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Jagannathan R, Anand S, Kondal D, Han J, Montez-Rath M, Ali MK, Patel SA, Singh K, Shivashankar R, Anjana RM, Gupta R, Mohan S, Chertow GM, Mohan V, Tandon N, Venkat Narayan K, Prabhakaran D. Prospective Study on Kidney Dysfunction Markers and Risk for Mortality among South Asians. Kidney Int Rep 2024; 9:2537-2545. [PMID: 39156172 PMCID: PMC11328749 DOI: 10.1016/j.ekir.2024.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Associations between markers of impaired kidney function and adverse outcomes among South Asians is understudied and could differ from existing data derived mostly from North American or European cohorts. Methods We conducted a prospective analysis of 9797 participants from the ongoing cardiometabolic risk reduction study in South Asia, India. We examined the associations between baseline spot urine albumin-to-creatinine (UACR) ratio and creatinine-based estimated glomerular filtration rate (eGFR) estimating equations with all-cause mortality using Cox proportional hazards regression, adjusting for baseline age, sex, diabetes, systolic blood pressure, tobacco, history of cardiovascular disease, and cholesterol. Additionally, we calculated population attributable fraction (PAF) for both markers. Results Over a median 7-year follow-up, with 66,909 person-years, 791 deaths occurred. At baseline, the weighted prevalence of UACR ≥ 30 mg/g and eGFRCKD-EPI 2009 <60 ml/min per 1.73 m2 was 6.6% and 1.6%, respectively. The risk for mortality was increased with higher UACR (10-30 hazard ratio [HR]: 1.6 [1.2-2.1]), 30-300 HR: 2.4 [1.8-3.1]), and ≥300 (HR: 6.0 [3.8-9.4] relative to UACR <10 mg/g). Risk for mortality was also higher with lower eGFRCKD-EPI 2009 (44-30; HR: 4.5 [2.5-8.3] and <30 HR: 7.0 [3.7-13.0], relative to 90-104 ml/min per 1.73 m2). PAF for mortality because of UACR ≥30 mg/g and eGFRCKD-EPI 2009 <45 ml/min per 1.73 m2 were 24.4% and 13.4%, respectively. Conclusion Single-time point assessment of UACR ≥30 mg/g or eGFRCKD-EPI 2009 <45 ml/min per 1.73 m2 portends higher mortality risk among urban South Asians. Because albuminuria is common and associated with accelerated decline in GFR, screening and targeted efforts to reduce albuminuria are warranted.
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Affiliation(s)
- Ram Jagannathan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
| | - Shuchi Anand
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dimple Kondal
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jialin Han
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Maria Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mohammed K. Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
| | - Shivani A. Patel
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
- Centre for Chronic Disease Control, New Delhi, India
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | | | - RM Anjana
- Madras Diabetes Research Foundation and Dr Mohan’s Diabetes Specialties Centre, Chennai, India
| | - Ruby Gupta
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Sailesh Mohan
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan’s Diabetes Specialties Centre, Chennai, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - K.M. Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- CoE-CARRS, Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
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Masrouri S, Tamehri Zadeh SS, Pishgahi M, Azizi F, Shapiro MD, Hadaegh F. Kidney function decline is associated with mortality events: over a decade of follow-up from Tehran Lipid and Glucose Study. J Nephrol 2024; 37:107-118. [PMID: 37665526 DOI: 10.1007/s40620-023-01756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND To investigate the association between estimated glomerular filtration rate (eGFR) change and mortality risk in a cohort from the Middle East and North Africa region with increasing chronic kidney disease burden. METHODS We included 2210 participants aged ≥ 50 years from the prospective cohort of the Tehran Lipid and Glucose Study. The interval for eGFR measurement was between the examinations in 2002-2005 to 2009-2011, and participants were followed through March 2018. Glomerular filtration rate was estimated from serum creatinine using the CKD-EPI creatinine equation. We assessed the association of rapid kidney function decline, (defined as annual eGFR decline ≥ 3 ml/min/1.73 m2 per year); ≥ 30% eGFR decline over six years; and certain drop in kidney function (≥ 25% eGFR decline plus drop in eGFR category) with mortality outcomes. RESULTS During a median follow-up of 14.3 years after recruitment, 315 all-cause and 112 cardiovascular disease deaths were recorded. The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause death for rapid kidney function decline, ≥ 30% decline in eGFR over 6 years, and drop in kidney function were 1.68 (1.24-2.27), 2.01 (1.46-2.78), and 1.49 (1.11-1.98), respectively. The HRs of all-cause death and for rapid kidney function decline in those without and with chronic kidney disease were 1.41 (1.03-1.91) and 3.38 (1.69-6.76), respectively. Similar findings were observed regarding cardiovascular disease-related and non-cardiovascular disease-related mortality. CONCLUSIONS Estimated GFR decline is associated with an increased mortality risk, indicating its ability to provide additional prognostic information beyond traditional risk predictors in the general population.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Seyed Saeed Tamehri Zadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Mehdi Pishgahi
- Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran.
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Kuchi Bhotla H, Meyyazhagan A, Pushparaj K, Pappuswamy M, Chaudhary A, Arumugam VA, Balasubramanian B, Ragu Varman D, Orlacchio A, Rengasamy KRR. Prevalence of Cardiovascular Diseases in South Asians: Scrutinizing Traditional Risk Factors and Newly Recognized Risk Factors Sarcopenia and Osteopenia/Osteoporosis. Curr Probl Cardiol 2024; 49:102071. [PMID: 37690535 DOI: 10.1016/j.cpcardiol.2023.102071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
One of the primary reasons for complications and death worldwide are cardiovascular diseases (CVDs), with a death toll of approximately 18 million per year. CVDs include cardiomyopathy, hypertension, ischemic heart disease, coronary heart disease, myocardial infarction, heart attack, hearth failure, etc. Over 80% of the CVD mortality is recorded from lower and middle-income countries. Records from the past decade have highlighted the increase of CVDs among the South Asian populations, and the prime purpose of the review is to jot down the reasons for the steep spike in CVDs. Studies analyzing the causative factors for the increase of CVDs in South Asians are still to be verified. Apart from known predisposing and lifestyle factors, other emerging risk factors associated with CVDs, namely the musculoskeletal diseases sarcopenia and osteopenia, should be tracked to tackle research gaps in upcoming analyses. This requires loads of scientific efforts. With proper monitoring, the raising alarm that the CVD burden generates can be reduced. This review discusses the already established signs and recognizes important clues to the emerging etiology of CVDs in the Asian population and prevention measures to keep it at bay.
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Affiliation(s)
- Haripriya Kuchi Bhotla
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Arun Meyyazhagan
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India; Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Karthika Pushparaj
- Department of Zoology, School of Biosciences, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India
| | - Manikantan Pappuswamy
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Aditi Chaudhary
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Vijaya Anand Arumugam
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | | | - Durairaj Ragu Varman
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Antonio Orlacchio
- Laboratorio di Neurogenetica, Centro Europeo di Ricerca sul Cervello (CERC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy; Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Kannan R R Rengasamy
- Laboratory of Natural Products and Medicinal Chemistry (LNPMC), Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai, India.
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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Ling S, Xu G, Zaccardi F, Khunti K, Brunskill NJ. Kidney Function and Long-Term Risk of End-Stage Kidney Disease and Mortality in a Multiethnic Population. Kidney Int Rep 2023; 8:1761-1771. [PMID: 37705903 PMCID: PMC10496088 DOI: 10.1016/j.ekir.2023.06.014] [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: 01/19/2023] [Revised: 05/12/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Contemporary differences between South Asian and White ethnicities in the incidence of end-stage kidney disease (ESKD) and mortality are poorly described. Methods Data for all South Asian patients who had an estimated glomerular filtration rate (eGFR) measure after January 1, 2006, and 1 million randomly selected participants of other ethnicities were extracted from the Clinical Practice Research Datalink (CPRD). All participants were followed-up with from index date until ESKD, all-cause mortality, or end of study. All-cause mortality rate and ESKD incidence rate by age were described among Whites and South Asians, and adjusted hazard ratios (HRs) of these 2 outcomes by baseline eGFR estimated using Cox proportional hazard model. Results A total of 40,888 South Asians and 236,634 Whites were followed for a median of 5.3 and 9.4 years for ESKD incidence and mortality outcomes, respectively. All-cause mortality rates were higher among Whites than South Asians; South Asian women aged between 70 and 85 years had a slightly higher ESKD incidence rate compared to their White counterparts. Compared to Whites with a baseline eGFR of 90 ml/min per 1.73 m2, adjusted HRs for all-cause mortality were significantly lower among South Asians than Whites; however, adjusted HRs for ESKD incidence by baseline eGFR were similar in both ethnicities. Calculating South Asian eGFRs using an ethnicity-specific equation had no impact on the results. Conclusions South Asians experience lower mortality than Whites but not substantially higher rates of ESKD. Further research is warranted to better understand the reasons for these ethnic differences and possible impacts on chronic kidney disease (CKD) service delivery and patient outcomes.
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Affiliation(s)
- Suping Ling
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester, UK
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, LSHTM, London, UK
| | - Gang Xu
- Department of Nephrology, Leicester General Hospital, Gwendolen Rd, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester, UK
| | - Nigel J. Brunskill
- Department of Nephrology, Leicester General Hospital, Gwendolen Rd, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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6
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Smit LCM, Bots ML, van der Leeuw J, Damen JAAG, Blankestijn PJ, Verhaar MC, Vernooij RWM. One Heartbeat Away from a Prediction Model for Cardiovascular Diseases in Patients with Chronic Kidney Disease: A Systematic Review. Cardiorenal Med 2023; 13:109-142. [PMID: 36806550 PMCID: PMC10472924 DOI: 10.1159/000529791] [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: 07/26/2022] [Accepted: 01/07/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) have a high risk of cardiovascular disease (CVD). Prediction models, combining clinical and laboratory characteristics, are commonly used to estimate an individual's CVD risk. However, these models are not specifically developed for patients with CKD and may therefore be less accurate. In this review, we aim to give an overview of CVD prognostic studies available, and their methodological quality, specifically for patients with CKD. METHODS MEDLINE was searched for papers reporting CVD prognostic studies in patients with CKD published between 2012 and 2021. Characteristics regarding patients, study design, outcome measurement, and prediction models were compared between included studies. The risk of bias of studies reporting on prognostic factors or the development/validation of a prediction model was assessed with, respectively, the QUIPS and PROBAST tool. RESULTS In total, 134 studies were included, of which 123 studies tested the incremental value of one or more predictors to existing models or common risk factors, while only 11 studies reported on the development or validation of a prediction model. Substantial heterogeneity in cohort and study characteristics, such as sample size, event rate, and definition of outcome measurements, was observed across studies. The most common predictors were age (87%), sex (75%), diabetes (70%), and estimated glomerular filtration rate (69%). Most of the studies on prognostic factors have methodological shortcomings, mostly due to a lack of reporting on clinical and methodological information. Of the 11 studies on prediction models, six developed and internally validated a model and four externally validated existing or developed models. Only one study on prognostic models showed a low risk of bias and high applicability. CONCLUSION A large quantity of prognostic studies has been published, yet their usefulness remains unclear due to incomplete presentation, and lack of external validation of prognostic models. Our review can be used to select the most appropriate prognostic model depending on the patient population, outcome, and risk of bias. Future collaborative efforts should aim at improving existing models by externally validating them, evaluating the addition of new predictors, and assessment of the clinical impact. REGISTRATION We have registered the protocol of our systematic review on PROSPERO (CRD42021228043).
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Affiliation(s)
- Leanne C M Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joep van der Leeuw
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland Hospital, Rotterdam, The Netherlands
| | - Johanna A A G Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robin W M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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Chen DC, Lees JS, Lu K, Scherzer R, Rutherford E, Mark PB, Kanaya AM, Shlipak MG, Estrella MM. Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank. J Am Heart Assoc 2023; 12:e027079. [PMID: 36695320 PMCID: PMC9973614 DOI: 10.1161/jaha.122.027079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/09/2022] [Indexed: 01/26/2023]
Abstract
Background South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine- rather than cystatin C-based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Methods and Results Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m2) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55-3.65]) and incident HF (sub-HR [sHR], 1.87 [95% CI, 1.09-3.22]) versus the eGFRcys ≥90 category; the creatinine-based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine-based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56-9.31]), incident HF (sHR, 4.96 [95% CI, 2.21-11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14-4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45-3.51]). Conclusions Among South Asian individuals, cystatin C identified a high-risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate-based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.
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Affiliation(s)
- Debbie C. Chen
- Division of Nephrology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Genentech, Inc.South San FranciscoCA
| | - Jennifer S. Lees
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Kaiwei Lu
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
| | - Rebecca Scherzer
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Renal Unit, Mountainhall Treatment Centre, NHS Dumfries and GallowayDumfriesUnited Kingdom
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Alka M. Kanaya
- Department Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCA
- Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
| | - Michael G. Shlipak
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
- Department Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCA
| | - Michelle M. Estrella
- Division of Nephrology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
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Gupta K, Al Rifai M, Hussain A, Minhas AMK, Patel J, Kalra D, Samad Z, Virani SS. South Asian ethnicity: What can we do to make this risk enhancer a risk equivalent? Prog Cardiovasc Dis 2022; 75:21-32. [PMID: 36279943 DOI: 10.1016/j.pcad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
South Asians account for around 25% of the global population and are the fastest-growing ethnicity in the US. This population has an increasing burden of atherosclerotic cardiovascular disease (ASCVD) which is also seen in the diaspora. Current risk prediction equations underestimate this risk and consider the South Asian ethnicity as a risk-enhancer among those with borderline-intermediate risk. In this review, we discuss why the South Asian population is at a higher risk of ASCVD and strategies to mitigate this increased risk.
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Affiliation(s)
- Kartik Gupta
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Mahmoud Al Rifai
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aliza Hussain
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaideep Patel
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Dinesh Kalra
- Rudd Heart & Lung Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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9
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Jagannathan R, Anand S, Hogan J, Mandal S, Kondal D, Gupta R, Patel SA, Anjana RM, Deepa M, Ali MK, Mohan V, Tandon N, Narayan KV, Prabhakaran D. Estimated glomerular filtration rate trajectories in south Asians: Findings from the cardiometabolic risk reduction in south Asia study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 6:100062. [PMID: 37383342 PMCID: PMC10305991 DOI: 10.1016/j.lansea.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Few longitudinal data characterize kidney function decline among South Asians, one of the world's largest population groups. We aimed to identify estimated glomerular filtration rate (eGFR) trajectories in a population-based cohort from India and assess predictors of rapid kidney function decline. Methods We used 6-year longitudinal data from participants of a population-representative study from Delhi and Chennai, India who had at least two serum creatinine measures and baseline CKD-EPI eGFR> 60 ml/min/1.73m2 (n=7779). We used latent class trajectory modeling to identify patterns of kidney function trajectory (CKD-EPI eGFR) over time. In models accounting for age, sex, education, and city, we tested the association between 15 hypothesized risk factors and rapid kidney function decline. Findings Baseline mean eGFR was 108 (SD 16); median eGFR was 110 [IQR: 99-119] ml/min/1.73m2. Latent class trajectory modeling and functional characterization identified three distinct patterns of eGFR: class-1 (no decline; 58%) annual eGFR change 0.2 [0.1, 0.3]; class-2 (slow decline; 40%) annual eGFR change -0.2 [-0.4, -0.1], and class-3 (rapid decline; 2%) annual eGFR change -2.7 [-3.4, -2.0] ml/min/1.73m2. Albuminuria (>30 mg/g) was associated with rapid eGFR decline (OR for class-3 vs class-1: 5.1 [95% CI: 3.2; 7.9]; class-3 vs. class-2: 4.3 [95% CI:2.7; 6.6]). Other risk factors including self-reported diabetes, cardiovascular disease, peripheral arterial disease, and metabolic biomarkers such as HbA1c and systolic blood pressure were associated with rapid eGFR decline phenotype but potential 'non-traditional' risk factors such as manual labor or household water sources were not. Interpretation Although mean and median eGFRs in our population-based cohort were higher than those reported in European cohorts, we found that a sizeable number of adults residing in urban India are experiencing rapid kidney function decline. Early and aggressive risk modification among persons with albuminuria could improve kidney health among South Asians. Funding The CARRS study has been funded with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, under Contract No. HHSN2682009900026C and P01HL154996. Dr. Anand was supported by NIDDK K23DK101826 and R01DK127138.
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Affiliation(s)
- Ram Jagannathan
- Emory University School of Medicine, Division of Hospital Medicine, Atlanta, GA, United States
| | - Shuchi Anand
- Centers for Chronic Disease Control, India
- Stanford University School of Medicine, Division of Nephrology
| | - Julien Hogan
- Department of Surgery, Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Siddhartha Mandal
- Centers for Chronic Disease Control, India
- Public Health Foundation of India, New Delhi, India
| | | | - Ruby Gupta
- Centers for Chronic Disease Control, India
| | - Shivani A. Patel
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Ranjit Mohan Anjana
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohan Deepa
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Madras Diabetes Research Foundation, Chennai, India
| | - Viswanathan Mohan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Delhi, India
| | - K.M. Venkat Narayan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Dorairaj Prabhakaran
- Centers for Chronic Disease Control, India
- Public Health Foundation of India, New Delhi, India
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Park S, Yum Y, Cha JJ, Joo HJ, Park JH, Hong SJ, Yu CW, Lim DS. Prevalence and Clinical Impact of Electrocardiographic Abnormalities in Patients with Chronic Kidney Disease. J Clin Med 2022; 11:jcm11185414. [PMID: 36143060 PMCID: PMC9506179 DOI: 10.3390/jcm11185414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is a strong risk factor for cardiovascular disease. An electrocardiogram (ECG) is a basic test for screening cardiovascular disease. However, the impact of ECG abnormalities on cardiovascular prognosis in patients with CKD is largely unknown. A total of 2442 patients with CKD (stages 3−5) who underwent ECG between 2013 and 2015 were selected from the electronic health record database of the Korea University Anam Hospital. ECG abnormalities were defined using the Minnesota classification. The five-year major adverse cerebrocardiovascular event (MACCE), the composite of death, myocardial infarction (MI), and stroke were analyzed. The five-year incidences for MACCE were 27.7%, 20.8%, and 17.2% in patients with no, minor, and major ECG abnormality (p < 0.01). Kaplan−Meier curves also showed the highest incidence of MI, death, and MACCE in patients with major ECG abnormality. Multivariable Cox regression analysis revealed age, sex, diabetes, CKD stage, hsCRP, antipsychotic use, and major ECG abnormality as independent risk predictors for MACCE (adjusted HR of major ECG abnormality: 1.39, 95% CI: 1.09−1.76, p < 01). Among the detailed ECG diagnoses, sinus tachycardia, myocardial ischemia, atrial premature complex, and right axis deviation were proposed as important ECG diagnoses. The accuracy of cardiovascular risk stratification was improved when the ECG results were added to the conventional SCORE model (net reclassification index 0.07). ECG helps to predict future cerebrocardiovascular events in CKD patients. ECG diagnosis can be useful for cardiovascular risk evaluation in CKD patients when applied in addition to the conventional risk stratification model.
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Affiliation(s)
- Sejun Park
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Korea
| | - Yunjin Yum
- Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea
| | - Jung-Joon Cha
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Hyung Joon Joo
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
- Department of Medical Informatics, Korea University College of Medicine, Seoul 02841, Korea
- Research Institute for Medical Bigdata Science, College of Medicine, Korea University, Seoul 02708, Korea
- Correspondence: ; Tel.: +82-2-920-6411
| | - Jae Hyoung Park
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Soon Jun Hong
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Cheol Woong Yu
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Do-Sun Lim
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
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11
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Aiumtrakul N, Kittithaworn A, Supasyndh O, Krittayaphong R, Phrommintikul A, Satirapoj B. Prediction of cardiovascular outcome by estimated glomerular filtration rate among high-risk patients: a Thai nationwide cohort study. Clin Exp Nephrol 2022; 26:1180-1193. [PMID: 35999302 DOI: 10.1007/s10157-022-02262-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Decline of estimated glomerular filtration rate (eGFR) is associated with increased cardiovascular (CV) morbidity and mortality, but the predictive value of different eGFR on CV outcomes is limited in Southeast Asian populations. AIMS We aimed to stratify CV outcomes according to renal function among Thai patients with high atherosclerosis risk. METHODS We performed a secondary analysis in a 5-year national cohort entitled "CORE-Thailand study." Subjects were classified in 6 groups according to baseline kidney function: group I, eGFR ≥ 90; group II, eGFR 60-89; group IIIa, eGFR 45-59; group IIIb, eGFR 30-44; group IV, eGFR 15-29; group V, eGFR < 15 ml/min/1.73 m2 or receiving renal replacement therapy. The primary outcome was 4-point major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, CV mortality, hospitalization for heart failure, nonfatal myocardial infarction, and nonfatal stroke. RESULTS A total of 6376 subjects (3467 men and 2909 women) were categorized in 6 groups. After adjusting covariates in the Cox proportional hazards model, compared to group I, subjects in groups II-V had a 1.65-fold, 2.17-fold, 2.67-fold, 4.24-fold, and 4.87-fold risk for 4-point MACE, respectively, with statistical significance at P < 0.05 in all groups. Kaplan-Meier analysis illustrated stepwise lower survivals from 4-point MACE following the groups with lower baseline eGFR (log-rank test with P < 0.001). All secondary outcomes showed similar trends as the primary outcome, except nonfatal stroke. CONCLUSION Lower baseline kidney function was independently associated with increased risk of CV events and all-cause mortality in Thai populations at high CV risk.
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Affiliation(s)
- Noppawit Aiumtrakul
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | - Annop Kittithaworn
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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12
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West M, Kirby A, Stewart RA, Blankenberg S, Sullivan D, White HD, Hunt D, Marschner I, Janus E, Kritharides L, Watts GF, Simes J, Tonkin AM. Circulating Cystatin C Is an Independent Risk Marker for Cardiovascular Outcomes, Development of Renal Impairment, and Long-Term Mortality in Patients With Stable Coronary Heart Disease: The LIPID Study. J Am Heart Assoc 2022; 11:e020745. [PMID: 35179040 PMCID: PMC9075058 DOI: 10.1161/jaha.121.020745] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Elevated plasma cystatin C levels reflect reduced renal function and increased cardiovascular risk. Less is known about whether the increased risk persists long‐term or is independent of renal function and other important biomarkers. Methods and Results Cystatin C and other biomarkers were measured at baseline (in 7863 patients) and 1 year later (in 6106 patients) in participants in the LIPID (Long‐Term Intervention with Pravastatin in Ischemic Disease) study, who had a previous acute coronary syndrome. Outcomes were ascertained during the study (median follow‐up, 6 years) and long‐term (median follow‐up, 16 years). Glomerular filtration rate (GFR) was estimated using Chronic Kidney Disease Epidemiology Collaboration equations (first GFR‐creatinine, then GFR‐creatinine‐cystatin C). Over 6 years, in fully adjusted multivariable time‐to‐event models, with respect to the primary end point of coronary heart disease mortality or nonfatal myocardial infarction, for comparison of Quartile 4 versus 1 of baseline cystatin C, the hazard ratio was 1.37 (95% CI, 1.07–1.74; P=0.01), and for major cardiovascular events was 1.47 (95% CI, 1.19–1.82; P<0.001). Over 16 years, the association of baseline cystatin C with coronary heart disease, cardiovascular, and all‐cause mortality persisted (each P<0.001) and remained significant after adjustment for estimated GFR‐creatinine‐cystatin C. Cystatin C also predicted the development of chronic kidney disease for 6 years (odds ratio, 6.61; 95% CI, 4.28–10.20) independently of estimated GFR‐creatinine and other risk factors. However, this association was no longer significant after adjustment for estimated GFR‐creatinine‐cystatin C. Conclusions Cystatin C independently predicted major cardiovascular events, development of chronic kidney disease, and cardiovascular and all‐cause mortality. Prediction of long‐term mortality was independent of improved estimation of GFR. Registration URL: https://anzctr.org.au; Unique identifier: ACTRN12616000535471.
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Affiliation(s)
- Malcolm West
- Department of MedicineUniversity of QueenslandBrisbaneAustralia
| | - Adrienne Kirby
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Ralph A. Stewart
- Green Lane Cardiovascular ServiceAuckland City HospitalUniversity of AucklandAucklandNew Zealand
| | | | - David Sullivan
- Department of Chemical PathologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Harvey D. White
- Green Lane Cardiovascular ServiceAuckland City HospitalUniversity of AucklandAucklandNew Zealand
| | - David Hunt
- Cardiology DepartmentRoyal Melbourne HospitalMelbourneAustralia
| | - Ian Marschner
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Edward Janus
- Department of MedicineWestern Health Chronic Disease AllianceWestern HealthMelbourne Medical SchoolUniversity of MelbourneMelbourneAustralia
| | - Leonard Kritharides
- Department of CardiologyConcord Repatriation General HospitalSydney Local Health DistrictSydneyAustralia
- ANZAC Medical Research InstituteFaculty of MedicineUniversity of SydneySydneyAustralia
| | - Gerald F. Watts
- School of MedicineFaculty of Health and Medical SciencesUniversity of Western AustraliaPerthAustralia
| | - John Simes
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
| | - Andrew M. Tonkin
- School of Public Health and Preventive MedicineMonash UniversityPerthAustralia
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13
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Prasad GVR, Bhamidi V. Managing cardiovascular disease risk in South Asian kidney transplant recipients. World J Transplant 2021; 11:147-160. [PMID: 34164291 PMCID: PMC8218347 DOI: 10.5500/wjt.v11.i6.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.
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Affiliation(s)
- G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
| | - Vaishnavi Bhamidi
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
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14
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Unruh ML, Arzhan S, Feldman HI, Looker HC, Nelson RG, Faber T, Johnson D, Son-Stone L, Pankratz VS, Myaskovsky L, Shah VO. American Indian chronic Renal insufficiency cohort study (AI-CRIC study). BMC Nephrol 2020; 21:291. [PMID: 32698776 PMCID: PMC7376925 DOI: 10.1186/s12882-020-01954-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an increasing epidemic globally that is associated with adverse health outcomes including end stage kidney disease (ESKD), cardiovascular disease (CVD), and death. American Indians (AIs) have a higher prevalence of CKD than most other racial/ethnic groups, due in part to a high prevalence of type 2 diabetes. Other genetic and environmental factors not yet identified may also contribute to the disproportionate burden of CKD in AIs. METHOD We will establish 3 clinical centers to recruit AIs from the Southwest United States (US) to expand the Chronic Renal Insufficiency Cohort (CRIC) study. We will follow the current CRIC protocol for kidney and cardiovascular measures and outcomes, which include ambulatory monitoring of kidney function and the use of mobile health technologies for CVD sub-phenotyping, and compare the outcomes in AIs with those in other racial/ethnic groups in CRIC. DISCUSSION AI-CRIC will identify the role of various risk factors for rapid loss of kidney function among AIs of the Southwest US. In addition, to better understand the natural history of CKD and CVD in this high-risk population, we will identify unique risk factors for CKD and CVD progression in AIs. We will also compare event rates and risk factors for kidney and cardiovascular events in AIs with the other populations represented in CRIC.
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Affiliation(s)
- Mark L Unruh
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Soraya Arzhan
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | | | | | | | | | | | | | - Vernon S Pankratz
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA.
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