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Le Gall L, Harambat J, Combe C, Philipps V, Proust-Lima C, Dussartre M, Drüeke T, Choukroun G, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Massy ZA, Stengel B, Alencar de Pinho N, Leffondré K, Prezelin-Reydit M. Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events. Nephrol Dial Transplant 2024; 39:669-682. [PMID: 37935529 DOI: 10.1093/ndt/gfad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). METHODS We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT) and (iii) non-cardiovascular death. RESULTS During the follow-up, we gathered 33 874 haemoglobin measurements from 3011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. CONCLUSION In this study, we observed that two-thirds of patients had a stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. Better attention should be paid to dynamic changes of haemoglobin in CKD.
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Affiliation(s)
- Lisa Le Gall
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Jérôme Harambat
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Bordeaux University Hospital, Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux, France
| | - Christian Combe
- Bordeaux University Hospital, Department of Nephrology, transplantation, dialysis, Bordeaux, France
- University Bordeaux, INSERM U1026, Bordeaux, France
| | - Viviane Philipps
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Maris Dussartre
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Tilman Drüeke
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Gabriel Choukroun
- Amiens Picardie University Hospital, Department of Nephrology Dialysis Transplantation, Amiens, France
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
| | - Denis Fouque
- Hopital Lyon Sud, Département de néphrologie, Lyon, France
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Luc Frimat
- CHRU de Nancy, Department of Nephrology, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Nancy, France
| | - Christian Jacquelinet
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Agence de la biomedecine, La Plaine-Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
- Amiens-Picardie University Medical Center, Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens, France
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, MI, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Cutitiba, PR, Brazil
| | - Ziad A Massy
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, Boulogne-Billancourt/Paris, France
| | - Bénédicte Stengel
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Karen Leffondré
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Maison du REIN AURAD Aquitaine, Néphrologie, Gradignan, Nouvelle-Aquitaine, FR
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Yan Y, Liu H, Abedini A, Sheng X, Palmer M, Li H, Susztak K. Unraveling the epigenetic code: human kidney DNA methylation and chromatin dynamics in renal disease development. Nat Commun 2024; 15:873. [PMID: 38287030 PMCID: PMC10824731 DOI: 10.1038/s41467-024-45295-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
Epigenetic changes may fill a critical gap in our understanding of kidney disease development, as they not only reflect metabolic changes but are also preserved and transmitted during cell division. We conducted a genome-wide cytosine methylation analysis of 399 human kidney samples, along with single-nuclear open chromatin analysis on over 60,000 cells from 14 subjects, including controls, and diabetes and hypertension attributed chronic kidney disease (CKD) patients. We identified and validated differentially methylated positions associated with disease states, and discovered that nearly 30% of these alterations were influenced by underlying genetic variations, including variants known to be associated with kidney disease in genome-wide association studies. We also identified regions showing both methylation and open chromatin changes. These changes in methylation and open chromatin significantly associated gene expression changes, most notably those playing role in metabolism and expressed in proximal tubules. Our study further demonstrated that methylation risk scores (MRS) can improve disease state annotation and prediction of kidney disease development. Collectively, our results suggest a causal relationship between epigenetic changes and kidney disease pathogenesis, thereby providing potential pathways for the development of novel risk stratification methods.
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Affiliation(s)
- Yu Yan
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
| | - Hongbo Liu
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
| | - Amin Abedini
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
| | - Xin Sheng
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
| | - Matthew Palmer
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Department of Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, PA, 19014, USA
| | - Hongzhe Li
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA
- Department of Pathology, Perelman School of Medicine, Philadelphia, PA, 19014, USA
| | - Katalin Susztak
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA.
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA.
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA.
- Kidney Innovation Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19014, USA.
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3
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Wu EL, Christian B, Rivera AS, Fabian E, Macha I, Aris E, Mpangala S, Ulenga N, Mugusi F, Murphy RL, Hawkins CA. Renal outcomes in adults with HBV, HIV and HBV/HIV coinfection after 3 years of antiviral therapy in urban Tanzania. J Antimicrob Chemother 2024; 79:36-45. [PMID: 37935111 DOI: 10.1093/jac/dkad341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND An enhanced understanding of renal outcomes in persons with chronic HBV, HIV, and HBV/HIV coinfection is needed to mitigate chronic kidney disease in regions where HBV and HIV are endemic. OBJECTIVES To investigate changes in estimated glomerular filtration rate (eGFR) in adults with HBV, HIV or HBV/HIV enrolled in a 3 year prospective cohort study of liver outcomes in Dar es Salaam, Tanzania and initiated on antiviral therapy. METHODS We compared eGFR between and within groups over time using mixed-effects models. RESULTS Four hundred and ninety-nine participants were included in the analysis (HBV: 164; HIV: 271; HBV/HIV: 64). Mean baseline eGFRs were 106.88, 106.03 and 107.18 mL/min/1.73 m2, respectively. From baseline to Year 3, mean eGFR declined by 4.3 mL/min/1.73 m2 (95% CI -9.3 to 0.7) and 3.7 (-7.8 to 0.5) in participants with HBV and HIV, respectively, and increased by 5.1 (-4.7 to 14.9) in those with HBV/HIV. In multivariable models, participants with HBV had lower eGFRs compared with those with HIV or HBV/HIV and, after adjusting for HBV DNA level and hepatitis B e antigen (HBeAg) status, significantly lower eGFRs than those with HBV/HIV at all follow-up visits. CONCLUSIONS In this Tanzanian cohort, coinfection with HBV/HIV did not appear to exacerbate renal dysfunction compared with those with either infection alone. Although overall changes in eGFR were small, persons with HBV experienced lower eGFRs throughout follow-up despite their younger age and similar baseline values. Longer-term studies are needed to evaluate continuing changes in eGFR and contributions from infection duration and other comorbidities.
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Affiliation(s)
- En-Ling Wu
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Adovich S Rivera
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Emanuel Fabian
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Irene Macha
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Eric Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Shida Mpangala
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Robert L Murphy
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Claudia A Hawkins
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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4
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Michon-Colin A, Metzger M, Bankir L, Gauci C, Brunel M, Baron S, Prot-Bertoye C, Stengel B, Thervet E, Haymann JP, Boffa JJ, Vrtovsnik F, Flamant M, Houillier P, Prie D, Courbebaisse M. Fibroblast growth factor 23 but not copeptin is independently associated with kidney failure and mortality in patients with chronic kidney disease. Clin Kidney J 2023; 16:2472-2481. [PMID: 38046034 PMCID: PMC10689138 DOI: 10.1093/ckj/sfad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background Copeptin and intact fibroblast growth factor 23 (iFGF23) increase early during chronic kidney disease (CKD) and may be predictive of unfavourable outcomes. The aim of this study was to evaluate their respective associations with renal and vital outcomes in CKD patients. Methods We included CKD patients from the NephroTest cohort with concomitant measurements of plasma copeptin and iFGF23 concentrations and isotopic glomerular filtration rate measurement (mGFR). The primary endpoint was a composite outcome including kidney failure (KF) (dialysis initiation, pre-emptive transplantation or a 57% decrease of mGFR, corresponding to doubling of serum creatinine) or death before KF. Hazard ratios (HRs) of the primary endpoint associated with log-transformed copeptin and iFGF23 concentrations were estimated by Cox models. The slope of mGFR over time was analysed using a linear mixed model. Results A total of 329 CKD patients (243 men, mean age 60.3 ± 14.6 years) were included. Among them, 301 with an mGFR >15 ml/min/1.73 m2 were included in survival and mGFR slope analyses. During a median follow-up of 4.61 years (quartile 1-quartile 3: 3.72-6.07), 61 KFs and 32 deaths occurred. Baseline iFGF23 concentrations were associated with the composite outcome after multiple adjustments {HR 2.72 [95% confidence interval (CI) 1.85-3.99]}, whereas copeptin concentrations were not [HR 1.01 (95% CI 0.74-1.39)]. Neither copeptin nor iFGF23 were associated with mGFR slope over time. Conclusion Our study shows for the first time in population of CKD patients an independent association between iFGF23 and unfavourable renal and vital outcomes and shows no such association regarding copeptin, encouraging the integration of iFGF23 measurement into the follow-up of CKD.
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Affiliation(s)
- Arthur Michon-Colin
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Marie Metzger
- INSERM UMRS 1018, Equipe d'Epidémiologie Clinique, CESP, Université Paris-Saclay, Villejuif, France
| | - Lise Bankir
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- CNRS, ERL 8228, Laboratory of Kidney Physiology and Tubulopathies, Paris, France
| | - Cédric Gauci
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- INSERM UMRS 1018, Equipe d'Epidémiologie Clinique, CESP, Université Paris-Saclay, Villejuif, France
| | - Mélanie Brunel
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Stéphanie Baron
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Caroline Prot-Bertoye
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- CNRS, ERL 8228, Laboratory of Kidney Physiology and Tubulopathies, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Bénédicte Stengel
- INSERM UMRS 1018, Equipe d'Epidémiologie Clinique, CESP, Université Paris-Saclay, Villejuif, France
| | - Eric Thervet
- Université Paris Cité, Paris, France
- Néphrologie et Hémodialyse, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Haymann
- Explorations Fonctionnelles Multidisciplinaires, Sorbonne Université Paris, France
- Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Jean-Jacques Boffa
- Explorations Fonctionnelles Multidisciplinaires, Sorbonne Université Paris, France
- Néphrologie et Dialyse, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - François Vrtovsnik
- Université Paris Cité, Paris, France
- Néphrologie, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Martin Flamant
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Multidisciplinaires, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Pascal Houillier
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
| | - Dominique Prie
- Université Paris Cité, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
- Département de Physiologie, Hôpital Necker, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Université Paris Cité, Paris, France
- Explorations Fonctionnelles Rénales – Physiologie, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
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Aurpibul L, Paklak W, Taecharoenkul S, Rerkasem A, Srithanaviboonchai K. Chronic Kidney Disease and Accelerated Decline of Renal Function in Older Adults with HIV in Northern Thailand. AIDS Res Hum Retroviruses 2023; 39:677-680. [PMID: 37276182 DOI: 10.1089/aid.2023.0032] [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] [Indexed: 06/07/2023] Open
Abstract
Kidney disease remains prevalent in people living with HIV even in the antiretroviral treatment era. We determine the frequency of chronic kidney disease (CKD), rate of renal function decline, and associated factors in older adults with HIV (OAHIV) aged ≥50 years in northern Thailand. We used data from the medical records and calculated the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation. Of the 269 participants (58% women, 61.8 years median age), 7.1% had CKD (eGFR <60 mL/min per 1.73 m2). There were 21 OAHIV (7.8%) with >25% decline in eGFR in the past year, 90 (33%) with accelerated (>5 mL/min per 1.73 m2 per year), and 44 (16%) with rapid (>10 mL/min per 1.73 m2 per year) declining eGFR. Female gender was the only factor associated with an accelerated decline in eGFR (odds ratio, 2.307; 95% confidence interval, 1.331-3.998; p = .003). Continuous monitoring of renal function is recommended for OAHIV to guide treatment modification and intervention.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wason Paklak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Amaraporn Rerkasem
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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6
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Rashid I, Tiwari P, Cruz SD, Jaswal S. Rates and determinants of fast chronic kidney disease progression distinguished by nutritional status, and the impact of malnutrition on mortality - evidence from a clinical population. Clin Nutr ESPEN 2023; 57:683-690. [PMID: 37739723 DOI: 10.1016/j.clnesp.2023.08.008] [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: 04/08/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a serious problem that influences morbidity, mortality, functional activity, and quality of life in patients with chronic kidney disease (CKD). However, there has not been much research done on how nutritional status appears to affect mortality in non-dialysis CKD patients. This study aimed to recognize the rates and predictors of fast CKD progression distinguished by nutritional status, and also sought to determine the impact of malnutrition on mortality in non-dialysis CKD patients. METHODS This prospective cohort study (n = 360) involved non-dialysis CKD patients with index estimated glomerular filtration rate (eGFR) between the range of 15-89 ml/min/1.73 m2. Nutritional status was evaluated by using the "Pt-Global web tool/PG-SGA". A loss of eGFR >4 ml/min/1.73 m2 per year was considered to be a sign of fast CKD progression. Kaplan-Meier plots were used to evaluate the cumulative survival, and Cox-proportional hazard models were used to analyze the renal outcomes. RESULTS Around 244 (67.8%) of patients have experienced a fast decline in kidney function. In the malnourished group, systolic blood pressure and hyperphosphatemia were observed to have increased hazards for fast CKD progression. The overall incidence of mortality and composite endpoints were found to be 13.9% & 37.6%, respectively. Death rates (11.6%) and composite endpoints (29.8%) were higher in the malnourished (severe & moderate) group. Cox regression hazard model reported 4 times increased hazards for death [HR 4.41 (1.99-9.77) 95% CI; P ≤ 0.005] and 3 times increased hazards for composite endpoints [HR 3.29 (2.10-5.16) 95% CI; P ≤ 0.005] for 'severely malnourished' category in reference to 'normal nutrition' category. CONCLUSIONS Fast CKD progression was observed to be more common in malnourished patients. Systolic blood pressure and hyperphosphatemia were recognized as potential predictors of fast CKD progression. Moreover, malnutrition was found to be a significant predictor of mortality among non-dialysis CKD patients. The findings of this study advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD.
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Affiliation(s)
- Ishfaq Rashid
- National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India; M.M. College of Pharmacy, M.M. University Ambala, 133203, India.
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India.
| | - Sanjay D Cruz
- Department of General Medicine, Government Medical College and Hospital (GMCH), Chandigarh, 160030, India.
| | - Shivani Jaswal
- Department of Biochemistry, Government Medical College and Hospital (GMCH), Chandigarh, 160030, India.
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7
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Eriksen BO, Fasiolo M, Mathisen UD, Jenssen TG, Stefansson VTN, Melsom T. Ambulatory blood pressure as risk factor for long-term kidney function decline in the general population: a distributional regression approach. Sci Rep 2023; 13:14296. [PMID: 37652955 PMCID: PMC10471748 DOI: 10.1038/s41598-023-41181-7] [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: 02/06/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
The results of randomized controlled trials are unclear about the long-term effect of blood pressure (BP) on kidney function assessed as the glomerular filtration rate (GFR) in persons without chronic kidney disease or diabetes. The limited duration of follow-up and use of imprecise methods for assessing BP and GFR are important reasons why this issue has not been settled. Since a long-term randomized trial is unlikely, we investigated the association between 24-h ambulatory BP (ABP) and measured GFR in a cohort study with a median follow-up of 11 years. The Renal Iohexol Clearance Survey (RENIS) cohort is a representative sample of persons aged 50 to 62 years without baseline cardiovascular disease, diabetes, or kidney disease from the general population of Tromsø in northern Norway. ABP was measured at baseline, and iohexol clearance at baseline and twice during follow-up. The study population comprised 1589 persons with 4127 GFR measurements. Baseline ABP or office BP components were not associated with the GFR change rate in multivariable adjusted conventional regression models. In generalized additive models for location, scale, and shape (GAMLSS), higher daytime systolic, diastolic, and mean arterial ABP were associated with a slight shift of the central part of the GFR distribution toward lower GFR and with higher probability of GFR < 60 mL/min/1.73 m2 during follow-up (p < 0.05). The use of a distributional regression method and precise methods for measuring exposure and outcome were necessary to detect an unfavorable association between BP and GFR in this study of the general population.
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Affiliation(s)
- Bjørn O Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Matteo Fasiolo
- School of Mathematics, University of Bristol, Bristol, UK
| | - Ulla D Mathisen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Trond G Jenssen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Transplant Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Vidar T N Stefansson
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Ebert N, Schneider A, Huscher D, Mielke N, Balabanova Y, Brobert G, Lakenbrink C, Kuhlmann M, Fietz AK, van der Giet M, Wenning V, Schaeffner E. Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults. BMC Nephrol 2023; 24:226. [PMID: 37528401 PMCID: PMC10394866 DOI: 10.1186/s12882-023-03272-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND In older adults, epidemiological data on incidence rates (IR) of hospital-acquired acute kidney injury (AKI) are scarce. Also, little is known about trajectories of kidney function before hospitalization with AKI. METHODS We used data from biennial face-to-face study visits from the prospective Berlin Initiative Study (BIS) including community-dwelling participants aged 70+ with repeat estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C. Primary outcome was first incident of hospital-acquired AKI assessed through linked insurance claims data. In a nested case-control study, kidney function decline prior to hospitalization with and without AKI was investigated using eGFR trajectories estimated with mixed-effects models adjusted for traditional cardiovascular comorbidities. RESULTS Out of 2020 study participants (52.9% women; mean age 80.4 years) without prior AKI, 383 developed a first incident AKI, 1518 were hospitalized without AKI, and 119 were never hospitalized during a median follow-up of 8.8 years. IR per 1000 person years for hospital-acquired AKI was 26.8 (95% confidence interval (CI): 24.1-29.6); higher for men than women (33.9 (29.5-38.7) vs. 21.2 (18.1-24.6)). IR (CI) were lowest for persons aged 70-75 (13.1; 10.0-16.8) and highest for ≥ 90 years (54.6; 40.0-72.9). eGFR trajectories declined more steeply in men and women with AKI compared to men and women without AKI years before hospitalization. These differences in eGFR trajectories remained after adjustment for traditional comorbidities. CONCLUSION AKI is a frequent in-hospital complication in individuals aged 70 + showing a striking increase of IR with age. eGFR decline was steeper in elderly patients with AKI compared to elderly patients without AKI years prior to hospitalization emphasising the need for long-term kidney function monitoring pre-admission to improve risk stratification.
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Affiliation(s)
- Natalie Ebert
- Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany.
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Doerte Huscher
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Nina Mielke
- Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | | | | | - Carla Lakenbrink
- Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Martin Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Markus van der Giet
- Division of Nephrology and Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Volker Wenning
- AOK Nordost - Die Gesundheitskasse Berlin, Berlin, Germany
| | - Elke Schaeffner
- Charité-Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
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Enoksen ITT, Rinde NB, Svistounov D, Norvik JV, Solbu MD, Eriksen BO, Melsom T. Validation of eGFR for Detecting Associations Between Serum Protein Biomarkers and Subsequent GFR Decline. J Am Soc Nephrol 2023; 34:1409-1420. [PMID: 37093083 PMCID: PMC10400103 DOI: 10.1681/asn.0000000000000147] [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: 09/16/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
SIGNIFICANCE STATEMENT eGFR from creatinine, cystatin C, or both has been primarily used in search of biomarkers for GFR decline. Whether the relationships between biomarkers and eGFR decline are similar to associations with measured GFR (mGFR) decline has not been investigated. This study revealed that some biomarkers showed statistically significant different associations with eGFR decline compared with mGFR decline, particularly for eGFR from cystatin C. The findings indicate that non-GFR-related factors, such as age, sex, and body mass index, influence the relationship between biomarkers and eGFR decline. Therefore, the results of biomarker studies using eGFR, particularly eGFRcys, should be interpreted with caution and perhaps validated with mGFR. BACKGROUND Several serum protein biomarkers have been proposed as risk factors for GFR decline using eGFR from creatinine or cystatin C. We investigated whether eGFR can be used as a surrogate end point for measured GFR (mGFR) when searching for biomarkers associated with GFR decline. METHODS In the Renal Iohexol Clearance Survey, GFR was measured with plasma iohexol clearance in 1627 individuals without diabetes, kidney, or cardiovascular disease at baseline. After 11 years of follow-up, 1409 participants had one or more follow-up GFR measurements. Using logistic regression and interval-censored Cox regression, we analyzed the association between baseline levels of 12 serum protein biomarkers with the risk of accelerated GFR decline and incident CKD for both mGFR and eGFR. RESULTS Several biomarkers exhibited different associations with eGFR decline compared with their association with mGFR decline. More biomarkers showed different associations with eGFRcys decline than with eGFRcre decline. Most of the different associations of eGFR decline versus mGFR decline remained statistically significant after adjustment for age, sex, and body mass index, but several were attenuated and not significant after adjusting for the corresponding baseline mGFR or eGFR. CONCLUSIONS In studies of some serum protein biomarkers, eGFR decline may not be an appropriate surrogate outcome for mGFR decline. Although the differences from mGFR decline are attenuated by adjustment for confounding factors in most cases, some persist. Therefore, proposed biomarkers from studies using eGFR should preferably be validated with mGFR.
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Affiliation(s)
- Inger T. T. Enoksen
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
| | - Nikoline B. Rinde
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
| | - Dmitri Svistounov
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
| | - Jon V. Norvik
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marit D. Solbu
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O. Eriksen
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT– The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Diamantidis CJ, Storfer-Isser A, Fishman E, Wang V, Zepel L, Maciejewski ML. Costs Associated With Progression of Mildly Reduced Kidney Function Among Medicare Advantage Enrollees. Kidney Med 2023; 5:100636. [PMID: 37250500 PMCID: PMC10220400 DOI: 10.1016/j.xkme.2023.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Rationale & Objective The prevalence of early chronic kidney disease (CKD) in older adults has increased in the past 2 decades, yet CKD disease progression, overall, is variable. It is unclear whether health care costs differ by progression trajectory. The purpose of this study was to estimate the trajectories of CKD progression and examine Medicare Advantage (MA) health care costs of each trajectory over a 3-year period in a large cohort of MA enrollees with mildly reduced kidney function. Study Design Cohort study. Setting & Population 421,187 MA enrollees with stage G2 CKD in 2014-2017. Outcomes We identified 5 trajectories of kidney function over time. Model Perspective & Timeframe Mean total health care costs for each of the trajectories were described in each of the following 3 years from a payer perspective: 1 year before and 2 years after the index date establishing stage G2 CKD (study entry). Results The mean estimated glomerular filtration rate (eGFR) at study entry was 75.9 mL/min/1.73 m2 and the median (interquartile range) follow-up period was 2.6 (1.6, 3.7) years. The cohort had a mean age of 72.6 years and had predominantly female participants (57.2%), and White (71.2%). We identified the following 5 distinct trajectories of kidney function: a stable eGFR (22.3%); slow eGFR decline with a mean eGFR at study entry of 78.6 (30.2%); slow eGFR decline with an eGFR at study entry of 70.9 (28.4%); steep eGFR decline (16.3%); and accelerated eGFR decline (2.8%). Mean costs of enrollees with accelerated eGFR decline were double the MA enrollees' mean costs in each of the other 4 trajectories in every year ($27,738 vs $13,498 for a stable eGFR 1 year after study entry). Limitations Results may not generalized beyond MA and a lack of albumin values. Conclusions The small fraction of MA enrollees with accelerated eGFR decline has disproportionately higher costs than other enrollees with mildly reduced kidney function.
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Affiliation(s)
- Clarissa J. Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Ezra Fishman
- National Committee for Quality Assurance, Washington DC
- Optum Labs, Minneapolis, Minnesota
| | - Virginia Wang
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Lindsay Zepel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Optum Labs, Minneapolis, Minnesota
| | - Matthew L. Maciejewski
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
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Liu J, Bankir L, Verma A, Waikar SS, Palsson R. Association of the Urine-to-Plasma Urea Ratio With CKD Progression. Am J Kidney Dis 2023; 81:394-405. [PMID: 36356680 DOI: 10.1053/j.ajkd.2022.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
RATIONALE & OBJECTIVES The urine-to-plasma (U/P) ratio of urea is correlated with urine-concentrating capacity and associated with progression of autosomal dominant polycystic kidney disease. As a proposed biomarker of tubular function, we hypothesized that the U/P urea ratio would also be associated with progression of more common forms of chronic kidney disease (CKD). STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 3,723 adults in the United States with estimated glomerular filtration rate (eGFR) of 20-70 mL/min/1.73 m2, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE U/P urea ratio, calculated from 24-hour urine collections and plasma samples at baseline. OUTCOME Associations of U/P urea ratio with eGFR slope, initiation of kidney replacement therapy (KRT), and CKD progression, defined as 50% decline in eGFR or incident KRT. ANALYTICAL APPROACH Multivariable linear mixed-effects models tested associations with eGFR slope. Cox proportional hazards models tested associations with dichotomous CKD outcomes. RESULTS The median U/P urea ratio was 14.8 (IQR, 9.5-22.2). Compared with participants in the highest U/P urea ratio quintile, those in the lowest quintile had a greater eGFR decline by 1.06 mL/min/1.73 m2 per year (P < 0.001) over 7.0 (IQR, 3.0-11.0) years of follow-up observation. Each 1-SD lower natural log-transformed U/P urea ratio was independently associated with CKD progression (HR, 1.22 [95% CI, 1.12-1.33]) and incident KRT (HR, 1.22 [95% CI, 1.10-1.33]). Associations differed by baseline eGFR (P interaction = 0.009). Among those with an eGFR ≥30 mL/min/1.73 m2, each 1-SD lower in ln(U/P urea ratio) was independently associated with CKD progression (HR, 1.30 [95% CI, 1.18-1.45]), but this was not significant among those with eGFR <30 mL/min/1.73 m2 (HR, 1.00 [95% CI, 0.84-1.20]). LIMITATIONS Possibility of residual confounding. Single baseline 24-hour urine collection for U/P urea ratio. CONCLUSIONS In a large and diverse cohort of patients with common forms of CKD, U/P urea was independently associated with disease progression and incident kidney failure. Associations were not significant among those with advanced CKD at baseline.
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Affiliation(s)
- Jing Liu
- Kidney Research Institute, Renal Division, West China Hospital of Sichuan University, Chengdu, People's Republic of China; Section of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Lise Bankir
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France; CNRS, ERL 8228, Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France
| | - Ashish Verma
- Section of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Sushrut S Waikar
- Section of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ragnar Palsson
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Medical School, Harvard University, Boston, Massachusetts.
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12
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Battaglia Y, Bellasi A, Esposito P, Bortoluzzi A, Rotondi S, Andreucci M, Fiorini F, Russo D, Storari A. The Impact of Cholecaciferol Supplementation on Bone Mineral Density in Long-Term Kidney Transplant Recipients. Biomolecules 2023; 13:biom13040629. [PMID: 37189376 DOI: 10.3390/biom13040629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Although reduced bone mineral density (BMD) is associated with a higher risk of fractures, morbidity, and mortality in kidney transplant patients (KTRs), there is no consensus on optimal treatment for the alterations of BMD in this population. This study aims at assessing the effect of cholecalciferol supplementation on BMD over a follow-up period of 2 years in a cohort of long-term KTRs. Patients with age ≥ 18 years were included and divided into two subgroups based on treatment with bisphosphonate and/or calcimimetics and/or active vitamin D sterols (KTRs-treated) or never treated with the above medications (KTRs-free). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral neck (FN) with standard DEXA at the beginning and end of the study. According to World Health Organization (WHO) criteria, results were expressed as T-score and Z-score. Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and >−2.5 SD, respectively. Cholecalciferol was supplemented at a dose of 25,000 IU/week over 12 weeks followed by 1500 IU/day. KTRs-free (n. 69) and KTRs-treated (n. 49) consecutive outpatients entered the study. KTRs-free were younger (p < 0.05), with a lower prevalence of diabetes (p < 0.05) and of osteopenia at FN (46.3 % vs. 61.2 %) compared to KTRs-treated. At the entry none of the study subjects had a sufficient level of cholecalciferol; Z-score and T-score at LV and FN were not different between groups. At the end of the study period, serum cholecalciferol concentration was significantly increased in both groups (p < 0.001); the KTRs-free group presented an improvement in both T-score and Z-score at LV (p < 0.05) as well as a lower prevalence of osteoporotic cases (21.7% vs. 15.9%); in contrast, no changes were recorded in KTR-treated individuals. In conclusion, supplementation with cholecalciferol ameliorated Z-score and T-score at LV in long-term KTRs who had been never treated with active or inactive vitamin D sterols, bisphosphonates, and calcimimetics. Future endeavours are needed to confirm these preliminary findings.
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Kammer M, Heinzel A, Hu K, Meiselbach H, Gregorich M, Busch M, Duffin KL, Gomez MF, Eckardt KU, Oberbauer R. Different roles of protein biomarkers predicting eGFR trajectories in people with chronic kidney disease and diabetes mellitus: a nationwide retrospective cohort study. Cardiovasc Diabetol 2023; 22:74. [PMID: 36991445 PMCID: PMC10061741 DOI: 10.1186/s12933-023-01808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/19/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common comorbidity in people with diabetes mellitus, and a key risk factor for further life-threatening conditions such as cardiovascular disease. The early prediction of progression of CKD therefore is an important clinical goal, but remains difficult due to the multifaceted nature of the condition. We validated a set of established protein biomarkers for the prediction of trajectories of estimated glomerular filtration rate (eGFR) in people with moderately advanced chronic kidney disease and diabetes mellitus. Our aim was to discern which biomarkers associate with baseline eGFR or are important for the prediction of the future eGFR trajectory. METHODS We used Bayesian linear mixed models with weakly informative and shrinkage priors for clinical predictors (n = 12) and protein biomarkers (n = 19) to model eGFR trajectories in a retrospective cohort study of people with diabetes mellitus (n = 838) from the nationwide German Chronic Kidney Disease study. We used baseline eGFR to update the models' predictions, thereby assessing the importance of the predictors and improving predictive accuracy computed using repeated cross-validation. RESULTS The model combining clinical and protein predictors had higher predictive performance than a clinical only model, with an [Formula: see text] of 0.44 (95% credible interval 0.37-0.50) before, and 0.59 (95% credible interval 0.51-0.65) after updating by baseline eGFR, respectively. Only few predictors were sufficient to obtain comparable performance to the main model, with markers such as Tumor Necrosis Factor Receptor 1 and Receptor for Advanced Glycation Endproducts being associated with baseline eGFR, while Kidney Injury Molecule 1 and urine albumin-creatinine-ratio were predictive for future eGFR decline. CONCLUSIONS Protein biomarkers only modestly improve predictive accuracy compared to clinical predictors alone. The different protein markers serve different roles for the prediction of longitudinal eGFR trajectories potentially reflecting their role in the disease pathway.
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Affiliation(s)
- Michael Kammer
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Heinzel
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Karin Hu
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Heike Meiselbach
- Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mariella Gregorich
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Martin Busch
- Department of Internal Medicine III, University Hospital Jena, Friedrich-Schiller Universität, Jena, Germany
| | - Kevin L Duffin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rainer Oberbauer
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Metabolic dysfunction-associated fatty liver disease is associated with an increase in systolic blood pressure over time: linear mixed-effects model analyses. Hypertens Res 2023; 46:1110-1121. [PMID: 36717630 DOI: 10.1038/s41440-023-01179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/24/2022] [Accepted: 12/24/2022] [Indexed: 02/01/2023]
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD), a new feature of fatty liver (FL) disease that is defined as FL with overweight/obesity, type 2 diabetes mellitus or metabolic dysregulation, has been reported to be associated with the development of diabetes mellitus, chronic kidney disease and cardiovascular disease. However, the association between MAFLD and hypertension remains unclear. We investigated the association between MAFLD and systolic blood pressure (SBP) over a 10-year period in 28,990 Japanese subjects who received annual health examinations. After exclusion of subjects without data for SBP and abdominal ultrasonography at baseline, a total of 17,021 subjects (men/women: 10,973/6048; mean age: 49 years) were recruited. Linear mixed-effects model analyses using diagnoses of FL, nonalcoholic fatty liver disease (NAFLD) or MAFLD and age, sex, SBP, use of anti-hypertensive drugs, levels of uric acid and estimated glomerular filtration rate, family history of hypertension and habits of current smoking and alcohol drinking at baseline as well as the duration of the observation period and the interaction between each covariate and the duration of the observation period showed that the significant association of change in SBP over time with diagnosis of MAFLD (estimate: 0.223 mmHg/year, P < 0.001) was greater than that with diagnoses of FL (estimate: 0.196 mmHg/year, P < 0.001) and NAFLD (estimate: 0.203 mmHg/year, P < 0.001). Furthermore, the rate of increase in SBP over time was higher in subjects with MAFLD than in subjects without FL and subjects with FL who had no MAFLD. In conclusion, MAFLD is significantly associated with an increase in SBP over time. The presence of metabolic dysfunction-associated fatty liver disease (MAFLD) is significantly associated with an increase in systolic blood pressure over time.
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Orieux A, Prezelin-Reydit M, Prevel R, Combe C, Gruson D, Boyer A, Rubin S. Clinical trajectories and impact of acute kidney disease after acute kidney injury in the intensive care unit: a 5-year single-centre cohort study. Nephrol Dial Transplant 2023; 38:167-176. [PMID: 35238922 DOI: 10.1093/ndt/gfac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Patients suffering from acute kidney injury(AKI) in the intensive care unit (ICU) can have various renal trajectories and outcomes. Aims were to assess the various clinical trajectories after AKI in the ICU and to determine risk factors for developing chronic kidney disease (CKD). METHODS We conducted a prospective 5-year follow-up study in a medical ICU at Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI from September 2013 to May 2015 were included. In the Cox analysis, the violation of the proportional hazard assumption for AKD was handled using appropriate interaction terms with time, resulting in a time-dependent hazard ratio (HR). RESULTS A total of 232 patients were enrolled, with an age of 62 ± 16 years and a median follow-up of 52 days (interquartile range 6-1553). On day 7, 109/232 (47%) patients progressed to acute kidney disease (AKD) and 66/232 (28%) recovered. A linear trajectory (AKI, AKD to CKD) was followed by 44/63 (70%) of the CKD patients. The cumulative incidence of CKD was 30% [95% confidence interval (CI) 24-36] at the 5-year follow-up. In a multivariable Cox model, in the 6 months following AKI, the HR for CKD was higher in AKD patients [HR 29.2 (95% CI 8.5-100.7); P < 0.0001). After 6 months, the HR for CKD was 2.2 (95% CI 0.6-7.9; P = 0.21; n = 172 patients). CONCLUSION There were several clinical trajectories of kidney disease after ICU-acquired AKI. CKD risk was higher in AKD patients only in the first 6 months. Lack of renal recovery rather than AKD per se was associated with the risk of CKD.
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Affiliation(s)
- Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- AURAD Aquitaine, 2, allée des demoiselles, Gradignan, France.,Unité INSERM U1219 Bordeaux Population Health, ISPED, Université de Bordeaux, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,Unité INSERM Biotis U1026, Université de Bordeaux, Bordeaux, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Sébastien Rubin
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
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16
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Rijkse E, Roodnat JI, Baart SJ, Bijdevaate DC, Dijkshoorn ML, Kimenai HJAN, van de Wetering J, IJzermans JNM, Minnee RC. Ipsilateral Aorto-Iliac Calcification is Not Directly Associated With eGFR After Kidney Transplantation: A Prospective Cohort Study Analyzed Using a Linear Mixed Model. Transpl Int 2023; 36:10647. [PMID: 36756277 PMCID: PMC9901502 DOI: 10.3389/ti.2023.10647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
Aorto-iliac calcification (AIC) is a well-studied risk factor for post-transplant cardiovascular events and mortality. Its effect on graft function remains unknown. The primary aim of this prospective cohort study was to assess the association between AIC and estimated glomerular filtration rate (eGFR) in the first year post-transplant. Eligibility criteria were: ≥50 years of age or ≥30 years with at least one risk factor for vascular disease. A non-contrast-enhanced CT-scan was performed with quantification of AIC using the modified Agatston score. The association between AIC and eGFR was investigated with a linear mixed model adjusted for predefined variables. One-hundred-and-forty patients were included with a median of 31 (interquartile range 26-39) eGFR measurements per patient. No direct association between AIC and eGFR was found. We observed a significant interaction between follow-up time and ipsilateral AIC, indicating that patients with higher AIC scores had lower eGFR trajectory over time starting 100 days after transplant (p = 0.014). To conclude, severe AIC is not directly associated with lower post-transplant eGFR. The significant interaction indicates that patients with more severe AIC have a lower eGFR trajectory after 100 days in the first year post-transplant.
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Affiliation(s)
- Elsaline Rijkse
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Joke I. Roodnat
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sara J. Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Marcel L. Dijkshoorn
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Hendrikus J. A. N. Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Robert C. Minnee
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands,*Correspondence: Robert C. Minnee,
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17
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Hricik DE, Armstrong B, Alhamad T, Brennan DC, Bromberg JS, Bunnapradist S, Chandran S, Fairchild RL, Foley DP, Formica R, Gibson IW, Kesler K, Kim SJ, Mannon RB, Menon MC, Newell KA, Nickerson P, Odim J, Poggio ED, Sung R, Shapiro R, Tinckam K, Vincenti F, Heeger PS. Infliximab Induction Lacks Efficacy and Increases BK Virus Infection in Deceased Donor Kidney Transplant Recipients: Results of the CTOT-19 Trial. J Am Soc Nephrol 2023; 34:145-159. [PMID: 36195441 PMCID: PMC10101585 DOI: 10.1681/asn.2022040454] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Ischemia-reperfusion (IR) of a kidney transplant (KTx) upregulates TNF α production that amplifies allograft inflammation and may negatively affect transplant outcomes. METHODS We tested the effects of blocking TNF peri-KTx via a randomized, double-blind, placebo-controlled, 15-center, phase 2 clinical trial. A total of 225 primary transplant recipients of deceased-donor kidneys (KTx; 38.2% Black/African American, 44% White) were randomized to receive intravenous infliximab (IFX) 3 mg/kg or saline placebo (PLBO) initiated before kidney reperfusion. All patients received rabbit anti-thymocyte globulin induction and maintenance immunosuppression (IS) with tacrolimus, mycophenolate mofetil, and prednisone. The primary end point was the difference between groups in mean 24-month eGFR. RESULTS There was no difference in the primary end point of 24-month eGFR between IFX (52.45 ml/min per 1.73 m 2 ; 95% CI, 48.38 to 56.52) versus PLBO (57.35 ml/min per 1.73 m 2 ; 95% CI, 53.18 to 61.52; P =0.1). There were no significant differences between groups in rates of delayed graft function, biopsy-proven acute rejection (BPAR), development of de novo donor-specific antibodies, or graft loss/death. Immunosuppression did not differ, and day 7 post-KTx plasma analyses showed approximately ten-fold lower TNF ( P <0.001) in IFX versus PLBO. BK viremia requiring IS change occurred more frequently in IFX (28.9%) versus PLBO (13.4%; P =0.004), with a strong trend toward higher rates of BKV nephropathy in IFX (13.3%) versus PLBO (4.9%; P =0.06). CONCLUSIONS IFX induction therapy does not benefit recipients of kidney transplants from deceased donors on this IS regimen. Because the intervention unexpectedly increased rates of BK virus infections, our findings underscore the complexities of targeting peritransplant inflammation as a strategy to improve KTx outcomes.Clinical Trial registry name and registration number:clinicaltrials.gov (NCT02495077).
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Affiliation(s)
- Donald E Hricik
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Tarek Alhamad
- Department of Medicine, Washington University, Saint Louis, Missouri
| | | | | | | | - Sindhu Chandran
- Departments of Medicine and Surgery, University of California, San Francisco, California
| | - Robert L Fairchild
- Glickman Urological and Kidney Institute and the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - David P Foley
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Richard Formica
- Departments of Medicine and Surgery, Yale University, New Haven, Connecticut
| | - Ian W Gibson
- Departments of Medicine and Pathology, University of Manitoba, Winnipeg, Canada
| | | | - S Joseph Kim
- Department of Medicine, University Health Network, Toronto, Canada
| | - Roslyn B Mannon
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Madhav C Menon
- Departments of Medicine and Surgery, Yale University, New Haven, Connecticut
| | | | - Peter Nickerson
- Departments of Medicine and Pathology, University of Manitoba, Winnipeg, Canada
| | - Jonah Odim
- Transplant Branch, Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Emilio D Poggio
- Glickman Urological and Kidney Institute and the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Randall Sung
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ron Shapiro
- Departments of Medicine, Icahn School of Medicine at Mount Sinai and Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York
| | - Kathryn Tinckam
- Department of Medicine, University Health Network, Toronto, Canada
| | - Flavio Vincenti
- Departments of Medicine and Surgery, University of California, San Francisco, California
| | - Peter S Heeger
- Departments of Medicine, Icahn School of Medicine at Mount Sinai and Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York
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18
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Carrero JJ, Fu EL, Vestergaard SV, Jensen SK, Gasparini A, Mahalingasivam V, Bell S, Birn H, Heide-Jørgensen U, Clase CM, Cleary F, Coresh J, Dekker FW, Gansevoort RT, Hemmelgarn BR, Jager KJ, Jafar TH, Kovesdy CP, Sood MM, Stengel B, Christiansen CF, Iwagami M, Nitsch D. Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations. Kidney Int 2023; 103:53-69. [PMID: 36280224 DOI: 10.1016/j.kint.2022.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
The availability of electronic health records and access to a large number of routine measurements of serum creatinine and urinary albumin enhance the possibilities for epidemiologic research in kidney disease. However, the frequency of health care use and laboratory testing is determined by health status and indication, imposing certain challenges when identifying patients with kidney injury or disease, when using markers of kidney function as covariates, or when evaluating kidney outcomes. Depending on the specific research question, this may influence the interpretation, generalizability, and/or validity of study results. This review illustrates the heterogeneity of working definitions of kidney disease in the scientific literature and discusses advantages and limitations of the most commonly used approaches using 3 examples. We summarize ways to identify and overcome possible biases and conclude by proposing a framework for reporting definitions of exposures and outcomes in studies of kidney disease using routinely collected health care data.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Søren V Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alessandro Gasparini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Viyaasan Mahalingasivam
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research and Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Faye Cleary
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Manish M Sood
- Department of Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bénédicte Stengel
- CESP (Center for Research in Epidemiology and Population Health), Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Inserm U1018, Villejuif, France
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Masao Iwagami
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; UK Renal Registry, UK Kidney Association, Bristol, UK.
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19
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Melsom T, Norvik JV, Enoksen IT, Stefansson V, Mathisen UD, Fuskevåg OM, Jenssen TG, Solbu MD, Eriksen BO. Sex Differences in Age-Related Loss of Kidney Function. J Am Soc Nephrol 2022; 33:1891-1902. [PMID: 35977806 PMCID: PMC9528336 DOI: 10.1681/asn.2022030323] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND CKD is more prevalent in women, but more men receive kidney replacement therapy for kidney failure. This apparent contradiction is not well understood. METHODS We investigated sex differences in the loss of kidney function and whether any sex disparities could be explained by comorbidity or CKD risk factors. In the Renal Iohexol Clearance Survey (RENIS) in northern Europe, we recruited 1837 persons (53% women, aged 50-62 years) representative of the general population and without self-reported diabetes, CKD, or cardiovascular disease. Participants' GFR was measured by plasma iohexol clearance in 2007-2009 (n=1627), 2013-2015 (n=1324), and 2018-2020 (n=1384). At each study visit, healthy persons were defined as having no major chronic diseases or risk factors for CKD. We used generalized additive mixed models to assess age- and sex-specific GFR decline rates. RESULTS Women had a lower GFR than men at baseline (mean [SD], 90.0 [14.0] versus 98.0 [13.7] ml/min per 1.73 m2; P<0.001). The mean GFR change rate was -0.96 (95% confidence interval [CI], -0.88 to -1.04) ml/min per 1.73 m2 per year in women and -1.20 (95% confidence interval [CI], -1.12 to -1.28) in men. Although the relationship between age and GFR was very close to linear in women, it was curvilinear in men, with steeper GFR slopes at older ages (nonlinear effect; P<0.001). Healthy persons had a slower GFR decline, but health status did not explain the sex difference in the GFR decline. CONCLUSION Among middle-aged and elderly individuals in the general population, decline in the mean GFR in women was slower than in men, independent of health status.
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Affiliation(s)
- Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Jon Viljar Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Vidar Stefansson
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Trond G. Jenssen
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
- Department of Transplant Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marit D. Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Bjørn O. Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
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20
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Magnetic Resonance Elastography-derived Stiffness Predicts Renal Function Loss and Is Associated With Microvascular Inflammation in Kidney Transplant Recipients. Transplant Direct 2022; 8:e1334. [PMID: 35721457 PMCID: PMC9197345 DOI: 10.1097/txd.0000000000001334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022] Open
Abstract
Background. Organ stiffening can be caused by inflammation and fibrosis, processes that are common causes of transplant kidney dysfunction. Magnetic resonance elastography (MRE) is a contrast-free, noninvasive imaging modality that measures kidney stiffness. The objective of this study was to assess the ability of MRE to serve as a prognostic factor for renal outcomes. Methods. Patients were recruited from the St Michael’s Hospital Kidney Transplant Clinic. Relevant baseline demographic, clinical, and Banff histologic information, along with follow-up estimated glomerular filtration rate (eGFR) data, were recorded. Two-dimensional gradient-echo MRE imaging was performed to obtain kidney “stiffness” maps. Binary logistic regression analyses were performed to examine for relationships between stiffness and microvascular inflammation score. Linear mixed-effects modeling was used to assess the relationship between stiffness and eGFR change over time controlling for other baseline variables. A G2-likelihood ratio Chi-squared test was performed to compare between the baseline models with and without “stiffness.” Results. Sixty-eight transplant kidneys were scanned in 66 patients (mean age 56 ± 12 y, 24 females), with 38 allografts undergoing a contemporaneous biopsy. Mean transplant vintage was 7.0 ± 6.8 y. In biopsied allografts, MRE-derived allograft stiffness was associated only with microvascular inflammation (Banff g + ptc score, Spearman ρ = 0.43, P = 0.01), but no other histologic parameters. Stiffness was negatively associated with eGFR change over time (Stiffness × Time interaction β = –0.80, P < 0.0001), a finding that remained significant even when adjusted for biopsy status and baseline variables (Stiffness × Time interaction β = –0.46, P = 0.04). Conversely, the clinical models including “stiffness” showed significantly better fit (P = 0.04) compared with the baseline clinical models without “stiffness.” Conclusions. MRE-derived renal stiffness provides important prognostic information regarding renal function loss for patients with allograft dysfunction, over and above what is provided by current clinical variables.
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21
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Shenavar R, Sajjadi SF, Farmani A, Zarmehrparirouy M, Azadbakht L. Improvement in Anthropometric Measurements of Malnourished Children by Means of Complementary Food and Nutritional Education in Fars Province, Iran: A Community-Based Intervention. Front Nutr 2022; 9:813449. [PMID: 35308266 PMCID: PMC8924542 DOI: 10.3389/fnut.2022.813449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background Childhood malnutrition could have adverse impacts on the growth of child and eventually on fertility and general economic growth, and still, this issue remains a worldwide priority and a concern. This study aimed to evaluate the effectiveness of the national nutritional interventions program on the improvement and nutritional status of malnourished children children aged 6–59 months. Methods This community-based intervention study was conducted with 1288 acute and moderately malnourished children aged 6–59 months referred to health centers. Children received combined nutritional education and counseling with the provision of affordable complementary food for 10 months. Anthropometric measurements were assessed monthly according to the standard protocols. Results Our results showed the reduction in the risk of malnutrition among children after nutritional interventions for weight-for-height (WHZ) (P < 0.001), height-for-age (HAZ) (P < 0.001), and weight-for-age (WAZ) (P = 0.008). Total malnourished children indicated improvement in HAZ (<-3 SD: OR = 1.10, P = 0.026), WAZ (<-2SD: OR = 1.21, P < 0.001; <-3SD: OR = 1.60, P < 0.001), and WHZ (<-3SD: OR = 1.10, P = 0.030). Controlling potential confounders (socioeconomic status, childrens' birth supine length, and weight) showed a significant amelioration in HAZ (<-2 SD: OR = 6.20, P = 0.020; <-3 SD: OR = 9, P = 0.003) and WAZ (<-2 SD: OR = 5.85, P = 0.010; <-3 SD: OR = 7.50, P = 0.004). In urban areas, significant amelioration was observed in HAZ (<-3 SD: OR = 1.22, P = 0.010) and WAZ (<-2 SD: OR = 1.24, P = 0.003; <-3 SD: OR = 1.64, P < 0.001). In rural, considerable amelioration was observed in WAZ (<-2 SD: OR = 1.20, P = 0.010; <-3 SD: OR = 1.50, P < 0.001) and WHZ (<-3 SD: OR = 1.20, P = 0.020). Conclusion Nutritional training and counseling as well as complementary food intervention among the malnourished children significantly improved the nutritional status of children. So community-based intervention is recommended to reduce the malnutrition among children.
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Affiliation(s)
- Razieh Shenavar
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
- Department of Community Nutrition, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Forough Sajjadi
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Farmani
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
| | - Mina Zarmehrparirouy
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Leila Azadbakht
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22
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Modeling pulse wave velocity trajectories—challenges, opportunities, and pitfalls. Kidney Int 2022; 101:459-462. [DOI: 10.1016/j.kint.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023]
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23
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Serum uric acid level is associated with an increase in systolic blood pressure over time in female subjects: Linear mixed-effects model analyses. Hypertens Res 2022; 45:344-353. [PMID: 34848887 DOI: 10.1038/s41440-021-00792-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Abstract
Whether hyperuricemia is a true risk factor for elevated blood pressure (BP) is controversial, and the sex-specific effects of serum uric acid (SUA) on BP during a follow-up period remain unclear. We investigated whether the association of SUA level with systolic or diastolic BP during a 10-year period differs by sex in a Japanese general population of individuals who received annual health examinations (n = 28,990). After exclusion of subjects who had no BP or SUA data at baseline, a total of 22,994 subjects (male/female: 14,603/8391, age: 47 ± 11 years) were recruited. After adjustment for age; body mass index; BP; SUA level; use of drugs for hyperuricemia and hypertension; diagnosis of diabetes mellitus, dyslipidemia, and chronic kidney disease; family history of hypertension; habits of current smoking and alcohol consumption at baseline; the duration of the observation period; and the interaction between each covariate and the duration of the observation period indicated a significant association of SUA level with change in systolic or diastolic BP over time. There was a significant interaction between sex and SUA level for the change in systolic BP (P = 0.003) but not the change in diastolic BP (P = 0.081). The SUA level at baseline (per 1 mg/dL) was significantly associated with a change in systolic BP over time in females (estimate: 0.073 mmHg/year, P = 0.003) but not in males (estimate: 0.020 mmHg/year, P = 0.160). In conclusion, a high SUA level at baseline is significantly associated with an increase in systolic BP over time in female individuals but not in male individuals.
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24
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Battaglia Y, Bellasi A, Bortoluzzi A, Tondolo F, Esposito P, Provenzano M, Russo D, Andreucci M, Cianciolo G, Storari A. Bone Mineral Density Changes in Long-Term Kidney Transplant Recipients: A Real-Life Cohort Study of Native Vitamin D Supplementation. Nutrients 2022; 14:nu14020323. [PMID: 35057505 PMCID: PMC8780110 DOI: 10.3390/nu14020323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
Vitamin D insufficiency has been associated with reduced bone mineral density (BMD) in kidney transplant patients (KTRs). However, the efficacy of vitamin D supplementation on BMD remains poorly defined, especially for long-term KTRs. We aimed to investigate the effect of native vitamin D supplementation on the BMD of KTRs during a 2-year follow-up. Demographic, clinical, and laboratory data were collected. BMD was evaluated with standard DEXA that was performed at baseline (before vitamin D supplementation) and at the end of study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. According to WHO criteria, results were expressed as the T-score (standard deviation (SD) relative to young healthy adults) and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as a T-score ≤ -2.5 SD and a T-score < -1 and a > -2.5 SD, respectively. Based on plasma levels, 25-OH-vitamin D (25-OH-D) was supplemented as recommended for the general population. Data from 100 KTRs were analyzed. The mean study period was 27.7 ± 3.4 months. At study inception, 25-OH-D insufficiency and deficiency were recorded in 65 and 35 patients. At the basal DEXA, the percentage of osteopenia and osteoporosis was 43.3% and 18.6% at LV and 54.1% and 12.2% at FN, respectively. At the end of the study, no differences in the Z-score and T-score gains were observed. During linear mixed model analysis, native vitamin D supplementation was found to have a negative nitration with Z-score changes at the right femoral neck in KTRs (p < 0.05). The mean dose of administered cholecalciferol was 13.396 ± 7.537 UI per week; increased 25-OH-D levels were found (p < 0.0001). Either low BMD or 25-OH-vitamin D concentration was observed in long-term KTRs. Prolonged supplementation with 25-OH-D did not modify BMD, Z-score, or T-score.
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Affiliation(s)
- Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, 37019 Verona, Italy
- Correspondence:
| | - Antonio Bellasi
- Nephrology Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and St. Anna University-Hospital, 44124 Ferrara, Italy;
| | - Francesco Tondolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (F.T.); (G.C.)
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy;
- Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Domenico Russo
- Department of Public Health, University Federico II, 80100 Napoli, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (F.T.); (G.C.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University-Hospital, 44124 Ferrara, Italy;
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Lee YT, Hsu CN, Fu CM, Wang SW, Huang CC, Li LC. Comparison of Adverse Kidney Outcomes With Empagliflozin and Linagliptin Use in Patients With Type 2 Diabetic Patients in a Real-World Setting. Front Pharmacol 2022; 12:781379. [PMID: 34992535 PMCID: PMC8724779 DOI: 10.3389/fphar.2021.781379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background: To compare the effects of empagliflozin and linagliptin use on kidney outcomes of type 2 diabetes mellitus (T2DM) patients in a real-world setting. Methods: The study involved a propensity score-matched cohort comprising new users of empagliflozin or linagliptin with T2DM between January 1, 2013 and December 31, 2018 from a large healthcare delivery system in Taiwan. Clinical outcomes assessed: acute kidney injury (AKI), post-AKI dialysis, and mortality. Cox proportional hazard model was used to estimate the relative risk of empagliflozin or linagliptin use; a linear mixed model was used to compare the average change in estimated glomerular filtration rate (eGFR) over time. Results: Of the 7,042 individuals, 67 of 3,521 (1.9%) in the empagliflozin group and 144 of 3,521 (4.1%) in the linagliptin group developed AKI during the 2 years follow-up. Patients in the empagliflozin group were at a 40% lower risk of developing AKI compared to those in the linagliptin group (adjusted hazard ratio [aHR], 0.60; 95% confidence interval [CI], 0.45-0.82, p = 0.001). Stratified analysis showed that empagliflozin users ≥65 years of age (aHR, 0.70; 95% CI, 0.43-1.13, p = 0.148), or with a baseline eGFR <60 ml/min/1.73 m2 (aHR, 0.97; 95% CI, 0.57-1.65, p = 0.899), or with a baseline glycohemoglobin ≦7% (aHR, 1.01; 95% CI, 0.51-2.00, p =0.973) experienced attenuated benefits with respect to AKI risk. A smaller decline in eGFR was observed in empagliflozin users compared to linagliptin users regardless of AKI occurrence (adjusted β = 1.51; 95% CI, 0.30-2.72 ml/min/1.73 m2, p = 0.014). Conclusion: Empagliflozin users were at a lower risk of developing AKI and exhibited a smaller eGFR decline than linagliptin users. Thus, empagliflozin may be a safer alternative to linagliptin for T2DM patients.
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Affiliation(s)
- Yueh-Ting Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Ming Fu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Wang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiang-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Diamantidis CJ, Zepel L, Wang V, Smith VA, Hudson Scholle S, Tamayo L, Maciejewski ML. Disparities in Chronic Kidney Disease Progression by Medicare Advantage Enrollees. Am J Nephrol 2021; 52:949-957. [PMID: 34875668 DOI: 10.1159/000519758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD) in Medicare beneficiaries has quadrupled in the past 2 decades, but little is known about risk factors affecting the progression of CKD. This study aims to understand the progression in Medicare Advantage enrollees and whether it differs by provider recognition of CKD, race and ethnicity, or geographic location. In a large cohort of Medicare Advantage (MA) enrollees, we examined whether CKD progression, up to 5 years after study entry, differed by demographic and clinical factors and identified additional risk factors of CKD progression. METHODS In a cohort of 1,002,388 MA enrollees with CKD stages 1-4 based on 2013-2018 labs, progression was estimated using a mixed-effects model that adjusted for demographics, geographic location, comorbidity, urine albumin-to-creatinine ratio, clinical recognition via diagnosed CKD, and time-fixed effects. Race and ethnicity, geographic location, and clinical recognition of CKD were interacted with time in 3 separate regression models. RESULTS Mean (median) follow-up was 3.1 (3.0) years. Black and Hispanic MA enrollees had greater kidney function at study entry than other beneficiaries, but their kidney function declined faster. MA enrollees with clinically recognized CKD had estimated glomerular filtration rate levels that were 18.6 units (95% confidence interval [CI]: 18.5-18.7) lower than levels of unrecognized patients, but kidney function declined more slowly in enrollees with clinical recognition. There were no differences in CKD progression by geography. After removal of the race coefficient from the eGFR equation in a sensitivity analysis, kidney function was much lower in all years among Black MA enrollees, but patterns of progression remained the same. DISCUSSION/CONCLUSIONS These results suggest that patients with clinically recognized CKD and racial and ethnic minorities merit closer surveillance and management to reduce their risk of faster progression.
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Affiliation(s)
- Clarissa Jonas Diamantidis
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lindsay Zepel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- OptumLabs Visiting Fellow, Cambridge, Massachusetts, USA
| | - Virginia Wang
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | - Loida Tamayo
- Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | - Matthew L Maciejewski
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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Wong RBK, Minkovich M, Famure O, Li Y, Lee JY, Selzner M, Kim SJ, Ghanekar A. Surgical site complications in kidney transplant recipients: incidence, risk factors and outcomes in the modern era. Can J Surg 2021; 64:E669-E676. [PMID: 34933944 PMCID: PMC8711553 DOI: 10.1503/cjs.015820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Surgical site complications (SSCs) are an important source of morbidity after kidney transplantation. We assessed the incidence, risk factors, outcomes and economic impact of SSCs in a large, diverse population of kidney transplant recipients. METHODS We conducted a single-centre, observational cohort study of adult (age ≥ 18 yr) patients who underwent kidney transplantation between Jan. 1, 2005, and Dec. 31, 2015, with a minimum of 1 year of follow-up. Cases of SSC, including infections and wound dehiscence, were determined from patient records. Inpatient and outpatient hospital costs were determined 6 and 12 months after transplantation. We used the Kaplan-Meier product-limit method to determine the cumulative probability of SSCs and other outcomes. We evaluated risk factors and clinical outcomes using Cox proportional hazard ratios. Linear regression models were used to study the effect of SSCs on graft function. RESULTS The incidence rate of SSCs within 30 days after transplantation was 4.19 per 100 person-months. The cumulative probability of developing an SSC within 30 days after transplantation was 4.13% (95% confidence interval [CI] 3.23%-5.28%). Increased recipient body mass index (BMI) (hazard ratio [HR] 1.07, 95% CI 1.02-1.11), longer cold ischemic time (HR 1.05, 95% CI 1.01-1.09) and transplantation in 2010-2012 versus 2005-2009 (HR 2.20, 95% CI 1.19-4.04) were risk factors for SSC development. In multivariable stepwise Cox proportional hazard models, SSC was a significant risk factor for death-censored graft failure (HR 3.08, 95% CI 1.60-5.90) and total graft failure (HR 2.09, 95% CI 1.32-3.32). Cumulative median hospital costs were $2238.46 greater for patients with an SSC than for those without. CONCLUSION Increased BMI, longer cold ischemic time and the 2010-2012 transplantation period predisposed to SSCs. The development of SSCs was associated with a higher risk of graft failure. Strategies to minimize SSCs may improve outcomes after kidney transplantation and reduce costs.
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Affiliation(s)
- Rebecca Bic Kay Wong
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - Michelle Minkovich
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - Olusegun Famure
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - Yanhong Li
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - Jason Young Lee
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - Markus Selzner
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - S Joseph Kim
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim)
| | - Anand Ghanekar
- From the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ont. (Wong, Minkovich, Famure, Li, Lee, Selzner, Kim, Ghanekar); the Division of Nephrology, University Health Network, Toronto, Ont. (Lee); the Department of Surgery, University of Toronto, Toronto, Ont. (Lee, Selzner, Ghanekar); the Division of General Surgery, University Health Network, Toronto, Ont. (Selzner, Ghanekar); and the Department of Medicine, University of Toronto, Toronto, Ont. (Kim).
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Kim H, Lee H, Kwon SH, Jeon JS, Noh H, Han DC, Kim H. Relationship between carbohydrate-to-fat intake ratio and the development of chronic kidney disease: A community-based prospective cohort study. Clin Nutr 2021; 40:5346-5354. [PMID: 34555715 DOI: 10.1016/j.clnu.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/12/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS It is well-known that high protein intake is associated with renal hyperfiltration and faster renal function decline, but the association of other macronutrients, carbohydrate and fat, with development of chronic kidney disease (CKD) is still inconclusive. Therefore, we aimed to examine the relationship between fat-to-carbohydrate intake ratio (F/C ratio) and incident CKD. METHODS We included 9226 subjects from the Korean Genome and Epidemiology Study. The subjects were divided into two groups depending on 1 g protein intake per ideal body weight per day. Primary exposure was the F/C ratio defined as calorie intake of fat/calorie intake of fat and carbohydrate. The primary outcome was the development of CKD, which was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 and/or proteinuria (≥1+). RESULTS During a median follow-up duration of 11.4 years, 778 (8.4%) CKD events occurred. Subjects in the lowest F/C ratio tertile had faster eGFR decline rate than other tertiles. In multivariable Cox analysis, a significantly higher CKD risk was observed in the lowest tertile when protein intake > 1 g/kg/day (hazard ratio [HR] for T1 (<16.1%) vs. T3 (>21.5%), 1.38; 95% confidence interval [CI], 1.03-1.84; P = 0.031). In sensitivity analysis, subjects maintained low F/C ratio diet (<16.1%) during 4 years showed higher risk of subsequent CKD development than those maintained high F/C ratio diet (≥16.1%; HR, 1.70; 95% CI, 1.10-2.63; P = 0.018). In cubic spline analysis, CKD risk was sharply increased in F/C ratio <16.1%, but the risk was nearly constant in F/C ratio ≥16.1%. CONCLUSIONS A diet with a low F/C ratio was associated with increased risk of CKD in the general population. Therefore, it is necessary to limit excessive high carbohydrate and low fat intake to prevent CKD development in this population.
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Affiliation(s)
- Hyoshik Kim
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Haekyung Lee
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Soon Hyo Kwon
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Seok Jeon
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyunjin Noh
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Dong Cheol Han
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyoungnae Kim
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Hyonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
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29
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Enoksen ITT, Svistounov D, Norvik JV, Stefansson VTN, Solbu MD, Eriksen BO, Melsom T. Serum Matrix Metalloproteinase 7 and accelerated GFR decline in a general non-diabetic population. Nephrol Dial Transplant 2021; 37:1657-1667. [PMID: 34436577 PMCID: PMC9395374 DOI: 10.1093/ndt/gfab251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Age-related reduction of glomerular filtration rate (GFR) is a major contributor to the global chronic kidney disease (CKD) epidemic. We investigated whether baseline serum levels of the pro-fibrotic matrix metalloproteinase 2 (MMP2), MMP7 and their inhibitor, tissue inhibitor of metalloproteinase 1 (TIMP1), which mediates fibrosis development in aging animals, were associated with GFR decline in a general nondiabetic population. METHODS In the Renal Iohexol Clearance Survey (RENIS), we measured GFR using iohexol clearance in 1627 subjects aged 50-64 without self-reported diabetes, kidney or cardiovascular disease. After a median of 5.6 years, 1324 had follow-up GFR measurements. Using linear mixed models and logistic regression analyses, we evaluated the association of MMP7, MMP2 and TIMP1 with the mean GFR decline rate, risk of accelerated GFR decline (defined as subjects with the 10% steepest GFR slopes: ≥1.8 ml/min/1.73 m2/year) and incident CKD (GFR <60 ml/min/1.73 m2 and/or urinary albumin to creatinine ratio (ACR) ≥3.0 mg/mmol). RESULTS Higher MMP7 levels (per SD increase of MMP7) were associated with steeper GFR decline rates (-0.23 ml/min/1.73m2/year [95% confidence interval, -0.34 to -0.12]) and increased risk of accelerated GFR decline and incident CKD, (odds ratios; 1.58 (1.30-1.93) and 1.45 (1.05-2.01), respectively, in a model adjusted for age, sex, baseline GFR, ACR and cardiovascular risk factors). MMP2 and TIMP1 showed no association with GFR decline or incident CKD. CONCLUSION The pro-fibrotic biomarker MMP7, but not MMP2 or TIMP1, is associated with increased risk of accelerated GFR decline and incident CKD in middle-aged persons from the general population.
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Affiliation(s)
| | - Dmitri Svistounov
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jon V Norvik
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Vidar T N Stefansson
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit D Solbu
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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30
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Chan L, Nadkarni GN, Fleming F, McCullough JR, Connolly P, Mosoyan G, El Salem F, Kattan MW, Vassalotti JA, Murphy B, Donovan MJ, Coca SG, Damrauer SM. Derivation and validation of a machine learning risk score using biomarker and electronic patient data to predict progression of diabetic kidney disease. Diabetologia 2021; 64:1504-1515. [PMID: 33797560 PMCID: PMC8187208 DOI: 10.1007/s00125-021-05444-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
AIM Predicting progression in diabetic kidney disease (DKD) is critical to improving outcomes. We sought to develop/validate a machine-learned, prognostic risk score (KidneyIntelX™) combining electronic health records (EHR) and biomarkers. METHODS This is an observational cohort study of patients with prevalent DKD/banked plasma from two EHR-linked biobanks. A random forest model was trained, and performance (AUC, positive and negative predictive values [PPV/NPV], and net reclassification index [NRI]) was compared with that of a clinical model and Kidney Disease: Improving Global Outcomes (KDIGO) categories for predicting a composite outcome of eGFR decline of ≥5 ml/min per year, ≥40% sustained decline, or kidney failure within 5 years. RESULTS In 1146 patients, the median age was 63 years, 51% were female, the baseline eGFR was 54 ml min-1 [1.73 m]-2, the urine albumin to creatinine ratio (uACR) was 6.9 mg/mmol, follow-up was 4.3 years and 21% had the composite endpoint. On cross-validation in derivation (n = 686), KidneyIntelX had an AUC of 0.77 (95% CI 0.74, 0.79). In validation (n = 460), the AUC was 0.77 (95% CI 0.76, 0.79). By comparison, the AUC for the clinical model was 0.62 (95% CI 0.61, 0.63) in derivation and 0.61 (95% CI 0.60, 0.63) in validation. Using derivation cut-offs, KidneyIntelX stratified 46%, 37% and 17% of the validation cohort into low-, intermediate- and high-risk groups for the composite kidney endpoint, respectively. The PPV for progressive decline in kidney function in the high-risk group was 61% for KidneyIntelX vs 40% for the highest risk strata by KDIGO categorisation (p < 0.001). Only 10% of those scored as low risk by KidneyIntelX experienced progression (i.e., NPV of 90%). The NRIevent for the high-risk group was 41% (p < 0.05). CONCLUSIONS KidneyIntelX improved prediction of kidney outcomes over KDIGO and clinical models in individuals with early stages of DKD.
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Affiliation(s)
- Lili Chan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Girish N Nadkarni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fergus Fleming
- Renalytix AI Plc, Cardiff, UK
- Renalytix AI, Inc., New York, NY, USA
| | | | | | - Gohar Mosoyan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fadi El Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA
| | - Joseph A Vassalotti
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara Murphy
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael J Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven G Coca
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
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Santos J, Oliveira P, Severo M, Lobato L, Cabrita A, Fonseca I. Different kidney function trajectory patterns before dialysis in elderly patients: clinical implications and outcomes. Ren Fail 2021; 43:1049-1059. [PMID: 34187290 PMCID: PMC8253175 DOI: 10.1080/0886022x.2021.1945464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background. Identifying trajectories of kidney disease progression in chronic kidney disease (CKD) patients may help to deliver better care. We aimed to identify and characterize trajectories of renal function decline in CKD patients and to investigate their association with mortality after dialysis. Methods. This retrospective cohort study included 378 CKD patients who initiated dialysis (aged 65 years and over) between 2009 and 2016. Were considered mixed models using linear quadratic and cubic models to define the trajectories, and we used probabilistic clustering procedures. Patient characteristics and care practices at and before dialysis were examined by multivariable multinomial logistic regression. The association of these trajectories with mortality after dialysis was examined using Cox models. Results. Four distinct groups of eGFR trajectories decline before dialysis were identified: slower decline (18.3%), gradual decline (18.3%), early rapid decline (41.2%), and rapid decline (22.2%). Patients with rapid eGFR decline were more likely to have diabetes, more cognitive impairment, to have been hospitalized before dialysis, and were less likely to have received pre-dialysis care compared to the patients with a slower decline. They had a higher risk of death within the first and fourth year after dialysis initiation, and after being more than 4 years in dialysis. Conclusions. There are different patterns of eGFR trajectories before dialysis initiation in the elderly, that may help to identify those who are more likely to experience an accelerated decline in kidney function, with impact on pre ESKD care and in the mortality risk after dialysis.
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Affiliation(s)
- Josefina Santos
- Nephrology Department, Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Pedro Oliveira
- EPI Unit, ISPUP - Institute of Public Health, University of Porto, Porto, Portugal.,Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Milton Severo
- EPI Unit, ISPUP - Institute of Public Health, University of Porto, Porto, Portugal
| | - Luísa Lobato
- Nephrology Department, Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - António Cabrita
- Nephrology Department, Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal
| | - Isabel Fonseca
- Nephrology Department, Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,EPI Unit, ISPUP - Institute of Public Health, University of Porto, Porto, Portugal
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32
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Association of High-Density Lipoprotein Cholesterol With GFR Decline in a General Nondiabetic Population. Kidney Int Rep 2021; 6:2084-2094. [PMID: 34386657 PMCID: PMC8343778 DOI: 10.1016/j.ekir.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Although lower high-density lipoprotein cholesterol (HDL-C) levels are considered a risk factor for cardiovascular disease (CVD), experimental evidence suggest that aging, inflammation, and oxidative stress may remodel HDL-C, leading to dysfunctional HDL-C. Population studies on HDL-C and loss of the glomerular filtration rate (GFR) reported inconsistent results, but they used inaccurate estimates of the GFR and may have been confounded by comorbidity. Methods We investigated the association of HDL-C levels with risk of GFR loss in a general population cohort; the participants were aged 50-62 years and did not have diabetes, CVD, or chronic kidney disease (CKD) at baseline. The GFR was measured using iohexol-clearance at baseline (n=1627) and at the follow-up (n=1324) after a median of 5.6 years. We also investigated any possible effect modification by low-grade inflammation, physical activity, and sex. Results Higher HDL-C levels were associated with steeper GFR decline rates and increased risk of rapid GFR decline (>3 ml/min per 1.73 m2 per year) in multivariable adjusted linear mixed models and logistic regression (-0.64 ml/min per 1.73 m2 per year [95% CI -0.99, -0.29; P < 0.001] and odds ratio 2.7 [95% CI 1.4, 5.2; P < 0.001] per doubling in HDL-C). Effect modifications indicated a stronger association between high HDL-C and GFR loss in physically inactive persons, those with low-grade inflammation, and men. Conclusion Higher HDL-C levels were independently associated with accelerated GFR loss in a general middle-aged nondiabetic population.
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Nugent J, Aklilu A, Yamamoto Y, Simonov M, Li F, Biswas A, Ghazi L, Greenberg J, Mansour S, Moledina D, Wilson FP. Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19. JAMA Netw Open 2021; 4:e211095. [PMID: 33688965 PMCID: PMC7948062 DOI: 10.1001/jamanetworkopen.2021.1095] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Acute kidney injury (AKI) occurs in up to half of patients hospitalized with coronavirus disease 2019 (COVID-19). The longitudinal effects of COVID-19-associated AKI on kidney function remain unknown. Objective To compare the rate of change in estimated glomerular filtration rate (eGFR) after hospital discharge between patients with and without COVID-19 who experienced in-hospital AKI. Design, Setting, and Participants A retrospective cohort study was conducted at 5 hospitals in Connecticut and Rhode Island from March 10 to August 31, 2020. Patients who were tested for COVID-19 and developed AKI were screened, and those who survived past discharge, did not require dialysis within 3 days of discharge, and had at least 1 outpatient creatinine level measurement following discharge were included. Exposures Diagnosis of COVID-19. Main Outcomes and Measures Mixed-effects models were used to assess the association between COVID-19-associated AKI and eGFR slope after discharge. The secondary outcome was the time to AKI recovery for the subgroup of patients whose kidney function had not returned to the baseline level by discharge. Results A total of 182 patients with COVID-19-associated AKI and 1430 patients with AKI not associated with COVID-19 were included. The population included 813 women (50.4%); median age was 69.7 years (interquartile range, 58.9-78.9 years). Patients with COVID-19-associated AKI were more likely to be Black (73 [40.1%] vs 225 [15.7%]) or Hispanic (40 [22%] vs 126 [8.8%]) and had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension. Patients with COVID-19-associated AKI had a greater decrease in eGFR in the unadjusted model (-11.3; 95% CI, -22.1 to -0.4 mL/min/1.73 m2/y; P = .04) and after adjusting for baseline comorbidities (-12.4; 95% CI, -23.7 to -1.2 mL/min/1.73 m2/y; P = .03). In the fully adjusted model controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, the eGFR slope difference persisted (-14.0; 95% CI, -25.1 to -2.9 mL/min/1.73 m2/y; P = .01). In the subgroup of patients who had not achieved AKI recovery by discharge (n = 319), COVID-19-associated AKI was associated with decreased kidney recovery during outpatient follow-up (adjusted hazard ratio, 0.57; 95% CI, 0.35-0.92). Conclusions and Relevance In this cohort study of US patients who experienced in-hospital AKI, COVID-19-associated AKI was associated with a greater rate of eGFR decrease after discharge compared with AKI in patients without COVID-19, independent of underlying comorbidities or AKI severity. This eGFR trajectory may reinforce the importance of monitoring kidney function after AKI and studying interventions to limit kidney disease after COVID-19-associated AKI.
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Affiliation(s)
- James Nugent
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Abinet Aklilu
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Fan Li
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Aditya Biswas
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jason Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sherry Mansour
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis Moledina
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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34
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Mao W, Yang N, Zhang L, Li C, Wu Y, Ouyang W, Xu P, Zou C, Pei C, Shi W, Zhan J, Yang H, Chen H, Wang X, Tian Y, Yuan F, Sun W, Xiong G, Chen M, Guan J, Tang S, Zhang C, Liu Y, Deng Y, Lin Q, Lu F, Hong W, Yang A, Fang J, Rao J, Wang L, Bao K, Lin F, Xu Y, Lu Z, Su G, Zhang L, Johnson DW, Zhao D, Hou H, Fu L, Guo X, Yang L, Qin X, Wen Z, Liu X. Bupi Yishen Formula Versus Losartan for Non-Diabetic Stage 4 Chronic Kidney Disease: A Randomized Controlled Trial. Front Pharmacol 2021; 11:627185. [PMID: 33708125 PMCID: PMC7941267 DOI: 10.3389/fphar.2020.627185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/29/2020] [Indexed: 01/30/2023] Open
Abstract
Chinese herbal medicine (CHM) might have benefits in patients with non-diabetic chronic kidney disease (CKD), but there is a lack of high-quality evidence, especially in CKD4. This study aimed to assess the efficacy and safety of Bupi Yishen Formula (BYF) vs. losartan in patients with non-diabetic CKD4. This trial was a multicenter, double-blind, double-dummy, randomized controlled trial that was carried out from 11-08-2011 to 07-20-2015. Patients were assigned (1:1) to receive either BYF or losartan for 48 weeks. The primary outcome was the change in the slope of the estimated glomerular filtration rate (eGFR) over 48 weeks. The secondary outcomes were the composite of end-stage kidney disease, death, doubling of serum creatinine, stroke, and cardiovascular events. A total of 567 patients were randomized to BYF (n = 283) or losartan (n = 284); of these, 549 (97%) patients were included in the final analysis. The BYF group had a slower renal function decline particularly prior to 12 weeks over the 48-week duration (between-group mean difference of eGFR slopes: −2.25 ml/min/1.73 m2/year, 95% confidence interval [CI]: −4.03,−0.47), and a lower risk of composite outcome of death from any cause, doubling of serum creatinine level, end-stage kidney disease (ESKD), stroke, or cardiovascular events (adjusted hazard ratio = 0.61, 95%CI: 0.44,0.85). No significant between-group differences were observed in the incidence of adverse events. We conclude that BYF might have renoprotective effects among non-diabetic patients with CKD4 in the first 12 weeks and over 48 weeks, but longer follow-up is required to evaluate the long-term effects. Clinical Trial Registration:http://www.chictr.org.cn, identifier ChiCTR-TRC-10001518.
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Affiliation(s)
- Wei Mao
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nizhi Yang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Zhang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuang Li
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yifan Wu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenwei Ouyang
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Xu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuan Zou
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunpeng Pei
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Ha'erbin, China
| | - Wei Shi
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Jihong Zhan
- The First Affiliated Hospital of Guiyang University of Traditional Chinese Medicine, Guiyang, China
| | - Hongtao Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongyu Chen
- Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Xiaoqin Wang
- Hubei Province Hospital of Traditional Chinese Medicine, The Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Yun Tian
- Shanxi Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Fang Yuan
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Wei Sun
- Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Guoliang Xiong
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Ming Chen
- The Teaching Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jianguo Guan
- Liu Zhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Shuifu Tang
- The First Affiliated Hospital of Guangdong University of Chinese Medicine, Guangzhou, China
| | - Chunyan Zhang
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China.,Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuning Liu
- Dongzhimen Hospital to Beijing University of Chinese Medicine, Beijing, China
| | - Yueyi Deng
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese, Shanghai, China
| | - Qizhan Lin
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fuhua Lu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihong Hong
- Zhu Hai Hospital of Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
| | - Aicheng Yang
- The Affiliated Jiang men Traditional Chinese Medicine Hospital, Jinan University, Jiangmen, China
| | - Jingai Fang
- The First Affiliated Hospital to Shanxi Medical University, Taiyuan, China
| | - Jiazhen Rao
- Guangzhou Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Lixin Wang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kun Bao
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feng Lin
- Xinhui Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Yuan Xu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhaoyu Lu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guobin Su
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - La Zhang
- Royal Melbourne Institute of Technology, Melbourne, VIC, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, University of Queensland, Brisbane, Australia, Translational Research Institute, Brisbane, Australia
| | - Daixin Zhao
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haijing Hou
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lizhe Fu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lihong Yang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xindong Qin
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xusheng Liu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Kinoshita Y, Yagisawa T, Sugihara T, Hara K, Takeshima S, Kubo T, Shinzato T, Shimizu T, Suzuki M, Maeshima A, Kamei J, Fujisaki A, Ando S, Suzuki M, Kume H, Fujimura T. Clinical outcomes in donors and recipients of kidney transplantations involving medically complex living donors - a retrospective study. Transpl Int 2020; 33:1417-1423. [PMID: 32654198 DOI: 10.1111/tri.13699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
We retrospectively compared the post-transplantation graft survival and the donor's estimated glomerular filtration rates (eGFRs) following living donor kidney transplantations (LDKTs) involving medically complex living donors (MCLDs) (the elderly and patients with obesity, hypertension, diabetes mellitus, or reduced renal function) and standard living donors (SLDs). The clinical data on patients who underwent LDKTs at our institution from 2006-2019, including 192 SLDs and 99 MCLDs, were evaluated. Regarding recipients, the log-rank test and multivariable Cox proportional hazards analyses showed a higher incidence of overall and death-censored graft loss in the recipients who received kidneys from MCLDs (Hazard ratio = 2.16 and 3.25, P = 0.015 and 0.004, respectively), after adjusting for recipient-related variables including age, sex, duration of dialysis, ABO compatibility, and donor-specific antibody positivity. Regarding donors, a linear mixed model showed significantly lower postdonation eGFRs (-2.25 ml/min/1.73 m2 , P = 0.048) at baseline in MCLDs than SLDs, but comparable change (difference = 0.01 ml/min/1.73 m2 /year, P = 0.97). In conclusion, although kidneys from MCLDs are associated with impaired graft survival, the donation did not adversely affect the MCLDs' renal health in at least the short-term. LDKTs involving carefully selected MCLDs would be an acceptable alternative for recipients with no SLDs.
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Affiliation(s)
- Yoshitaka Kinoshita
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan.,Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Toru Sugihara
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Konan Hara
- Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Saki Takeshima
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Taro Kubo
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takahiro Shinzato
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Toshihiro Shimizu
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Michiko Suzuki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Jun Kamei
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Akira Fujisaki
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Satoshi Ando
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Division of Urology, Department of Urology, Jichi Medical University, Tochigi, Japan
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36
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Manangama G, Audignon-Durand S, Migault L, Gramond C, Zaros C, Teysseire R, Sentilhes L, Brochard P, Lacourt A, Delva F. Maternal occupational exposure to carbonaceous nanoscale particles and small for gestational age and the evolution of head circumference in the French Longitudinal Study of Children - Elfe study. ENVIRONMENTAL RESEARCH 2020; 185:109394. [PMID: 32247149 DOI: 10.1016/j.envres.2020.109394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/03/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the association between exposure to unintentionally emitted carbonaceous nanoscale particles (NPs) and small for gestational age (SGA), as well as head circumference (HC) at birth and at two years of age. METHODS Mothers from the French Longitudinal Study of Children (Elfe cohort) who worked during pregnancy were selected for our study. Data collected at birth and during follow-up (up to two years) were used. The probability and frequency of maternal occupational exposure to unintentionally emitted carbonaceous NPs was estimated using a job exposure matrix (MatPUF). Multivariate logistic regression, linear regression, and mixed models were applied to estimate any associations. Analyses were carried out depending on whether mothers stopped working during the first, second, or third trimester of pregnancy. RESULTS Maternal occupational exposure to unintentionally emitted carbonaceous NPs was associated with SGA in the overall study population by multivariate analysis (ORa = 1.80, 95% CI: 1.29, 2.46), as well as in sub-groups of mothers who stopped working during the second (ORa = 1.84, 95% CI: 1.13, 3.02) or third (ORa = 1.80, 95% CI: 1.10, 2.95) trimesters. There were no significant associations with HC at birth or two years of age. CONCLUSIONS We found a significant association between occupational exposure to carbonaceous NPs and SGA, with the effect depending on the period of exposure during pregnancy. These results should encourage further studies concerning the adverse effects of exposure to carbonaceous NPs on the development of offspring.
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Affiliation(s)
- Guyguy Manangama
- Bordeaux Teaching Hospital, Artemis Center, Bordeaux, France; University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France.
| | - Sabyne Audignon-Durand
- University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France
| | - Lucile Migault
- French Agency for Food, Environmental and Occupational Health & Safety, Paris, France
| | - Céline Gramond
- University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France
| | - Cécile Zaros
- Joint Research Unit Elfe, Ined-Inserm-EFS, France
| | - Raphaëlle Teysseire
- Bordeaux Teaching Hospital, Artemis Center, Bordeaux, France; University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France
| | - Loïc Sentilhes
- Bordeaux Teaching Hospital, Artemis Center, Bordeaux, France; Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Patrick Brochard
- Bordeaux Teaching Hospital, Artemis Center, Bordeaux, France; University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France
| | - Aude Lacourt
- University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France
| | - Fleur Delva
- Bordeaux Teaching Hospital, Artemis Center, Bordeaux, France; Clinical and Epidemiological Research Unit, INSERM CIC1401, F-33000, Bordeaux, France; University of Bordeaux, Inserm UMR1219-EPICENE, Bordeaux Population Health Research Center, Bordeaux, France
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37
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Bernier-Jean A, Prince RL, Lewis JR, Craig JC, Hodgson JM, Lim WH, Teixeira-Pinto A, Wong G. Dietary plant and animal protein intake and decline in estimated glomerular filtration rate among elderly women: a 10-year longitudinal cohort study. Nephrol Dial Transplant 2020; 36:1640-1647. [DOI: 10.1093/ndt/gfaa081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Many older women demonstrate an age-related accelerating rate of renal decline that is associated with increased rates of bone disease, cardiovascular disease and mortality. Population-based protein restriction has been studied principally in patients with reduced renal function. In this investigation, we examined the hypothesis of a differential effect of plant-derived protein compared with animal-derived protein on renal function in older women.
Methods
We assessed dietary intake from a validated food frequency questionnaire and the estimated glomerular filtration rate (eGFR) (using the Chronic Kidney Disease Epidemiology Collaboration creatinine and cystatin C equation) at baseline, 5 and 10 years in the Longitudinal Study of Aging Women cohort. We tested the association between plant- and animal-sourced protein intake and kidney function using linear mixed modeling.
Results
A total of 1374 Caucasian women [mean (standard deviation, SD) age = 75 years (2.7) and mean (SD) baseline eGFR = 65.6 mL/min/1.73 m2 (13.1)] contributed to the analysis. The average decline in eGFR was 0.64 mL/min/1.73 m2/year [95% confidence interval (CI) 0.56–0.72]. Higher intakes of plant-sourced protein were associated with slower declines in eGFR after adjusting for covariates including animal protein and energy intake (P = 0.03). For each 10 g of plant protein, the yearly decline in eGFR was reduced by 0.12 mL/min/1.73 m2 (95% CI 0.01–0.23), principally associated with fruit-, vegetable- and nut-derived protein. The intake of animal protein was not associated with eGFR decline (P = 0.84).
Conclusions
Older women consuming a diet that is richer in plant-sourced protein have a slower decline in kidney function. These data extend support for the health benefits of plant-rich diets in the general population to maintain kidney health.
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Affiliation(s)
- Amélie Bernier-Jean
- Centre for Kidney Research, Children’s Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Richard L Prince
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Joshua R Lewis
- Centre for Kidney Research, Children’s Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Medical School, University of Western Australia, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jonathan M Hodgson
- Medical School, University of Western Australia, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, Children’s Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children’s Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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38
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Patrice HM, Pascal KA, François KF, Hilaire D, Solange DM, Gloria AE, Pierre CS. Markers and risk factors for chronic kidney disease in sub-Saharan Africans: baseline levels and 12-month trajectories in newly referred patients in Cameroon. BMC Nephrol 2020; 21:101. [PMID: 32188410 PMCID: PMC7079528 DOI: 10.1186/s12882-020-01760-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/09/2020] [Indexed: 01/13/2023] Open
Abstract
Background Little is known about the changes in disease makers and risk factors in patients with chronic kidney disease (CKD) under nephrological care in Africa. This study aimed to evaluate the baseline level of markers of CKD and their 12-month time-trend in newly referred patients in a tertiary hospital in Cameroon. Methods This was a retrospective cohort study including 420 patients referred for CKD between 2006 and 2012 to the nephrology unit of the Douala General Hospital in the littoral region of Cameroon. Their disease and risk profile was assessed at baseline and every 3 months for 1 year. Estimated glomerular filtration rate (eGFR) was based on MDRD and Schwartz equations. CKD was diagnosed in the presence of eGFR< 60 ml/min/1.73 m2 and/or proteinuria> 1+ and/or abnormal renal ultrasound persisting for ≥3 months. Data analysis used mixed linear regressions. Results Of the 420 patients included, 66.9% were men and mean age was 53.8 (15.1) years. At referral, 37.5% of the participants were at CKD Stage 3, 30.8% at stage 4 and 26.8% at stage 5. There was 168 (40%) diabetic and 319 (75.9%) hypertensive patients. After some improvement during the first 3 months, eGFR steadily decreased during the first year of follow-up, and this pattern was robust to adjustment for many confounders. Systolic and diastolic blood pressure levels significantly fluctuated during the first twelve months of follow-up. Changes in the levels of other risk factors and markers of disease severity over time were either borderline or non-significant. Conclusion Patients with CKD in African settings are referred to the nephrologist at advanced stages. This likely translates into a less beneficial effects of specialised care on the course of the disease.
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Affiliation(s)
- Halle Marie Patrice
- Department of internal medicine Douala General Hospital Cameroon Faculty of medicine and pharmaceutical science, University of Douala, Douala, Cameroon.
| | - Kengne Andre Pascal
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Djantio Hilaire
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon
| | - Doualla Marie Solange
- Department of internal medicine Douala General Hospital Cameroon, Faculty of medicine and pharmaceutical science, University of Douala, Douala, Cameroon
| | - Ashuntantang Enow Gloria
- Department of internal medicine Yaounde general hospital Cameroon, Faculty of medicine and biomedical sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Choukem Siméon Pierre
- Department of Internal Medicine Douala General Hospital Cameroon, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Bonnéric S, Karadkhele G, Couchoud C, Patzer RE, Greenbaum LA, Hogan J. Sex and Glomerular Filtration Rate Trajectories in Children. Clin J Am Soc Nephrol 2020; 15:320-329. [PMID: 32111703 PMCID: PMC7057295 DOI: 10.2215/cjn.08420719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/21/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Differences in CKD progression by sex have been hypothesized to explain disparities in access to kidney transplantation in children. This study aims to identify distinct trajectories of eGFR decline and to investigate the association of sex with eGFR decline. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used data from the CKD in Children study. Latent class mixed models were used to identify eGFR trajectories and patient characteristics were compared between trajectories. Progression was studied to two outcomes: ESKD (dialysis or transplantation) and a combined outcome of ESKD or 50% eGFR decline from baseline, using multivariable parametric failure time models. RESULTS Among 888 patients, 613 with nonglomerular and 275 with glomerular diseases, we observed four and two distinct GFR trajectories, respectively. Among patients with nonglomerular diseases, there was a higher proportion of males in the group with a low baseline GFR. This group had an increased risk of ESKD or 50% GFR decline, despite a similar absolute decline in GFR. Eight patients with nonglomerular diseases, mostly males with obstructive uropathies, had a more rapid absolute GFR decline. However, the association between male sex and rapid absolute GFR decline was NS after adjustment for age, baseline GFR, and proteinuria. Among patients with glomerular diseases, a subgroup including mostly females with systemic immunologic diseases or crescentic GN had a rapid absolute GFR decline. CONCLUSIONS This study identifies different trajectories of CKD progression in children and found a faster progression of CKD in females in patients with glomerular diseases, but no significant sex difference in patients with nonglomerular diseases. The differences in progression seem likely explained by sex differences in the underlying primary kidney disease and in baseline GFR rather than by a direct effect of sex on progression.
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Affiliation(s)
- Stéphanie Bonnéric
- Department of Pediatric Nephrology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Geeta Karadkhele
- Department of Surgery, Emory Transplant Center, Emory School of Medicine, Atlanta, Georgia
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, French Biomedicine Agency, La Plaine-Saint Denis, France
| | - Rachel E Patzer
- Department of Surgery, Emory Transplant Center, Emory School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Larry A Greenbaum
- Department of Pediatric Nephrology, Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, Georgia
| | - Julien Hogan
- Department of Pediatric Nephrology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; .,Department of Surgery, Emory Transplant Center, Emory School of Medicine, Atlanta, Georgia
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Janmaat CJ, van Diepen M, Tsonaka R, Jager KJ, Zoccali C, Dekker FW. Pitfalls of linear regression for estimating slopes over time and how to avoid them by using linear mixed-effects models. Nephrol Dial Transplant 2020; 34:561-566. [PMID: 29796633 DOI: 10.1093/ndt/gfy128] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical epidemiological studies often focus on investigating the underlying causes of disease. For instance, a nephrologist may be interested in the association between blood pressure and the development of chronic kidney disease (CKD). However, instead of focusing on the mere occurrence of CKD, the decline of kidney function over time might be the outcome of interest. For examining this kidney function trajectory, patients are typically followed over time with their kidney function estimated at several time points. During follow-up, some patients may drop out earlier than others and for different reasons. Furthermore, some patients may have greater kidney function at study entry or faster kidney function decline than others. Also, a substantial heterogeneity may exist in the number of kidney function estimates available for each patient. This heterogeneity with respect to kidney function, dropout and number of kidney function estimates is important to take into account when estimating kidney function trajectories. In general, two methods are used in the literature to estimate kidney function trajectories over time: linear regression to estimate individual slopes and the linear mixed-effects model (LMM), i.e. repeated measures analysis. Importantly, the linear regression method does not properly take into account the above-mentioned heterogeneity, whereas the LMM is able to retain all information and variability in the data. However, the underlying concepts, use and interpretation of LMMs are not always straightforward. Therefore we illustrate this using a clinical example and offer a framework of how to model and interpret the LMM.
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Affiliation(s)
- Cynthia J Janmaat
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roula Tsonaka
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands and
| | - Carmine Zoccali
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Guo Y, Cui L, Ye P, Li J, Wu S, Luo Y. Change of Kidney Function Is Associated With All-Cause Mortality and Cardiovascular Diseases: Results From the Kailuan Study. J Am Heart Assoc 2019; 7:e010596. [PMID: 30608199 PMCID: PMC6404220 DOI: 10.1161/jaha.118.010596] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Current evaluation about the relationship of sequential change in estimated glomerular filtration rate (eGFR) and clinical outcomes are still inconsistent. We aimed to investigate the association between the change in kidney function over time and the risk of all‐cause mortality and cardiovascular disease. Methods and Results This prospective cohort including 37 691 participants aged ≥45 years used data from the Kailuan Health Registry. The relationship of the annual percentage and absolute change in eGFR and outcomes were analyzed with Cox proportional regression. The participants were stratified according to the quintiles distribution of the percentage annual change in eGFR (Q1–Q5). After adjusting for baseline covariates including initial eGFR, participants with annual eGFR decline were at significantly greater risk for all‐cause mortality (Q1: hazard ratio, 1.22 [95% confidence interval, 1.04–1.43]; Q2: 1.19 [1.01–1.40]) than noted for patients in Q3. Cardiovascular disease risk was also significantly higher in participants with annual eGFR decline (Q1 and Q2). No significantly increased risk of adverse outcomes was noted for patients with annual eGFR increased groups (Q4 and Q5). When considering the absolute eGFR annual change rate (no/mild/rapid decline), we obtained similar results in chronic kidney disease participants, whereas non–chronic kidney disease participants had less pronounced association of eGFR decline with cardiovascular disease, though not with mortality. Conclusions A decline in eGFR over time is associated with higher risk for all‐cause mortality and cardiovascular disease independent of initial eGFR and other known risk factors at baseline. Our data support the serial evaluation of change in kidney function as a better prognostic indicator than single eGFR assessments.
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Affiliation(s)
- Yidan Guo
- 1 Department of Nephrology Beijing Shijitan Hospital Capital Medical University Beijing China
| | - Liufu Cui
- 2 Department of Rheumatology and Immunology Kailuan General Hospital Hebei United University Tangshan China
| | - Pengpeng Ye
- 5 Division of Injury Prevention and Mental Health The National Center for Chronic and Non-communicable Disease Control and Prevention Beijing China
| | - Junjuan Li
- 3 Department of Nephrology Kailuan General Hospital Hebei United University Tangshan China
| | - Shouling Wu
- 4 Department of Cardiology Kailuan General Hospital Hebei United University Tangshan China
| | - Yang Luo
- 1 Department of Nephrology Beijing Shijitan Hospital Capital Medical University Beijing China
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Bénard V, Pichette M, Lafrance JP, Elftouh N, Pichette V, Laurin LP, Nadeau-Fredette AC. Impact of Arteriovenous fistula creation on estimated glomerular filtration rate decline in Predialysis patients. BMC Nephrol 2019; 20:420. [PMID: 31760936 PMCID: PMC6876290 DOI: 10.1186/s12882-019-1607-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) is the vascular access of choice for patients on hemodialysis. Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The study objective was to assess the impact of the AVF creation on eGFR decline, after controlling for key confounding factors. METHODS This retrospective cohort study included adult patients followed in a single-center predialysis clinic between 1999 and 2016. Patients with a patent AVF were followed up to 2 years pre- and post-AVF creation. Estimated GFR trajectory was reported using linear mixed models adjusted for demographic characteristics, comorbidities and use of renin-angiotensin-aldosterone blockade. RESULTS A total of 146 patients were studied with a median age 68.7 (60.5-75.4) years and a median eGFR at time of AVF creation of 12.8 (11.3-13.9) mL/min/1.73m2. The crude annual eGFR decline rates were - 3.60 ± 4.00 mL/min/1.73 m2 pre- and - 2.28 ± 3.56 mL/min/1.73 m2 post-AVF, resulting in a mean difference of 1.28 mL/min/1.73 m2 (95% CI 0.49, 2.07). In a mixed effect linear regression model, monthly eGFR decline was - 0.63 (95% CI -0.81, - 0.46; p < 0.001) mL/min/1.73m2/month. The period after AVF creation was associated with a relatively higher eGFR (β 0.94, 95% CI 0.61-1.26, p < 0.001). There was a significant association between follow-up time and the period pre/post AVF (β 0.19, 95% CI 0.16, 0.22; p < 0.001) such that eGFR decline was more attenuated each month after AVF creation. CONCLUSIONS In this cohort, AVF creation was associated with a significant reduction of eGFR decline. Further prospective studies are needed to confirm this association.
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Affiliation(s)
- Valérie Bénard
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Maude Pichette
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Department of pharmacology and physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Naoual Elftouh
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Vincent Pichette
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Department of pharmacology and physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada.
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, l'Assomption blvd., Quebec, Montreal, H1T 2M4, Canada.
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Norris KC, Duru OK, Alicic RZ, Daratha KB, Nicholas SB, McPherson SM, Bell DS, Shen JI, Jones CR, Moin T, Waterman AD, Neumiller JJ, Vargas RB, Bui AAT, Mangione CM, Tuttle KR. Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD. BMC Nephrol 2019; 20:416. [PMID: 31747918 PMCID: PMC6868861 DOI: 10.1186/s12882-019-1558-9] [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] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD.
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Affiliation(s)
- Keith C Norris
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA.
- UCLA Department of Medicine, Division of General Internal Medicine, 1100 Glendon Ave. Suite 900, Los Angeles, CA, 90024, USA.
| | - O Kenrik Duru
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Radica Z Alicic
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kenn B Daratha
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Sterling M McPherson
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Douglas S Bell
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Jenny I Shen
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Cami R Jones
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Tannaz Moin
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- VA Greater Los Angeles, Los Angeles, USA
| | - Amy D Waterman
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Joshua J Neumiller
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, USA
| | - Roberto B Vargas
- Charles R. Drew University of Medicine and Science, Los Angeles, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Alex A T Bui
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Carol M Mangione
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Katherine R Tuttle
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
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Oshima M, Jun M, Ohkuma T, Toyama T, Wada T, Cooper ME, Hadjadj S, Hamet P, Harrap S, Mancia G, Marre M, Williams B, Chalmers J, Woodward M, Perkovic V. The relationship between eGFR slope and subsequent risk of vascular outcomes and all-cause mortality in type 2 diabetes: the ADVANCE-ON study. Diabetologia 2019; 62:1988-1997. [PMID: 31302707 PMCID: PMC6805825 DOI: 10.1007/s00125-019-4948-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Some studies have reported that annual change in eGFR (eGFR slope) is associated with the future risk of end-stage kidney disease, cardiovascular disease and death in general or chronic kidney disease cohorts. However, the benefits of using eGFR slopes for prediction of major clinical outcomes in diabetes are unclear. METHODS We used data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial and the ADVANCE Post-Trial Observational Study (ADVANCE-ON). After excluding the first 4 months during which an acute fall in eGFR was induced by the initiation of an ACE inhibitor and diuretic combination agent, eGFR slopes were estimated by linear mixed models, using three measurements of eGFR at 4, 12 and 24 months after randomisation over 20 months, and categorised according to quartiles. Cox regression models were used to evaluate adjusted HRs for the study's primary outcome, a composite of major renal events, major macrovascular events and all-cause mortality during the subsequent follow-up from 24 months after randomisation. RESULTS A total of 8,879 participants (80%) were included in this cohort. The mean age was 65.6 years (SD 6.3), the mean eGFR was 75 ml min-1 (1.73 m)-2 (SD 17) and the median urinary albumin/creatinine ratio was 14 μg/mg (interquartile range 7-38). The mean eGFR slope was -0.63 ml min-1 (1.73 m)-2 year-1 (SD 1.75). Over a median follow-up of 7.6 years following the 20-month eGFR slope ascertainment period, 2,221 participants (25%) met the primary outcome. An annual substantial decrease in eGFR (lowest 25%, <-1.63 ml min-1 [1.73 m]-2 year-1) was significantly associated with the subsequent risk of the primary outcome (HR 1.30 [95% CI 1.17, 1.43]) compared with a stable change in eGFR (middle 50%, -1.63 to 0.33). An annual substantial increase in eGFR (highest 25%, >0.33) had no significant association with the risk of the primary outcome (HR 0.96 [95% CI 0.86, 1.07]). CONCLUSIONS/INTERPRETATION Our study supports the utility of eGFR slope in type 2 diabetes as a surrogate endpoint for renal outcomes, as well as a prognostic factor for identifying individuals at high risk of cardiovascular disease and all-cause mortality. TRIAL REGISTRY NUMBER ClinicalTrials.gov registration no. NCT00145925 and no. NCT00949286.
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Affiliation(s)
- Megumi Oshima
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | - Toshiaki Ohkuma
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | - Tadashi Toyama
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Mark E Cooper
- Diabetes Domain, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Samy Hadjadj
- Department of Endocrinology, Institut du Thorax, Inserm, CNRS, CHU Nantes, Nantes, France
| | - Pavel Hamet
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Stephen Harrap
- Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Michel Marre
- Department of Endocrinology, Hôpital Bichat-Claude Bernard, Université Paris, Paris, France
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford, OX1 2BQ, UK.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
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Zoccali C, D'Arrigo G, Leonardis D, Pizzini P, Postorino M, Tripepi G, Mallamaci F, van den Brand J, van Zuilen A, Wetzels J, Bots ML, Blankestijn P. Neuropeptide Y and chronic kidney disease progression: a cohort study. Nephrol Dial Transplant 2019; 33:1805-1812. [PMID: 29370406 DOI: 10.1093/ndt/gfx351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022] Open
Abstract
Background Neuropeptide Y (NPY) is a sympathetic neurotransmitter that has been implicated in various disorders including obesity, gastrointestinal and cardiovascular diseases. Methods We investigated the relationship between circulating NPY and the progression of the glomerular filtration rate (GFR) and proteinuria and the risk for a combined renal endpoint (>30% GFR loss, dialysis/transplantation) in two European chronic kidney disease (CKD) cohorts including follow-up of 753 and 576 patients for 36 and 57 months, respectively. Results Average plasma NPY was 104 ± 32 pmol/L in the first CKD cohort and 119 ± 41 pmol/L in the second one. In separate analyses of the two cohorts, NPY associated with the progression of the estimated GFR (eGFR) and proteinuria over time in both unadjusted and adjusted {eGFR: -3.60 mL/min/1.73 m2 [95% confidence interval (CI): -4.46 to - 2.74] P < 0.001 and -0.83 mL/min/1.73 m2 (-1.41 to - 0.25, P = 0.005); proteinuria: 0.18 g/24 h (0.11-0.25) P < 0.001 and 0.07 g/24 h (0.005-0.14) P = 0.033} analyses by the mixed linear model. Accordingly, in a combined analysis of the two cohorts accounting for the competitive risk of death (Fine and Gray model), NPY predicted (P = 0.005) the renal endpoint [sub-distribution hazard ratio (SHR): 1.09; 95% CI: 1.03-1.16; P = 0.005] and the SHR in the first cohort (1.14, 95% CI: 1.04-1.25) did not differ (P = 0.25) from that in the second cohort (1.06, 95% CI: 0.98-1.15). Conclusions NPY associates with proteinuria and faster CKD progression as well as with a higher risk of kidney failure. These findings suggest that the sympathetic system and/or properties intrinsic to the NPY molecule may play a role in CKD progression.
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Affiliation(s)
- Carmine Zoccali
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Graziella D'Arrigo
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Daniela Leonardis
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Patrizia Pizzini
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Maurizio Postorino
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giovanni Tripepi
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Francesca Mallamaci
- CNR-IFC, Center of Clinical Physiology, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Jan van den Brand
- Radboud University Nijmegen Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Arjan van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jack Wetzels
- Radboud University Nijmegen Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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Guerville F, de Souto Barreto P, Taton B, Bourdel-Marchasson I, Rolland Y, Vellas B. Estimated Glomerular Filtration Rate Decline and Incident Frailty in Older Adults. Clin J Am Soc Nephrol 2019; 14:1597-1604. [PMID: 31628118 PMCID: PMC6832058 DOI: 10.2215/cjn.03750319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Low eGFR is known to be associated with frailty, but the association between the longitudinal decline of eGFR and incident frailty in older persons remains to be determined. The objective of this study was to investigate whether a fast decline on eGFR would be associated with incident frailty. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Community dwellers, aged ≥70, were included in this secondary analysis of the 5-year Multidomain Alzheimer Preventive Trial (MAPT). eGFR was calculated using CKD-Epidemiology Collaboration equation at baseline and at 6, 12, and 24 months. The lowest quartile of eGFR slope (-4.1 ml/min per 1.73 m2 per yr) defined a fast decline. The frailty phenotype (unintentional weight loss, exhaustion, low physical activity, slow gait, low handgrip strength assessed with a 0-5 score, where higher is worse; a score ≥3 defines frailty) was assessed at baseline, 6, 12, 24, 36, 48, and 60 months. Cox models were used to test the association between fast eGFR decline and incident frailty. RESULTS A total of 833 participants were frail neither at baseline nor at 2 years and had appropriate follow-up data. Median (IQR) baseline eGFR was 73 (61-84) ml/min per 1.73 m2. Frailty occurred in 95 (11%) participants between 24 and 60 months. Among them, 31/207 (15%) had fast eGFR decline between baseline and 24 months, and 64/626 (10%) did not. In a Cox model adjusted for demographic variables, cardiovascular comorbidity, C-reactive protein, and baseline eGFR, a fast eGFR decline was associated with incident frailty (HR 1.67, 95% CI 1.03 to 2.71). Sensitivity analyses provided consistent findings. CONCLUSIONS In community-dwelling older adults with relatively preserved baseline eGFR, a fast eGFR decline is associated with incident frailty.
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Affiliation(s)
- Florent Guerville
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France;
| | - Philipe de Souto Barreto
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/INSERM (Institut National de la Santé et de la Recherche Médicale) UMR (Unité Mixte de Recherche) 1027, University of Toulouse III, Toulouse, France
| | - Benjamin Taton
- Departments of Nephrology, Kidney Transplantation and Dialysis and.,MONC Team, INRIA (Institut National de Recherche en Informatique et en Automatique) Bordeaux South West, Talence, France; and
| | - Isabelle Bourdel-Marchasson
- CNRS (Centre National de la Recherche Scientifique), CRMSB (Centre de Résonance Magnétique des Systèmes Biologiques) UMR 5536, University of Bordeaux, Bordeaux, France.,Clinical Gerontology, Bordeaux University Hospital (CHU Bordeaux), Bordeaux, France
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/INSERM (Institut National de la Santé et de la Recherche Médicale) UMR (Unité Mixte de Recherche) 1027, University of Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/INSERM (Institut National de la Santé et de la Recherche Médicale) UMR (Unité Mixte de Recherche) 1027, University of Toulouse III, Toulouse, France
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Faucon AL, Flamant M, Metzger M, Boffa JJ, Haymann JP, Houillier P, Thervet E, Vrtovsnik F, Stengel B, Geri G, Vidal-Petiot E. Extracellular fluid volume is associated with incident end-stage kidney disease and mortality in patients with chronic kidney disease. Kidney Int 2019; 96:1020-1029. [PMID: 31477263 DOI: 10.1016/j.kint.2019.06.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/14/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023]
Abstract
Volume overload has been shown to be an independent risk factor for mortality in patients receiving chronic dialysis, but data in non-dialysis patients are scarce. Therefore we evaluated the prognostic value of extracellular fluid (ECF) volume for chronic kidney disease (CKD) progression and mortality in a prospective hospital-based cohort with CKD stage 1-4 (NephroTest Study). ECF (scaled to body surface area) and the measured glomerular filtration rate (mGFR) were determined using the distribution volume and clearance of 51Cr-EDTA, respectively. Cause-specific Cox and linear mixed-effect regression models were used to analyze the association of ECF with end-stage kidney disease (ESKD) and mortality, and with mGFR decline, respectively. The 1593 patients were mean age 58.8 years, 67% were men, mean mGFR of 43.6 mL/min/1.73m2 and mean ECF 15.1 L/1.73m2. After a median follow-up of 5.3 years, ESKD occurred in 324 patients and 185 patients died before ESKD. In multivariable analysis, ECF was significantly associated with the risk of ESKD (hazard ratio per 1L/1.73m2 increase: 1.14; 95% confidence interval [1.07; 1.21]) and with a faster GFR decline (adjusted mean difference in mGFR slope per 1L/1.73m2 increase -0.14 [-0.23; -0.05] mL/min/year). The relationship of ECF with mortality was non-linear and not significant (per 1L/1.73m2 increase 0.92, [0.73; 1.16]), below 15L/1.73m2, but significant (1.28; [1.14-1.45]) above 15L/1.73m2. Thus, in this large cohort of carefully phenotyped patients with CKD, ECF was an independent risk factor of CKD progression and mortality. Hence, close monitoring and treatment of fluid overload are important for the clinical management of patients with non-dialysis CKD.
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Affiliation(s)
- Anne-Laure Faucon
- Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France
| | - Martin Flamant
- Université de Paris, Paris, France; Department of Physiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; INSERM U1149, Centre de recherche sur l'inflammation, Paris, France
| | - Marie Metzger
- Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France
| | - Jean-Jacques Boffa
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Pierre et Marie Curie University, Paris, France
| | - Jean-Philippe Haymann
- Pierre et Marie Curie University, Paris, France; Department of Physiology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Pascal Houillier
- Université de Paris, Paris, France; Department of Physiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Eric Thervet
- Université de Paris, Paris, France; Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - François Vrtovsnik
- Université de Paris, Paris, France; Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Bénédicte Stengel
- Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France
| | - Guillaume Geri
- Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France; Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Versailles Saint Quentin University, Versailles, France
| | - Emmanuelle Vidal-Petiot
- Université de Paris, Paris, France; Department of Physiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; INSERM U1149, Centre de recherche sur l'inflammation, Paris, France.
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Trends in and Predictors of Carbapenem Consumption across North American Hospitals: Results from a Multicenter Survey by the MAD-ID Research Network. Antimicrob Agents Chemother 2019; 63:AAC.00327-19. [PMID: 31061154 DOI: 10.1128/aac.00327-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/29/2019] [Indexed: 02/03/2023] Open
Abstract
We sought to define trends in and predictors of carbapenem consumption across community, teaching, and university-affiliated hospitals in the United States and Canada. We conducted a retrospective multicenter survey of carbapenem and broad-spectrum noncarbapenem beta-lactam consumption between January 2011 and December 2013. Consumption was tabulated as defined daily doses (DDD) or as days of therapy (DOT) per 1,000 patient days (PD). Multivariate mixed-effects models were explored, and final model goodness of fit was assessed by regressions of observed versus predicted values and residual distributions. A total of 20 acute-care hospitals responded. The centers treated adult patients (n = 19/20) and pediatric/neonatal patients (n = 17/20). The majority of the centers were nonprofit (n = 17/20) and not affiliated with medical/teaching institutions (n = 11/20). The median (interquartile range [IQR]) carbapenem consumption rates were 38.8 (17.4 to 95.7) DDD/1,000 PD and 29.7 (19.2 to 40.1) DOT/1,000 PD overall. Carbapenem consumption was well described by a multivariate linear mixed-effects model (fixed effects, R 2 = 0.792; fixed plus random effects, R 2 = 0.974). Carbapenem consumption increased by 1.91-fold/quarter from 48.6 DDD/1,000 PD (P = 0.004) and by 0.056-fold/quarter from 45.7 DOT/1,000 PD (P = 0.93) over the study period. Noncarbapenem consumption was independently related to increasing carbapenem consumption (beta = 0.31 for increasing noncarbapenem beta-lactam consumption; P < 0.001). Regular antibiogram publication and promotion of conversion from intravenous (i.v.) to oral (p.o.) administration independently affected carbapenem consumption rates. In the final model, 58.5% of the observed variance in consumption was attributable to between-hospital differences. Rates of carbapenem consumption across 20 North American hospitals differed greatly, and the observed differences were correlated with hospital-specific demographics. Additional studies focusing on the drivers of hospital-specific carbapenem consumption are needed to determine whether these rates are justifiable.
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Boucquemont J, Loubère L, Metzger M, Combe C, Stengel B, Leffondre K. Identifying subgroups of renal function trajectories. Nephrol Dial Transplant 2019; 32:ii185-ii193. [PMID: 28031345 DOI: 10.1093/ndt/gfw380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/21/2016] [Indexed: 02/03/2023] Open
Abstract
Background Renal function in patients with chronic kidney disease (CKD) may follow different trajectory profiles. The aim of this study was to evaluate and illustrate the ability of the latent class linear mixed model (LCMM) to identify clinically relevant subgroups of renal function trajectories within a multicenter hospital-based cohort of CKD patients. Methods We analysed data from the NephroTest cohort including 1967 patients with all-stage CKD at baseline who had glomerular filtration rate (GFR) both measured by 51 Cr-EDTA renal clearance (mGFR) and estimated by the CKD-EPI equation (eGFR); 1103 patients had at least two measurements. The LCMM was used to identify subgroups of GFR trajectories, and patients' characteristics at baseline were compared between the subgroups identified. Results Five classes of mGFR trajectories were identified. Three had a slow linear decline of mGFR over time at different levels. In the two others, patients had a high level of mGFR at baseline with either a strong nonlinear decline over time ( n = 11) or a nonlinear improvement ( n = 94) of mGFR. Higher levels of proteinuria and blood pressure at baseline were observed in classes with either severely decreased mGFR or strong mGFR decline over time. Using eGFR provided similar findings. Conclusion The LCMM allowed us to identify in our cohort five clinically relevant subgroups of renal function trajectories. It could be used in other CKD cohorts to better characterize their different profiles of disease progression, as well as to investigate specific risk factors associated with each profile.
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Affiliation(s)
- Julie Boucquemont
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Research, Bordeaux, France
| | - Lucie Loubère
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Research, Bordeaux, France
| | - Marie Metzger
- CESP, Inserm, Univ Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
| | - Christian Combe
- Centre Hospitalier Universitaire de Bordeaux, Service de Néphrologie Transplantation Dialyse, Bordeaux, France.,Unité INSERM 1026, University of Bordeaux, Bordeaux, France
| | - Bénédicte Stengel
- CESP, Inserm, Univ Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
| | - Karen Leffondre
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Research, Bordeaux, France
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50
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Ho J, Sharma A, Kroeker K, Carroll R, De Serres S, Gibson IW, Hirt-Minkowski P, Jevnikar A, Kim SJ, Knoll G, Rush DN, Wiebe C, Nickerson P. Multicentre randomised controlled trial protocol of urine CXCL10 monitoring strategy in kidney transplant recipients. BMJ Open 2019; 9:e024908. [PMID: 30975673 PMCID: PMC6500325 DOI: 10.1136/bmjopen-2018-024908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Subclinical inflammation is an important predictor of death-censored graft loss, and its treatment has been shown to improve graft outcomes. Urine CXCL10 outperforms standard post-transplant surveillance in observational studies, by detecting subclinical rejection and early clinical rejection before graft functional decline in kidney transplant recipients. METHODS AND ANALYSIS This is a phase ii/iii multicentre, international randomised controlled parallel group trial to determine if the early treatment of rejection, as detected by urine CXCL10, will improve kidney allograft outcomes. Incident adult kidney transplant patients (n~420) will be enrolled to undergo routine urine CXCL10 monitoring postkidney transplant. Patients at high risk of rejection, defined as confirmed elevated urine CXCL10 level, will be randomised 1:1 stratified by centre (n=250). The intervention arm (n=125) will undergo a study biopsy to check for subclinical rejection and biopsy-proven rejection will be treated per protocol. The control arm (n=125) will undergo routine post-transplant monitoring. The primary outcome at 12 months is a composite of death-censored graft loss, clinical biopsy-proven acute rejection, de novo donor-specific antibody, inflammation in areas of interstitial fibrosis and tubular atrophy (Banff i-IFTA, chronic active T-cell mediated rejection) and subclinical tubulitis on 12-month surveillance biopsy. The secondary outcomes include decline of graft function, microvascular inflammation at 12 months, development of IFTA at 12 months, days from transplantation to clinical biopsy-proven rejection, albuminuria, EuroQol five-dimension five-level instrument, cost-effectiveness analysis of the urine CXCL10 monitoring strategy and the urine CXCL10 kinetics in response to rejection therapy. ETHICS AND DISSEMINATION The study has been approved by the University of Manitoba Health Research Ethics Board (HS20861, B2017:076) and the local research ethics boards of participating centres. Recruitment commenced in March 2018 and results are expected to be published in 2023. De-identified data may be shared with other researchers according to international guidelines (International Committee of Medical Journal Editors [ICJME]). TRIAL REGISTRATION NUMBER NCT03206801; Pre-results.
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Affiliation(s)
- Julie Ho
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
- Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Atul Sharma
- Data Science, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Kristine Kroeker
- Data Science, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Robert Carroll
- Transplant Nephrology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sacha De Serres
- Internal Medicine & Nephrology, Universite Laval, Québec, Québec, Canada
| | - Ian W Gibson
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anthony Jevnikar
- Internal Medicine & Nephrology, Western University, London, Ontario, Canada
| | - S Joseph Kim
- Internal Medicine & Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Greg Knoll
- Internal Medicine & Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - David N Rush
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Chris Wiebe
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Peter Nickerson
- Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
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