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Ruhe J, Nadal J, Bärthlein B, Meiselbach H, Schultheiss UT, Kotsis F, Stockmann H, Krane V, Sommerer C, Löffler I, Saritas T, Kielstein JT, Sitter T, Schneider MP, Schmid M, Wanner C, Eckardt KU, Wolf G, Busch M. Cardiovascular risk due to diabetes mellitus in patients with chronic kidney disease-prospective data from the German Chronic Kidney Disease cohort. Clin Kidney J 2023; 16:2032-2040. [PMID: 37915914 PMCID: PMC10616496 DOI: 10.1093/ckj/sfad194] [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: 05/31/2023] [Indexed: 11/03/2023] Open
Abstract
Background Diabetes mellitus (DM) and chronic kidney disease (CKD) are well-known cardiovascular and mortality risk factors. To what extent they act in an additive manner and whether the etiology of CKD modifies the risk is uncertain. Methods The multicenter, prospective, observational German Chronic Kidney Disease study comprises 5217 participants (1868 with DM) with a baseline mean estimated glomerular filtration rate of 30-60 mL/min/1.73 m2 and/or proteinuria >0.5 g/day. We categorized patients whose CKD was caused by cardiovascular or metabolic diseases (CKDcvm) with and without DM, as opposed to genuine CKD (CKDgen) with and without DM. Recorded outcomes were first events of non-cardiovascular and cardiovascular death, 4-point major adverse cardiovascular events (4-point MACE) and hospitalization for heart failure (HHF). Results During the 6.5-year follow-up 603 (12%) non-cardiovascular and 209 (4%) cardiovascular deaths, 645 (12%) 4-point MACE, and 398 (8%) HHF were observed, most frequently in patients with DM having CKDcvm. DM increased the risk of non-cardiovascular [hazard ratio (HR) 1.92; 95% confidence interval (CI) 1.59-2.32] and cardiovascular (HR 2.25; 95% CI 1.62-3.12) deaths, 4-point MACE (HR 1.93; 95% CI 1.62-2.31) and HHF (HR 1.87; 95% CI 1.48-2.36). Mortality risks were elevated by DM to a similar extent in CKDcvm and CKDgen, but for HHF in CKDcvm only (HR 2.07; 95% CI 1.55-2.77). In patients with DM, CKDcvm (versus CKDgen) only increased the risk for HHF (HR 1.93; 95% CI 1.15-3.22). Conclusions DM contributes to cardiovascular and mortality excess risk in patients with moderate to severe CKD in both, CKDcvm and CKDgen. Patients with DM and CKDcvm are particularly susceptible to HHF.
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Affiliation(s)
- Johannes Ruhe
- Department of Internal Medicine III, Nephrology, University Hospital Jena – Friedrich Schiller University, Jena, Germany
| | - Jennifer Nadal
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Barbara Bärthlein
- Medical Centre for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Heike Meiselbach
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Departmentof Medicine IV-Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Fruzsina Kotsis
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Departmentof Medicine IV-Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Helena Stockmann
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Vera Krane
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommerer
- Nephrology Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivonne Löffler
- Department of Internal Medicine III, Nephrology, University Hospital Jena – Friedrich Schiller University, Jena, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan T Kielstein
- Medical Clinic V Nephrology, Rheumatology, Blood Purification – Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Thomas Sitter
- Department of Medicine, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Markus P Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Nephrology, University Hospital Jena – Friedrich Schiller University, Jena, Germany
| | - Martin Busch
- Department of Internal Medicine III, Nephrology, University Hospital Jena – Friedrich Schiller University, Jena, Germany
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Yarrarapu SNS, Shah P, Arty F, Ravilla J, Ghose M, Khan MA, Anwar D. Pericardial Tamponade and Berger's Disease: An Unusual Association. Cureus 2023; 15:e41281. [PMID: 37533624 PMCID: PMC10392956 DOI: 10.7759/cureus.41281] [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] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Cardiac tamponade is considered a medical emergency because a patient can deteriorate easily and die of cardiac arrest if the fluid is not drained immediately. The most common etiologies are the same as pericarditis as fluid accumulates due to pericardial inflammation, including infection, malignancy, trauma, iatrogenic, autoimmune, post-myocardial infarction, radiation, and renal failure. Although the treatment is pericardiocentesis or pericardial window, finding the etiology responsible for the development of pericardial effusion is important. Here, we describe the case of a 40-year-old female who presented to the emergency department with a chief complaint of severe epigastric pain of a two-day duration that was associated with multiple episodes of nausea, vomiting, dysphagia, and severe shortness of breath (New York Heart Association III). The patient was eventually diagnosed with cardiac tamponade as a cause of her dyspnea, as a two-dimensional cardiac echocardiogram detected a large pericardial effusion (>2 cm) with echocardiographic indications for cardiac tamponade with severe pulmonary hypertension. The patient underwent a therapeutic pericardial window with drainage of 250 mL of pericardial fluid. Ultrasound of the abdomen focusing on the kidneys showed an atrophic and echogenic right kidney with a bidirectional flow in the hepatic veins, suggestive of right heart failure. Subsequently, she underwent a kidney biopsy that showed diffuse mesangial proliferative glomerulonephritis with segmental sclerosing features consistent with IgA nephropathy, associated with tubular atrophy, interstitial fibrosis, interstitial inflammation, and moderate arteriosclerosis. The patient was diagnosed with stage V chronic kidney disease secondary to IgA nephropathy. IgA nephropathy is usually common in Caucasian or Asian males in their teens and late 30s, with hematuria as a usual presentation. This case is unique as cardiac tamponade with renal failure is rarely the presenting symptom of IgA nephropathy.
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Affiliation(s)
| | - Parth Shah
- Hospital Medicine, Tower Health Medical Group, Reading, USA
| | - Fnu Arty
- Internal Medicine, Monmouth Medical Center/Rutgers University, Long Branch, USA
| | - Jayasree Ravilla
- Internal Medicine, Monmouth Medical Center/Rutgers University, Long Branch, USA
| | - Medha Ghose
- Internal Medicine, Monmouth Medical Center/Rutgers University, Long Branch, USA
| | - Mahrukh A Khan
- Internal Medicine, Monmouth Medical Center/Rutgers University, Long Branch, USA
| | - David Anwar
- Cardiology, Monmouth Medical Center/Rutgers University, Long Branch, USA
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Miguita R, Matsumoto AK, Michelin AP, Morelli NR, Baltus THL, Delfino VDA, Barbosa DS. Effect of Dialyzer Reuse on the Activity of Paraoxonase 1 in Patients on Hemodialysis. Indian J Nephrol 2022; 32:606-610. [PMID: 36704581 PMCID: PMC9872931 DOI: 10.4103/ijn.ijn_77_21] [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: 02/20/2021] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cardiovascular disease is the major cause of mortality in patients undergoing chronic hemodialysis treatment. The oxidative modification of low-density lipoprotein is a crucial step in the pathogenesis of atherosclerosis. Paraoxonase 1 (PON1) is the protein responsible for most of the antioxidant activity of high-density lipoprotein, and its reduced levels are associated with more cardiovascular events in several populations. In hemodialysis patients, reduced PON1 activity has been shown to be associated with increased cardiovascular mortality. Studies have shown that after the hemodialysis session, the activity of PON1 increases. The influence of dialyzer reuse on the activity of PON1 is unknown. We aimed to evaluate the effect of the reuse of two types of dialyzers (polynephron and polyethersulfone) on the PON1 activity of hemodialysis patients. Subjects and Methods A total of 30 patients on hemodialysis were included. Pre- and post-dialysis blood samples were collected to analyze the activity of PON1 in thefirst use of the dialyzer and in the hemodialysis session of its sixth reuse. This process was carried out with polynephron (bisphenol-free) and polyethersulfone dialyzers. Results We found that post-dialysis PON1 activity was significantly higher than pre-dialysis activity in both thefirst use and sixth reuse (P < 0.001). Conclusion The practice of reusing the dialyzer did not interfere with the improvement of PON1 activity after the hemodialysis session.
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Affiliation(s)
- Reynaldo Miguita
- Department of Clinical Medicine, Post-Graduation Program in Health Sciences, Londrina State University (UEL), Paraná, Brazil
| | - Andressa K. Matsumoto
- Department of Clinical Medicine, Post-Graduation Program in Health Sciences, Londrina State University (UEL), Paraná, Brazil
| | - Ana P. Michelin
- Department of Pathology, Clinical and Toxicological Analysis, Londrina State University (UEL), Paraná, Brazil
| | - Nayara R. Morelli
- Department of Pathology, Clinical and Toxicological Analysis, Londrina State University (UEL), Paraná, Brazil
| | - Thiago H. L. Baltus
- Department of Pathology, Clinical and Toxicological Analysis, Londrina State University (UEL), Paraná, Brazil
| | - Vinicius D. A. Delfino
- Department of Clinical Medicine, Discipline of Nephrology, Londrina State University (UEL), Paraná,
| | - Décio S. Barbosa
- Department of Pathology, Clinical and Toxicological Analysis, Londrina State University (UEL), Paraná, Brazil
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Shivani S, Kao CY, Chattopadhyay A, Chen JW, Lai LC, Lin WH, Lu TP, Huang IH, Tsai MH, Teng CH, Wu JJ, Hsieh YH, Wang MC, Chuang EY. Uremic Toxin-Producing Bacteroides Species Prevail in the Gut Microbiota of Taiwanese CKD Patients: An Analysis Using the New Taiwan Microbiome Baseline. Front Cell Infect Microbiol 2022; 12:726256. [PMID: 35558102 PMCID: PMC9086402 DOI: 10.3389/fcimb.2022.726256] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/16/2022] [Indexed: 12/02/2022] Open
Abstract
Rationale and Objective Gut microbiota have been targeted by alternative therapies for non-communicable diseases. We examined the gut microbiota of a healthy Taiwanese population, identified various bacterial drivers in different demographics, and compared them with dialysis patients to associate kidney disease progression with changes in gut microbiota. Study Design This was a cross-sectional cohort study. Settings and Participants Fecal samples were obtained from 119 healthy Taiwanese volunteers, and 16S rRNA sequencing was done on the V3-V4 regions to identify the bacterial enterotypes. Twenty-six samples from the above cohort were compared with fecal samples from 22 peritoneal dialysis and 16 hemodialysis patients to identify species-level bacterial biomarkers in the dysbiotic gut of chronic kidney disease (CKD) patients. Results Specific bacterial species were identified pertaining to different demographics such as gender, age, BMI, physical activity, and sleeping habits. Dialysis patients had a significant difference in gut microbiome composition compared to healthy controls. The most abundant genus identified in CKD patients was Bacteroides, and at the species level hemodialysis patients showed significant abundance in B. ovatus, B. caccae, B. uniformis, and peritoneal dialysis patients showed higher abundance in Blautia producta (p ≤ 0.05) than the control group. Pathways pertaining to the production of uremic toxins were enriched in CKD patients. The abundance of the bacterial species depended on the type of dialysis treatment. Conclusion This study characterizes the healthy gut microbiome of a Taiwanese population in terms of various demographics. In a case-control examination, the results showed the alteration in gut microbiota in CKD patients corresponding to different dialysis treatments. Also, this study identified the bacterial species abundant in CKD patients and their possible role in complicating the patients’ condition.
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Affiliation(s)
- Subhashree Shivani
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Amrita Chattopadhyay
- Center for Translational Genomic Research, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jenn-Wei Chen
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chuan Lai
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Pin Lu
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Hsiu Huang
- Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Mong-Hsun Tsai
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Ching-Hao Teng
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiunn-Jong Wu
- Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsien Hsieh
- Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Cheng Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Eric Y. Chuang, ; Ming-Cheng Wang,
| | - Eric Y. Chuang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
- Master Program for Biomedical Engineering, China Medical University, Taichung, Taiwan
- *Correspondence: Eric Y. Chuang, ; Ming-Cheng Wang,
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Selen T, Akoglu H, Agbaht K. Relationship between liver function tests & cardiovascular risk factors in stage 3-5 pre-dialysis chronic kidney disease. Indian J Med Res 2022; 155:397-402. [DOI: 10.4103/ijmr.ijmr_1777_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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The risk of major bleeding event in patients with chronic kidney disease on pentoxifylline treatment. Sci Rep 2021; 11:13521. [PMID: 34188087 PMCID: PMC8241975 DOI: 10.1038/s41598-021-92753-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Patients with chronic kidney diseases (CKD) are often treated with antiplatelets due to aberrant haemostasis. This study aimed to evaluate the bleeding risk with CKD patients undergoing pentoxifylline (PTX) treatment with/without aspirin. In this retrospective study, we used Taiwan’s National Health Insurance Research Database to identify PTX treated CKD patients. Patients undergoing PTX treatment after CKD diagnosis were PTX group. A 1:4 age, sex and aspirin used condition matched CKD patients non-using PTX were identified as controls. The outcome was major bleeding event (MBE: intracranial haemorrhage (ICH) and gastrointestinal tract bleeding) during 2-year follow-up period. Risk factors were estimated using Cox regression for overall and stratified analysis. The PTX group had higher MBE risk than controls (hazard ratio (HR) 1.19; 95% confidence interval (CI) 0.94–1.50). In stratified analysis, hyperlipidaemia was a significant risk factor (HR: 1.42; 95% CI 1.01–2.01) of MBE. A daily PTX dose larger than 800 mg, females, non-regular aspirin usage, and ischaemic stroke were risk factors for MBE in PTX group. When prescribing PTX in CKD patients, bleeding should be closely monitored, especially in those with daily dose more than 800 mg, aspirin users, and with a history of ischaemic stroke.
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7
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Circulating Renalase as Predictor of Renal and Cardiovascular Outcomes in Pre-Dialysis CKD Patients: A 5-Year Prospective Cohort Study. Life (Basel) 2021; 11:life11030210. [PMID: 33800219 PMCID: PMC7999882 DOI: 10.3390/life11030210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 01/06/2023] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for adverse cardiovascular and cerebrovascular events (MACCEs), and mortality since the earlier stages. Therefore, it is critical to identify the link between CKD and cardiovascular risk (CVR) through early and reliable biomarkers. Acknowledging that CKD and CKD progression are associated with increased sympathetic tone, which is implicated in CVR, and that renalase metabolizes catecholamines, we aimed to evaluate the relationship between renalase serum levels (RNLS) and cardiovascular and renal outcomes. The study included 40 pre-dialysis CKD patients (19F:21M) with median age of 61 (IQ 45–66) years. At baseline, we measured RNLS as well as routine biomarkers of renal and cardiovascular risk. A prospective analysis was performed to determine whether RNLS are associated with CKD progression, MACCEs, hospitalizations and all-cause mortality. At baseline, the median level of RNLS and median estimated glomerular filtration rate (eGFR) were 63.5 (IQ 48.4–82.7) µg/mL and 47 (IQ 13–119) mL/min/1.73 m2, respectively. In univariate analysis, RNLS were strongly associated with eGFR, age and Charlson Index. Over the course of a mean follow-up of 65 (47 to 70) months, 3 (7.5%) deaths, 2 (5%) fatal MACCEs, 17 (42.5%) hospital admissions occurred, and 16 (40%) patients experienced CKD progression. In univariate analysis, RNLS were associated with CKD progression (p = 0.001), hospitalizations (p = 0.001) and all-cause mortality (p = 0.022) but not with MACCEs (p = 0.094). In adjusted analysis, RNLS predicted CKD progression and hospitalizations regardless of age, Charlson comorbidity index, cardiovascular disease, hypertension, diabetes and dyslipidemia. Our results suggest that RNLS, closely related with renal function, might have a potential role as predictor of renal outcomes, hospitalizations, and mortality in pre-dialysis CKD patients.
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8
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Gluba-Brzozka A, Franczyk B, Rysz J. Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients. Nutrients 2019; 11:E2820. [PMID: 31752189 PMCID: PMC6893650 DOI: 10.3390/nu11112820] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022] Open
Abstract
Chronic kidney disease (CKD) is a widespread disease with increasing prevalence in the modern society. Lipid disturbances are common in this group of patients. In most patients with CKD atherogenic dyslipidemia is observed. Dyslipidemia in patients with renal diseases increases the risk of cardiovascular diseases and it accelerates the progression of chronic kidney disease to its end stage. The amelioration of dyslipidemia and the lowering of oxidative stress, inflammatory processes, insulin sensitivity and remnant lipoproteins levels may lead to the reduction in cardiovascular burden. Nutritional interventions can strengthen the beneficial effect of treatment and they play an important role in the preservation of overall well-being of the patients with CKD since the aim of appropriate diet is to reduce the risk of cardiovascular events, prevent malnutrition, and hamper the progression of kidney disease. The management of dyslipidemia, regardless of the presence of chronic kidney disease, should be initiated by the introduction of therapeutic lifestyle changes. The introduction of diet change was shown to exert beneficial effect on the lipid level lowering that reaches beyond pharmacological therapy. Currently available evidence give the impression that data on dietary interventions in CKD patients is not sufficient to make any clinical practice guidelines and is of low quality.
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Affiliation(s)
- Anna Gluba-Brzozka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (B.F.); (J.R.)
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9
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Prevalence of micro albuminuria and diagnostic accuracy of urine dipstick for the screening of diabetic nephropathy in type 2 diabetes patients. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2019. [DOI: 10.1016/j.bcab.2019.101316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Leiva O, Bekendam RH, Garcia BD, Thompson C, Cantor A, Chitalia V, Ravid K. Emerging Factors Implicated in Fibrotic Organ-Associated Thrombosis: The Case of Two Organs. TH OPEN 2019; 3:e165-e170. [PMID: 31259299 PMCID: PMC6598088 DOI: 10.1055/s-0039-1692204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/30/2019] [Indexed: 12/19/2022] Open
Abstract
Thrombosis is at the heart of cardiovascular complications observed in specific diseases. A heightened thrombosis risk above that in general population in diseases such as myelofibrosis and chronic kidney disease implicates disease-specific mediators of thrombosis. This relative lack of information regarding the mechanisms of thrombosis in specific organ pathologies hitherto has remained limited. Evolving literature implicates some soluble factors in the blood of patients with discrete disorders, inflicting fundamental changes in the components of thrombosis. In this era of precision medicine, integrating these disease-specific factors in a comprehensive thrombotic risk assessment of patients is imperative in guiding therapeutic decisions. A complex network of mechanisms regulates each organ pathology and resultant thrombotic phenotypes. This review surveys different effectors of thrombogenicity associated with two pathologically fibrotic organs used as model systems, the bone marrow and kidney, as well as focuses attention to a common inducer of fibrosis and thrombosis, lysyl oxidase.
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Affiliation(s)
- Orly Leiva
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Roelof H Bekendam
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Brenda D Garcia
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Medicine, Mount Auburn Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Cristal Thompson
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Alan Cantor
- Children's Hospital Boston, Boston, Massachusetts, United States
| | - Vipul Chitalia
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States.,VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Katya Ravid
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
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11
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Wang J, Zeng XW, Bloom MS, Qian Z, Hinyard LJ, Belue R, Lin S, Wang SQ, Tian YP, Yang M, Chu C, Gurram N, Hu LW, Liu KK, Yang BY, Feng D, Liu RQ, Dong GH. Renal function and isomers of perfluorooctanoate (PFOA) and perfluorooctanesulfonate (PFOS): Isomers of C8 Health Project in China. CHEMOSPHERE 2019; 218:1042-1049. [PMID: 30609483 DOI: 10.1016/j.chemosphere.2018.11.191] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/23/2018] [Accepted: 11/27/2018] [Indexed: 05/05/2023]
Abstract
Perfluoroalkyl substances (PFASs) are widely-utilized synthetic chemicals commonly found in industrial and consumer products. Previous studies have examined associations between PFASs and renal function, yet the results are mixed. Moreover, evidence on the associations of isomers of PFASs with renal function in population from high polluted areas is scant. To help to address this data gap, we used high performance liquid chromatography-mass spectrometry to measure serum isomers of perfluorooctanoate (PFOA), perfluorooctanesulfonate (PFOS), and other PFASs from 1612 adults residing in Shenyang, China, and characterized their associations with estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD). Results showed that after adjusted for multiple confounding factors, most of the higher fluorinated PFASs, except for PFOA and PFDA, were negatively associated with eGFR and positively associated with CKD. Compared with linear PFOS (n-PFOS), branched PFOS isomers (Br-PFOS) were more strongly associated with eGFR (Br-PFOS; β = -1.22, 95%CI: 2.02, -0.42; p = 0.003 vs. n-PFOS; β = -0.16, 95%CI: 0.98, 0.65; p = 0.691) and CKD (Br-PFOS; OR = 1.27; 95% CI: 1.02, 1.58; p = 0.037 vs. n-PFOS; OR = 0.98; 95% CI: 0.80, 1.20; p = 0.834). In conclusion, branched PFOS isomers were negatively associated with renal function whereas their linear counterparts were not. Given widespread exposure to PFASs, potential nephrotoxic effects are of great public health concern, Furthermore, longitudinal research on the potential nephrotoxic effects of PFASs isomers will be necessary to more definitively assess the risk.
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Affiliation(s)
- Jia Wang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, 12144, USA; Department of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, 63104, USA
| | - Leslie J Hinyard
- Center for Health Outcomes Research, Saint Louis University, Saint Louis, 63104, USA
| | - Rhonda Belue
- Department of Health Management and Policy, College for Public Health & Social Justice, Saint Louis University, Saint Louis 63104, USA
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, 12144, USA; Department of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Si-Quan Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Yan-Peng Tian
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Mo Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chu Chu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Namratha Gurram
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Department of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Kang-Kang Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Dan Feng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ru-Qing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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12
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Affiliation(s)
- Shiying Wang
- Department of Nephrology, Huaihe Hospital of Henan University
| | - Fang Chen
- Department of Nephrology, Huaihe Hospital of Henan University
| | - Suxia Yang
- Department of Nephrology, Huaihe Hospital of Henan University
| | - Jun Shi
- Department of Nephrology, Huaihe Hospital of Henan University
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13
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Lin SY, Lin CL, Chang CH, Wu HC, Wang IK, Chou CY, Liang JA. Risk of acute myocardial infarction in upper tract urothelial carcinoma patients receiving radical nephroureterectomy: a population-based cohort study. Oncotarget 2017; 8:79498-79506. [PMID: 29108329 PMCID: PMC5668062 DOI: 10.18632/oncotarget.18495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background The outcomes of upper tract urothelial carcinoma (UTUC) receiving radical nephroureterectomy were usually limited to small sample size, case-control studies, and often focused on cancer progression. Risk of acute myocardial infarction (AMI) in these patients was never investigated. Results The overall incidences of AMI were 3.39, 1.44, and 1.70 per 10,000 person-years in the radical nephroureterectomy, nonnephroureterectomy, and non-UTUC cohorts, respectively. Multivariable Cox proportional hazard regression analysis revealed a significantly higher AMI risk in the radical nephroureterectomy cohort [adjusted HR (aHR) = 1.83, 95% confidence interval (CI) = 1.08–3.11], compared with non-UTUC cohorts. The risk of mortality were the highest in patients with UTUC who had undergone radical nephroureterectomy [adjusted HR (aHR) = 5.37, 95% confidence interval (CI) = 4.80–6.02]. Materials and Methods From the Taiwan National Health Insurance claims data, 1,359 patients with UTUC who had undergone radical nephroureterectomy and 3,154 patients with UTUC who had undergone nephron sparing surgery and were newly diagnosed between 2000 and 2010 were identified. For each patient, 4 individuals without UTUC were randomly selected and frequency matched by age, sex, and diagnosis year. Conclusions Patients with UTUC who have undergone radical nephroureterectomy are at a higher risk of developing AMI, compared with those receiving nephron sparing surgery.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Managment Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - His-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Che-Yi Chou
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
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14
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Rehman KA, Betancor J, Xu B, Kumar A, Rivas CG, Sato K, Wong LP, Asher CR, Klein AL. Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: Insights and pathophysiology. Clin Cardiol 2017; 40:839-846. [PMID: 28873222 DOI: 10.1002/clc.22770] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
A rising prevalence of end-stage renal disease (ESRD) has led to a rise in ESRD-related pericardial syndromes, calling for a better understanding of its pathophysiology, diagnoses, and management. Uremic pericarditis, the most common manifestation of uremic pericardial disease, is a contemporary problem that calls for intensive hemodialysis, anti-inflammatories, and often, drainage of large inflammatory pericardial effusions. Likewise, asymptomatic pericardial effusions can become large and impact the hemodynamics of patients on chronic hemodialysis. Constrictive pericarditis is also well documented in this population, ultimately resulting in pericardiectomy for definitive treatment. The management of pericardial diseases in ESRD patients involves internists, cardiologists, and nephrologists. Current guidelines lack clarity with respect to the management of pericardial processes in the ESRD population. Our review aims to describe the etiology, classification, clinical manifestations, diagnostic imaging tools, and treatment options of pericardial diseases in this population.
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Affiliation(s)
| | - Jorge Betancor
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Kimi Sato
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leslie P Wong
- Department of Nephrology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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15
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Subbiah AK, Chhabra YK, Mahajan S. Cardiovascular disease in patients with chronic kidney disease: a neglected subgroup. HEART ASIA 2016; 8:56-61. [PMID: 27933104 DOI: 10.1136/heartasia-2016-010809] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 01/11/2023]
Abstract
The burden of non-communicable diseases has increased exponentially over the past decade and they account for majority of the health-related morbidity and mortality worldwide. In line with this, the prevalence of chronic kidney disease (CKD) has been increasing over the years. CKD progresses through stages and it is well known that patients are more likely to die than to progress to end-stage renal disease. The presence of multiple classical and novel risk factors predisposes this group of patients to premature cardiovascular mortality. Though being a common entity, prevention, diagnosis and treatment of cardiovascular diseases in CKD are mired with controversies. This is due to the fact that many of the well-established diagnostic modalities and treatment strategies have not been studied in detail in patients with CKD. Moreover, most of the studies have excluded patients with renal dysfunction though they are at a higher risk for adverse outcomes and require specific dose modifications. This has limited the evidence base for optimal decision making. In this review, we aim to cover the risk factors, diagnosis and effectiveness of interventional strategies in patients with CKD.
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Affiliation(s)
- Arun Kumar Subbiah
- Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India
| | - Yogesh K Chhabra
- Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India
| | - Sandeep Mahajan
- Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India
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16
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Rahbar M, Chitsazian Z, Abdoli F, Moeini Taba SM, Akbari H. Pure red cell aplasia due to antibody against erythropoietin in hemodialysis patients. J Nephropathol 2016; 6:25-29. [PMID: 28042550 PMCID: PMC5106879 DOI: 10.15171/jnp.2017.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/08/2016] [Indexed: 11/15/2022] Open
Abstract
Background Anemia is a common complication of chronic renal failure due to reduce erythropoietin production by kidneys. Anemia treated with recombinant human erythropoietin (rHu-EPO). Pure red cell aplasia (PRCA) due to antibody productionagainst rHu-EPO is a rare but major complication of this drug.
Objectives The aim of this study was to determine the prevalence of PRCA due to antibodies in dialysis patients with resistant anemia who received erythropoietin.
Patients and Methods We studied 128 under maintenance hemodialysis patients more than 3 month in Kashan. In patients with anemia who received erythropoietin with dose requirements based on weight and anemia and without any another cause for anemia, evaluate for PRCA and anti-rHu-EPO antibody level were measured by ELISA.
Results In this research, 75 patients (58.6%) were male and 53 patients (41.4%) were female. The mean age of the patients was 59.05 ± 16.66 years. The result of analysis showed that 55 (43%) patients had anemia with hemoglobin level less than 10 mg/dL. Only 3 patients had PRCA and antibodies against erythropoietin in serum. There were no correlation between age, gender, cause of renal failure, hemodialysis duration, hemoglobin level, rHu-EPO dose and levels of anti-rHu-EPO antibody serum value.
Conclusions The result of this study indicated that administration of rHu-EPO in dialysis patients afflicted to kidney failure may cause PRCA especially through intravenous injection. However, this change is not statistically significant.
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Affiliation(s)
- Maryam Rahbar
- Department of Nephrology, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Chitsazian
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Firoozeh Abdoli
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Hosein Akbari
- Departement of Biostatics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
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17
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Hayashi M, Yasuda Y, Suzuki S, Tagaya M, Ito T, Kamada T, Yoshinaga M, Sugishita Y, Fujiwara W, Yokoi H, Ozaki Y, Izawa H. Brain natriuretic peptide as a potential novel marker of salt-sensitivity in chronic kidney disease patients without cardiac dysfunction. Heart Vessels 2016; 32:279-286. [PMID: 27385024 DOI: 10.1007/s00380-016-0867-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/01/2016] [Indexed: 01/13/2023]
Abstract
Although the renin-angiotensin system (RAS) is counter-balanced by a salt-sensitive mechanism in the hypertensive state, both are reported to be up-regulated in chronic kidney disease (CKD) patients. We conducted this study to evaluate the associations among the RAS, renal function, hypertension, and atherosclerosis, as well as to identify markers for salt-sensitivity. A total of 213 pre-dialysis CKD patients with preserved cardiac function (EF >50 %) were enrolled. Their renal and cardiac biochemical markers and plasma renin activity (PRA) were measured, and echocardiography and carotid artery ultrasound were performed. Their salt intake was estimated by the NaCl excretion from a 24-h collected urine sample. The PRA was higher in patients with hypertension (p = 0.018), and had a significant negative correlation with the eGFR (r = -0.23, p = 0.0067). Importantly, the PRA had a strong negative correlation with the brain natriuretic peptide (BNP) level (r = -0.28, p = 0.017) regardless of whether the patients were being treated with RAS inhibitors. The BNP level was related to the renal functions (eGFR: p = 0.001, ACR: p = 0.009). There was a significant positive correlation between the BNP level and carotid intima-media thickness (p < 0.001). A multivariate analysis revealed that older age and an excess of NaCl excretion were independent predictors of BNP elevation (p = 0.02 and 0.003, respectively). Our analysis revealed details of the counterbalance between BNP and PRA, as well as identifying that excess salt intake is a predictor of BNP elevation. These results indicate that the BNP could be a possible valuable marker for salt sensitivity, and that high salt sensitivity could facilitate atherosclerosis in CKD patients.
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Affiliation(s)
- Mutsuharu Hayashi
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan. .,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manaka Tagaya
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Takehiro Ito
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Tomohito Kamada
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Masataka Yoshinaga
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yoshinori Sugishita
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Wakaya Fujiwara
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Hiroatsu Yokoi
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
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18
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Screening for Nephropathy in Diabetes Mellitus: Is Micral-Test Valid among All Diabetics? Int J Chronic Dis 2016; 2016:2910627. [PMID: 27294192 PMCID: PMC4887651 DOI: 10.1155/2016/2910627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background. Using Micral-test (MT) for screening microalbuminuria (MA) among type 2 diabetics (T2D) is helpful. We aimed at determining prevalence of MA and at describing the MT validity. Methods. We studied 182 T2D followed up in family medicine. Two 24-hour urinary quantitative assays of MA had been used as a gold standard. Results. Prevalence of MA was 23%, CI 95%: 16.9–29.1. MT validity was 77% for sensitivity, 88% for negative predictive value, and 0.2 for Kappa coefficient (p = 0.001). Among subjects having a blood pressure ≥130/80 mmHg, having a CHT/HDL ratio ≥ 3, being a T2D for more than 5 years, and being women, negative predictive values were, respectively, 91%, 89%, 95%, and 91%. The area under the ROC curve was 0.81 in men (p = 0.008) and 0.80 when diabetes duration exceeds 5 years (p = 0.001). The MA value at 100% Sp for MT was 35 mg/L. Conclusion. The use of MT in primary healthcare for yearly screening for MA in T2D must be accentuated especially when diabetes duration exceeds 5 years or when associated with other cardiovascular risks.
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19
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Becherucci F, Roperto RM, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J 2016; 9:583-91. [PMID: 27478602 PMCID: PMC4957724 DOI: 10.1093/ckj/sfw047] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/04/2016] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) is a major health problem worldwide. Although relatively uncommon in children, it can be a devastating illness with many long-term consequences. CKD presents unique features in childhood and may be considered, at least in part, as a stand-alone nosologic entity. Moreover, some typical features of paediatric CKD, such as the disease aetiology or cardiovascular complications, will not only influence the child's health, but also have long-term impact on the life of the adult that they will become. In this review we will focus on the unique issues of paediatric CKD, in terms of aetiology, clinical features and treatment. In addition, we will discuss factors related to CKD that start during childhood and require appropriate treatments in order to optimize health outcomes and transition to nephrologist management in adult life.
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Affiliation(s)
| | - Rosa Maria Roperto
- Nephrology and Dialysis Unit , Meyer Children's Hospital , Florence , Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit , Meyer Children's Hospital , Florence , Italy
| | - Paola Romagnani
- Nephrology andDialysis Unit, Meyer Children's Hospital, Florence, Italy; Department ofBiomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
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20
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Cardinaels EPM, Altintas S, Versteylen MO, Joosen IA, Jellema LJC, Wildberger JE, Das M, Crijns HJ, Bekers O, van Dieijen-Visser MP, Kietselaer BL, Mingels AMA. High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well? PLoS One 2016; 11:e0153300. [PMID: 27096420 PMCID: PMC4838230 DOI: 10.1371/journal.pone.0153300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 03/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers to detect myocardial injury, making them promising risk-stratifying tools for patients with symptoms of chest pain. However, circulating hs-cTn are also elevated in other conditions like renal dysfunction, complicating appropriate interpretation of low-level hs-cTn concentrations. METHODS A cross-sectional analysis was performed in 1864 patients with symptoms of chest discomfort from the cardiology outpatient department who underwent cardiac computed tomographic angiography (CCTA). Serum samples were analyzed using hs-cTnT and hs-cTnI assays. Renal function was measured by the estimated glomerular filtration rate (eGFR), established from serum creatinine and cystatin C. On follow-up, the incidence of adverse events was assessed. RESULTS Median hs-cTnT and hs-cTnI concentrations were 7.2(5.8-9.2) ng/L and 2.6(1.8-4.1) ng/L, respectively. Multivariable regression analysis revealed that both assay results were more strongly associated with eGFR (hs-cTnT:stβ:-0.290;hs-cTnI:stβ:-0.222) than with cardiac imaging parameters, such as coronary calcium score, CCTA plaque severity score and left ventricular mass (all p<0.01). Furthermore, survival analysis indicated lower relative risks in patients with normal compared to reduced renal function for hs-cTnT [HR(95%CI), 1.02(1.00-1.03) compared to 1.07(1.05-1.09)] and hs-cTnI [1.01(1.00-1.01) compared to 1.02(1.01-1.02)] (all p<0.001). CONCLUSION In patients with chest discomfort, we identified an independent influence of renal function on hs-cTn concentrations besides CAD, that affected the association of hs-cTn concentrations with adverse events. Estimating renal function is therefore warranted when interpreting baseline hs-cTn concentrations.
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Affiliation(s)
- Eline P. M. Cardinaels
- Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Sibel Altintas
- Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands
| | | | - Ivo A. Joosen
- Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands
| | - Laurens-Jan C. Jellema
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, the Netherlands
| | | | - Marco Das
- Department of Radiology, CARIM, MUMC+, Maastricht, the Netherlands
| | - Harry J. Crijns
- Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Marja P. van Dieijen-Visser
- Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Bastiaan L. Kietselaer
- Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands
- Department of Radiology, CARIM, MUMC+, Maastricht, the Netherlands
| | - Alma M. A. Mingels
- Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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21
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Dhingra R, Lally C, Darrow LA, Klein M, Winquist A, Steenland K. Perfluorooctanoic acid and chronic kidney disease: Longitudinal analysis of a Mid-Ohio Valley community. ENVIRONMENTAL RESEARCH 2016; 145:85-92. [PMID: 26656498 DOI: 10.1016/j.envres.2015.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/04/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Perfluorooctanoic acid (PFOA) is an environmentally persistent chemical found at low-levels in the serum of almost all U.S. residents. Chronic kidney disease (CKD) has been positively associated with serum PFOA in prior cross-sectional studies and in one occupational mortality study, while other investigations have found no association between kidney function and PFOA. METHODS We conducted a longitudinal analysis of chronic kidney disease among adults, aged ≥20 years, (N=32,254) in a Mid-Ohio Valley community cohort, exposed to high PFOA levels from contaminated drinking water. Estimated retrospective yearly serum PFOA concentrations (1951-2011) were previously modeled in this population. Information about lifetime history of CKD diagnosis was collected during surveys in 2008-2011; self-reported CKD diagnoses were validated through medical record review. Using a Cox proportional hazards model, we retrospectively examined the association between validated adult onset CKD, and modeled PFOA exposure, from time of first exposure. We also analyzed data for the cohort prospectively, among people with no CKD diagnosis prior to enrollment in a baseline survey in 2005-2006. Both the full cohort and a non-diabetic subset were analyzed, retrospectively and prospectively. RESULTS Neither in retrospective nor in prospective analyses did we find a significant (α=0.05) trend between PFOA exposure and CKD. In the full cohort, estimated hazard ratios by quintile of cumulative serum PFOA in the retrospective analysis were 1.00 (referent), 1.26, 1.12, 1.12 and 1.24 (trend test for log cumulative exposure: p=0.80). CONCLUSION Our analyses suggest that CKD is not associated with exposure to PFOA.
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Affiliation(s)
- Radhika Dhingra
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Cathy Lally
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Mitch Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
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22
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Cai Q, Wang X, Ye J, Zhuo L, Song H, Liu C, Zhuo L. Metabolic syndrome does not always play a critical role in decreased GFR. Ren Fail 2016; 38:383-9. [PMID: 26804106 DOI: 10.3109/0886022x.2015.1136873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a paucity of literature available as to the relationship between different levels of each metabolic syndrome (MetS) component and decreased GFR. In the present study, we aimed to demonstrate whether MetS always plays a critical role in decreased GFR. METHODS A cross-sectional study was conducted between February 2010 and September 2012, with 75,468 adults enrolled undergoing measurements of blood pressure as well as tests of blood and urine samples. Univariate and multivariable logistic regression analyses were performed to estimate the odds ratio (OR) with 95% confidence intervals (CI), and the chi-square test was used for categorical variables and described as a percentage. RESULTS Of the 75,468 participants, 350 (0.5%) subjects met criteria for the decreased GFR, with a mean age of 48.79 ± 13.76 years. After adjustment for age, diastolic blood pressure and high-density lipoprotein were inversely related to decreased estimated glomerular filtration rate (eGFR) in multivariable analyses, with an OR (95% CI) of 0.57 (0.39-0.84) and 0.41 (0.24-0.72), respectively. The prevalence rate of CKD in critical group was 0.73% (154 of 21,127) and 0% (0 of 370) in noncritical group. In analysis stratified by the type of MetS components, the differences in noncritical group and the reference group were not statistically significant (χ(2 )=( )1.349, p > 0.05). CONCLUSIONS MetS does not always play a critical role in decreased GFR, with different levels of individual components of MetS exerting idiosyncratic effects in decreased eGFR. In fact, patients with abnormal body mass index, high triglycerides, and elevated fasting plasma glucose would not have impact on decreased GFR.
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Affiliation(s)
- Qingqing Cai
- a Department of Epidemiology, School of Public Health , Xuzhou Medical College , Xuzhou , Jiangsu , China
| | - Xiuying Wang
- b Division of Nephrology , Xuzhou Central Hospital , Xuzhou , Jiangsu , China
| | - Jingtao Ye
- a Department of Epidemiology, School of Public Health , Xuzhou Medical College , Xuzhou , Jiangsu , China
| | - Lin Zhuo
- c School of Basic Medical Sciences , Xinxiang Medical University , Xinxiang , Henan , China
| | - Hui Song
- a Department of Epidemiology, School of Public Health , Xuzhou Medical College , Xuzhou , Jiangsu , China
| | - Chen Liu
- a Department of Epidemiology, School of Public Health , Xuzhou Medical College , Xuzhou , Jiangsu , China
| | - Lang Zhuo
- a Department of Epidemiology, School of Public Health , Xuzhou Medical College , Xuzhou , Jiangsu , China
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Kaur M, Chandran DS, Jaryal AK, Bhowmik D, Agarwal SK, Deepak KK. Baroreflex dysfunction in chronic kidney disease. World J Nephrol 2016; 5:53-65. [PMID: 26788464 PMCID: PMC4707168 DOI: 10.5527/wjn.v5.i1.53] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/04/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) patients have high cardiovascular mortality and morbidity. The presence of traditional and CKD related risk factors results in exaggerated vascular calcification in these patients. Vascular calcification is associated with reduced large arterial compliance and thus impaired baroreflex sensitivity (BRS) resulting in augmented blood pressure (BP) variability and hampered BP regulation. Baroreflex plays a vital role in short term regulation of BP. This review discusses the normal baroreflex physiology, methods to assess baroreflex function, its determinants along with the prognostic significance of assessing BRS in CKD patients, available literature on BRS in CKD patients and the probable patho-physiology of baroreflex dysfunction in CKD.
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Plasma Nitration of High-Density and Low-Density Lipoproteins in Chronic Kidney Disease Patients Receiving Kidney Transplants. Mediators Inflamm 2015; 2015:352356. [PMID: 26648662 PMCID: PMC4662997 DOI: 10.1155/2015/352356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Functional abnormalities of high-density lipoprotein (HDL) could contribute to cardiovascular disease in chronic kidney disease patients. We measured a validated marker of HDL dysfunction, nitrated apolipoprotein A-I, in kidney transplant recipients to test the hypothesis that a functioning kidney transplant reduces serum nitrated apoA-I concentrations. METHODS Concentrations of nitrated apoA-I and apoB were measured using indirect sandwich ELISA assays on sera collected from each transplant subject before transplantation and at 1, 3, and 12 months after transplantation. Patients were excluded if they have history of diabetes, treatment with lipid-lowering medications or HIV protease inhibitors, prednisone dose > 15 mg/day, nephrotic range proteinuria, serum creatinine > 1.5 mg/dL, or active inflammatory disease. Sera from 18 transplanted patients were analyzed. Four subjects were excluded due to insufficient data. Twelve and eight patients had creatinine < 1.5 mg/dL at 3 and 12 months after transplantation, respectively. RESULTS. Nitrated apoA-I was significantly reduced at 12 months after transplantation (p = 0.039). The decrease in apoA-I nitration was associated with significant reduction in myeloperoxidase (MPO) activity (p = 0.047). In contrast to apoA-I, nitrated apoB was not affected after kidney transplantation. CONCLUSIONS Patients with well-functioning grafts had significant reduction in nitrated apoA-I 12 months after kidney transplantation. Further studies are needed in a large cohort to determine if nitrated apoA-I can be used as a valuable marker for cardiovascular risk stratification in chronic kidney disease.
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Chan W, Ivanov J, Ko D, Fremes S, Rao V, Jolly S, Cantor WJ, Lavi S, Overgaard CB, Ruel M, Tu JV, Džavík V. Clinical outcomes of treatment by percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with chronic kidney disease undergoing index revascularization in Ontario. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001973. [PMID: 25582144 DOI: 10.1161/circinterventions.114.001973] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a paucity of data on the comparative effectiveness of percutaneous coronary intervention using contemporary drug-eluting stent (DES) compared with coronary artery bypass graft (CABG) surgery in patients with chronic kidney disease. METHODS AND RESULTS A population-based study was performed using the Cardiac Care Network, a provincial registry of all patients undergoing cardiac catheterization in Ontario, to evaluate patients treated with either percutaneous coronary intervention using DES or CABG between October 1, 2008, and September 30, 2011. Chronic kidney disease was defined as creatinine clearance <60 mL/min. A total of 1786 propensity-matched patients from 4006 patients with chronic kidney disease undergoing index revascularization for multivessel disease with either DES or isolated CABG (n=893 each group) were analyzed. Baseline and procedural characteristics between percutaneous coronary intervention and CABG groups were well-balanced, including urgent revascularization priority, diabetes mellitus, left ventricular function, and 3-vessel disease. The 1-, 2-, and 3-year Kaplan-Meier survival analyses in propensity-matched patients favored CABG (93.2% versus 89.3%; 86.6% versus 80.3%; 80.8% versus 71.5%, respectively; P<0.001). The CABG cohort had greater 1-, 2-, and 3-year freedom from major adverse cardiac and cerebrovascular events (89.4% versus 71.2%; 81.9% versus 60.5%; 75.2% versus 51.8%, respectively; P<0.001). Cox regression analysis identified DES use to be associated with greater hazard for late mortality (hazard ratio, 1.58; 95% confidence interval, 1.32-1.90) and major adverse cardiac and cerebrovascular events (2.62; 2.28-3.01; all P<0.001). CONCLUSIONS In this large provincial registry, CABG was associated with improved early and late clinical outcomes when compared with percutaneous coronary intervention using DES in patients with chronic kidney disease undergoing index revascularization.
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Affiliation(s)
- William Chan
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Joan Ivanov
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Dennis Ko
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Stephen Fremes
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Vivek Rao
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Sanjit Jolly
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Warren J Cantor
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Shahar Lavi
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Christopher B Overgaard
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Marc Ruel
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Jack V Tu
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Vladimír Džavík
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
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Shara N, Yassin SA, Valaitis E, Wang H, Howard BV, Wang W, Lee ET, Umans JG. Randomly and Non-Randomly Missing Renal Function Data in the Strong Heart Study: A Comparison of Imputation Methods. PLoS One 2015; 10:e0138923. [PMID: 26414328 PMCID: PMC4587557 DOI: 10.1371/journal.pone.0138923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/04/2015] [Indexed: 01/19/2023] Open
Abstract
Kidney and cardiovascular disease are widespread among populations with high prevalence of diabetes, such as American Indians participating in the Strong Heart Study (SHS). Studying these conditions simultaneously in longitudinal studies is challenging, because the morbidity and mortality associated with these diseases result in missing data, and these data are likely not missing at random. When such data are merely excluded, study findings may be compromised. In this article, a subset of 2264 participants with complete renal function data from Strong Heart Exams 1 (1989-1991), 2 (1993-1995), and 3 (1998-1999) was used to examine the performance of five methods used to impute missing data: listwise deletion, mean of serial measures, adjacent value, multiple imputation, and pattern-mixture. Three missing at random models and one non-missing at random model were used to compare the performance of the imputation techniques on randomly and non-randomly missing data. The pattern-mixture method was found to perform best for imputing renal function data that were not missing at random. Determining whether data are missing at random or not can help in choosing the imputation method that will provide the most accurate results.
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Affiliation(s)
- Nawar Shara
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, United States of America
- * E-mail:
| | - Sayf A. Yassin
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
| | - Eduardas Valaitis
- Department of Mathematics and Statistics, American University, Washington, District of Columbia, United States of America
| | - Hong Wang
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, United States of America
| | - Barbara V. Howard
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, United States of America
| | - Wenyu Wang
- College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, United States of America
| | - Elisa T. Lee
- College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, United States of America
| | - Jason G. Umans
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, United States of America
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Han H, Zhu J, Zhu Z, Ni J, Du R, Dai Y, Chen Y, Wu Z, Lu L, Zhang R. p-Cresyl sulfate aggravates cardiac dysfunction associated with chronic kidney disease by enhancing apoptosis of cardiomyocytes. J Am Heart Assoc 2015; 4:e001852. [PMID: 26066032 PMCID: PMC4599533 DOI: 10.1161/jaha.115.001852] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Cardiovascular disease is the leading cause of death in patients with chronic kidney disease. A body of evidence suggests that p-cresyl sulfate (PCS), a uremic toxin, is associated with the cardiovascular mortality rate of patients with chronic kidney disease; however, the molecular mechanisms underlying this feature have not yet been fully elucidated. Methods and Results We aimed to determine whether PCS accumulation could adversely affect cardiac dysfunction via direct cytotoxicity to cardiomyocytes. In mice that underwent 5/6 nephrectomy, PCS promoted cardiac apoptosis and affected the ratio of left ventricular transmitral early peak flow velocity to left ventricular transmitral late peak flow velocity (the E/A ratio) observed by echocardiography (n=8 in each group). Apocynin, an inhibitor of NADPH oxidase activity, attenuates this alteration of the E/A ratio (n=6 in each group). PCS also exhibited proapoptotic properties in H9c2 cells by upregulating the expression of p22phox and p47phox, NADPH oxidase subunits, and the production of reactive oxygen species. Apocynin and N-acetylcysteine were both able to suppress the effect of PCS, underscoring the importance of NADPH oxidase activation for the mechanism of action. Conclusions This study demonstrated that the cardiac toxicity of PCS is at least partially attributed to induced NADPH oxidase activity and reactive oxygen species production facilitating cardiac apoptosis and resulting in diastolic dysfunction.
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Affiliation(s)
- Hui Han
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.) Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., Y.D., Y.C., L.L., R.Z.)
| | - Jinzhou Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.)
| | - Zhengbin Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.)
| | - Jingwei Ni
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.)
| | - Run Du
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.)
| | - Yang Dai
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., Y.D., Y.C., L.L., R.Z.)
| | - Yanjia Chen
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., Y.D., Y.C., L.L., R.Z.)
| | - Zhijun Wu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.)
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.) Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., Y.D., Y.C., L.L., R.Z.)
| | - Ruiyan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., J.Z., Z.Z., J.N., R.D., Z.W., L.L., R.Z.) Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China (H.H., Y.D., Y.C., L.L., R.Z.)
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Pommer W. Prevalence of nephropathy in the German diabetes population-Is early referral to nephrological care a realistic demand today? NDT Plus 2015; 1:iv2-iv5. [PMID: 25983981 PMCID: PMC4421149 DOI: 10.1093/ndtplus/sfn115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 06/19/2008] [Indexed: 11/29/2022] Open
Abstract
In Germany, diabetes mellitus in the general population has increased to ∼8 million people. The implication of this trend for future nephrological care is not well known, as data on this issue are rather limited. Results from different population-based studies suggest that microalbuminuria in diabetic patients is present in 20–30% of the cases. Findings from the diabetes disease management programme in the North-Rhine area revealed the prevalence of chronic kidney disease (CKD) stage II in half of the participants (CKD stage III was present in ∼20%). Only a small proportion of this cohort (∼1–2%) will reach end-stage renal failure, probably due to the excess mortality risks attributed to advanced kidney disease. Results from the QUASI-Niere registry, which reports on renal replacement therapy in Germany, indicate almost constant incidence and prevalence rates of diabetes in the last 5 years (30.6–34.2% and 23.6–27.1%, respectively). The high percentages of early stages of CKD in the diabetes population indicate a potentially high burden of future nephrological care, especially if patients are referred to nephrologists at an early stage. In reality, in nephrological care, bearing this burden is impossible without expanding the resources for this patient group.
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Affiliation(s)
- Wolfgang Pommer
- Department of Internal Medicine-Nephrology , Vivantes Humboldt Hospital , Berlin , Germany
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Watanabe H, Miyamoto Y, Enoki Y, Ishima Y, Kadowaki D, Kotani S, Nakajima M, Tanaka M, Matsushita K, Mori Y, Kakuta T, Fukagawa M, Otagiri M, Maruyama T. p-Cresyl sulfate, a uremic toxin, causes vascular endothelial and smooth muscle cell damages by inducing oxidative stress. Pharmacol Res Perspect 2014; 3:e00092. [PMID: 25692011 PMCID: PMC4317224 DOI: 10.1002/prp2.92] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/22/2014] [Indexed: 01/19/2023] Open
Abstract
The major cause of death in patients with chronic kidney disease (CKD) is cardiovascular disease. Here, p-Cresyl sulfate (PCS), a uremic toxin, is considered to be a risk factor for cardiovascular disease in CKD. However, our understanding of the vascular toxicity induced by PCS and its mechanism is incomplete. The purpose of this study was to determine whether PCS enhances the production of reactive oxygen species (ROS) in vascular endothelial and smooth muscle cells, resulting in cytotoxicity. PCS exhibited pro-oxidant properties in human umbilical vein endothelial cells (HUVEC) and aortic smooth muscle cells (HASMC) by enhancing NADPH oxidase expression. PCS also up-regulates the mRNA levels and the protein secretion of monocyte chemotactic protein-1 (MCP-1) in HUVEC. In HASMC, PCS increased the mRNA levels of alkaline phosphatase (ALP), osteopontin (OPN), core-binding factor alpha 1, and ALP activity. The knockdown of Nox4, a subunit of NADPH oxidase, suppressed the cell toxicity induced by PCS. The vascular damage induced by PCS was largely suppressed in the presence of probenecid, an inhibitor of organic anion transporters (OAT). In PCS-overloaded 5/6-nephrectomized rats, plasma MCP-1 levels, OPN expression, and ALP activity of the aortic arch were increased, accompanied by the induction of Nox4 expression. Collectively, the vascular toxicity of PCS can be attributed to its intracellular accumulation via OAT, which results in an enhanced NADPH oxidase expression and increased ROS production. In conclusion, we found for the first time that PCS could play an important role in the development of cardiovascular disease by inducing vascular toxicity in the CKD condition.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto UniversityKumamoto, Japan
| | - Yohei Miyamoto
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
| | - Yuki Enoki
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
| | - Yu Ishima
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto UniversityKumamoto, Japan
| | - Daisuke Kadowaki
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto UniversityKumamoto, Japan
| | - Shunsuke Kotani
- Department of Organic Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
| | - Makoto Nakajima
- Department of Organic Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
| | - Motoko Tanaka
- Department of Nephrology, Akebono ClinicKumamoto, Japan
| | | | - Yoshitaka Mori
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of MedicineKanagawa, Japan
| | - Takatoshi Kakuta
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of MedicineKanagawa, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of MedicineKanagawa, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo UniversityKumamoto, Japan
- DDS Research Institute, Sojo UniversityKumamoto, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto UniversityKumamoto, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto UniversityKumamoto, Japan
- Correspondence Toru Maruyama, Department of, Biopharmaceutics, Graduate School of, Pharmaceutical Sciences, Kumamoto, University, 5-1, Oe-honmachi, Chuo-ku,, Kumamoto 862-0973, Japan. Tel: +81-96-, 371-4150; Fax: +81-96-371-4153; E-mail:,
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Chan W, Ivanov J, Kotowycz MA, Sibbald M, McGeoch R, Crooks N, Hatton R, Ing D, Daly P, Mackie K, Osten MD, Seidelin PH, Barolet A, Overgaard CB, Džavík V. Association Between Drug-Eluting Stent Type and Clinical Outcomes in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention. Can J Cardiol 2014; 30:1170-6. [DOI: 10.1016/j.cjca.2014.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/07/2014] [Accepted: 04/17/2014] [Indexed: 12/14/2022] Open
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Senghore T, Su FH, Lin YS, Chu FY, Yeh CC. Association Between Hepatitis B Virus Infection and Chronic Kidney Disease in University Students Receiving Physical Check-ups: A Cross-sectional Study. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jecm.2013.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Shah VO, Townsend RR, Feldman HI, Pappan KL, Kensicki E, Vander Jagt DL. Plasma metabolomic profiles in different stages of CKD. Clin J Am Soc Nephrol 2012; 8:363-70. [PMID: 23220422 DOI: 10.2215/cjn.05540512] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES CKD is a common public health problem. Identifying biomarkers adds prognostic/diagnostic value by contributing to an understanding of CKD at the molecular level and possibly defining new drug targets. Metabolomics provides a snapshot of biochemical events at a particular time in the progression of CKD. This cross-sectional metabolomics study ascertained whether plasma metabolite profiles are significantly different in CKD stages 2, 3, and 4. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS An analysis of plasma metabolites, using gas and liquid chromatography coupled to mass spectrometry, was conducted on 30 nondiabetic men ages 40-52 years, with 10 participants each in CKD stages 2, 3, and 4 based on their estimated GFR (calculated by the Modified Diet in Renal Disease formula). Participants were recruited in late 2008, and plasma samples were tested at Metabolon Inc and analyzed in 2012. RESULTS Comparison of stage 3/stage 2 identified 62 metabolites that differed (P ≤ 0.05), with 39 higher and 23 lower in stage 3 compared with stage 2; comparisons of stage 4/stage 2 identified 111 metabolites, with 66 higher and 45 lower; and comparisons of stage 4/stage 3 identified 11 metabolites, with 7 higher and 4 lower. Major differences in metabolite profiles with increasing stage of CKD were observed, including altered arginine metabolism, elevated coagulation/inflammation, impaired carboxylate anion transport, and decreased adrenal steroid hormone production. CONCLUSIONS Global metabolite profiling of plasma uncovered potential biomarkers of stages of CKD. Moreover, these biomarkers provide insight into possible pathophysiologic processes that may contribute to progression of CKD.
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Affiliation(s)
- Vallabh O Shah
- Department of Biochemistry and Molecular Biology, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
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Wong G, Li MW, Howard K, Hua DK, Chapman JR, Bourke M, Turner R, Tong A, Craig JC. Health benefits and costs of screening for colorectal cancer in people on dialysis or who have received a kidney transplant. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs490] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Elewa U, Sanchez-Niño MD, Martin-Cleary C, Fernandez-Fernandez B, Egido J, Ortiz A. Cardiovascular risk biomarkers in CKD: the inflammation link and the road less traveled. Int Urol Nephrol 2012; 44:1731-44. [DOI: 10.1007/s11255-012-0271-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/13/2012] [Indexed: 12/11/2022]
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Barra S, Providência R, Silva J, Gomes PL, Seca L, Nascimento J, Leitão-Marques A. Glomerular filtration rate: Which formula should be used in patients with myocardial infarction? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Barra S, Providência R, Silva J, Gomes PL, Seca L, Nascimento J, Leitão-Marques A. Taxa de filtração glomerular: que fórmula deverá ser usada em doentes com enfarte agudo do miocárdio? Rev Port Cardiol 2012; 31:493-502. [DOI: 10.1016/j.repc.2012.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 01/21/2012] [Indexed: 11/25/2022] Open
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Abstract
Chronic heart failure and chronic renal failure are at epidemic proportions. These patients have significantly altered cardiac, renal, and all-cause outcomes. Much of the current research has focused on treating these individual organs in isolation. Although there are positive data on outcomes with neurohormonal modulation, they, however, remain underused. At present, data lacks for novel treatment options, while evidence continues to point at significantly worsened prognosis. Current diagnostic tools that detect acute changes in renal function or renal injury appear retrospective, which often hinder meaningful diagnostic and therapeutic decisions. This review is aimed at exploring the importance of accurate assessment of renal function for the heart failure patient by providing a synopsis on cardio-renal physiology and establishing the possibility of novel approaches in bridging the divide.
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Aras S, Varli M, Uzun B, Atli T, Keven K, Turgay M. Comparison of different glomerular filtration methods in the elderly: which formula provides better estimates? Ren Fail 2012; 34:435-41. [PMID: 22268784 DOI: 10.3109/0886022x.2011.654168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Technetium-99m diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) is an ideal radioisotopic method having a high correlation with inulin clearance for the determination of glomerular filtration rate (GFR). Different formulas like creatinine clearance (CrCl) in 24 h urine samples, Cockroft-Gault formula (CGF), and modification of diet in renal disease (MDRD) are being used to come up with an estimate. In this study, we compared (99m)Tc-DTPA with the formulas mentioned above in an attempt to best identify the method that would yield the nearly ideal GFR estimates in the elderly. MATERIALS AND METHODS In 76 patients who were admitted to our clinic, we measured 24 h urine volume (V), urine creatinine (Ucr), and serum creatinine (Scr) levels together with CrCl, Scr, serum urea (Su), and albumin (Alb) levels. By using coefficients identified for age, gender, and race, we calculated modification of diet in renal disease 1 (MDRD1). Different from MDRD1, we calculated modification of diet in renal disease 2 (MDRD2) that does not include Su and Alb parameters and formulas like CGF that include Scr, age, gender, and weight parameters to come up with GFR levels. All patients underwent (99m)Tc-DTPA procedure. RESULTS The mean of the GFR values measured by (99m)Tc-DTPA was 54.3 ± 19.9. The means of GFR values calculated by CrCl, MDRD1, MDRD2, and CGF were 58.0 ± 30.5, 60.9 ± 22.1, 54.4 ± 20.1, and 57.9 ± 22.4, respectively. GFR as measured by (99m)Tc-DTPA showed statistically significant correlations with the results of other methods (p < 0.001 for all methods). The most significant correlation was with MDRD1. CONCLUSION MDRD1 can be used for next to ideal and accurate predictions of GFR in the elderly in the daily practice.
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Affiliation(s)
- Sevgi Aras
- Department of Geriatric Medicine, School of Medicine, Ankara University, Ankara, Turkey.
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Trimarchi H, Muryan A, Dicugno M, Young P, Forrester M, Lombi F, Pomeranz V, Iriarte R, Raña MS, Alonso M. Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis. Int J Nephrol Renovasc Dis 2011; 5:1-7. [PMID: 22334794 PMCID: PMC3278252 DOI: 10.2147/ijnrd.s27675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients, the main etiologies being diabetes and hypertension. Cardiac and inflammatory biomarkers are usually employed to assess risk or damage, or during follow-up. Proteinuria is considered a strong predictor of morbidity, a cause of inflammation, oxidative stress, hemodynamic alteration, and progression of chronic kidney disease. However, proteinuria is rarely considered in the clinical assessment of HD patients. METHODS This was a concurrent, cohort-observational, cross-sectional study in which 52 chronic HD subjects were divided into three groups according to the degree of proteinuria: Group (G) A: <1 g/day, n = 25; GB: 1-3 g/day, n = 13; GC: >3 g/day, n = 14. Baseline hemoglobin, albuminemia, cholesterol, body mass index, Malnutrition-Inflammatory Score, pro-B-type natriuretic peptide, troponin T, C-reactive protein (CRP), and ultrafiltration rates were analyzed. RESULTS There was no difference between groups in terms of baseline age, gender, hypertension, cause of renal failure, hemoglobin, cholesterol, albumin, CRP levels, cardiac biomarkers, adiponectin, body mass index, or Malnutrition-Inflammatory Score. Time on HD: GA, 34.56 ± 23.3 (range [r]: 6-88); GB, 25.15 ± 19.40 (r: 6-58); GC, 18.21 ± 9.58 (r: 6-74) months; P = 0.048. Proteinuria: GA, 0.33 ± 0.30 (r: 0.0-0.88); GB, 1.66 ± 0.54 (r: 1.03-2.75); GC, 7.18 ± 2.80 (r: 3.04-21.5) g/day; P < 0.001. Mean ultrafiltration rates were significantly different: GA, 2.80 ± 0.73; GB: 1.85 ± 0.96 liters/session; P = 0.003. Fourteen diabetic patients were identified (27%): GA, 3 (12%); GB, 3 (23%); GC, 8 (57%); P = 0.009. A positive and significant correlation was observed between diabetes and proteinuria >3 g/day: rho 0.438, P = 0.027. Although troponin T, pro-B-type natriuretic peptide, adiponectin, and CRP were not different among groups, the positive correlation between troponin T and CRP elevated significantly as proteinuria increased: GA, rho 377, P = 0.063; GB, rho 663, P = 0.013; GC, rho 687, P = 0.007. CONCLUSION In chronic HD, nephrotic-range proteinuria was significantly higher in diabetic nephropathy patients versus other causes. This was associated with inflammation and cardiac stress and was independent of fluid removal. Proteinuria >3 g/day was associated with shorter time on HD. Whether severe proteinuria is associated with shorter survival in HD, independent of diabetes, is to be determined. Proteinuria should be considered in the assessment of cardiovascular and inflammatory states in HD patients.
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Sajja LR, Mannam G, Chakravarthi RM, Guttikonda J, Sompalli S, Bloomstone J. Impact of preoperative renal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg 2011; 92:2161-7. [PMID: 21962259 DOI: 10.1016/j.athoracsur.2011.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study assessed whether preoperative renal insufficiency predisposes patients undergoing off-pump coronary artery revascularization to postoperative dialysis. METHODS From August 2004 through June 2009, 2,275 patients undergoing off-pump coronary artery bypass were categorized into five groups (stages) by glomerular filtration rate (GFR). Of these, 1,855 patients had renal insufficiency: stage 2: 1,406; stage 3: 428; stage 4: 21, and 414 had normal renal function, stage 1. Excluded were 6 patients with end-stage renal disease (stage 5). Preoperative variables and postoperative outcomes were compared among groups. RESULTS Preoperative patient characteristics were similar; however, patients with normal renal function were younger (p = 0.001). Serum creatinine rose significantly above baseline on the first postoperative day in the renal insufficiency groups (p = 0.001). The GFR groups had similar inotrope use, reexploration rate, duration of postoperative mechanical ventilation, postoperative stroke, wound infection, and mortality rate. Stage 4 patients had a higher incidence of postoperative myocardial infarction (p = 0.002). Stage 3 and 4 patients had an increased need for postoperative dialysis vs stage 1 patients (p = 0.002). CONCLUSIONS Nonparametric contingency analysis showed patients with low preoperative GFR (stage 3 and 4, p < 0.0001) and a history of smoking (p = 0.04) were at increased risk for postoperative dialysis. Patients who required postoperative inotropic support tended toward requiring postoperative dialysis (p = 0.06). Low preoperative ejection fraction (p = 0.83), class III or IV angina (p = 0.069), and postoperative blood transfusions were not associated with the need for postoperative dialysis in patients undergoing off-pump revascularization.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India.
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Al-Aly Z, Zeringue A, Fu J, Rauchman MI, McDonald JR, El-Achkar TM, Balasubramanian S, Nurutdinova D, Xian H, Stroupe K, Abbott KC, Eisen S. Rate of kidney function decline associates with mortality. J Am Soc Nephrol 2010; 21:1961-9. [PMID: 20947634 DOI: 10.1681/asn.2009121210] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the definition of CKD may transform a static definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual.
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Affiliation(s)
- Ziyad Al-Aly
- Division of Nephrology, Saint Louis Veterans Affairs Medical Center, St. Louis, MO 63106, USA.
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Umemura S, Kawamori R, Matsuoka H, Saito Y. Effects of renal dysfunction on cardiovascular events in diabetic patients with hypertension: challenge-DM Study subgroup analysis. Clin Exp Nephrol 2010; 15:64-72. [PMID: 20844915 DOI: 10.1007/s10157-010-0344-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 08/09/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigated the relation between renal dysfunction and cardiovascular events in patients from the Challenge-DM Study (a large-scale investigation of Japanese diabetic patients with hypertension on candesartan therapy). METHODS The subjects were 4706 patients in whom renal function could be assessed at the time of registration among 16860 patients analyzed in the Challenge-DM Study. The definition of renal dysfunction (low GFR) was an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) calculated by the formula for Japanese. RESULTS The low GFR group was older, and had a high proportion of females and a high prevalence of cerebrovascular or cardiovascular disease (CVD) compared to the normal GFR group (eGFR ≥ 60 ml/min/1.73 m(2)). Univariate Cox regression analysis of cardiovascular events showed a significant increase in the incidence of primary events and total events in the low GFR group. Among patients <65 years old, the same results were obtained, but no differences were found between the low GFR and normal GFR groups aged over 65 years. Multivariate Cox regression analysis was done with patient characteristics at registration and the presence/absence of achieving the target blood pressure and HbA(1c) before the event as explanatory variables. As a result, low GFR was not the main cause of cardiovascular events, but it had a significant influence on primary events and total events among patients <65 years old. CONCLUSIONS Low GFR may be an independent risk factor for cerebrovascular and CVD among young and middle-aged Japanese diabetic patients with hypertension on candesartan therapy.
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Affiliation(s)
- Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
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Galle J. [Cardiorenal syndrome]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2010; 105:142-149. [PMID: 20349291 DOI: 10.1007/s00063-010-1023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 12/23/2009] [Indexed: 05/29/2023]
Abstract
With increasing age of a population, the rate and severity of comorbidities are also growing, resulting in a rising number of people with a condition described as "cardiorenal syndrome". Initially, cardiorenal syndrome defined the decline in cardiac and renal function due to diminished renal perfusion in the context of heart failure. However, in order to give consideration to the numerous comorbidities, nowadays the definition has been widened. Following a new classification, five types of cardiorenal syndrome are distinguished. Such a differentiation is helpful to find the appropriate therapeutic approach, according to the underlying disease. Therefore, the new classification and modern therapeutic concepts shall be presented here.
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Affiliation(s)
- Jan Galle
- Klinik für Nephrologie und Dialyseverfahren, Klinikum Lüdenscheid, Lüdenscheid.
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The role of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) as a prognostic marker in older people: the impact of reduced renal function. ACTA ACUST UNITED AC 2009. [DOI: 10.1017/s0959259809990189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
SummaryThe N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is released in response to volume expansion and/or increased tension on left ventricular myocytes. NT-pro-BNP is a useful diagnostic and prognostic biomarker both in patients with dyspnoea of unknown aetiology, and for risk assessment of patients with established heart failure. However, impaired kidney function – a common condition in older people as well as a strong risk factor for cardiovascular disease is associated with elevated circulating levels of NT-pro-BNP. Therefore, it is important to know the kidney function when interpreting an elevated NT-pro-BNP measurement obtained in older people in order to diagnose or stage congestive heart failure.
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Shimizu H, Hirose Y, Nishijima F, Tsubakihara Y, Miyazaki H. ROS and PDFG-β receptors are critically involved in indoxyl sulfate actions that promote vascular smooth muscle cell proliferation and migration. Am J Physiol Cell Physiol 2009; 297:C389-96. [DOI: 10.1152/ajpcell.00206.2009] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with chronic renal failure are at greater risk of developing atherosclerosis than healthy individuals, and recent data suggest that the putative uremic toxin indoxyl sulfate (IS) promotes the pathogenesis of atherosclerosis. The present study examined the effects of IS on vascular smooth muscle cells (VSMCs) with respect to reactive oxygen species (ROS), platelet-derived growth factor (PDGF) receptors, and mitogen-activated protein kinases (MAPKs). IS induced the migration and proliferation of VSMCs and synergistically enhanced their PDGF-induced migration as well as proliferation. The effects of PDGF were promoted after a 24-h incubation with IS despite the absence of IS during PDGF stimulation. Intracellular ROS levels were increased in the presence of IS, and PDGF-dependent ROS production was augmented by a prior 24-h incubation with IS even in the absence of IS during PDGF stimulation. These data suggest that IS increases the sensitivity of VSMCs to PDGF. IS also phosphorylated PDGF-β-receptors and upregulated PDGF-β receptor but not α-receptor protein expression in the absence of exogenous PDGF. The NADPH oxidase inhibitor diphenylene iodonium blocked IS-dependent increase in receptor expression. Administration of IS to nephrectomized rats also elevated receptor protein expression in arterial VSMCs. Inhibitors of NADPH oxidase, PDGF-β receptors, extracellular-regulated protein kinase (ERK), and p38 MAPK all inhibited IS-induced VSMCs migration and proliferation. Taken together, these findings indicate that IS induces the migration as well as proliferation of VSMCs through PDGF-β receptors and that ROS generation is critically involved in this process, which promotes the development of atherosclerosis.
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Abstract
Chronic kidney disease (CKD) is associated with accelerated progression of cardiovascular disease, perhaps because patients with CKD have a high burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. Although the cardiovascular burden of CKD is well documented, potentially beneficial therapies are sometimes underused in patients with stage 3-4 CKD and are rarely studied in patients on dialysis. In this Review, we describe the epidemiology of cardiovascular disease in patients with stage 3-5 CKD (excluding kidney transplant recipients) and outline cardiovascular risk factors that are relevant in this population; we then discuss the implications of this knowledge for the optimal management of cardiovascular risk in this setting. Finally, we highlight opportunities for further research.
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Affiliation(s)
- Diana Rucker
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Mazzuchi N, Schwedt E, Solá L, González C, Ferreiro A. Risk Factors and Prevention of End Stage Renal Disease in Uruguay. Ren Fail 2009; 28:617-25. [PMID: 17162418 DOI: 10.1080/08860220600925677] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Uruguay is a developing country with a privileged established program for renal replacement therapy (RRT) for all patients with end stage renal disease (ESRD) since 1981. In December 2004, the RRT prevalence reached 916 patients per million population. The ESRD incidence has not changed significantly in the last eight years, differing with what is observed in other countries. In contrast, the ESRD incidence secondary to diabetic nephropathy has shown a permanent increase. The prevention of chronic kidney disease (CKD) began in 1989 with the Program of Prevention and Treatment of Glomerulonephritis (PPTG), being extended in 2002 to all CKD and canalized through the National Program of Renal Healthcare (NPRH) since 2004. The registry of glomerulonephritis has been demonstrated in recent years: patients are referral to nephrologists earlier, there is an increase of the frequency of patients with "clinical remission," and thus there is a decrease of the frequency of ESRD in the first three months after referral. The NPRH has been developed in a progressive way with the involvement of government authorities and the active participation of the nephrologists. A global prevention program, integrating the prevention of CKD, cardiovascular diseases, hypertension, and diabetes was developed. The first steps of the program have had important achievements: a rational reorientation of nephrologic care in the first level of attention, patient access to renoprotective medications without cost; a registration system of patients, the creation of a formal multidisciplinary team, and the instauration of a continuous medical education program.
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Affiliation(s)
- Nelson Mazzuchi
- Sociedad Uruguaya de Nefrología, 21 de Seteiembre 2819, 11300 Montevideo, Uruguay.
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González-Juanatey J, Grigorián L, Otero Raviña F. Función renal en pacientes con insuficiencia cardíaca. Influencia pronóstica e implicaciones terapéuticas. Med Clin (Barc) 2009; 132 Suppl 1:13-9. [DOI: 10.1016/s0025-7753(09)70957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yamamoto R, Kanazawa A, Shimizu T, Hirose T, Tanaka Y, Kawamori R, Watada H. Association between atherosclerosis and newly classified chronic kidney disease stage for Japanese patients with type 2 diabetes. Diabetes Res Clin Pract 2009; 84:39-45. [PMID: 19223087 DOI: 10.1016/j.diabres.2009.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 01/14/2009] [Accepted: 01/15/2009] [Indexed: 10/21/2022]
Abstract
Using a new estimated glomerular filtration rate (eGFR) equation, we undertook a retrospective chart review to investigate the clinical significance of chronic kidney disease (CKD) stage for atherosclerosis in 653 Japanese patients with type 2 diabetes that were followed from January 2004 to December 2006 at Juntendo University Hospital. Diabetic patients with CKD stage 2 or 3 detected in 2004 or before had more history of cardiovascular disease (CVD) compared with those patients without CKD [ischemic heart disease (IHD): 25% vs. 9.3%, P<0.01 and stroke: 17.6% vs. 10.5%, P<0.05]. In Addition, the incidence of CVD through the observation period tended to increase with progression of CKD stage (0.9% in stage 0, 3.2% in stage 1 or 2, and 3.4% in stage > or =3, P=0.056), and patients with eGFR<75 had a higher incidence of IHD (2.5% vs. 0.3%) and IHD or Stroke (3.3% vs. 0.7%) compared with those who had eGFR > or =75. Patients with urinary albumin excretion rate (UACR) > or =20mg/g Cr also had a higher incidence of IHD or stroke compared to patients with UACR<20 (3.5% vs. 0.6%). In conclusion, diabetic patients with eGFR<75 and/or UACR > or =20 might be a high-risk population for CVD.
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Affiliation(s)
- Risako Yamamoto
- Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Abstract
The presence of kidney disease, manifested by low glomerular filtration rates (GFR) and/or large amounts of protein in the urine, is independently associated with increased rates of cardiovascular disease (CVD). The severity of kidney disease is associated with graded increases in risk for CVD and death. Chronic kidney disease (CKD) should be recognized and treatment initiated early to maximize the chances for slowing nephropathy progression and reducing proteinuria. We recommend screening for CKD in all patients with CVD, including computing an estimated GFR and evaluating for proteinuria using a spot urine albumin:creatinine ratio. Aggressive management of traditional cardiovascular risk factors should be employed in this high-risk population, specifically rigorous hypertension control (including the use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blocking agents (ARB)), management of hyperglycemia, hyperlipidemia and smoking cessation. Further studies are needed to identify the unique renal failure-related (non-traditional) risk factors that contribute to accelerated atherosclerosis in this population and performance of randomized trials to assess the effects of cardiovascular interventions in individuals with CKD.
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Affiliation(s)
- Anita M Saran
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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