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Song J, Wang P, Li H. Sex disparities in the association between serum cotinine and chronic kidney disease. Tob Induc Dis 2024; 22:TID-22-68. [PMID: 38686043 PMCID: PMC11056949 DOI: 10.18332/tid/185965] [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: 11/07/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Despite the existence of numerous studies highlighting the adverse effects of smoking on kidney function, the investigation of the correlation between serum cotinine and chronic kidney disease (CKD) remains inconclusive due to insufficient evidence. Consequently, the primary objective of this study was to ascertain the association between serum cotinine levels and CKD. METHODS This study analyzed data from 10900 Americans participating in the National Health and Nutrition Examination Survey between 2005 and 2016. The independent variable under investigation was log serum cotinine, while the dependent variable was the presence of CKD. To investigate the potential linear and non-linear correlations between serum cotinine and CKD, logistic regression models and generalized additive models (GAM) were employed. Furthermore, stratified analyses and interaction tests were conducted to evaluate potential disparities in the relationship between serum cotinine and CKD, based on sex. RESULTS The median age in the study participants was 49.28 ± 17.96 years, and the median log serum cotinine (ng/mL) was -0.54 ± 1.68. The prevalence of CKD was found to be 17.04%. Multifactorial regression analysis did not show a statistically significant association between log serum cotinine and CKD (OR=1.02; 95% CI: 0.98-1.06, p=0.4387). A statistically significant non-linear association between log serum cotinine and CKD was also not observed in the GAM analysis (p non-linear value=0.091). Subgroup analyses revealed sex differences in the association between log serum cotinine and CKD. Briefly, males had a positive association between log serum cotinine and incident CKD (OR=1.08; 95% CI: 1.02-1.15, p=0.0049). In females, there was a U-shaped association between log serum cotinine and CKD, with an optimal inflection point for log serum cotinine of -0.30 (serum cotinine=0.5 ng/mL). CONCLUSIONS Cross-sectional analyses of NHANES data showed gender differences in the association between serum cotinine and the development of CKD.
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Affiliation(s)
- Jianling Song
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People's Republic of China
| | - Ping Wang
- Department of Gynecology and Obstetrics, Yongfeng People's Hospital, Jian, People's Republic of China
| | - Hong Li
- Department of Medical Records, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People's Republic of China
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Vadalà G, Alaimo C, Buccheri G, Di Fazio L, Di Caccamo L, Sucato V, Cipriani M, Galassi AR. Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates. Diagnostics (Basel) 2023; 13:2709. [PMID: 37627968 PMCID: PMC10453389 DOI: 10.3390/diagnostics13162709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients and during the first year after transplantation. For these reasons, and due to the shortage of organs available for transplant, it is of utmost importance to identify patients with a good life expectancy after transplant and minimize the transplant peri-operative risk. Various conditions, such as severe pulmonary diseases, recent myocardial infarction or stroke, and severe aorto-iliac atherosclerosis, need to be ruled out before adding a patient to the transplant waiting list. The effectiveness of systematic coronary artery disease (CAD) treatment before kidney transplant is still debated, and there is no universal screening protocol, not to mention that a nontailored screening could lead to unnecessary invasive procedures and delay or exclude some patients from transplantation. Despite the different clinical guidelines on CAD screening in kidney transplant candidates that exist, up to today, there is no worldwide universal protocol. This review summarizes the key points of cardiovascular risk assessment in renal transplant candidates and faces the role of noninvasive cardiovascular imaging tools and the impact of coronary revascularization versus best medical therapy before kidney transplant on a patient's cardiovascular outcome.
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Affiliation(s)
- Giuseppe Vadalà
- Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Chiara Alaimo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Giancarlo Buccheri
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Luca Di Fazio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Leandro Di Caccamo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Vincenzo Sucato
- Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
| | - Manlio Cipriani
- Institute of Transplant and Highly Specialized Therapies (ISMETT) of Palermo, 90100 Palermo, Italy;
| | - Alfredo Ruggero Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90100 Palermo, Italy; (C.A.); (G.B.); (L.D.F.); (L.D.C.); (A.R.G.)
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Chu CD, Xia F, Du Y, Singh R, Tuot DS, Lamprea-Montealegre JA, Gualtieri R, Liao N, Kong SX, Williamson T, Shlipak MG, Estrella MM. Estimated Prevalence and Testing for Albuminuria in US Adults at Risk for Chronic Kidney Disease. JAMA Netw Open 2023; 6:e2326230. [PMID: 37498594 PMCID: PMC10375308 DOI: 10.1001/jamanetworkopen.2023.26230] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 07/28/2023] Open
Abstract
Importance Albuminuria testing is crucial for guiding evidence-based treatments to mitigate chronic kidney disease (CKD) progression and cardiovascular morbidity, but it is widely underutilized among persons with or at risk for CKD. Objective To estimate the extent of albuminuria underdetection from lack of testing and evaluate its association with CKD treatment in a large US cohort of patients with hypertension or diabetes. Design, Setting, and Participants This cohort study examined adults with hypertension or diabetes, using data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES) and the Optum deidentified electronic health record (EHR) data set of diverse US health care organizations. Analyses were conducted from October 31, 2022, to May 19, 2023. Main Outcomes and Measures Using NHANES as a nationally representative sample, a logistic regression model was developed to estimate albuminuria (urine albumin-creatinine ratio ≥30 mg/g). This model was then applied to active outpatients in the EHR from January 1, 2017, to December 31, 2018. The prevalence of albuminuria among those with and without albuminuria testing during this period was estimated. A multivariable logistic regression was used to examine associations between having albuminuria testing and CKD therapies within the subsequent year (prescription for angiotensin-converting enzyme inhibitor [ACEi] or angiotensin II receptor blocker [ARB], prescription for sodium-glucose cotransporter 2 inhibitor [SGLT2i], and blood pressure control to less than 130/80 mm Hg or less than 140/90 mm Hg on the latest outpatient measure). Results The total EHR study population included 192 108 patients (mean [SD] age, 60.3 [15.1] years; 185 589 [96.6%] with hypertension; 50 507 [26.2%] with diabetes; mean [SD] eGFR, 84 [21] mL/min/1.73 m2). There were 33 629 patients (17.5%) who had albuminuria testing; of whom 11 525 (34.3%) had albuminuria. Among 158 479 patients who were untested, the estimated albuminuria prevalence rate was 13.4% (n = 21 231). Thus, only 35.2% (11 525 of 32 756) of the projected population with albuminuria had been tested. Albuminuria testing was associated with higher adjusted odds of receiving ACEi or ARB treatment (OR, 2.39 [95% CI, 2.32-2.46]), SGLT2i treatment (OR, 8.22 [95% CI, 7.56-8.94]), and having blood pressure controlled to less than 140/90 mm Hg (OR, 1.20 [95% CI, 1.16-1.23]). Conclusions and Relevance In this cohort study of patients with hypertension or diabetes, it was estimated that approximately two-thirds of patients with albuminuria were undetected due to lack of testing. These results suggest that improving detection of CKD with albuminuria testing represents a substantial opportunity to optimize care delivery for reducing CKD progression and cardiovascular complications.
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Affiliation(s)
- Chi D. Chu
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
| | - Fang Xia
- Gilead Sciences Inc, Foster City, California
| | | | | | | | - Julio A. Lamprea-Montealegre
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
| | | | | | | | | | - Michael G. Shlipak
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
| | - Michelle M. Estrella
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
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Alkhatib L, Velez Diaz LA, Varma S, Chowdhary A, Bapat P, Pan H, Kukreja G, Palabindela P, Selvam SA, Kalra K. Lifestyle Modifications and Nutritional and Therapeutic Interventions in Delaying the Progression of Chronic Kidney Disease: A Review. Cureus 2023; 15:e34572. [PMID: 36874334 PMCID: PMC9981552 DOI: 10.7759/cureus.34572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Chronic kidney disease (CKD) is a debilitating progressive illness that affects more than 10% of the world's population. In this literature review, we discussed the roles of nutritional interventions, lifestyle modifications, hypertension (HTN) and diabetes mellitus (DM) control, and medications in delaying the progression of CKD. Walking, weight loss, low-protein diet (LPD), adherence to the alternate Mediterranean (aMed) diet, and Alternative Healthy Eating Index (AHEI)-2010 slow the progression of CKD. However, smoking and binge alcohol drinking increase the risk of CKD progression. In addition, hyperglycemia, altered lipid metabolism, low-grade inflammation, over-activation of the renin-angiotensin-aldosterone system (RAAS), and overhydration (OH) increase diabetic CKD progression. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend blood pressure (BP) control of <140/90 mmHg in patients without albuminuria and <130/80 mmHg in patients with albuminuria to prevent CKD progression. Medical therapies aim to target epigenetic alterations, fibrosis, and inflammation. Currently, RAAS blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, and finerenone are approved for managing CKD. In addition, according to the completed Study of Diabetic Nephropathy with Atrasentan (SONAR), atrasentan, an endothelin receptor antagonist (ERA), decreased the risk of renal events in diabetic CKD patients. However, ongoing trials are studying the role of other agents in slowing the progression of CKD.
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Affiliation(s)
- Lean Alkhatib
- Internal Medicine, Royal Medical Services, Amman, JOR
| | | | - Samyukta Varma
- Internal Medicine, Madurai Medical College, Madurai, IND
| | - Arsh Chowdhary
- Nephrology, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Prachi Bapat
- General Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, IND
| | - Hai Pan
- Pathology, Tianjin University of Chinese Medicine, Tianjin, CHN
| | - Geetika Kukreja
- Internal Medicine and Hematology/Oncology, Henry Ford Health System, Clinton Township, USA
| | | | | | - Kartik Kalra
- Nephrology, Geisinger Medical Center, Danville, USA
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Kopp W. Pathogenesis of (smoking-related) non-communicable diseases-Evidence for a common underlying pathophysiological pattern. Front Physiol 2022; 13:1037750. [PMID: 36589440 PMCID: PMC9798240 DOI: 10.3389/fphys.2022.1037750] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Non-communicable diseases, like diabetes, cardiovascular diseases, cancer, stroke, chronic obstructive pulmonary disease, osteoporosis, arthritis, Alzheimer's disease and other more are a leading cause of death in almost all countries. Lifestyle factors, especially poor diet and tobacco consumption, are considered to be the most important influencing factors in the development of these diseases. The Western diet has been shown to cause a significant distortion of normal physiology, characterized by dysregulation of the sympathetic nervous system, renin-angiotensin aldosterone system, and immune system, as well as disruption of physiological insulin and oxidant/antioxidant homeostasis, all of which play critical roles in the development of these diseases. This paper addresses the question of whether the development of smoking-related non-communicable diseases follows the same pathophysiological pattern. The evidence presented shows that exposure to cigarette smoke and/or nicotine causes the same complex dysregulation of physiology as described above, it further shows that the factors involved are strongly interrelated, and that all of these factors play a key role in the development of a broad spectrum of smoking-related diseases. Since not all smokers develop one or more of these diseases, it is proposed that this disruption of normal physiological balance represents a kind of pathogenetic "basic toolkit" for the potential development of a range of non-communicable diseases, and that the decision of whether and what disease will develop in an individual is determined by other, individual factors ("determinants"), such as the genome, epigenome, exposome, microbiome, and others. The common pathophysiological pattern underlying these diseases may provide an explanation for the often poorly understood links between non-communicable diseases and disease comorbidities. The proposed pathophysiological process offers new insights into the development of non-communicable diseases and may influence the direction of future research in both prevention and therapy.
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6
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Drugs of abuse and kidney toxicity. CURRENT OPINION IN TOXICOLOGY 2022. [DOI: 10.1016/j.cotox.2022.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Nath D, Shivasekar M. Role of Cigarette Smoking on Serum Angiotensin-Converting Enzyme and Its Association With Inflammation and Lipid Peroxidation. Cureus 2022; 14:e27857. [PMID: 36110446 PMCID: PMC9462588 DOI: 10.7759/cureus.27857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/05/2022] Open
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8
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Schrauben SJ, Apple BJ, Chang AR. Modifiable Lifestyle Behaviors and CKD Progression: A Narrative Review. KIDNEY360 2022; 3:752-778. [PMID: 35721622 DOI: 10.34067/kid.0003122021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022]
Abstract
Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current CKD management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis-dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption, and tobacco use on the progression of CKD, as measured by decline in GFR, incident ESKD, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow-up and small sample sizes, and meta-analyses were limited because the studies were sparse and had heterogeneous classifications of behaviors and/or referent groups and of CKD progression. Further research should be done to determine optimal methods to assess behaviors to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the effect of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, BP control, and survival.
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Affiliation(s)
- Sarah J Schrauben
- Renal, Electrolyte-Hypertension Division, Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Apple
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Alex R Chang
- Kidney Health Research Institute, Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
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Chen Y, Cao F, Xiao JP, Fang XY, Wang XR, Ding LH, Wang DG, Pan HF. Emerging role of air pollution in chronic kidney disease. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:52610-52624. [PMID: 34448134 DOI: 10.1007/s11356-021-16031-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
Chronic kidney disease (CKD), a global disease burden related to high rates of incidence and mortality, manifests as progressive and irretrievable nephron loss and decreased kidney regeneration capacity. Emerging studies have suggested that exposure to air pollution is closely relevant to increased risk of CKD, CKD progression and end-stage kidney disease (ESKD). Inhaled airborne particles may cause vascular injury, intraglomerular hypertension, or glomerulosclerosis through non-hemodynamic and hemodynamic factors with multiple complex interactions. The mechanisms linking air pollutants exposure to CKD include elevated blood pressure, worsening oxidative stress and inflammatory response, DNA damage and abnormal metabolic changes to aggravate kidney damage. In the present review, we will discuss the epidemiologic observations linking air pollutants exposure to the incidence and progression of CKD. Then, we elaborate the potential roles of several air pollutants including particulate matter and gaseous co-pollutants, environmental tobacco smoke, and gaseous heavy metals in its pathogenesis. Finally, this review outlines the latent effect of air pollution in ESKD patients undergoing dialysis or renal transplant, kidney cancer and other kidney diseases. The information obtained may be beneficial for further elucidating the pathogenesis of CKD and making proper preventive strategies for this disease.
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Affiliation(s)
- Yue Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, China
| | - Fan Cao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Jian-Ping Xiao
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xin-Yu Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, China
| | - Xue-Rong Wang
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Li-Hong Ding
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - De-Guang Wang
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, China.
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10
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Alfego D, Ennis J, Gillespie B, Lewis MJ, Montgomery E, Ferrè S, Vassalotti JA, Letovsky S. Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database. Diabetes Care 2021; 44:2025-2032. [PMID: 34353883 PMCID: PMC8740927 DOI: 10.2337/dc21-0723] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at risk for CKD. This study uses data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the U.S. RESEARCH DESIGN AND METHODS Patients with Laboratory Corporation of America Holdings (Labcorp) testing between 2013 and 2019 were defined as at risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) testing within the study year. RESULTS We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 years; 53.6% women): 16.2% had diabetes, 63.8% had hypertension, and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of patients with hypertension, and 41.4% of patients with both conditions. In a state-by-state comparison, annual testing rates ranged from 5 to 30%. The nationwide rate increased modestly each year between 2013 and 2018 (from 10.7% to 15.2%). CONCLUSIONS Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.
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Affiliation(s)
- David Alfego
- Laboratory Corporation of America Holdings, Burlington, NC
| | - Jennifer Ennis
- Laboratory Corporation of America Holdings, Burlington, NC.,Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, IL
| | - Barbara Gillespie
- Covance Inc., Princeton, NJ.,Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Joseph A Vassalotti
- National Kidney Foundation, New York, NY.,Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Nieto Iglesias J, Abellán-Huerta J, García López JC, Tárraga López PJ, Divisón-Garrote JA. Update on smoking. Alternatives for the management of patients with cardiovascular risk. HIPERTENSION Y RIESGO VASCULAR 2021; 38:178-185. [PMID: 33926853 DOI: 10.1016/j.hipert.2021.04.001] [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: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA.
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Affiliation(s)
- J Nieto Iglesias
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | - J Abellán-Huerta
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - J C García López
- Servicio de Cardiología, Hospital General Universitario de Albacete, Albacete, Spain
| | - P J Tárraga López
- Centro de Salud Zona 5, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - J A Divisón-Garrote
- Centro de Salud de Casas Ibáñez (Albacete), Universidad Católica San Antonio de Murcia (UCAM), Spain
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12
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Goraya N, Munoz-Maldonado Y, Simoni J, Wesson DE. Treatment of Chronic Kidney Disease-Related Metabolic Acidosis With Fruits and Vegetables Compared to NaHCO3 Yields More and Better Overall Health Outcomes and at Comparable Five-Year Cost. J Ren Nutr 2021; 31:239-247. [DOI: 10.1053/j.jrn.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/05/2020] [Accepted: 08/02/2020] [Indexed: 11/11/2022] Open
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13
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Chang HJ, Lin KR, Lin MT, Chang JL. Association between lifestyle factors and decreased kidney function in older adults: a community-based cross-sectional analysis of the Taipei City elderly health examination database. BMC Nephrol 2020; 21:169. [PMID: 32384928 PMCID: PMC7206742 DOI: 10.1186/s12882-020-01838-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Impaired kidney function is the hallmark of chronic kidney disease (CKD), and is associated with increased risk of all-cause mortality in the elderly. In the present cross-sectional population-based study, we aimed to evaluate the associations between lifestyle factors (exercise habit, alcohol consumption, smoking history, and betel nut chewing) and decreased kidney function. METHODS The data from the Taipei City Elderly Health Examination Database (2006 to 2012) were extracted. Associations between risk factors and reduced estimated Glomerular filtration rate (eGFR) were evaluated by regression and stratification analyses. RESULTS A total of 297,603 participants were included in the final analysis, and 29.7% of them had reduced eGFR. Smoking was significantly associated with an elevated risk of reduced eGFR. While, physical exercise conferred to a significantly decreased adjusted odds ratio (aOR) in reduced eGFR (regular exercise, aOR = 0.79; occasional exercise, aOR = 0.87). Furthermore, the protective effect of exercise habit against reduced eGFR was not affected by comorbid conditions, such as hypertension, diabetes, obesity, and cardiovascular disease. CONCLUSIONS Engaging in physical exercise was beneficially associated with reduced eGFR in older individuals. Longitudinal or prospective studies are warranted for confirmation and extrapolation of the current findings.
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Affiliation(s)
- Horng-Jinh Chang
- Department of Management Sciences, Tamkang University, No.151, Yingzhuan Rd., Tamsui Dist, New Taipei City, 25137, Taiwan, Republic of China
| | - Kuan-Reng Lin
- Department of Management Sciences, Tamkang University, No.151, Yingzhuan Rd., Tamsui Dist, New Taipei City, 25137, Taiwan, Republic of China.
| | - Meng-Te Lin
- Department of Pathology & Laboratory Medicine, Taoyuan Armed Forces General Hospital, No.168, Chung-Shing Rd., Long-Tang District, Taoyuan City, 325, Taiwan, Republic of China
| | - Junn-Liang Chang
- Department of Pathology & Laboratory Medicine, Taoyuan Armed Forces General Hospital, No.168, Chung-Shing Rd., Long-Tang District, Taoyuan City, 325, Taiwan, Republic of China.
- Biomedical Engineering Department, Ming Chuan University, Taoyuan City, 333, Taiwan.
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14
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Novel dietary and pharmacologic approaches for acid–base modulation to preserve kidney function and manage uremia. Curr Opin Nephrol Hypertens 2020; 29:39-48. [DOI: 10.1097/mnh.0000000000000568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Sedler AR, Mitchell CS. SemNet: Using Local Features to Navigate the Biomedical Concept Graph. Front Bioeng Biotechnol 2019; 7:156. [PMID: 31334227 PMCID: PMC6616276 DOI: 10.3389/fbioe.2019.00156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/10/2019] [Indexed: 01/12/2023] Open
Abstract
Literature-Based Discovery (LBD) aims to connect scientists across silos by assembling models of the literature to reveal previously hidden connections. Unfortunately, LBD systems have been unable to achieve user adoption on a large scale. This work develops opens source software in Python to convert a database of semantic predications of all of PubMed's 27.9 million indexed abstracts into a semantic inference network and biomedical concept graph in Neo4j. The developed software, called SemNet, queries a modified version of the publicly available SemMedDB and computes feature vectors on source-target pairs. Each unique United Medical Language System (UMLS) concept is represented as a node and each predication as an edge. Each node is assigned one of 132 node labels (e.g., Amino Acid, Peptide, or Protein (AAPP); Gene or Genome (GG); etc.) and each edge is labeled with one of 58 predications (e.g. treats, causes, inhibits, etc.). SemNet computes a single feature value for each metapath, or sequence of node types, between a source node and user-specified target node(s). Several different types of metapath-based features (count, degree weighted path count, and HeteSim metric) are computed and vectorized. SemNet employs an unsupervised learning algorithm for rank aggregation (ULARA) to rank identified source nodes that are most relevant to the user-specified target nodes(s). Statistical analysis of correlation among identified source nodes or resultant literature network features are used to identify patterns that can guide future research. Analysis of high residual nodes is used to compare and contrast SemNet rankings between different targets of interest. An example SemNet use case is presented to assess “the differential impact of smoking on cognition in males and females” using the following target nodes: nicotine, learning, memory, tetrahydrocannabinol (THC), cigarette smoke, X chromosome, and Y chromosome. Detailed rankings are discussed. Overall results suggest a hypothesis where smoking negatively impacts cognition to a greater extent in females, but smoking has stronger cardiovascular impacts in males. In summary, SemNet provides an adoptable method for efficient LBD of PubMed that extends beyond omics-only relationships to true multi-scalar connections that can provide actionable insight for predictive medicine, research prioritization, and clinical care.
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Affiliation(s)
- Andrew R Sedler
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA, United States
| | - Cassie S Mitchell
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA, United States
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Al-Tabakha MM, Alomar MJ, Awad MNG, Fahelelbom KMS. Smoking Patterns and Willingness to Quit: A Cross-sectional Study in Al Ain City, UAE. J Pharm Bioallied Sci 2019; 11:276-283. [PMID: 31555035 PMCID: PMC6662044 DOI: 10.4103/jpbs.jpbs_30_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Tobacco use is the major cause of preventable morbidity and mortality. The main objectives of this study were to identify smokers willing to participate in quit smoking campaigns using social media and to identify smoking habits of everyday smokers in Al Ain City, United Arab Emirates (UAE). Research Design and Methods: Everyday smokers from Al Ain city of the UAE were surveyed in different locations of the city including malls and specialized tobacco-selling shops. They were interviewed using a semi-structured survey and the information was recorded by one assessor. The information gathered included type and frequency of tobacco use, smoking history and habits, quitting history, desire to quit, and the preferred communication platform. Result: A total of 412 regular adult smokers were interviewed in which the majority (95%) reported first smoking at or before the age of 28 years. Participants were mainly UAE nationals (33.7%), Egyptians (14.1%), Syrians (12.9%), and Jordanians (10.9%). Manufactured cigarettes were the main form of tobacco consumption (59.5%), and smoking was mainly solitary (56.3%) and at home (26.3%) and coffee shops (24.9%). The majority of interviewed subjects (76.7%; 95% confidence interval [CI]: 72.4%–80.5%) expressed their interest to quit smoking in the future and 55.3% (95% CI: 50.5%–60.2%) were ready to get involved immediately in a smoking cessation program. Of those, 80.3% (95% CI: 74.6%–84.9%) preferred WhatsApp for receiving smoking cessation motivational education. Conclusion: The majority of smokers started at younger ages, which warrant the age of smoking restriction to be raised to 29 years instead of 18 years by the health authority. Everyday smokers were aware of the potentially hazardous effects of tobacco smoking and many were willing to accept help to quit smoking that involves the use of WhatsApp.
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Affiliation(s)
- Moawia M Al-Tabakha
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Muaed J Alomar
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Mariam N G Awad
- Pharmaceutical Sciences Department, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, UAE
| | - Khairi M S Fahelelbom
- Pharmaceutical Sciences Department, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, UAE
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Wesson DE, Kitzman HE. How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:839-842. [PMID: 29342009 DOI: 10.1097/acm.0000000000002140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served and are willing to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.
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Affiliation(s)
- Donald E Wesson
- D.E. Wesson is president, Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, Dallas, Texas. H.E. Kitzman is director of research and education, Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, Dallas, Texas; ORCID: http://orcid.org/0000-0003-1219-6189
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