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Matsushita K, Kojima S, Hirakawa K, Tabata N, Ito M, Yamanaga K, Fujisue K, Hoshiyama T, Hanatani S, Sueta D, Kanazawa H, Takashio S, Arima Y, Araki S, Usuku H, Suzuki S, Yamamoto E, Nakamura T, Soejima H, Kaikita K, Tsujita K. Prognostic impact of diabetes mellitus on in-hospital mortality in patients with acute myocardial infarction complicating renal dysfunction according to age and sex. Hellenic J Cardiol 2023:S1109-9666(23)00221-X. [PMID: 37956769 DOI: 10.1016/j.hjc.2023.11.002] [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: 05/20/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) complicating renal dysfunction (RD) are recognized as being at high risk. Although diabetes mellitus (DM) is a major cause of RD, the prognostic impact of coexisting DM on mortality in patients with AMI complicating RD is ill-defined. This study compared the prognostic impact of coexisting DM in patients with AMI complicating RD according to both age and sex. METHODS A multicenter retrospective study was conducted on 2988 consecutive patients with AMI complicating RD (estimated glomerular filtration rate <60 mL/min per 1.73 m2). Multivariable Cox regression analysis was performed to investigate the effects of DM on in-hospital mortality. RESULTS Statistically significant interactions between age and DM and between sex and DM for in-hospital mortality were revealed in the entire cohort. Coexisting DM was identified as an independent risk factor for in-hospital mortality (hazard ratio [HR], 2.543) in young (aged <65 years), but not old (aged ≥65 years), patients. DM was identified as an independent risk factor (HR, 1.469) in male, but not female, patients. Kaplan-Meier survival curves showed that DM correlated with significantly low survival rates in patients that were young or male as compared to those who were old or female. CONCLUSIONS There were significant differences in the prognostic impact of DM on in-hospital mortality between young and old as well as male and female patients with AMI complicating RD. These results have implications for future research and the management of patients with DM, RD, and AMI comorbidities.
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Affiliation(s)
- Kenichi Matsushita
- Division of Advanced Cardiovascular Therapeutics, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan; Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan; The Maruki Memorial Medical and Social Welfare Center, Saitama, Japan; National Center for Child Health and Development Research Institute, Tokyo, Japan.
| | - Sunao Kojima
- Sakura-jyuji Yatsushiro Rehabilitation Hospital, Kumamoto, Japan
| | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Miwa Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoru Suzuki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Chen T, Zhang X, Qian W, Zhou R, Su M, Ma Y. Serum miR-497-5p serves as a diagnostic biomarker for acute coronary syndrome and predicts the occurrence of major adverse cardiovascular events after percutaneous coronary intervention. Bioengineered 2022; 13:8266-8276. [PMID: 35302437 PMCID: PMC9161957 DOI: 10.1080/21655979.2022.2051885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the diagnostic value of microRNA (miR)-497-5p in acute coronary syndrome (ACS) and its predictive value for the occurrence of adverse major adverse cardiovascular events (MACEs). Real-time quantitative polymerase chain reaction (RT-qPCR) was performed to detect the expression of serum miR-497-5p in 110 ACS patients and 82 controls. And miR-497-5p levels were found to be significantly elevated in the patients (P < 0.001). Pearson correlation coefficient confirmed that miR-497-5p was positively correlated with Gensini scores (r = 0.684). The area under the Receiver-operating characteristic (ROC) curve was 0.861, which significantly identified patients with ACS, and was confirmed by logistic regression (OR = 8.533, 95%CI = 4.113–17.787, P < 0.001). Kaplan-Meier and Cox regression was performed to evaluate the predictive value of miR-497-5p in the occurrence of MACEs during a 6-month follow-up after percutaneous coronary intervention (PCI) in patients with ACS. The results demonstrated that miR-497-5p was an independent predictor of MACEs (HR = 4.773, 95%CI = 1.569–12.036, P = 0.013) and that patients with high level of miR-497-5p were more likely to develop MACEs after PCI (long-rank P = 0.019). Finally, miR-497-5p positively correlated with endothelial proinflammatory and adhesion factors. Our study suggests that serum miR-497-5p is a potential diagnostic marker for ACS and its elevated levels can predict a high risk of MACEs in ACS patients after PCI. And this may be associated with vascular endothelial injury.
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Affiliation(s)
- Tao Chen
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xueshan Zhang
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Qian
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ran Zhou
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Mingyu Su
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yanfeng Ma
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Chen CC, Yu T, Chou HH, Chiou YY, Kuo PL. Premature birth carries a higher risk of nephrotic syndrome: a cohort study. Sci Rep 2021; 11:20639. [PMID: 34667222 PMCID: PMC8526683 DOI: 10.1038/s41598-021-00164-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022] Open
Abstract
The pathogenesis of nephrotic syndrome is unclear. We conducted a nationwide population-based cohort study to examine the associations between preterm births and subsequent development of NS. NS was defined as ≥ 3 records with ICD-9-CM codes for NS in hospital admission or outpatient clinic visits. To avoid secondary nephrotic syndrome or nephritis with nephrotic range proteinuria, especially IgA nephropathy, we excluded patients with associated codes. A total of 78,651 preterm infants (gestational age < 37 weeks) and 786,510 matched term infants born between 2004 and 2009 were enrolled and followed until 2016. In the unadjusted models, preterm births, maternal diabetes, and pregnancy induced hypertension were associated with subsequent NS. After adjustment, preterm births remained significantly associated with NS (p = 0.001). The risk of NS increased as the gestational age decreased (p for trend < 0.001). Among the NS population, preterm births were not associated with more complications (Hypertension: p = 0.19; Serious infections: p = 0.63, ESRD: p = 0.75) or a requirement for secondary immunosuppressants (p = 0.61). In conclusion, preterm births were associated with subsequent NS, where the risk increased as the gestational age decreased. Our study provides valuable information for future pathogenesis studies.
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Affiliation(s)
- Chih-Chia Chen
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Pediatric Nephrology, Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chia-Yi City, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Yuan-Yow Chiou
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Division of Pediatric Nephrology, Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan.
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan.
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Klein EC, Kapoor R, Lewandowski D, Mason PJ. Revascularization Strategies in Patients with Chronic Kidney Disease and Acute Coronary Syndromes. Curr Cardiol Rep 2019; 21:113. [PMID: 31471758 DOI: 10.1007/s11886-019-1213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a highly prevalent condition that increases the incidence and complexity of acute coronary syndrome (ACS). The purpose of this review is to summarize current evidence, uncertainties, and opportunities in the management of patients with CKD and ACS, with a focus on revascularization. RECENT FINDINGS Patients with CKD have been systematically under-represented or excluded from clinical trials in ACS. Available data, however, demonstrates that although patients with CKD and ACS benefit from revascularization, they are also less likely to receive recommended medical and revascularization therapies when compared to patients with normal kidney function. Despite the increased short-term risk of major morbidity and mortality, patients with CKD and ACS should be considered for an early invasive strategy while also trying to mitigate the risks of procedural related complications. Until evidence emerges from randomized clinical trials, the decision about revascularization strategy should involve multi-disciplinary collaboration, heart team consensus, and patient shared decision-making.
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Affiliation(s)
- Evan C Klein
- Medical College of Wisconsin, Milwaukee, WI, USA
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Cheng YY, Chang YT, Cheng HL, Shen KH, Sung JM, Guo HR. Associations between arsenic in drinking water and occurrence of end-stage renal disease with modifications by comorbidities: A nationwide population-based study in Taiwan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 626:581-591. [PMID: 29353796 DOI: 10.1016/j.scitotenv.2018.01.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/28/2017] [Accepted: 01/05/2018] [Indexed: 06/07/2023]
Abstract
Arsenic may affect the function of proximal convoluted tubules and glomeruli, but epidemiological data on the association between arsenic ingestion and end-stage renal disease (ESRD) are limited. Therefore, we conducted a nationwide population-based study in Taiwan, where the incidence of ESRD is the highest in the world, to study the potential association. Using the National Health Insurance Database in Taiwan, we constructed a cohort of 362,505 members with age≥40years in 1998. We identified patients of ESRD newly diagnosed between January 1, 1998 and December 31, 2010 and performed Cox proportional hazard regressions to identify risk factors for ESRD and evaluate their effects. Arsenic levels in drinking water were assessed on the basis of a nationwide census survey conducted by the government, of which measurement reports were available for 311 townships. We identified 5442 new patient of ESRD during the study period and found that residents of areas with arsenic levels≥50μg/L in the drinking water had a hazard ratio (HR) of 1.14 (95% confidence interval [CI]: 1.08-1.21) for ESRD. After adjusting for sex, age, income, and comorbidities, we found an adjusted HR of 1.12 (95% CI: 1.06-1.19), which was still statistically significant. Furthermore, the effect was modified by comorbidities, with more prominent effects on patients with less than three comorbidities (adjusted HR=1.51; 95% CI: 1.22-1.86 for low comorbidity score). In conclusion, a high arsenic level in drinking water was a risk factor for ESRD, independent of other documented risk factors. Reducing high-risk comorbidities in patients with early-stage renal dysfunction is important for slowing the progression of the disease to ESRD, even in the endemic area of arsenic exposure.
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Affiliation(s)
- Ya-Yun Cheng
- Department of Environmental and Occupational Health, College of Medical, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Tzu Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hong-Lin Cheng
- Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kun-Hung Shen
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan; Department of Urology, Taipei Medical University, Taipei, Taiwan
| | - Junne-Ming Sung
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medical, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan.
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Chou HH, Chiou MJ, Liang FW, Chen LH, Lu TH, Li CY. Association of maternal chronic disease with risk of congenital heart disease in offspring. CMAJ 2016; 188:E438-E446. [PMID: 27729382 DOI: 10.1503/cmaj.160061] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Information about known risk factors for congenital heart disease is scarce. In this population-based study, we aimed to investigate the relation between maternal chronic disease and congenital heart disease in offspring. METHODS The study cohort consisted of 1 387 650 live births from 2004 to 2010. We identified chronic disease in mothers and mild and severe forms of congenital heart disease in their offspring from Taiwan's National Health Insurance medical claims. We used multivariable logistic regression analysis to assess the associations of all cases and specific types of congenital heart disease with various maternal chronic diseases. RESULTS For mothers with the following chronic diseases, the overall prevalence of congenital heart disease in their children was significantly higher than for mothers without these diseases: diabetes mellitus type 1 (adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 1.66-3.25), diabetes mellitus type 2 (adjusted OR 2.85, 95% CI 2.60-3.12), hypertension (adjusted OR 1.87, 95% CI 1.69-2.07), congenital heart defects (adjusted OR 3.05, 95% CI 2.45-3.80), anemia (adjusted OR 1.31, 95% CI 1.25-1.38), connective tissue disorders (adjusted OR 1.39, 95% CI 1.19-1.62), epilepsy (adjusted OR 1.37, 95% CI 1.08-1.74) and mood disorders (adjusted OR 1.25, 95% CI 1.11-1.41). The same pattern held for mild forms of congenital heart disease. A higher prevalence of severe congenital heart disease was seen only among offspring of mothers with congenital heart defects or type 2 diabetes. INTERPRETATION The children of women with several kinds of chronic disease appear to be at risk for congenital heart disease. Preconception counselling and optimum treatment of pregnant women with chronic disease would seem prudent.
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Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics (Chou), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Department of Applied Life Science and Health (Chou), College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Institute of Public Health, College of Medicine (Chiou, Liang, Lu, Li), National Cheng Kung University, Tainan, Taiwan; Department of Statistics (Chen), Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health (Li), College of Public Health, China Medical University, Taichung, Taiwan
| | - Meng-Jiun Chiou
- Department of Pediatrics (Chou), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Department of Applied Life Science and Health (Chou), College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Institute of Public Health, College of Medicine (Chiou, Liang, Lu, Li), National Cheng Kung University, Tainan, Taiwan; Department of Statistics (Chen), Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health (Li), College of Public Health, China Medical University, Taichung, Taiwan
| | - Fu-Wen Liang
- Department of Pediatrics (Chou), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Department of Applied Life Science and Health (Chou), College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Institute of Public Health, College of Medicine (Chiou, Liang, Lu, Li), National Cheng Kung University, Tainan, Taiwan; Department of Statistics (Chen), Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health (Li), College of Public Health, China Medical University, Taichung, Taiwan
| | - Lea-Hua Chen
- Department of Pediatrics (Chou), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Department of Applied Life Science and Health (Chou), College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Institute of Public Health, College of Medicine (Chiou, Liang, Lu, Li), National Cheng Kung University, Tainan, Taiwan; Department of Statistics (Chen), Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health (Li), College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsung-Hsueh Lu
- Department of Pediatrics (Chou), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Department of Applied Life Science and Health (Chou), College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Institute of Public Health, College of Medicine (Chiou, Liang, Lu, Li), National Cheng Kung University, Tainan, Taiwan; Department of Statistics (Chen), Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health (Li), College of Public Health, China Medical University, Taichung, Taiwan
| | - Chung-Yi Li
- Department of Pediatrics (Chou), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Department of Applied Life Science and Health (Chou), College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Institute of Public Health, College of Medicine (Chiou, Liang, Lu, Li), National Cheng Kung University, Tainan, Taiwan; Department of Statistics (Chen), Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health (Li), College of Public Health, China Medical University, Taichung, Taiwan
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Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience. Clin Exp Nephrol 2016; 21:307-315. [PMID: 27339442 DOI: 10.1007/s10157-016-1290-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/01/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several risk factors were associated with poor outcomes in diabetic patients with chronic kidney disease (CKD). However, few studies addressed the prognostic implications of these factors in advanced CKD. Our study aimed to provide more evidence for risk factor stratification of diabetic patients with advanced CKD. METHOD A total of 447 diabetic patients with advanced CKD, age of 18-80, who visited the nephrology out-patient clinic were enrolled. All patients were in stage 3B-5 CKD. The primary outcomes included long-term renal replacement therapy and mortality. The occurrence of cardiovascular events was also analyzed as secondary outcome. Multivariate Cox regression models were used to address each risk factor in this cohort. We also used this cohort to evaluate the validity of the modified diabetic nephropathy score. RESULTS Patients with lower estimated glomerular filtration rate (eGFR) were associated with higher degree of proteinuria. In the multivariate Cox regression model, eGFR and the degree of proteinuria were both strong outcome predictors. The effects of glycosylated hemoglobin and blood pressure in this advanced CKD cohort were minimal. Elder patients with advanced CKD had a higher mortality rate, but commenced less renal replacement therapy. Applying these indicator analyses, we proposed a modified diabetic nephropathy score for outcome prediction. CONCLUSIONS Our analysis demonstrated the impact of eGFR and proteinuria in the advanced CKD group. Indicators in early CKD possessed a different prognostic profile in this advanced CKD cohort, therefore, necessitating a modified scoring system.
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