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Merinopoulos I, Bhalraam U, Kasmai B, Hewson D, Greenwood R, Eccleshall SC, Smith J, Tsampasian V, Vassiliou V. Myocardial inflammation after elective percutaneous coronary intervention. Hellenic J Cardiol 2024:S1109-9666(24)00134-9. [PMID: 38960369 DOI: 10.1016/j.hjc.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE It is well established that inflammation plays a central role in the sequelae of percutaneous coronary intervention (PCI). Most of the studies to date have focused on the inflammatory reaction affecting the vessel wall after angioplasty. However, there are data to suggest that the main foci of inflammation are in fact in the myocardium beyond the vessel wall. The main aim of our study was to investigate the myocardial inflammation after elective, uncomplicated angioplasty with cardiovascular magnetic resonance (CMR) enhanced by ultrasmall superparamagnetic particles of iron oxide (USPIO) and also blood biomarkers. This is the first study to report such findings after elective angioplasty. METHODS We assessed patients undergoing elective angioplasty for stable angina with USPIO-enhanced CMR two weeks after the procedure and compared the results with those of healthy volunteers who constituted the control group. We excluded patients with previous myocardial infarction, previous PCI, or any significant inflammatory condition. All patients also underwent blood biomarker testing at baseline (pre-PCI), 4 h, and two weeks later. RESULTS A total of five patients and three controls were scanned. There was a small absolute increase, although statistically insignificant, in R2∗ values in the PCI area compared with either remote myocardium from the same patient (PCI area [left anterior descending artery (LAD)] vs remote myocardium [circumflex area]: 19.3 ± 10.8 vs 9.2 ± 7.9, p = 0.1) or healthy myocardium from healthy volunteers (PCI area [LAD] vs healthy myocardium [LAD]: 19.3 ± 10.8 vs 12.2 ± 4.0, p = 0.2). PTX3 and IL-6 were the only biomarkers that changed significantly from baseline to 4 h and 2 weeks. Both biomarkers peaked at 4 h. CONCLUSION We used USPIO-enhanced CMR for the first time to assess myocardial inflammation after elective, uncomplicated PCI. We have demonstrated a small numerical increase in inflammation, which was not statistically significant. This study opens the way for future studies to use this method as a means to target inflammation.
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Affiliation(s)
- Ioannis Merinopoulos
- Norwich Medical School, University of East Anglia, UK; Department of Cardiology, Norfolk and Norwich University Hospital, UK
| | - U Bhalraam
- Norwich Medical School, University of East Anglia, UK; Department of Cardiology, Norfolk and Norwich University Hospital, UK
| | - Bahman Kasmai
- Norwich Medical School, University of East Anglia, UK
| | - David Hewson
- Norwich Medical School, University of East Anglia, UK
| | | | | | - James Smith
- Norwich Medical School, University of East Anglia, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, UK; Department of Cardiology, Norfolk and Norwich University Hospital, UK
| | - Vassilios Vassiliou
- Norwich Medical School, University of East Anglia, UK; Department of Cardiology, Norfolk and Norwich University Hospital, UK.
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Siddique SM, Tipton K, Leas B, Jepson C, Aysola J, Cohen JB, Flores E, Harhay MO, Schmidt H, Weissman GE, Fricke J, Treadwell JR, Mull NK. The Impact of Health Care Algorithms on Racial and Ethnic Disparities : A Systematic Review. Ann Intern Med 2024; 177:484-496. [PMID: 38467001 DOI: 10.7326/m23-2960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND There is increasing concern for the potential impact of health care algorithms on racial and ethnic disparities. PURPOSE To examine the evidence on how health care algorithms and associated mitigation strategies affect racial and ethnic disparities. DATA SOURCES Several databases were searched for relevant studies published from 1 January 2011 to 30 September 2023. STUDY SELECTION Using predefined criteria and dual review, studies were screened and selected to determine: 1) the effect of algorithms on racial and ethnic disparities in health and health care outcomes and 2) the effect of strategies or approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of algorithms. DATA EXTRACTION Outcomes of interest (that is, access to health care, quality of care, and health outcomes) were extracted with risk-of-bias assessment using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool and adapted CARE-CPM (Critical Appraisal for Racial and Ethnic Equity in Clinical Prediction Models) equity extension. DATA SYNTHESIS Sixty-three studies (51 modeling, 4 retrospective, 2 prospective, 5 prepost studies, and 1 randomized controlled trial) were included. Heterogenous evidence on algorithms was found to: a) reduce disparities (for example, the revised kidney allocation system), b) perpetuate or exacerbate disparities (for example, severity-of-illness scores applied to critical care resource allocation), and/or c) have no statistically significant effect on select outcomes (for example, the HEART Pathway [history, electrocardiogram, age, risk factors, and troponin]). To mitigate disparities, 7 strategies were identified: removing an input variable, replacing a variable, adding race, adding a non-race-based variable, changing the racial and ethnic composition of the population used in model development, creating separate thresholds for subpopulations, and modifying algorithmic analytic techniques. LIMITATION Results are mostly based on modeling studies and may be highly context-specific. CONCLUSION Algorithms can mitigate, perpetuate, and exacerbate racial and ethnic disparities, regardless of the explicit use of race and ethnicity, but evidence is heterogeneous. Intentionality and implementation of the algorithm can impact the effect on disparities, and there may be tradeoffs in outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Quality and Research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania; and Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (S.M.S.)
| | - Kelley Tipton
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Brian Leas
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Christopher Jepson
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Jaya Aysola
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Division of General Internal Medicine, University of Pennsylvania; and Penn Medicine Center for Health Equity Advancement, Penn Medicine, Philadelphia, Pennsylvania (J.A.)
| | - Jordana B Cohen
- Division of Renal-Electrolyte and Hypertension, University of Pennsylvania; and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania (J.B.C.)
| | - Emilia Flores
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Michael O Harhay
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Center for Evidence-Based Practice, Penn Medicine; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (M.O.H.)
| | - Harald Schmidt
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania (H.S.)
| | - Gary E Weissman
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W.)
| | - Julie Fricke
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Jonathan R Treadwell
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Nikhil K Mull
- Center for Evidence-Based Practice, Penn Medicine; and Division of Hospital Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (N.K.M.)
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El-Khoury B, Yang TC. Reviewing Racial Disparities in Living Donor Kidney Transplantation: a Socioecological Approach. J Racial Ethn Health Disparities 2024; 11:928-937. [PMID: 36991297 PMCID: PMC10057682 DOI: 10.1007/s40615-023-01573-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/31/2022] [Accepted: 03/19/2023] [Indexed: 03/31/2023]
Abstract
Despite kidney transplantation having superior outcomes to dialytic therapies, disparities continue to exist among rates of kidney transplantation between Black and non-Hispanic White patients, which cannot be explained by differences in individual characteristics. To better evaluate the persistent Black/White disparities in living kidney transplantation, we review the extant literature and include the critical factors and recent development in living kidney transplantation in the socioecological approach. We also emphasize the potential vertical and hierarchical associations among factors in the socioecological model. Specifically, this review explores the possibility that the relatively low living kidney transplantation among Blacks may be a consequence of individual, interpersonal, and structural inequalities in various social and cultural dimensions. At the individual level, the Black/White differences in socioeconomic conditions and transplant knowledge may account for the low transplantation rates among Blacks. Interpersonally, the relatively weak social support and poor communication between Black patients and their providers may contribute to disparities. At the structural level, the race-based glomerular filtration rate (GFR) calculation that is widely used to screen Black donors is a barrier to receiving living kidney transplantation. This factor is directly related to structural racism in the health care system but its potential impact on living donor transplantation is underexplored. Finally, this literature review emphasizes the current perspective that a race-free GFR should be considered and a multidisciplinary and interprofessional perspective is necessary to devise strategies and interventions to reduce the Black/White disparities in living donor kidney transplantation in the U.S.
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Affiliation(s)
- Bashir El-Khoury
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, USA.
- Civilian Institution Programs, Air Force Institute of Technology, Wright-Patterson Air Force Base, OH, USA.
| | - Tse-Chuan Yang
- Department of Epidemiology, University of Texas Medical Branch, Galveston, USA
- Department of Sociology, University at Albany, State University of New York, Albany, USA
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Romine MM, Leeser DB, Kennamer K, Nguyen C, Jones H, McLawhorn K, Kendrick S, Irish W. Early outcomes associated with de novo once-daily extended-release versus twice-daily immediate-release tacrolimus in a predominantly African American kidney transplant population: A single-center observational study. Clin Transplant 2024; 38:e15268. [PMID: 38450751 DOI: 10.1111/ctr.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The purpose of this study was to compare early outcomes of de novo LCPT (once-daily extended-release tacrolimus) to IR TAC (twice-daily immediate-release tacrolimus) in a predominantly African American (AA) adult kidney transplant population. METHODS This is a single center, retrospective cohort study. Patients were divided into two cohorts: IR TAC (administered between January 1, 2017, and January 31, 2019) and LCPT (administered between February 1, 2019, and May 31, 2020). Primary endpoints were changes in tacrolimus trough levels (ng/mL) and estimated glomerular filtration rate up to 12 months post-transplantation. Clinical endpoints included graft survival, delayed graft function, biopsy-proven rejection, CMV viremia, and BK. A propensity score weighted generalized linear mixed effects model was used for analysis. RESULTS The rate of change in tacrolimus levels was significantly higher in the LCPT cohort compared to the IR TAC cohort at 14 days post-discharge (.2455 ng/mL per day vs. .1073 ng/mL, respectively; p < .001). Subsequently, the LCPT cohort had a slightly higher rate of decline (-.015 ng/mL per day vs. -.010 ng/mL with IR TAC; p = .0894) up to 12 months post-discharge. Although eGFR was similar between the two cohorts at 12 months post-transplant, the rate of increase was slower in the LCPT cohort (.1371 mL/min per day vs. .1852 mL/min per day, p = .0314). No significant differences were found in graft survival, DGF, BPAR, CMV, or BK infection. CONCLUSION This study demonstrates that despite higher early trough levels with immediate post-transplant LCPT use, clinical outcomes are comparable to IR TAC at one-year post-transplant. Notably, LCPT use does not increase the incidence of DGF and that this formulation of CNI can be used as first line therapy post-transplant.
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Affiliation(s)
- Margaret M Romine
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - David B Leeser
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Karen Kennamer
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Catherine Nguyen
- East Carolina University Health System, Greenville, North Carolina, USA
| | - Heather Jones
- Eastern Nephrology Associates, Greenville, North Carolina, USA
| | | | - Scott Kendrick
- Eastern Nephrology Associates, Greenville, North Carolina, USA
| | - William Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Gao Z, Hu Y, Gao Y, Ma X, Hu Z. The association of hepcidin, reticulocyte hemoglobin equivalent and anemia-related indicators on anemia in chronic kidney disease. Medicine (Baltimore) 2023; 102:e33558. [PMID: 37115087 PMCID: PMC10145874 DOI: 10.1097/md.0000000000033558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Hepcidin is an essential regulator of iron homeostasis in chronic kidney disease (CKD) anemia, reticulocyte hemoglobin equivalent (RET-He) can be used to evaluate the availability of iron for erythropoiesis. Previous research has found that hepcidin indirectly regulates RET-He. This study aimed to investigate the association of hepcidin, RET-He and anemia-related indicators on anemia in chronic kidney disease. A total of 230 individuals were recruited, including 40 CKD3-4 patients, 70 CKD5 patients without renal replacement therapy, 50 peritoneal dialysis patients, and 70 hemodialysis patients. The serum levels of hemoglobin (Hb), reticulocyte, RET-He, serum iron, serum creatinine, serum ferritin, total iron binding capacity, hepcidin-25, high sensitivity C-reactive protein, transferrin, erythropoietin, intrinsic factor antibody, soluble transferrin receptor and interleukins-6 (IL-6) were measured. Hepcidin-25 was positively associated with IL-6, and negatively with total iron binding capacity, intrinsic factor antibody, and transferrin. Reticulocyte Hb equivalent was associated positively with Hb, serum ferritin, serum iron, transferrin saturation, and negatively with serum creatinine, reticulocyte, IL-6, STfR. Hepcidin-25 was not associated with RET-He, while IL-6 was independently associated with hepcidin-25 and RET-He, suggesting that hepcidin has no effffect on the iron dynamics of reticulocytes in CKD, may be related to IL-6, indicate a likelihood of a threshold for stimulation of hepcidin-25 expression by IL-6 in order to indirectly regulates RET-He.
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Affiliation(s)
- Zhaoli Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Yingying Hu
- Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanxia Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Xiaotian Ma
- Department of Medicine Experimental Center, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Mohottige D, Olabisi O, Boulware LE. Use of Race in Kidney Function Estimation: Lessons Learned and the Path Toward Health Justice. Annu Rev Med 2023; 74:385-400. [PMID: 36706748 DOI: 10.1146/annurev-med-042921-124419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In 2020, the nephrology community formally interrogated long-standing race-based clinical algorithms used in the field, including the kidney function estimation equations. A comprehensive understanding of the history of kidney function estimation and racial essentialism is necessary to understand underpinnings of the incorporation of a Black race coefficient into prior equations. We provide a review of this history, as well as the considerations used to develop race-free equations that are a guidepost for a more equity-oriented, scientifically rigorous future for kidney function estimation and other clinical algorithms and processes in which race may be embedded as a variable.
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Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; .,Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Opeyemi Olabisi
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; .,Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - L Ebony Boulware
- Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Scott PO, Catlett JL, Seah C, Leisman S. A Framework for Antiracist Curriculum Changes in Nephrology Education. Adv Chronic Kidney Dis 2022; 29:493-500. [PMID: 36371111 DOI: 10.1053/j.ackd.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022]
Abstract
Addressing persistent racial health disparities in cases of kidney disease will first require significant investment in examining how structural racism has influenced our clinical practice and medical education. Improving how we understand and articulate race is critical for achieving this goal. This work begins with ensuring that race's mention within nephrology literature and curricular materials for medical trainees is thoroughly rooted in evidence-based rationale-not to serve as a proxy for polygenic contributions, social determinants of health, or systemic health care barriers. While many institutions are increasingly recognizing the importance of instituting such changes on behalf of the systematically marginalized patient populations who are most affected by these disparities, there is a paucity of guidance on how to critically appraise and revise decades of pathophysiological and epidemiological findings through an antiracist lens. In this article, we propose an inquiry-based framework with case-study examples to help readers recognize improper use of race within nephrology, assess personal and institutional readiness to introduce changes to said content, and generate materials that center evidence-based findings and reject harmful misinterpretations of race.
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Affiliation(s)
| | | | - Carina Seah
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Staci Leisman
- Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Division of Nephrology, Mount Sinai Hospital, New York, NY.
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Hsu CY, Go AS. The race coefficient in glomerular filtration rate-estimating equations and its removal. Curr Opin Nephrol Hypertens 2022; 31:527-533. [PMID: 36093899 PMCID: PMC9645369 DOI: 10.1097/mnh.0000000000000833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW To review new publications about the use of the race coefficient in glomerular filtration rate (GFR)-estimating equations since this topic was last reviewed a year ago in Current Opinion in Nephrology and Hypertension . RECENT FINDINGS Accounting for race (or genetic ancestry) does improve the performance of GFR-estimating equations when serum creatinine (SCr) is used as the filtration marker but not when cystatin C is used. The National Kidney Foundation (NKF)-American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease recommended immediate adoption of a new refitted SCr-based equation without race and increased use of cystatin C. This report has created consensus but the endorsed new SCr equation without race underestimates GFR in Black Americans and overestimates GFR in non-Black Americans, which may result in diminished ability to detect racial disparities. SUMMARY The approach recommended by the NKF-ASN Task Force represents a compromise attempting to balance a number of competing values, including racial justice, benefit of classifying more Black Americans as having (more severe) chronic kidney disease, accuracy compared with measured GFR, and financial cost. The full implications of adopting the race-free refitted CKD-EPI SCr equation are yet to be known.
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Affiliation(s)
- Chi-yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Bittermann T, Lewis JD, Goldberg DS. Recipient and Center Factors Associated With Immunosuppression Practice Beyond the First Year After Liver Transplantation and Impact on Outcomes. Transplantation 2022; 106:2182-2192. [PMID: 35706103 PMCID: PMC9613480 DOI: 10.1097/tp.0000000000004209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Immunosuppression is a critical aspect of post-transplant management, yet practices at intermediate and late time points after liver transplantation (LT) are poorly characterized. METHODS A retrospective cohort of 11 326 adult first LT alone recipients between 2007 and 2016 was identified by linking United Network for Organ Sharing transplant data to Medicare administrative claims. The immunosuppression regimen was obtained from Medicare billing claims. Factors associated with calcineurin inhibitor (CNI) monotherapy at 1-, 3-, and 5-y post-LT were investigated using mixed-effects logistic regression. Center practice heterogeneity was evaluated. The association of immunosuppression regimen (time-updating) with patient and graft survival was studied. RESULTS CNI monotherapy was used in 51.9% at 1-y post-LT and 68.6% at 5-y post-LT. Center-specific rates ranged from 20.0%-79.9% to 15.4%-95.2%, respectively. CNI monotherapy at 1- and 3-y post-LT was less likely among Black recipients ( P = 0.027 and P = 0.015 versus White, respectively). CNI plus antimetabolite was associated with improved adjusted patient (hazard ratio, 0.59; P < 0.001) and graft (hazard ratio, 0.62; P < 0.001) survival versus CNI monotherapy. The benefit of CNI plus antimetabolite on patient and graft survival increased with older age. CONCLUSIONS In this first longitudinal analysis of LT immunosuppression practices among Medicare beneficiaries, a CNI plus antimetabolite approach led to improved outcomes. Significant center heterogeneity in practice was observed.
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Affiliation(s)
- Therese Bittermann
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James D Lewis
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, FL
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Yuksel Y, Kose S. Prognostic Nutritional Index Predicts Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome. Angiology 2022:33197221116203. [DOI: 10.1177/00033197221116203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the effectiveness of prognostic nutritional index (PNI) in predicting contrast induced nephropathy (CIN) in patients with acute coronary syndrome (ACS). This study included 925 ACS patients (mean age 62.5 ± 12.4 years, 73.5% male); 604 were diagnosed as unstable angina pectoris/non–ST-elevation myocardial infarction (USAP/NSTEMI) and 321 as ST-elevation myocardial infarction (STEMI). The PNI formula was: 10 × serum albumin (g/dL) + .005 × total lymphocyte count (/mm3). The patients were divided into two groups: CIN (n = 232) and non-CIN (n = 693). Patients without CIN had a significantly lower PNI than patients with CIN (44.3 ± 6.9 vs 54.7 ± 7.4; P < .001). In the receiver operating characteristic (ROC) curve analysis, the cut-off value for PNI of 48.6 has 80% specificity and 81% sensitivity in predicting CIN (area under the ROC curve (AUC): .87, 95% CI [.84–.89]). PNI <48.6 (odds ratio (OR): 6.765, P < .001), pre-procedural creatinine levels (OR: 6.223, P < .001), left ventricular ejection fraction (LVEF) (OR: .960, P < .001), age (OR: 1.025, P = .005), diabetes mellitus (DM) (0R: 1.768, P = .006), contrast amount (OR: 1.003, P = .038), and having STEMI (OR: .594, P = .029) were found independently associated with CIN. PNI is a strong independent predictor of CIN in ACS patients.
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Affiliation(s)
- Yasin Yuksel
- Department of Cardiology, Saglik Bilimleri University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sennur Kose
- Department of Nephrology, Saglik Bilimleri University, Istanbul Training and Research Hospital, Istanbul, Turkey
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