.22-1.05]. Urinary Pb was elevated in 16 cases and 13 controls, respectively (P = 0.28, MOR 1.25, 95% CI 0.58-2.73). There was no significant association with As and Cd, while pesticide residues were undetectable in cases as well as controls. These results did not change even after excluding CKD cases with diabetes, stage 2 hypertension, and significant proteinuria. CONCLUSIONS There was no statistical significant association between any of the studied heavy metals and CKD, although there was a significant burden of heavy metals in the studied subjects.
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Affiliation(s)
- Y. J. Anupama
- Department of Nephrology, Nanjappa Hospital, Shivamogga, Karnataka, India
| | - S. K. Kiran
- Taluka Medical Officer, Thirthahalli, Karnataka, India
| | - Shrikanth N. Hegde
- Department of Medicine, Anushri Medical and Diabetes Care Center, Shivamogga, Karnataka, India
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Zeng X, Li C, Li Y, Yu H, Fu P, Hong HG, Zhang W. A network-based variable selection approach for identification of modules and biomarker genes associated with end-stage kidney disease. Nephrology (Carlton) 2019; 25:775-784. [PMID: 31464346 DOI: 10.1111/nep.13655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 02/05/2023]
Abstract
AIMS Intervention for end-stage kidney disease (ESKD), which is associated with adverse prognoses and major economic burdens, is challenging due to its complex pathogenesis. The study was performed to identify biomarker genes and molecular mechanisms for ESKD by bioinformatics approach. METHODS Using the Gene Expression Omnibus dataset GSE37171, this study identified pathways and genomic biomarkers associated with ESKD via a multi-stage knowledge discovery process, including identification of modules of genes by weighted gene co-expression network analysis, discovery of important involved pathways by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, selection of differentially expressed genes by the empirical Bayes method, and screening biomarker genes by the least absolute shrinkage and selection operator (Lasso) logistic regression. The results were validated using GSE70528, an independent testing dataset. RESULTS Three clinically important gene modules associated with ESKD, were identified by weighted gene co-expression network analysis. Within these modules, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed important biological pathways involved in ESKD, including transforming growth factor-β and Wnt signalling, RNA-splicing, autophagy and chromatin and histone modification. Furthermore, Lasso logistic regression was conducted to identify five final genes, namely, CNOT8, MST4, PPP2CB, PCSK7 and RBBP4 that are differentially expressed and associated with ESKD. The accuracy of the final model in distinguishing the ESKD cases and controls was 96.8% and 91.7% in the training and validation datasets, respectively. CONCLUSION Network-based variable selection approaches can identify biological pathways and biomarker genes associated with ESKD. The findings may inform more in-depth follow-up research and effective therapy.
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Affiliation(s)
- Xiaoxi Zeng
- West China Biomedical Big Data Center, West China School of Medicine (West China Hospital), Sichuan University, Chengdu, China.,Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Chunyang Li
- West China Biomedical Big Data Center, West China School of Medicine (West China Hospital), Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Yi Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Haopeng Yu
- West China Biomedical Big Data Center, West China School of Medicine (West China Hospital), Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Ping Fu
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Hyokyoung G Hong
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA
| | - Wei Zhang
- West China Biomedical Big Data Center, West China School of Medicine (West China Hospital), Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
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Wang J, Bao B, Shen P, Kong G, Yang Y, Sun X, Ding G, Gao B, Yang C, Zhao M, Lin H, Zhang L. Using electronic health record data to establish a chronic kidney disease surveillance system in China: protocol for the China Kidney Disease Network (CK-NET)-Yinzhou Study. BMJ Open 2019; 9:e030102. [PMID: 31467053 PMCID: PMC6719833 DOI: 10.1136/bmjopen-2019-030102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/02/2019] [Accepted: 07/25/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is an important public health problem worldwide. However, there are few active disease surveillance systems for it. The China Kidney Disease Network (CK-NET) was established as a comprehensive surveillance system for CKD using various data sources. As part of this, the proposed CK-NET-Yinzhou study aims to build a regional surveillance system in a developed coastal area in China to obtain detailed dynamic information about kidney disease and to improve the ability to manage the disease effectively. METHODS AND ANALYSIS Yinzhou is a district of Ningbo city, Zhejiang province. The district has a population of more than 1 million. By 2016, 98% were registered in a regional health information system that started in 2009. This system includes administrative databases containing general demographic characteristics, health check information, inpatient and outpatient electronic medical records, health insurance information, disease surveillance and management information, and death certificates. We will use longitudinal individual electronic health record data to identify people with CKD by repeated laboratory measurements and diagnostic codes. We will also evaluate the associated risk factors, prognosis and disease management. An intelligent clinical decision support system (CDSS) will be developed based on clinical guidelines, domain expert knowledge and real-world data, and will be integrated into the hospital information system. ETHICS AND DISSEMINATION The CK-NET-Yinzhou study has been reviewed and approved by the Peking University First Hospital Ethics Committee. Privacy of local residents registered with the health information system will be tightly protected through the study process. The findings of the study will be disseminated through peer-reviewed journal articles, posters and presentations in national and international scientific conferences, as well as among local practitioners through the CDSS.
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Affiliation(s)
- Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Beiyan Bao
- Renal Division, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Guilan Kong
- Center for Data Science in Health and Medicine, Peking University, Beijing, Beijing, China
| | - Yu Yang
- Center for Data Science in Health and Medicine, Peking University, Beijing, Beijing, China
| | - Xiaoyu Sun
- Center for Data Science in Health and Medicine, Peking University, Beijing, Beijing, China
| | - Guohui Ding
- College of Computer Science, Shenyang Aerospace University, Shenyang, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Center for Data Science in Health and Medicine, Peking University, Beijing, Beijing, China
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Hishida M, Imaizumi T, Nishiyama T, Okazaki M, Kaihan AB, Kato S, Kubo Y, Ando M, Kaneda H, Maruyama S. Survival Benefit of Maintained or Increased Body Mass Index in Patients Undergoing Extended-Hours Hemodialysis Without Dietary Restrictions. J Ren Nutr 2019; 30:154-162. [PMID: 31401040 DOI: 10.1053/j.jrn.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/16/2019] [Accepted: 06/02/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Low body mass index (BMI) is a potential risk factor for mortality in patients on maintenance hemodialysis. This suggests the usefulness of BMI as a prognostic factor and implies the importance of nutritional status, inflammation, and oxidative stress, all of which affect BMI. We aimed to evaluate BMI changes over time and the mortality risk in patients undergoing a novel combination therapy consisting of an extended-hours hemodialysis protocol without dietary restrictions, which enabled sufficient nutrition. DESIGN AND METHODS This is a retrospective cohort study. Patients were divided into 2 groups based on BMI change (ΔBMI < 0, ΔBMI ≥ 0) between the 3rd and 12th month after transfer to the clinic. We studied the associations of BMI changes with all-cause mortality. Further subgroup analyses were performed using Cox models. We finally studied 187 patients who were receiving the combined therapy. The main outcome measure was all-cause mortality of the study group. RESULTS The median (interquartile range) follow-up time was 4.9 (3.0-8.6) years. Overall, 138 patients were in the ΔBMI ≥ 0 group. As per unadjusted and adjusted Cox models, maintained or increased BMI during this period was associated with hazard ratios of 0.45 (confidence interval 0.23-0.87, P < .05) and 0.35 (confidence interval 0.17-0.75, P < .01) for all-cause mortality, respectively. In the same group, maintained or increased BMI was found to be significantly associated with decreased mortality in female, older, and nondiabetic patients. The data indicated that diabetic status could have a modifying effect on the association between variation in BMI and mortality (P = .006). CONCLUSIONS Extended-hours hemodialysis without dietary restrictions led to a beneficial effect of maintenance or increase in BMI, especially in females, patients aged ≥65 years, and those without diabetic nephropathy, which could lead to prolonged survival.
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Affiliation(s)
- Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Toshiro Nishiyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Masaki Okazaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Ahmad Baseer Kaihan
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Yoko Kubo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Masahiko Ando
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Hiroshi Kaneda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan.
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Tótoli C, Carvalho AB, Ammirati AL, Draibe SA, Canziani MEF. Associated factors related to chronic kidney disease progression in elderly patients. PLoS One 2019; 14:e0219956. [PMID: 31335919 PMCID: PMC6650050 DOI: 10.1371/journal.pone.0219956] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/06/2019] [Indexed: 01/10/2023] Open
Abstract
Background Chronic Kidney Disease (CKD) is a worldwide public health problem. The prevalence of CKD is rising especially in elderly, as consequence of population-ageing related to socioeconomic development and better life expectancy. There are scarce studies evaluating CKD progression and its associated factors in elderly patients. Methods This is a retrospective observational study including 340 patients (≥ 65 years old) CKD stages 3a–5 non-dialysis, incidents in an outpatient CKD clinic, followed by 2.1 years. CKD progression was assessed by the slope of eGFR calculated by CKD-EPI and BIS 1 equations. The patients were divided in progressor and non-progressor groups (eGFR slope < or ≥ 0 mL/min/1.73 m2/year, respectively). Results Kidney function declined in 193 (57%) patients. In this group, the progression rate was -2.83 (-5.1 / -1.1) mL /min /1.73 m2 /year. Compared to non progressor, the progressor patients were younger [72 (69–78) vs. 76 (69–80) years; p = 0.02]; had higher proportion of diabetic nephropathy, higher serum phosphorus [3.8 (3.3–4.1) vs. 3.5 (3.9–4.1) mg/dL; p = 0.04] and proteinuria [0.10 (0–0.9 vs. 0 (0–0.3)] g/L; p = 0.007)] at the admission. In the logistic regression analysis adjusted for gender and eGFR, proteinuria was independently associated with CKD progression [OR (Odds Ratio) (1.83; 95% CI, 1.17–2.86; p < 0.01)]. Conclusion CKD progression was observed in the majority of elderly CKD patients and proteinuria was the most important factor associated to the decline of kidney function in this population.
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Affiliation(s)
- Cláudia Tótoli
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Aluizio Barbosa Carvalho
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Adriano Luiz Ammirati
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Antônio Draibe
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Eugênia F. Canziani
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
- * E-mail:
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Lawal OM, Balogun MO, Akintomide AO, Ayoola OO, Mene-Afejuku TO, Ogunlade O, Okunola OO, Lawal AO, Akinsola A. Carotid Intima-Media Thickness: A Surrogate Marker for Cardiovascular Disease in Chronic Kidney Disease Patients. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819852941. [PMID: 31258338 PMCID: PMC6589967 DOI: 10.1177/1179546819852941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 05/03/2019] [Indexed: 12/18/2022]
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Carotid intima-media thickness (CIMT) is a measure of atherosclerotic vascular disease and considered a comprehensive picture of all alterations caused by multiple cardiovascular risk factors over time on the arterial walls. We therefore sought to determine the CIMT of the common carotid artery in patients with CKD and to evaluate the clinical pattern and prevalence of CVD in CKD patients. Methods: A case-control study involving 100 subjects made of 50 patients with CKD stages 2 to 4 and 50 age and sex matched apparently normal individuals. Carotid intima-media thickness of the common carotid artery was considered thickened if it measured greater than 0.8 mm. All subjects had laboratory investigations, 12-lead electrocardiogram, transthoracic echocardiography, and ankle-brachial index. Results: The mean CIMT was higher in CKD population compared with controls (P < .001). Eighty-four percent of the study population was found to have thickened CIMT compared with 18% of controls (P < .001). Patients with CKD had significantly higher blood pressure and heart rate than controls. Cardiovascular disease was also more prevalent among patients with CKD as compared with controls. Carotid intima-media thickness positively correlated with age, blood pressure, and random blood sugar. Conclusions: As CIMT was well correlated with many cardiovascular risk factors among CKD patients, it may serve as a surrogate marker for CVD and its early assessment may target patients who may need more aggressive therapy to retard the progression of kidney disease and improve outcome.
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Affiliation(s)
| | - Michael Olabode Balogun
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | - Anthony Olubunmi Akintomide
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | | | | | - Oluwadare Ogunlade
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | - Oluyomi Oluseun Okunola
- Nephrology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | | | - Adewale Akinsola
- Nephrology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
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AlFaadhel T, Alsuwaida A, Alsaad K, Almezaini L, Ahmed N, AlHamad MY, Bakheet A, Wadera J, Mokhtar G, Alsuwaida F, Siddiqui R, Kechrid M, Abdelrehman A, Husain S, Kfoury H, Alabdulsalam A, Alanazi M, Oudah NA, AlHozali H. Prevalence and 20-year epidemiological trends of glomerular diseases in the adult Saudi population: a multicenter study. Ann Saudi Med 2019; 39:155-161. [PMID: 31215222 PMCID: PMC6832335 DOI: 10.5144/0256-4947.2019.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recent international reports have shown significant changes in the incidence of different glomerular diseases. OBJECTIVE Examine temporal and demographic trends of biopsy-diagnosed glomerular diseases in the adult population of Saudi Arabia over the last two decades. DESIGN Medical record review. SETTINGS Four tertiary medical centers in Saudi Arabia. PATIENTS AND METHODS We identified all patients that underwent native kidney biopsy between 1998 and 2017. MAIN OUTCOME MEASURES The frequency and the disease trends in four biopsy eras (1998-2002, 2003-2007, 2008-2011, and 2012-2017) for different glomerular diseases. SAMPLE SIZE AND CHARACTERISTICS 1070 patients, 18-65 years of age; 54.1% female. RESULTS Of 1760 patients who underwent native kidney biopsies, 1070 met inclusion criteria. Focal segmental glomerulosclerosis was the most common biopsy-diagnosed disease, with comparable frequencies over the four eras (23.6%, 19.8%, 24.1%, and 17.1, respectively [ P value for trend=.07]). The frequency of immunoglobulin A nephropathy increased progressively. The incidence of membranoproliferative glomerulonephritis declined significantly. Among the secondary types of glomerular diseases, systemic lupus erythematosus-associated lupus nephritis was the most common, followed by diabetic nephropathy. The prevalence of diabetic nephropathy increased from 1.4% in the first era to 10.2% in the last one. CONCLUSIONS Trends in biopsy-diagnosed glomerular disease have changed. While focal segmental glomerulosclerosis remains the most common glomerular disease, there has been a significant rise in the prevalence of immunoglobulin A nephropathy and diabetic nephropathy. In contrast, membranoproliferative glomerulonephritis has declined. LIMITATIONS Retrospective methodologies are vulnerable to lost data. CONFLICT OF INTEREST None.
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Affiliation(s)
- Talal AlFaadhel
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Abdulkareem Alsuwaida
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Khaled Alsaad
- From Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Lamees Almezaini
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Noura Ahmed
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Yassin AlHamad
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Ammar Bakheet
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Junaid Wadera
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Ghadeer Mokhtar
- From Department of Pathology and Laboratory Medicine, King Abdulaziz University Hosppital, Jeddah, Saudi Arabia
| | - Feras Alsuwaida
- From Department of Medicine, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Rehan Siddiqui
- From Department of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Mohamed Kechrid
- From Department of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ashraf Abdelrehman
- From Department of Nephrology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sufia Husain
- From Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hala Kfoury
- From Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahaman Alabdulsalam
- From Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Majed Alanazi
- From Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Noura Al Oudah
- From Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanadi AlHozali
- From Deaprtment of Internal Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Kefale B, Alebachew M, Tadesse Y, Engidawork E. Quality of life and its predictors among patients with chronic kidney disease: A hospital-based cross sectional study. PLoS One 2019; 14:e0212184. [PMID: 30811447 PMCID: PMC6392259 DOI: 10.1371/journal.pone.0212184] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/23/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Quality of life (QoL) is increasingly being considered as an important measure of how disease affects patients’ lives, especially for long-term diseases like chronic kidney disease (CKD). Even though there is no statistically significant association between stages of CKD and QoL, it is decreased in patients with early stages of the disease. Hence, this study aimed to assess QoL and its predictors among patients with CKD at Tikur Anbessa Specialized Hospital (TASH). Methods A cross sectional study was conducted at the nephrology clinic of TASH. A total of 256 patients were recruited through systematic random sampling. Data were collected using the Medical Outcomes Study Short Form 36-Items (SF-36). The data were entered into Epi Info 7.2.2.2 and analyzed using SPSS version 20.0 statistical software. Descriptive statistics like frequency, percent, mean and standard deviation were used to summarize patients’ baseline characteristics. Student’s unpaired t-test and ANOVA were conducted to compare two groups and more than two groups in the analysis of QoL, respectively. Multivariable linear regression was employed to investigate the potential predictors of QoL. Results Quality of life was decreased in all stages of CKD. A reduction in physical functioning (p = 0.03), bodily pain (p = 0.004), vitality (p = 0.019) and social functioning (p = 0.002) was observed progressively across stages of CKD. High income status and greater than 11g/dl hemoglobin level were found to be predictors of all high score SF-36 domains. High family income (β 15.33; 95%CI: 11.33–19.33, p<0.001), higher educational status (β 7.9; 95%CI: 4.10–11.66, p<0.001), and hemoglobin ≥11g/dl (β 8.36; 95%CI: 6.31–10.41, p<0.001) were predictors of better QoL in the physical component summary, whereas absence of CKD complications (β 2.75; 95%CI: 0.56–4.94, p = 0.014), high family income (β 10.10; 95%CI: 5.10–15.10, p<0.001) and hemoglobin ≥11g/dl (β 4.54, 95%CI: 2.01–7.08, p = 0.001) were predictors of better QoL in the mental component summary. Conclusion In this setting, QoL decreased in CKD patients in the early stages of the disease. Study participants with low income and hemoglobin level were considered to have worse quality of life in both physical and mental component summaries.
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Affiliation(s)
- Belayneh Kefale
- Department of Pharmacy, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
- * E-mail:
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yewondwossen Tadesse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Uhm JY, Kim HR, Kang GH, Choi YG, Park TH, Kim SY, Chang SS, Choo WO. The association between shift work and chronic kidney disease in manual labor workers using data from the Korea National Health and Nutrition Examination Survey (KNHANES 2011-2014). Ann Occup Environ Med 2018; 30:69. [PMID: 30564370 PMCID: PMC6295007 DOI: 10.1186/s40557-018-0279-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022] Open
Abstract
Objective Kidneys are organs having a biological clock, and it is well known that the disruption of the circadian rhythm increases the risk of chronic kidney disease (CKD), including the decline of renal and proteinuria. Because shift work causes circadian disruption, it can directly or indirectly affect the incidence of chronic kidney disease. Therefore, the purpose of this study was to investigate the association between shift work and chronic kidney disease using a Korean representative survey dataset. Methods This study was comprised of 3504 manual labor workers over 20 years of age from data from the fifth and sixth Korea National Health and Nutrition Examination Survey (2011–2014). The work schedules were classified into two types: day work and shift work. The estimated glomerular filtration rate, which is the ideal marker of renal function, was estimated according to the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and chronic kidney disease was defined as urinary albumin to a creatinine ratio equal to or high than 30 mg/g and/or estimated glomerular filtration rate lower than 60 mL/min/1.73 m2. The cross-tabulation analysis and multivariate logistic regression analysis were performed to confirm the association between shift work and chronic kidney disease stratified by gender. Results The risk of CKD showed a significant increase (odds ratio = 2.04, 95% confidence interval = 1.22, 3.41) in the female worker group. The same results were obtained after all confounding variables were adjusted (odds ratio = 2.34, 95% confidence interval = 1.35, 4.07). However, the results of the male worker group were not significant. Conclusions In this study using nationally representative surveys, we found that the risk of CKD was higher female workers and shift work. Future prospective cohort studies will be needed to clarify the causal relationship between shift work and CKD.
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Affiliation(s)
- Jun Young Uhm
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
| | - Hyoung-Ryoul Kim
- 2Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137701 Republic of Korea
| | - Gu Hyeok Kang
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
| | - Young Gon Choi
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
| | - Tae Hwi Park
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
| | - Soo Young Kim
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
| | - Seong Sil Chang
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
| | - Won Oh Choo
- 1Department of Occupational & Environmental Medicine, Eulji University Hospital, Daejeon, Republic of Korea 35233
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Jhee JH, Hwang SD, Song JH, Lee SW. Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years' Korean Genome and Epidemiology Study (KoGES). J Clin Med 2018; 7:E463. [PMID: 30469454 PMCID: PMC6262490 DOI: 10.3390/jcm7110463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 01/10/2023] Open
Abstract
Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m², a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m² were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m² on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m². The incidence of the development of eGFR <60 mL/min/1.73 m² was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m² (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29⁻6.74 in females; HR, 12.77; 95% CI, 7.69⁻21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m² (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
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Geletu AH, Teferra AS, Sisay MM, Teshome DF. Incidence and predictors of chronic kidney diseases among type 2 diabetes mellitus patients at St. Paul's Hospital, Addis Ababa, Ethiopia. BMC Res Notes 2018; 11:532. [PMID: 30064516 PMCID: PMC6069572 DOI: 10.1186/s13104-018-3618-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the incidence of chronic kidney disease and its predictors among newly diagnosed type 2 diabetes patients attending St. Paul's Hospital, Addis Ababa, Ethiopia. RESULTS The overall incidence of chronic kidney disease was a major public health issue among type 2 diabetes mellitus patients with 2178 (95% CI 12,801, 21,286) cases per 10,000 patient-months. Moreover, 62(14.25%) patients in the sample experienced chronic kidney disease. Old age [adjusted hazard ratio (AHR) = 1.06, 95%CI 1.03, 1.09], no diabetic retinopathy [AHR = 0.13, 95%CI 0.07-0.24], high density lipoprotein cholesterol ≥ 40 mg/dl [AHR = 0.55, 95%CI 0.31, 0.97] and high body mass index [AHR = 1.17, 95%CI 1.1, 1.25] were common factors for chronic kidney diseases.
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Affiliation(s)
- Alemayehu Hussen Geletu
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Shimeka Teferra
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
| | - Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
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Kefale B, Tadesse Y, Alebachew M, Engidawork E. Management Practice, and Adherence and Its Contributing Factors among Patients with Chronic Kidney Disease at Tikur Anbessa Specialized Hospital: A Hospital Based Cross-Sectional Study. Int J Nephrol 2018; 2018:2903139. [PMID: 30805215 PMCID: PMC6362475 DOI: 10.1155/2018/2903139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/18/2018] [Accepted: 05/30/2018] [Indexed: 01/10/2023] Open
Abstract
The objective of this study was to assess the management practice, medication adherence, and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). Methods. A cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 CKD (stages 1 and 2=50, stage 3=88, stage 4=55, and stage 5=63) patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The rate of adherence was determined using 8-item Morisky medication adherence scale. The data were analyzed using SPSS version 20.0 statistical software. Univariate and multivariate binary logistic regression were used to investigate the potential predictors of medication nonadherence. Results. About 57.3% of diabetes mellitus with hypertension were treated with combination of insulin and ACEI based regimens. Other cardiovascular comorbidities were predominantly treated with Acetyl Salicylic Acid in combination with β-blocker. Only 61.3% (stages 1 and 2=70%, stage 3=73.9%, stage 4=54.5%, and stage 5=43%) of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication nonadherence. Patients who had an average and high monthly income were 4.14 (AOR=4.14, 95% CI: 1.45-11.84, p=0.008) and 6.17 times (AOR=6.17, 95% CI: 1.02-37.46, p=0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR= 0.54, 95% CI: 0.27-1.10, p=0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, or teachers working in private school were about 7.46 times (AOR=7.46, 95% CI: 1.49-37.26, p=0.014) more likely to adhere compared with patients who were farmers. Conclusion. Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension comorbidities. Very low income, increased number of prescribed medications, and being a farmer were the predictors of medication nonadherence.
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Affiliation(s)
- Belayneh Kefale
- Department of Pharmacy, College of Medicine and Health Science, Ambo University, P.O. Box 19, Ambo, Ethiopia
| | - Yewondwossen Tadesse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kefale B, Tadesse Y, Alebachew M, Engidawork E. Management practice, and adherence and its contributing factors among patients with chronic kidney disease at Tikur Anbessa Specialized Hospital: A hospital-based cross-sectional study. PLoS One 2018; 13:e0200415. [PMID: 30044830 PMCID: PMC6059431 DOI: 10.1371/journal.pone.0200415] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) has a complicated interrelationship with other diseases and major risk factor for cardiovascular disease. Therapeutic management for CKD patients is complicated due to co-morbidities and dominant risk factors of CKD. Non-adherence to treatment is an increasing problem for patients with CKD and it has not been extensively studied in patients with CKD. Hence, the present study was carried out to assess the management practice, medication adherence and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). METHODS A hospital-based cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The degree of adherence was determined using eight-item Morisky Medication Adherence Scale. The data were entered into Epi Info 7.2.2.2 and analyzed using SPSS version 20.0 statistical software. Descriptive statistics such as frequency, percent, mean and standard deviation were used to summarize patients' baseline characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of medication non-adherence. RESULTS About 55% patients with hypertension only were treated with non-angiotensin converting enzyme inhibition based regimens; 57.3% of diabetes mellitus with hypertension treated with combination of insulin and ACEI based regimens. About three-fourth of patients with anemia and osteodystrophy complications were treated with iron preparations and calcium based phosphate binder. Only 61.3% of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication non-adherence. Patients who had an average and high monthly income were 4.14 (AOR = 4.14, 95% CI: 1.45-11.84, p = 0.008) and 6.17 times (AOR = 6.17, 95% CI: 1.02-37.46, p = 0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR = 0.54, 95% CI: 0.27-1.10, p = 0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, teachers working in private school were about 7.46 times (AOR = 7.46, 95% CI: 1.49-37.26, p = 0.014) more likely to adhere compared with patients who were farmers. CONCLUSION Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension co-morbidities. Very low income, increased number of prescribed medications and being a farmer were the predictors of medication non-adherence.
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Affiliation(s)
- Belayneh Kefale
- Department of Pharmacy, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Yewondwossen Tadesse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Chen HM, Hsiao SM, Kuo MC, Lo YC, Huang MF, Yeh YC, Yen CF, Chen CS. Identifying early decline of daily function and its association with physical function in chronic kidney disease: performance-based and self-reported measures. PeerJ 2018; 6:e5286. [PMID: 30042897 PMCID: PMC6054786 DOI: 10.7717/peerj.5286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/02/2018] [Indexed: 01/10/2023] Open
Abstract
Objective To verify self-reported basic and instrumental activities of daily living (IADL) with a disability and the results of performance-based tests (namely the Taiwan performance-based IADL (TPIADL), the 2-minute step test (2MST), the 30-second chair-stand test (30-s CST), and handgrip dynamometer measurement) to identify disability early and assess the associations with functional fitness in patients with advanced chronic kidney disease (CKD). Methods A cross-sectional study of 99 patients with stage 4-5 CKD and 57 healthy elderly adults were recruited. Self-reported measures were used to collect information on basic (Barthel Index) and IADL (Lawton-Brody scale). Objective measures of the TPIADL and functional fitness (2MST, 30-s CST, handgrip dynamometer) were also assessed. Results Only IADL, as detected by the TPIADL, were impaired to a greater extent in the CKD patients than those of healthy elderly adults. Among all the patients with CKD, a greater impairment in the TPIADL remained statistically associated with a lower ability in the 2MST. A one step increase in the 2MST score was significantly associated with an improvement of 0.2 s in the total performance time of the TPIADL. Conclusion Performance-based measures, such as the TPIADL, may detect a functional limitation before it becomes measurable by traditional self-reported basic and IADL scales; functional limitation is mainly associated with cardiac endurance for advanced CKD.
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Affiliation(s)
- Hui-Mei Chen
- Department of Occupational Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ming Hsiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Lo
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Feng Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kute VB, Prasad N, Shah PR, Modi PR. Kidney exchange transplantation current status, an update and future perspectives. World J Transplant 2018; 8:52-60. [PMID: 29988896 PMCID: PMC6033740 DOI: 10.5500/wjt.v8.i3.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 02/05/2023] Open
Abstract
Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n-way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel vs kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver vs kidney exchange, a legitimate hope or utopia?
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
| | - Narayan Prasad
- Department of Nephrology and Clinical Transplantation, SGPGI, Lucknow 226014, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
| | - Pranjal R Modi
- Department of Urology and transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
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46
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Sung SA, Hyun YY, Lee KB, Park HC, Chung W, Kim YH, Kim YS, Park SK, Oh KH, Ahn C. Sleep Duration and Health-Related Quality of Life in Predialysis CKD. Clin J Am Soc Nephrol 2018; 13:858-865. [PMID: 29724791 PMCID: PMC5989677 DOI: 10.2215/cjn.11351017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/07/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Sleep duration has been associated with cardiometabolic risk and mortality. The health-related quality of life represents a patient's comprehensive perception of health and is accepted as a health outcome. We examined the relationship between sleep duration and health-related quality of life in predialysis CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this cross-sectional study, data from 1910 adults with CKD enrolled in the Korean Cohort Study for Outcome in Patients with CKD were analyzed. Health-related quality of life was assessed with the physical component summary and mental component summary of the Short Form-36 Health Survey. Low health-related quality of life was defined as a Short Form-36 Health Survey score >1 SD below the mean. Using a generalized additive model and multivariable logistic regression analysis, the relationship between self-reported sleep duration and health-related quality of life was examined. RESULTS Seven-hour sleepers showed the highest health-related quality of life. We found an inverted U-shaped relationship between sleep duration and health-related quality of life as analyzed by a generalized additive model. In multivariable logistic analysis, short sleepers (≤5 h/d) had lower health-related quality of life (odds ratio, 3.23; 95% confidence interval, 1.86 to 5.60 for the physical component summary; odds ratio, 2.37; 95% confidence interval, 1.43 to 3.94 for the mental component summary), and long sleepers (≥9 h/d) had lower health-related quality of life (odds ratio, 2.80; 95% confidence interval, 1.55 to 5.03 for the physical component summary; odds ratio, 2.08; 95% confidence interval, 1.20 to 3.60 for the mental component summary) compared with 7-hour sleepers. Sleep duration had a significant U-shaped association with low health-related quality of life. CONCLUSIONS These findings suggest that short or long sleep duration is independently associated with low health-related quality of life in adults with CKD.
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Affiliation(s)
- Su-Ah Sung
- Department of Internal Medicine, Eulji General Hospital, Seoul, Korea
| | - Young Youl Hyun
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Beck Lee
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong-Soo Kim
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sue Kyung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea; and
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lin E, Chertow GM, Yan B, Malcolm E, Goldhaber-Fiebert JD. Cost-effectiveness of multidisciplinary care in mild to moderate chronic kidney disease in the United States: A modeling study. PLoS Med 2018; 15:e1002532. [PMID: 29584720 PMCID: PMC5870947 DOI: 10.1371/journal.pmed.1002532] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/14/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Multidisciplinary care (MDC) programs have been proposed as a way to alleviate the cost and morbidity associated with chronic kidney disease (CKD) in the US. METHODS AND FINDINGS We assessed the cost-effectiveness of a theoretical Medicare-based MDC program for CKD compared to usual CKD care in Medicare beneficiaries with stage 3 and 4 CKD between 45 and 84 years old in the US. The program used nephrologists, advanced practitioners, educators, dieticians, and social workers. From Medicare claims and published literature, we developed a novel deterministic Markov model for CKD progression and calibrated it to long-term risks of mortality and progression to end-stage renal disease. We then used the model to project accrued discounted costs and quality-adjusted life years (QALYs) over patients' remaining lifetime. We estimated the incremental cost-effectiveness ratio (ICER) of MDC, or the cost of the intervention per QALY gained. MDC added 0.23 (95% CI: 0.08, 0.42) QALYs over usual care, costing $51,285 per QALY gained (net monetary benefit of $23,100 at a threshold of $150,000 per QALY gained; 95% CI: $6,252, $44,323). In all subpopulations analyzed, ICERs ranged from $42,663 to $72,432 per QALY gained. MDC was generally more cost-effective in patients with higher urine albumin excretion. Although ICERs were higher in younger patients, MDC could yield greater improvements in health in younger than older patients. MDC remained cost-effective when we decreased its effectiveness to 25% of the base case or increased the cost 5-fold. The program costed less than $70,000 per QALY in 95% of probabilistic sensitivity analyses and less than $87,500 per QALY in 99% of analyses. Limitations of our study include its theoretical nature and being less generalizable to populations at low risk for progression to ESRD. We did not study the potential impact of MDC on hospitalization (cardiovascular or other). CONCLUSIONS Our model estimates that a Medicare-funded MDC program could reduce the need for dialysis, prolong life expectancy, and meet conventional cost-effectiveness thresholds in middle-aged to elderly patients with mild to moderate CKD.
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Affiliation(s)
- Eugene Lin
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Brandon Yan
- Duke University, Durham, North Carolina, United States of America
| | - Elizabeth Malcolm
- Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Jeremy D Goldhaber-Fiebert
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, California, United States of America
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Chakraborty S, Ghosh S, Banerjea A, De RR, Hazra A, Mandal SK. Prescribing patterns of medicines in chronic kidney disease patients on maintenance hemodialysis. Indian J Pharmacol 2017; 48:586-590. [PMID: 27721548 PMCID: PMC5051256 DOI: 10.4103/0253-7613.190760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To study medicine prescribing pattern for chronic kidney disease (CKD) patients on maintenance hemodialysis. MATERIALS AND METHODS This prospective observational study was conducted in hemodialysis unit of a teaching hospital with adult CKD patients on maintenance hemodialysis. Patients' clinical profile, drug-use pattern, and medication-related problem data were captured in a structured case report form and the data were analyzed descriptively. Adherence level was assessed by Morisky Medication-Taking Adherence Scale 4-item. RESULTS Data from 100 patients recruited over 6 months have been analyzed. The median (interquartile range [IQR]) age was 51 (42-57) years; 57% were male, mean [standard deviation (SD)] urea level was 160.11 (70.32) mg/dL, mean (SD) creatinine level was 8.73 (5.29) mg/dL. A large number (46%) were suffering from diabetic nephropathy. The common comorbidities were anemia (89%) followed by hypertension (85%). The median (IQR) number of drugs per prescription was 10 (9-13), with the bulk being cardiovascular drugs (23.41%) followed by gastrointestinal drugs (15.76%) and vitamins (12.29%). The median (IQR) number of potential drug-drug interaction per prescription was 2 (2-3). The incidence of adverse drug reactions (ADRs) was 46% with hyponatremia being most common (32%), followed by hypoglycemia (16%) and hypokalemia (10%). Adherence level was low in the majority (64%) of patients. CONCLUSIONS There is a high incidence of polypharmacy along with significant medication-related problems such as high drug-drug interactions/prescription, high incidence of ADRs, and low adherence.
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Affiliation(s)
- Sourav Chakraborty
- Department of Pharmacology, R.G.Kar Medical College, Kolkata, West Bengal, India
| | - Saugata Ghosh
- Department of Pharmacology, R.G.Kar Medical College, Kolkata, West Bengal, India
| | - Avishek Banerjea
- Department of Pharmacology, R.G.Kar Medical College, Kolkata, West Bengal, India
| | - Radha Raman De
- Department of Pharmacology, R.G.Kar Medical College, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Pharmacology, IPGMER, Kolkata, West Bengal, India
| | - Swapan Kumar Mandal
- Department of Hemodialysis, R.G.Kar Medical College, Kolkata, West Bengal, India
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Association of Renal Elasticity and Renal Function Progression in Patients with Chronic Kidney Disease Evaluated by Real-Time Ultrasound Elastography. Sci Rep 2017; 7:43303. [PMID: 28240304 PMCID: PMC5327389 DOI: 10.1038/srep43303] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/24/2017] [Indexed: 12/13/2022] Open
Abstract
Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal elasticity. This study was designed to evaluate the predictive ability of renal elasticity in patients with chronic kidney disease (CKD). 148 non-CKD patients and 227 patients with CKD were recruited. 145 (38.7%) were female, 166 (73.1%) had diabetes, the mean estimated glomerular filtration rate (eGFR) was 33.9 ± 15.8 ml/min/1.73 m2 and the median urinary protein-to-creatinine ratio (UPCR) 502 (122–1491) mg/g. Patients with later stages of CKD had lower renal elasticity values, indicating stiffer kidneys (p < 0.001), and smaller kidney (p < 0.001). Renal elasticity correlated with log-transformed UPCR (β = −7.544, P < 0.001). Renal length correlated with age (β = −0.231, P < 0.001), sex (β = −3.730, P < 0.001), serum albumin level (β = −3.024, P = 0.001), body mass index (β = 0.390, P = 0.009) and eGFR (β = 0.146, P < 0.001). In fully-adjusted logistic regression model, the odds ratio (OR) per 10 unit change in renal elasticity for rapid renal deterioration was 0.928 (95% CI, 0.864–0.997; P = 0.042). The OR per 1 mm change in renal length for rapid renal deterioration was 1.022 (95% CI, 0.994–1.050; P = 0.125). Renal elasticity is associated with proteinuria and rapid renal deterioration in patients with CKD.
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Adhikari UR, Taraphder A, Hazra A, Das T. Pill burden does not influence compliance with oral medication in recipients of renal transplant. Indian J Pharmacol 2017; 48:21-5. [PMID: 26997717 PMCID: PMC4778200 DOI: 10.4103/0253-7613.174425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: Insights about the predictors of noncompliance are key to develop compliance enhancing strategy in a given therapeutic situation. Renal transplantation is a critical surgical procedure that imposes a large medication burden on patients. There is a suspicion that the large pill burden may lead to noncompliance. Our objective was to ascertain the influence of pill burden on medication compliance in renal transplant patients in the Indian sociocultural context. Methods: A longitudinal observational study was conducted in two Tertiary Care Hospitals in Kolkata running renal transplant program – one each from the government and private sectors. Totally 120 literate adult transplant recipients were recruited through purposive sampling and followed up at 3 months intervals for 1 year. Data were collected through interview and review of prescriptions and medical records. Results: Data of 110 subjects were analyzed. The pill burden was high – ranging from 10-21 (median 14) at first visit shortly after discharge to 7–22 (median 11) at last visit at 12 months in the government sector; corresponding figures in the private sector were 14–32 (median 21) and 10–28 (median 17). Pill burden increased with age. Only 60.91% of the patients were fully compliant until 1 year after transplantation. The rate of immunosuppressant noncompliance was 27.78% in government sector and 25.00% in private sector. There was no significant association between median pill burden and medication compliance. Satisfaction with caregiver support was associated with better immunosuppressant compliance. Conclusions: Noncompliance in renal transplant recipients is likely to be multifactorial. Contrary to popular belief, pill burden was not a major determinant of noncompliant behavior.
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Affiliation(s)
| | - Abhijit Taraphder
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Tapas Das
- Department of Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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