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ÖZSAN YILMAZ M, DOĞAN S, TURGUT FH. Diyabet Hastalarında Hematüri Sıklığı ve Albüminüri ile İlişkisi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1014796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Yoshida N, Hanai K, Murata H, Uchigata Y, Babazono T. Cross-sectional and longitudinal associations between dipstick hematuria and chronic kidney disease in patients with type 2 diabetes. Diabetes Res Clin Pract 2021; 172:108519. [PMID: 33096189 DOI: 10.1016/j.diabres.2020.108519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
AIMS To examine the association of dipstick hematuria with kidney function and albuminuria in patients with type 2 diabetes (T2D). METHODS A total of 7,945 patients with T2D were studied. In the cross-sectional study, patients were classified into 6 groups based on the stage of albuminuria and estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 at baseline. In the longitudinal study where patients were classified by the presence of hematuria, the primary composite endpoint was a 30% decrease in eGFR from baseline or the initiation of kidney replacement therapy. Other outcomes included eGFR slope and stage progression of albuminuria. RESULTS Cross-sectionally, hematuria was more prevalent in patients with more advanced stages of albuminuria and with lower eGFR, independently of each other. In the longitudinal study, patients with hematuria experienced 50% increased incidence of the primary endpoint (p < 0.001). The eGFR slope was steeper in patients with hematuria than in those without hematuria (p < 0.001). On the other hand, hematuria was unlikely to be associated with the progression of albuminuria. CONCLUSIONS In patients with T2D, dipstick hematuria was associated with prevalent albuminuria and reduced eGFR, as well as faster decline in kidney function but not higher risk of development or progression of albuminuria.
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Affiliation(s)
- Noriko Yoshida
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ko Hanai
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
| | - Hidekazu Murata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Stefan G, Stancu S, Zugravu A, Petre N, Mandache E, Mircescu G. Histologic predictors of renal outcome in diabetic nephropathy: Beyond renal pathology society classification. Medicine (Baltimore) 2019; 98:e16333. [PMID: 31277183 PMCID: PMC6635249 DOI: 10.1097/md.0000000000016333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prognostic utility of histologic features in patients with diabetic nephropathy (DN) classified according to the Renal Pathology Society (RPS) classification is controversial. Therefore, we aimed to evaluate the relationship between histologic changes and renal outcome in DN patients.We examined the renal outcome at November 30, 2017 of 74 adult patients (median age of 54.6 years, 69% male, 81% diabetes mellitus (DM) type 2, estimated GFR (eGFR) 29.6 mL/min) with biopsy proven DN between 2010 and 2015. The primary endpoint was renal replacement therapy (RRT) initiation.Half of the patients progressed to end stage renal disease (ESRD) during follow-up; they had lower eGFR, increased proteinuria, hematuria and serum cholesterol. Regarding the pathologic features, they were more frequently in class III and IV, had higher interstitial fibrosis and tubular atrophy score (IFTA), increased interstitial inflammation, more frequent arteriolar hyalinosis and higher glomerular basement membrane (GBM) thickness. The mean kidney survival time was 2.7 (95%CI 2.1, 3.3) years. In univariate time-dependent analyses, higher RPS DN class, increased IFTA, the presence of arteriolar hyalinosis and arteriosclerosis were associated with RRT initiation.In the fully adjusted model, the clinical characteristics associated with poor renal survival were longer duration of DM, lower eGFR, increased proteinuria and higher hematuria and the only pathologic lesions to remain significant were the GBM thickness and the IFTA.In conclusion, in this European cohort, the severity of glomerular lesions evaluated with the RPS DN classification had limited utility in predicting RRT initiation. However, IFTA and GBM thickness were significantly associated with renal survival.
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Affiliation(s)
- Gabriel Stefan
- Dr Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila
| | - Simona Stancu
- Dr Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila
| | - Adrian Zugravu
- Dr Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila
| | - Nicoleta Petre
- Dr Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila
| | - Eugen Mandache
- Dr Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Mircescu
- Dr Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila
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Lin HYH, Niu SW, Kuo IC, Lim LM, Hwang DY, Lee JJ, Hwang SJ, Chen HC, Hung CC. Hematuria and Renal Outcomes in Patients With Diabetic Chronic KidneyDisease. Am J Med Sci 2018; 356:268-276. [PMID: 30286822 DOI: 10.1016/j.amjms.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hematuria may indicate nondiabetic renal disease in diabetic chronic kidney disease (CKD). However, some studies have reported that hematuria is noted in diabetic nephropathy and is associated with albuminuria. Hematuria is a risk factor for end-stage renal disease in glomerulonephritis, but its prognostic value in diabetic CKD is unknown. We investigated the factors associated with hematuria and the prognostic value of hematuria in patients with diabetic CKD. MATERIAL AND METHODS We included 1958 patients with type 2 diabetes and CKD stages 1-5, and 111 patients underwent renal biopsy. Patients in the biopsied cohort were younger and had more severe proteinuria, compared with those in the total cohort; hematuria was associated with nondiabetic renal disease. RESULTS In the total cohort, hematuria was observed in 15.0% of the patients and was associated with young age, a lower estimated glomerular filtration rate, proteinuria, high blood pressure and short diabetes duration. Hematuria was significantly associated with an increased risk (hazard ratio 1.39, 95% CI: 1.10-1.76, P < 0.001) of end-stage renal disease, particularly in patients with CKD stages 1-3 or a urine protein-to-creatinine ratio of <1,500mg/g (P for interaction < 0.05). The odds ratio of hematuria for rapid renal progression was 1.81 (95% CI: 1.29-2.53, P < 0.001). CONCLUSIONS Hematuria is associated with nondiabetic renal disease in biopsied patients with diabetic CKD and is associated with an increased risk of end-stage renal disease in patients with early diabetic CKD.
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Affiliation(s)
- Hugo You-Hsien Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Physiology and Biophysics, University of California at Irvine, Irvine,California; UC Irvine Diabetes Center, University of California at Irvine, Irvine,California
| | - Sheng-Wen Niu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ching Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lee-Moay Lim
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Daw-Yang Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Mashitani T, Hayashino Y, Okamura S, Kitatani M, Furuya M, Iburi T, Tsujii S, Ishii H. Association between dipstick hematuria and decline in estimated glomerular filtration rate among Japanese patients with type 2 diabetes: A prospective cohort study [Diabetes Distress and Care Registry at Tenri (DDCRT 14)]. J Diabetes Complications 2017; 31:1079-1084. [PMID: 28499960 DOI: 10.1016/j.jdiacomp.2017.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/28/2017] [Accepted: 04/12/2017] [Indexed: 12/18/2022]
Abstract
AIMS To assess the association between dipstick hematuria and estimated glomerular filtration rate (eGFR) decline in Japanese patients with type 2 diabetes. METHODS Longitudinal data were obtained from 3068 Japanese patients with type 2 diabetes. To assess the independent association between dipstick hematuria and eGFR decline, we used Cox proportional hazard model adjusted for potential confounders. RESULTS Median follow-up period was 699.7days. Mean age, body mass index (BMI), and HbA1c level were 65.7years, 24.6kg/m2, and 7.5% (58.1mmol/mol), respectively. Positive dipstick hematuria was significantly associated with baseline eGFR and severity of albuminuria (p<0.001). The multivariable-adjusted hazard ratio for eGFR decline in patients with dipstick hematuria compared with those without dipstick hematuria was 2.19 [95% confidence interval (CI): 1.22-3.91]; this association remained significant even after the exclusion of patients who did not have diabetic retinopathy (hazard ratio: 2.39; 95% CI: 1.13-5.04). CONCLUSION Positive dipstick hematuria was associated with severity of albuminuria and renal function. A significant association was found between dipstick hematuria and increased risk of eGFR decline among patients with type 2 diabetes. Therefore, our results suggest that dipstick hematuria is perhaps indicative of more severe diabetic nephropathy.
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Affiliation(s)
- Tsuyoshi Mashitani
- Department of Diabetology, Nara Medical University, Kashihara, Nara 634-8521, Japan; Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8521, Japan.
| | - Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, Tenri, Nara 632-8552, Japan
| | - Shintaro Okamura
- Department of Endocrinology, Tenri Hospital, Tenri, Nara 632-8552, Japan
| | - Masako Kitatani
- Department of Endocrinology, Tenri Hospital, Tenri, Nara 632-8552, Japan
| | - Miyuki Furuya
- Department of Endocrinology, Tenri Hospital, Tenri, Nara 632-8552, Japan
| | - Tadao Iburi
- Department of Endocrinology, Tenri Hospital, Tenri, Nara 632-8552, Japan
| | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, Tenri, Nara 632-8552, Japan
| | - Hitoshi Ishii
- Department of Diabetology, Nara Medical University, Kashihara, Nara 634-8521, Japan
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Dong ZY, Wang YD, Qiu Q, Hou K, Zhang L, Wu J, Zhu HY, Cai GY, Sun XF, Zhang XG, Liu MY, Kou J, Chen XM. Dysmorphic erythrocytes are superior to hematuria for indicating non-diabetic renal disease in type 2 diabetics. J Diabetes Investig 2015; 7:115-20. [PMID: 26812958 PMCID: PMC4718100 DOI: 10.1111/jdi.12371] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/03/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION There are sparse and limited studies on erythrocyte morphology in renal biopsy identifying nephropathic patients among type 2 diabetics. The present study sought to clarify the predictive value of dysmorphic erythrocytes in type 2 diabetics with non-diabetic renal disease and influences on hematuria. MATERIALS AND METHODS We examined 198 patients with type 2 diabetes who underwent kidney biopsies between 2012 and 2013. Hematuria was defined as >3 or >10 red blood cells per high-power field (RBCs/hpf) in urine sediment. If >80% of the erythrocytes were dysmorphic, glomerular hematuria was diagnosed. Clinical findings and predictive value of dysmorphic erythrocytes were compared between patients with hematuria (n = 19) and those without (n = 61). The potential risk factors for hematuria among diabetic nephropathy patients were also screened. RESULTS There was a statistically significant difference between the diabetic nephropathy group and the non-diabetic renal disease group (6.6 vs 16.8%; P = 0.04) when the demarcation point of hematuria was 10 RBCs/hpf. When the definition of hematuria was based on an examination of urinary erythrocyte morphology, a marked difference was seen (3.3 vs 24.8%; P < 0.001). Glomerular hematuria showed high specificity and a positive predictive value (0.97 and 0.94, respectively) in non-diabetic renal disease. A multivariate analysis showed that nephrotic syndrome was significantly associated with hematuria (odds ratio 3.636; P = 0.034). CONCLUSIONS Dysmorphic erythrocytes were superior to hematuria for indicating non-diabetic renal disease in type 2 diabetics. Nephrotic syndrome was an independent risk factor for hematuria.
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Affiliation(s)
- Zhe-yi Dong
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Yuan-da Wang
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Qiang Qiu
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Kai Hou
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Li Zhang
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Jie Wu
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Han-yu Zhu
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Guang-yan Cai
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Xue-feng Sun
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Xue-guang Zhang
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Mo-yan Liu
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Jia Kou
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
| | - Xiang-mei Chen
- Department of Nephrology Chinese PLA General Hospital Chinese PLA Institute of Nephrology State Key Laboratory of Kidney Diseases National Clinical Research Center of Kidney Diseases Beijing China
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Lee JJ, Yang IH, Kuo HK, Chung MS, Chen YJ, Chen CH, Liu RT. Serum uric acid concentration is associated with worsening in severity of diabetic retinopathy among type 2 diabetic patients in Taiwan--a 3-year prospective study. Diabetes Res Clin Pract 2014; 106:366-72. [PMID: 25108898 DOI: 10.1016/j.diabres.2014.07.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/16/2014] [Accepted: 07/20/2014] [Indexed: 12/13/2022]
Abstract
AIMS To explore the role of serum uric acid (SUA) concentration in diabetic retinopathy (DR) for patients with type 2 diabetes mellitus (T2DM). METHODS A 3-year prospective study in 749 patients with T2DM and without proliferative diabetic retinopathy (PDR) was conducted at a medical center. Baseline SUA concentration and parameters of glycemic control, blood pressure, kidney disease, and lipid profiles were analyzed to determine their contribution to DR. RESULTS Fundus examination showed that 184 patients (24.6%) had non-proliferative retinopathy and 565 (75.4%) without DR at baseline. After 3 years, increase in the severity of DR was recognized in 103 patients (13.8%), including 81 patients with newly developed DR. Patients with increase in severity of DR positively associated with duration of DM (11.9 vs. 9.4 years, p = 0.001), HbA1c (7.6 vs. 7.2%, p = 0.001), albuminuria (45.5 vs. 31.0%, p = 0.006), and SUA (6.47 vs. 5.87 mg/dl, p<0.001) than did those without change in DR stage. Cox regression showed that patients with SUA in the 3rd (5.9-6.9 mg/dl) and 4th (≥ 7.0mg/dl) quartiles had hazard ratios for DR worsening of 2.57 and 3.66 (95% C.I. 1.30-5.08 and 1.92-7.00) when compared with patients with SUA in the 1st quartile (<4.9 mg/dl). CONCLUSIONS SUA concentration is associated with the increase in severity of DR over a 3-year period in patients with T2DM. Further study is required to define the exact role of SUA in DR.
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Affiliation(s)
- Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - I-Hui Yang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Ming-Shien Chung
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Yung-Jen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Chih-Hsin Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Rue-Tsuan Liu
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
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Lewis JD, Habel L, Quesenberry C, Mamtani R, Peng T, Bilker WB, Hedderson M, Nessel L, Vaughn DJ, Strom BL, Ferrara A. Proteinuria testing among patients with diabetes mellitus is associated with bladder cancer diagnosis: potential for unmeasured confounding in studies of pioglitazone and bladder cancer. Pharmacoepidemiol Drug Saf 2014; 23:636-45. [PMID: 24764283 DOI: 10.1002/pds.3619] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The observed association between pioglitazone and bladder cancer could be causal or because of bias in the design of prior studies. We hypothesize that proteinuria testing may lead to detection bias if routine test results for proteinuria lead to a full urinalysis. METHODS We reanalyzed patients with diabetes mellitus within Kaiser Permanente Northern California. Logistic and Cox regression adjusted for age, sex, race, and smoking were used to assess the association of proteinuria testing with pioglitazone use, subsequent full urinalysis, and diagnosis with bladder cancer. RESULTS Patients treated with pioglitazone were more likely than others with diabetes to undergo testing for proteinuria (p < 0.001). The odds of positive tests for proteinuria were higher among pioglitazone-treated patients (OR = 1.41, 95%CI 1.36-1.46). A positive proteinuria test was associated with increased odds of completing a urinalysis in the following 6 months (OR = 1.78, 95%CI 1.73-1.85). Negative and positive proteinuria test results were inversely (hazard ratio (HR) 0.63, 95%CI 0.52-0.75) and positively associated (HR 2.45, 95%CI 2.12-2.82) with bladder cancer risk, respectively. Adjustment for negative and positive proteinuria testing reduced the magnitude of association between pioglitazone and bladder cancer by only 5 to 10% (ever-exposed HR: from 1.06 to 1.01 and >4 years exposure HR: from 1.38 to 1.28). CONCLUSIONS Proteinuria testing may be a confounder in studies of pioglitazone and bladder cancer but does not fully explain the association between pioglitazone and bladder cancer in this cohort. Optimal adjustment for proteinuria testing likely requires knowledge of the test result.
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Affiliation(s)
- James D Lewis
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes. J Am Coll Cardiol 2014; 63:2141-2147. [PMID: 24657685 DOI: 10.1016/j.jacc.2014.02.549] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/13/2014] [Accepted: 02/16/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study sought to characterize major bleeding on the basis of the components of the major bleeding definition, to explore major bleeding by location, to define 30-day mortality after a major bleeding event, and to identify factors associated with major bleeding. BACKGROUND Apixaban was shown to reduce the risk of major hemorrhage among patients with atrial fibrillation in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. METHODS All patients who received at least 1 dose of a study drug were included. Major bleeding was defined according to the criteria of the International Society on Thrombosis and Haemostasis. Factors associated with major hemorrhage were identified using a multivariable Cox model. RESULTS The on-treatment safety population included 18,140 patients. The rate of major hemorrhage among patients in the apixaban group was 2.13% per year compared with 3.09% per year in the warfarin group (hazard ratio [HR] 0.69, 95% confidence interval [CI]: 0.60 to 0.80; p < 0.001). Compared with warfarin, major extracranial hemorrhage associated with apixaban led to reduced hospitalization, medical or surgical intervention, transfusion, or change in antithrombotic therapy. Major hemorrhage followed by mortality within 30 days occurred half as often in apixaban-treated patients than in those receiving warfarin (HR 0.50, 95% CI: 0.33 to 0.74; p < 0.001). Older age, prior hemorrhage, prior stroke or transient ischemic attack, diabetes, lower creatinine clearance, decreased hematocrit, aspirin therapy, and nonsteroidal anti-inflammatory drugs were independently associated with an increased risk. CONCLUSIONS Apixaban, compared with warfarin, was associated with fewer intracranial hemorrhages, less adverse consequences following extracranial hemorrhage, and a 50% reduction in fatal consequences at 30 days in cases of major hemorrhage.
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Okada T, Nagao T, Matsumoto H, Nagaoka Y, Wada T, Nakao T. Clinical significance of microscopic haematuria in diabetic nephropathy in type 2 diabetes patients with overt proteinuria. Nephrology (Carlton) 2013; 18:563-8. [DOI: 10.1111/nep.12104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Toshitaka Nagao
- Department of Anatomic Pathology; Tokyo Medical University; Tokyo; Japan
| | | | - Yume Nagaoka
- Department of Nephrology; Tokyo Medical University
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