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Weight N, Moledina S, Ullah M, Wijeysundera HC, Davies S, Chew NWS, Lawson C, Khan SU, Gale CP, Rashid M, Mamas MA. Impact of Chronic Kidney Disease on the Processes of Care and Long-Term Mortality of Non-ST-Segment-Elevation Myocardial Infarction: A Nationwide Cohort Study and Long-Term Follow-Up. J Am Heart Assoc 2024:e032671. [PMID: 39119984 DOI: 10.1161/jaha.123.032671] [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: 01/20/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND A growing population of patients with chronic kidney disease (CKD) presents with non-ST-segment-elevation myocardial infarction, although little is known about their longer-term mortality. METHODS AND RESULTS Using the MINAP (Myocardial Ischaemia National Audit Project) registry, linked to Office for National Statistics mortality data, we analyzed 363 559 UK patients with non-ST-segment-elevation myocardial infarction, with or without CKD. Cox regression models were fitted, adjusting for baseline demographics. Compared with patients without CKD, patients with CKD were less frequently prescribed P2Y12 inhibitors (89% versus 86%, P<0.001) less likely to undergo invasive angiography (67% versus 41%, P<0.001) or percutaneous coronary intervention (41% versus 25%, P<0.001), and were less often referred to cardiac rehabilitation (80% versus 66%, P<0.001). Following non-ST-segment-elevation myocardial infarction, patients with CKD had higher risk of 30-day (adjusted hazard ratio [HR], 1.24 [95% CI, 1.20-1.29], 1-year 1.47 [95% CI, 1.44-1.51]) and 5-year mortality 1.55 (95% CI, 1.53-1.58) than patients without CKD (all P<0.001). Risk of mortality over the entire study period was highest in CKD Stage 5 (HR, 2.98 [95% CI, 2.87-3.10]), even after excluding mortality ≤30 days (HR, 3.03 [95% CI, 2.90-3.17]) (P<0.001). There was no significant difference in proportion of deaths attributable to cardiovascular disease at 30 days (CKD; 76% versus no CKD; 76%), or 1 -year (CKD; 62% versus no CKD; 62%). CONCLUSIONS Patients with CKD were significantly less likely to receive invasive investigation or undergo percutaneous coronary intervention and had significantly higher risk of short- and longer-term mortality. Risk of mortality increased with reducing CKD stage. Cardiovascular disease was the main cause of mortality in patients with CKD, but at comparable rates to the general population with non-ST-segment-elevation myocardial infarction.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
| | - Mohsin Ullah
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre University of Toronto, ICES Toronto Toronto Canada
| | - Simon Davies
- Department of Renal Medicine, School of Medicine Keele University Keele Staffordshire United Kingdom
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre National University Health System Singapore
| | - Claire Lawson
- Department of Cardiovascular Sciences University of Leicester United Kingdom
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston Texas USA
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
- Leeds Institute of Data Analytics University of Leeds United Kingdom
- Department of Cardiology Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
- Department of Cardiovascular Sciences Glenfield Hospital, University Hospitals of Leicester NHS Trust Leicester United Kingdom
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre Birmingham United Kingdom
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Basso A, Baldini P, Bertoldi G, Driussi G, Caputo I, Bettin E, Cacciapuoti M, Calò LA. Oxidative stress reduction by icodextrin-based glucose-free solutions in peritoneal dialysis: Support for new promising approaches. Artif Organs 2024. [PMID: 38822597 DOI: 10.1111/aor.14801] [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: 02/03/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Oxidative stress (OxSt) and inflammation are common in CKD and are known CV and mortality risk factors. In peritoneal dialysis (PD) OxSt and Inflammation even increase due to the use of glucose-based solutions. PATIENTS AND METHODS This study analyzed in 15 PD patients the effect of 3 and 6 months of treatment with icodextrin-based glucose-free solutions on OxSt and inflammation, evaluating p22phox protein expression (Western blot), NADPH oxidase subunit, essential for OxSt activation, MYPT-1 phosphorylation state, marker of RhoA/Rho kinase pathway (ROCK) activity, involved in the induction of OxSt (Western blot) and Malondialdehyde (MDA) production (fluorimetric assay). Interleukin (IL)-6 blood level (chemiluminescence assay) has been measured and used as a marker of inflammation. RESULTS p22phox protein expression, MYPT 1 phosphorylation, and MDA were reduced after 3 months from the start of icodextrin (1.28 ± 0.18 d.u. vs. 1.50 ± 0.19, p = 0.049; 0.89 ± 0.03 vs. 0.98 ± 0.03, p = 0.004; 4.20 ± 0.18 nmol/mL vs. 4.84 ± 0.32 nmol/mL, p = 0.045, respectively). In a subgroup of 9 patients who continued the treatment up to 6 months, MYPT-1 phosphorylation was further reduced at 6 months compared to baseline (0.84 ± 0.06 vs. 0.99 ± 0.04, p = 0.043), while p22phox protein expression was reduced only at 6 months versus baseline (1.03 ± 0.05 vs. 1.68 ± 0.22, p = 0.021). In this subgroup, MDA was reduced at 6 months versus baseline (4.03 ± 0.24 nmol/mL vs. 4.68 ± 0,32, p = 0.024) and also versus 3 months (4.03 ± 0.24 vs. 4.35 ± 0.21, p = 0.008). IL-6 level although reduced both at 3 and 6 months, did not reach statistical significance. CONCLUSIONS The reduction of OxSt with icodextrin-based PD solutions, although obtained in a small patients cohort and in a limited time duration study, strongly supports the rationale of using osmo-metabolic agents-based fluids replacing glucose-based fluids. Ongoing studies with these agents will provide information regarding preservation of peritoneal membrane integrity, residual renal function, and reduction of CVD risk factors such as OxSt and inflammation.
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Affiliation(s)
- Anna Basso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Paola Baldini
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Giovanni Bertoldi
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Giulia Driussi
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Ilaria Caputo
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Elisabetta Bettin
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Martina Cacciapuoti
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
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3
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Tian Z, Bergmann K, Kaufeld J, Schmidt-Ott K, Melk A, Schmidt BM. Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis. Transplant Direct 2024; 10:e1647. [PMID: 38769973 PMCID: PMC11104731 DOI: 10.1097/txd.0000000000001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/22/2024] Open
Abstract
Background Left ventricular hypertrophy (LVH) in patients with end stage renal disease undergoing renal replacement is linked to an increased risk for cardiovascular diseases. Dialysis does not completely prevent or correct this abnormality, and the evidence for kidney transplantation (KT) varies. This analysis aims to explore the relationship between KT and LVH. Methods MEDLINE and Scopus were systematically searched in October 2023. All cross-sectional and longitudinal studies that fulfilled our inclusion criteria were included. Outcome was left ventricular mass index (LVMI) changes. We conducted a meta-analysis using a random effects model. Meta-regression was applied to examine the LVMI changes dependent on various covariates. Sensitivity analysis was used to handle outlying or influential studies and address publication bias. Results From 7416 records, 46 studies met the inclusion criteria with 4122 included participants in total. Longitudinal studies demonstrated an improvement of LVMI after KT -0.44 g/m2 (-0.60 to -0.28). Blood pressure was identified as a predictor of LVMI change. A younger age at the time of KT and well-controlled anemia were also associated with regression of LVH. In studies longitudinally comparing patients on dialysis and renal transplant recipients, no difference was detected -0.09 g/m2 (-0.33 to 0.16). Meta-regression using changes of systolic blood pressure as a covariate showed an association between higher blood pressure and an increase in LVMI, regardless of the modality of renal replacement treatment. Conclusions In conclusion, our results indicated a potential cardiovascular benefit, defined as the regression of LVH, after KT. This benefit was primarily attributed to improved blood pressure control rather than the transplantation itself.
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Affiliation(s)
- Zhejia Tian
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Kai Bergmann
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Kai Schmidt-Ott
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Bernhard M.W. Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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4
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Rathod ML, Aw WY, Huang S, Lu J, Doherty EL, Whithworth CP, Xi G, Roy-Chaudhury P, Polacheck WJ. Donor-Derived Engineered Microvessels for Cardiovascular Risk Stratification of Patients with Kidney Failure. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2307901. [PMID: 38185718 PMCID: PMC11168887 DOI: 10.1002/smll.202307901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/28/2023] [Indexed: 01/09/2024]
Abstract
Cardiovascular disease is the cause of death in ≈50% of hemodialysis patients. Accumulation of uremic solutes in systemic circulation is thought to be a key driver of the endothelial dysfunction that underlies elevated cardiovascular events. A challenge in understanding the mechanisms relating chronic kidney disease to cardiovascular disease is the lack of in vitro models that allow screening of the effects of the uremic environment on the endothelium. Here, a method is described for microfabrication of human blood vessels from donor cells and perfused with donor serum. The resulting donor-derived microvessels are used to quantify vascular permeability, a hallmark of endothelial dysfunction, in response to serum spiked with pathophysiological levels of indoxyl sulfate, and in response to serum from patients with chronic kidney disease and from uremic pigs. The uremic environment has pronounced effects on microvascular integrity as demonstrated by irregular cell-cell junctions and increased permeability in comparison to cell culture media and healthy serum. Moreover, the engineered microvessels demonstrate an increase in sensitivity compared to traditional 2D assays. Thus, the devices and the methods presented here have the potential to be utilized to risk stratify and to direct personalized treatments for patients with chronic kidney disease.
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Affiliation(s)
- Mitesh L. Rathod
- Joint Department of Biomedical Engineering, University of
North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and
Raleigh, NC, United States of America
| | - Wen Yih Aw
- Joint Department of Biomedical Engineering, University of
North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and
Raleigh, NC, United States of America
| | - Stephanie Huang
- Joint Department of Biomedical Engineering, University of
North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and
Raleigh, NC, United States of America
| | - Jingming Lu
- Joint Department of Biomedical Engineering, University of
North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and
Raleigh, NC, United States of America
| | - Elizabeth L. Doherty
- Joint Department of Biomedical Engineering, University of
North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and
Raleigh, NC, United States of America
| | - Chloe P. Whithworth
- Department of Genetics, University of North Carolina at
Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Gang Xi
- UNC Kidney Centre, University of North Carolina at Chapel
Hill, NC, United States of America
| | - Prabir Roy-Chaudhury
- UNC Kidney Centre, University of North Carolina at Chapel
Hill, NC, United States of America
- WG (Bill Hefner) Salisbury VA Medical Center, United States
of America
| | - William J. Polacheck
- Joint Department of Biomedical Engineering, University of
North Carolina at Chapel Hill and North Carolina State University, Chapel Hill and
Raleigh, NC, United States of America
- Department of Cell Biology and Physiology, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- McAllister Heart Institute, University of North Carolina at
Chapel Hill, Chapel Hill, NC, United States of America
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5
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Wang X, Pan Y, Zhang R, Wang M, Meng X, Li Z, Li H, Wang Y, Zhao X, Wang Y, Liu G. Inflammation and Adverse Outcomes in Patients With Acute Ischemic Stroke With and Without Chronic Kidney Disease. J Am Heart Assoc 2024; 13:e033450. [PMID: 38686855 PMCID: PMC11179914 DOI: 10.1161/jaha.123.033450] [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: 12/15/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Elevated white blood cell count, fibrinogen levels, and lower levels of albumin signify higher systemic inflammatory response, hypercoagulable state, and poorer nutritional status, respectively. However, a consistent conclusion could not be drawn on whether the association between inflammatory markers and cardiovascular disease was affected by the presence of chronic kidney disease (CKD). We aimed to explore the association between inflammation and adverse outcomes in patients with acute ischemic stroke (AIS), as well as whether this association differs due to the presence of CKD. METHODS AND RESULTS This research was based on the Third China National Stroke Registry. The main adverse outcomes were poor functional outcome, stroke recurrence, and combined vascular event after 1 year. Inflammation was defined as the worst quartile of at least 2 of the aforementioned 3 markers. Finally, 8493 patients with AIS were enrolled in this study. The adjusted odds ratios/hazard ratios and 95% CIs of inflammation were 1.58 (1.34-1.86) for poor functional outcomes, 1.25 (1.06-1.47) for stroke recurrence, and 1.25 (1.06-1.46) for combined vascular event. The association between inflammation and adverse outcomes existed only in patients with AIS without CKD, although the interaction between CKD and inflammation was not statistically significant. (P for interaction >0.05). CONCLUSIONS Inflammation, which was defined as a combination of fibrinogen, white blood cell count, and albumin, was associated with all 1-year adverse outcomes among patients with AIS. Routine assessment of these biomarkers could become a potential part of the clinical evaluation for patients with AIS, especially those without CKD, aiding clinicians in risk stratification and treatment decision-making.
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Affiliation(s)
- Xiaoyu Wang
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
| | - Yuesong Pan
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Runhua Zhang
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Xia Meng
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Zixiao Li
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Hao Li
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Yilong Wang
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Xingquan Zhao
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Yongjun Wang
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical Sciences Beijing China
- Center for Excellence in Brain Science and Intelligence Technology Chinese Academy of Sciences Shanghai China
| | - Gaifen Liu
- Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Advanced Innovation Center for Human Brain Protection Capital Medical University Beijing China
- Beijing Office for Cerebrovascular Disease Prevention and Control Beijing China
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Yang X, Yang J, Zeng Y, Peng L, Liu X, Mo J, Wang T, Yao Y, Zheng Y, Song G. Circulating galectin-3 level association with cardiovascular risk factors during peritoneal dialysis. Clin Exp Nephrol 2024:10.1007/s10157-024-02498-3. [PMID: 38643287 DOI: 10.1007/s10157-024-02498-3] [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: 11/11/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Cardiovascular disease (CVD) represents the primary cause of mortality in patients afflicted with end-stage renal disease and undergoing peritoneal dialysis (PD) treatment. Galectin-3 (Gal-3), a molecule known to exhibit a correlation with CVD mortality garners considerable interest. The objective of this study was to explore the potential association between serum Gal-3 levels and other CVD risk factors among PD patients. METHODS In this cross-sectional study, a total of 114 PD patients with a minimum of 3 months of PD treatment were enrolled. Serum Gal-3 levels were quantified using an enzyme-linked immunosorbent assay. The data of patients with Gal-3 levels higher and lower than 26.744 pg/ml were compared using Mann-Whitney U tests or t tests. Pearson's correlation or Spearman's correlation analysis and multivariate regression were used to assess the associations between the known risk factors for CVD and Gal-3. RESULTS In comparison to the inter-group baseline data, the low Gal-3 group exhibited a higher glomerular filtration rate (GFR). Gal-3 levels correlate positively with PD duration, B-type natriuretic peptide (BNP), growth differentiation factor 15 (GDF-15), interventricular septal thickness in diastolic (IVST), and left ventricular mass index (LVMI). Conversely, Gal-3 exhibited a negative correlation with albumin levels. Multivariate linear regression analysis demonstrated a positive correlation between Gal-3 levels and BNP, GDF-15, PD duration, IVST and LVMI. Gal-3 levels were negatively correlated with albumin levels. CONCLUSIONS Gal-3 was strongly associated with BNP, GDF-15, IVST and LVMI in patients undergoing PD treatment. Prospective studies should be carried out to determine whether Gal-3 can be a promising biomarker in predicting increased risk of adverse cardiovascular events in PD patients.
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Affiliation(s)
- Xuerui Yang
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Jun Yang
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Youjia Zeng
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Ling Peng
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Xingzheng Liu
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Jinying Mo
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Taifen Wang
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Yutong Yao
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Yihou Zheng
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China
| | - Gaofeng Song
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, 1 Fuhua Road, Futian District, Shenzhen, 518033, Guangdong, China.
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8
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Kirchmayer U, Marino C, Feriozzi S, Massimetti C, Manzuoli M, Angelici L, Bargagli AM, Cascini S, Addis A, Davoli M, Agabiti N. Drug utilization in patients starting haemodialysis with a focus on cardiovascular and antidiabetic medications: an epidemiological study in the Lazio region (Italy), 2016-2020. BMC Nephrol 2024; 25:98. [PMID: 38493085 PMCID: PMC10943891 DOI: 10.1186/s12882-024-03539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Entering dialysis is a critical moment in patients' healthcare journey, and little is known about drug therapy around it. A study funded by the Italian Medicines Agency offered the opportunity to leverage data from the Lazio Regional Dialysis and Transplant Registry (RRDTL) and perform an observational study on drug use patterns before and after initiating chronic dialysis. METHODS Individuals initiating dialysis in 2016-2020 were identified from RRDTL, excluding patients with prior renal transplantation, stopping dialysis early, or dying within 12 months. Use of study drugs, predefined by clinicians, in the two years around the index date was retrieved from the drug claims register and described by semester. For each drug group, proportions of users (min 2 claims in 6 months) by semester, and intensity of treatment in terms of Defined Daily Doses (DDDs) for cardiovascular and antidiabetic agents were compared across semesters, stratifying by sex and age. RESULTS In our cohort of 3,882 patients we observed a general increase in drug use after initiating dialysis, with the mean number rising from 5.5 to 6.2. Cardiovascular agents accounted for the highest proportions, along with proton pump inhibitors and antithrombotics over all semesters. Dialysis-specific therapies showed the most evident increase, in particular anti-anaemics (iron 4-fold, erythropoietins almost 2-fold), anti-parathyroids (6-fold), and chelating agents (4-fold). Use of cardiovascular and antidiabetic drugs was characterised by significant variations in terms of patterns and intensity, with some differences between sexes and age groups. CONCLUSIONS Entering dialysis is associated with increased use of specific drugs and goes along with adaptations of chronic therapies.
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Grants
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
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Affiliation(s)
- Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Claudia Marino
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy.
| | | | | | - Micol Manzuoli
- UOC Nephrology and Dialysis, ASL Viterbo, Viterbo, Italy
| | - Laura Angelici
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Anna Maria Bargagli
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Silvia Cascini
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
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9
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Lalayiannis AD, Soeiro EMD, Moysés RMA, Shroff R. Chronic kidney disease mineral bone disorder in childhood and young adulthood: a 'growing' understanding. Pediatr Nephrol 2024; 39:723-739. [PMID: 37624528 PMCID: PMC10817832 DOI: 10.1007/s00467-023-06109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023]
Abstract
Chronic kidney disease (CKD) mineral and bone disorder (MBD) comprises a triad of biochemical abnormalities (of calcium, phosphate, parathyroid hormone and vitamin D), bone abnormalities (turnover, mineralization and growth) and extra-skeletal calcification. Mineral dysregulation leads to bone demineralization causing bone pain and an increased fracture risk compared to healthy peers. Vascular calcification, with hydroxyapatite deposition in the vessel wall, is a part of the CKD-MBD spectrum and, in turn, leads to vascular stiffness, left ventricular hypertrophy and a very high cardiovascular mortality risk. While the growing bone requires calcium, excess calcium can deposit in the vessels, such that the intake of calcium, calcium- containing medications and high calcium dialysate need to be carefully regulated. Normal physiological bone mineralization continues into the third decade of life, many years beyond the rapid growth in childhood and adolescence, implying that skeletal calcium requirements are much higher in younger people compared to the elderly. Much of the research into the link between bone (de)mineralization and vascular calcification in CKD has been performed in older adults and these data must not be extrapolated to children or younger adults. In this article, we explore the physiological changes in bone turnover and mineralization in children and young adults, the pathophysiology of mineral bone disease in CKD and a potential link between bone demineralization and vascular calcification.
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Affiliation(s)
- Alexander D Lalayiannis
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK.
| | | | - Rosa M A Moysés
- Sao Paulo University Faculty of Medicine, Universidade de Sao Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
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10
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Salzinger B, Lundwall K, Evans M, Mörtberg J, Wallén H, Jernberg T, Kahan T, Lundman P, Tornvall P, Erlinge D, Lindahl B, Baron T, Rezeli M, Spaak J, Jacobson SH. Associations between inflammatory and angiogenic proteomic biomarkers, and cardiovascular events and mortality in relation to kidney function. Clin Kidney J 2024; 17:sfae050. [PMID: 38524235 PMCID: PMC10959071 DOI: 10.1093/ckj/sfae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Indexed: 03/26/2024] Open
Abstract
Background The links between chronic kidney disease (CKD) and the high burden of cardiovascular disease remain unclear. We aimed to explore the association between selected inflammatory and angiogenic biomarkers, kidney function and long-term outcome in patients with an acute coronary syndrome (ACS) and to test the hypothesis that CKD status modifies this association. Methods A total of 1293 ACS patients hospitalized between 2008 and 2015 were followed until 31 December 2017. Plasma was collected on days 1-3 after admission. A total of 13 biomarkers were a priori identified and analysed with two proteomic methods, proximity extension assay or multiple reaction monitoring mass spectrometry. Boxplots and multiple linear regression models were used to study associations between biomarkers and kidney function and adjusted standardized Cox regression with an interaction term for CKD was used to assess whether CKD modified the association between biomarkers and major adverse cardiovascular events and death (MACE+). Results The concentrations of nine biomarkers-endothelial cell-specific molecule-1 (ESM-1), fibroblast growth factor 23 (FGF-23), fractalkine (CX3CL1), interleukin-1 receptor antagonist (IL-1RA), interleukin-18 (IL-18), monocyte chemotactic protein-1 (MCP-1), placenta growth factor (PlGF), transmembrane immunoglobulin 1 (TIM-1) and vascular endothelial growth factor A (VEGFA)-were inversely associated with kidney function. ESM-1, FGF-23 and TIM-1 showed associations with MACE+. Only FGF23 remained independently associated after adjustment for the other biomarkers (hazard ratio per standard deviation increase 1.34; 95% Bonferroni corrected confidence interval 1.19-1.50). None of the biomarkers showed an interaction with CKD. Conclusions The concentrations of 9 of the 13 prespecified inflammatory and angiogenic proteomic biomarkers increased when kidney function declined. Only FGF-23 demonstrated an independent association with MACE+, and this association was not modified by CKD status. These findings further support FGF-23 as an independent prognostic marker in ACS patients with and without CKD.
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Affiliation(s)
- Barbara Salzinger
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Kristina Lundwall
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Marie Evans
- ME Renal Medicine, Department of Clinical Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Josefin Mörtberg
- Division of Nephrology, Department of Internal Medicine, Centre for Clinical Research, County of Vastmanland and Uppsala University, Uppsala, Sweden
| | - Håkan Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Melinda Rezeli
- Clinical Protein Science & Imaging, Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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11
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Chen Z, Cheng Z, Ding C, Cao T, Chen L, Wang H, Li J, Huang X. ROS-Activated TRPM2 Channel: Calcium Homeostasis in Cardiovascular/renal System and Speculation in Cardiorenal Syndrome. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07531-3. [PMID: 38108918 DOI: 10.1007/s10557-023-07531-3] [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] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
The transient receptor potential melastatin 2 (TRPM2) channel is a nonselective calcium channel that is sensitive to oxidative stress (OS), and is widely expressed in multiple organs, such as the heart, kidney, and brain, which is inextricably related to calcium dyshomeostasis and downstream pathological events. Due to the increasing global burden of kidney or cardiovascular diseases (CVDs), safe and efficient drugs specific to novel targets are imperatively needed. Notably, investigation of the possibility to regard the TRPM2 channel as a new therapeutic target in ROS-related CVDs or renal diseases is urgently required because the roles of the TRPM2 channel in heart or kidney diseases have not received enough attention and thus have not been fully elaborated. Therefore, we aimed to review the involvement of the TRPM2 channel in cardiovascular disorders related to kidney or typical renal diseases and attempted to speculate about TRPM2-mediated mechanisms of cardiorenal syndrome (CRS) to provide representative perspectives for future research about novel and effective therapeutic strategies.
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Affiliation(s)
- Zihan Chen
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
- Queen Mary School, Medical Department, Nanchang University, Nanchang, China
| | - Zaihua Cheng
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Congcong Ding
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tianyu Cao
- Biological anthropology, University of California, Santa Barbara, CA, USA
| | - Ling Chen
- Department of Cardiology, the First People's Hospital of Jiujiang, Jiujiang, China
| | - Hong Wang
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Junpei Li
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Xiao Huang
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
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12
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Geißer D, Hetzel L, Westenfeld R, Boege F. Questionable Validity of Creatinine-Based eGFR in Elderly Patients but Cystatin C Is Helpful in First-Line Diagnostics. Geriatrics (Basel) 2023; 8:120. [PMID: 38132491 PMCID: PMC10742602 DOI: 10.3390/geriatrics8060120] [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: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The recommended chronic kidney disease (CKD) first-line diagnostic test is based on the creatinine-derived (estimated) glomerular filtration rate (eGFR). Cystatin C use may provide a better assessment. METHODS We compared creatinine- and cystatin C-derived eGFR determination as the first-line diagnostic test for 112 hospital patients aged > 60 years (median = 76 years). The patients were judged to not have CKD (no-CKD group) according to the first-line diagnostic recommendations (n = 61, eGFR (CKD Epidemiology Collaboration (CKD-EPI)) ≥ 60 mL/min/1.73 m2, total urine protein < 150 mg/g creatinine, urinary red/white blood cells not increased) or classified to be at risk for kidney insufficiency due to aortic valve dysfunction (at-risk group; n = 51). The accuracy of the eGFR values was evaluated retrospectively with the final case diagnoses. RESULTS The eGFR (Caucasian, Asian, pediatric, and adult formula (CAPA)) was found to be linearly correlated to the eGFR (CKD-EPI) (R2 = 0.5, slope = 0.69, p < 0.0001). In 93/112 (>80%) cases, the eGFR (CAPA) yielded lower values (on average ≈-20%). In 55/112 (49%) cases, the cystatin C-derived CKD stage was lower. CKD reclassification from no-CKD to a kidney-insufficient state (i.e., CKD1/2 to CKD3a/b or 4) or reclassification to a more severe kidney insufficiency (i.e., CKD3a → 3b/4 or 3b → 4) was found in 41/112 (37%) cases. A worse CKD classification (no-CKD → kidney-insufficient) based on the eGFR (CAPA) was plausible in 30% of cases in light of the final case diagnoses. CONCLUSION In elderly patients (>60 years), renal function appears to be systematically overestimated by the creatinine-based eGFR (CKD-EPI), indicating that, for this group, the cystatin C-based eGFR (CAPA) should be used as the first-line diagnostic test.
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Affiliation(s)
- Dario Geißer
- Central Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University and University Hospital, 40225 Düsseldorf, Germany;
| | - Lina Hetzel
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, Germany; (L.H.); (R.W.)
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, Germany; (L.H.); (R.W.)
| | - Fritz Boege
- Central Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University and University Hospital, 40225 Düsseldorf, Germany;
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13
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Cho H, Kwon SK, Lee SW, Yang YM, Kim HY, Kim SM, Heo TY, Seong CH, Kim KR. The Association Among Post-hemodialysis Blood Pressure, Nocturnal Hypertension, and Cardiovascular Risk Factors. Electrolyte Blood Press 2023; 21:53-60. [PMID: 38152598 PMCID: PMC10751209 DOI: 10.5049/ebp.2023.21.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
Background Most hemodialysis (HD) patients suffer from hypertension and have a heightened cardiovascular risk. While blood pressure (BP) control is essential to end-stage kidney disease (ESKD) patients, overly stringent control can lead to intradialytic hypotension (IDH). This study aimed to examine BP variations during and after HD to determine whether these variations correlate with IDH risk. Methods BP measurements during dialysis were taken from 28 ESKD patients, and ambulatory BP monitoring was applied post-dialysis. Laboratory parameters and risk factors, including diabetes, coronary disease, and LV mass index, were compared between IDH and non-IDH groups using an independent t-test. Results Of the 28 patients with an average age of 57.4 years, 16 (57.1%) had diabetes, 5 (17.9%) had coronary artery disease, and 1 (3.6%) had cerebrovascular disease. The mean systolic blood pressure (SBP) during and post-HD was 142.26 mmHg and 156.05 mmHg, respectively (p=0.0003). Similarly, the mean diastolic blood pressure (DBP) also demonstrated a significant increase, from 74.59 mmHg during HD to 86.82 mmHg post-HD (p<0.0001). Patients with IDH exhibited a more substantial SBP difference (delta SBP, 36.38 vs. 15.07 mmHg, p=0.0033; age-adjusted OR=1.58, p=0.0168) and a lower post-dialysis BUN level (12.75 vs. 18.77 mg/dL, p=0.0015; age-adjusted OR=0.76, p=0.0242). No significant variations were observed in daytime and nocturnal BP between the IDH and non-IDH groups. Conclusion Hemodialysis patients exhibited a marked increase in post-dialysis BP and lacked a nocturnal BP dip, suggesting augmented cardiovascular risks. This highlights the importance of more stringent BP control after hemodialysis.
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Affiliation(s)
- Hyunjeong Cho
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Soon Kil Kwon
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seung Woo Lee
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yu Mi Yang
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hye Young Kim
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sun Moon Kim
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Tae-Young Heo
- Department of Information and Statistics, Chungbuk National University Graduate School, Cheongju, Republic of Korea
| | - Chang Hwan Seong
- Department of Information and Statistics, Chungbuk National University Graduate School, Cheongju, Republic of Korea
| | - Kyeong Rok Kim
- Department of Information and Statistics, Chungbuk National University Graduate School, Cheongju, Republic of Korea
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14
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Xue K, Xing S. Blood urea nitrogen concentration is associated with severe abdominal aortic calcification in adults: a cross-sectional investigation. Sci Rep 2023; 13:19834. [PMID: 37964009 PMCID: PMC10645972 DOI: 10.1038/s41598-023-47109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
The purpose of this research is to examine the correlation between blood urea nitrogen (BUN) and severe abdominal aortic calcification (AAC) among American adults aged 40 years and older. A total of 2757 participants in the NHANES from 2013 to 2014 were included in the final analysis. BUN was measured by means of the enzymatic conductivity rate method. AAC scores were quantified by the Kauppila scoring system, and severe AAC was defined as an AAC score ≥ 6. Multivariable logistic regression and restricted cubic splines were used in the analyses. In the multivariable logistic regression model, the highest BUN level (log 2-transformed) was associated with an increased risk of severe AAC [odds ratio (OR) = 1.77, 95% CI 1.17, 2.71]. The restricted cubic spline plot displayed a reverse L-shaped association between BUN (log2-transformed) and severe AAC (p for nonlinearity < 0.001). In addition,the interactions of BUN were not discover. In general, there is a positive correlation between BUN and the risk of severe AAC.
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Affiliation(s)
- Kun Xue
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shanshan Xing
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
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15
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Masuda S, Hara T, Yamagami H, Mitsui Y, Kurahashi K, Yoshida S, Harada T, Otoda T, Yuasa T, Nakamura S, Kuroda A, Endo I, Matsumoto T, Matsuhisa M, Abe M, Aihara KI. Vascular Endothelial Function Is Associated with eGFR Slope in Female and Non-Smoking Male Individuals with Cardiovascular Risk Factors: A Pilot Study on the Predictive Value of FMD for Renal Prognosis. J Atheroscler Thromb 2023; 30:1727-1741. [PMID: 37081616 PMCID: PMC10627745 DOI: 10.5551/jat.63987] [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: 10/19/2022] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
AIMS It is known that there are sex differences in vascular endothelial function and the development of chronic kidney diseases; however, it remains unclear whether sex differences influence the association between vascular endothelial function and renal prognosis. METHODS To clarify the relationship between vascular endothelial function and longitudinal eGFR changes in male and female patients with cardiovascular risk factors, we retrospectively evaluated 341 patients (176 males and 165 females) with cardiovascular risk factors in whom vascular function was assessed by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV) and in whom 24-month longitudinal eGFR values were recorded after the vascular function examinations. Associations of values of FMD and baPWV with values of eGFR slope were statistically analyzed. RESULTS Simple regression analysis showed that the value of FMD was positively associated with eGFR slope in females (p=0.001) and non-smoking males (p=0.033) but not in smoking males. Multiple regression analysis showed that the value of FMD remains a positive contributor for eGFR slope in females (p=0.001) and non-smoking males (p=0.045) but not in smoking males. In contrast, values of baPWV had no significant association with eGFR slope regardless of sex and cigarette smoking. CONCLUSIONS In individuals with cardiovascular risk factors, evaluation of vascular endothelial function enables prediction of renal prognosis in females and non-smoking males.
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Affiliation(s)
- Shiho Masuda
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoyo Hara
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroki Yamagami
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yukari Mitsui
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kiyoe Kurahashi
- Department of Community Medicine for Respirology, Hematology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Sumiko Yoshida
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Harada
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Toshiki Otoda
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoyuki Yuasa
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shingen Nakamura
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Itsuro Endo
- Department of Bioregulatory Sciences, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ken-ichi Aihara
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Internal Medicine, Anan Medical Center, Tokushima, Japan
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16
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Søgaard SB, Andersen SB, Taghavi I, Schou M, Christoffersen C, Jacobsen JCB, Kjer HM, Gundlach C, McDermott A, Jensen JA, Nielsen MB, Sørensen CM. Super-Resolution Ultrasound Imaging of Renal Vascular Alterations in Zucker Diabetic Fatty Rats during the Development of Diabetic Kidney Disease. Diagnostics (Basel) 2023; 13:3197. [PMID: 37892017 PMCID: PMC10605617 DOI: 10.3390/diagnostics13203197] [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: 09/03/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Individuals with diabetes at risk of developing diabetic kidney disease (DKD) are challenging to identify using currently available clinical methods. Prognostic accuracy and initiation of treatment could be improved by a quantification of the renal microvascular rarefaction and the increased vascular tortuosity during the development of DKD. Super-resolution ultrasound (SRUS) imaging is an in vivo technique capable of visualizing blood vessels at sizes below 75 µm. This preclinical study aimed to investigate the alterations in renal blood vessels' density and tortuosity in a type 2 diabetes rat model, Zucker diabetic fatty (ZDF) rats, as a prediction of DKD. Lean age-matched Zucker rats were used as controls. A total of 36 rats were studied, subdivided into ages of 12, 22, and 40 weeks. Measured albuminuria indicated the early stage of DKD, and the SRUS was compared with the ex vivo micro-computed tomography (µCT) of the same kidneys. Assessed using the SRUS imaging, a significantly decreased cortical vascular density was detected in the ZDF rats from 22 weeks of age compared to the healthy controls, concomitant with a significantly increased albuminuria. Already by week 12, a trend towards a decreased cortical vascular density was found prior to the increased albuminuria. The quantified vascular density in µCT corresponded with the in vivo SRUS imaging, presenting a consistently lower vascular density in the ZDF rats. Regarding vessel tortuosity, an overall trend towards an increased tortuosity was present in the ZDF rats. SRUS shows promise for becoming an additional tool for monitoring and prognosing DKD. In the future, large-scale animal studies and human trials are needed for confirmation.
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Affiliation(s)
- Stinne Byrholdt Søgaard
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (S.B.S.); (S.B.A.); (C.C.); (J.C.B.J.); (A.M.)
- Department of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Sofie Bech Andersen
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (S.B.S.); (S.B.A.); (C.C.); (J.C.B.J.); (A.M.)
- Department of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Iman Taghavi
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark; (I.T.); (J.A.J.)
| | | | - Christina Christoffersen
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (S.B.S.); (S.B.A.); (C.C.); (J.C.B.J.); (A.M.)
- Department of Clinical Biochemistry, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jens Christian Brings Jacobsen
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (S.B.S.); (S.B.A.); (C.C.); (J.C.B.J.); (A.M.)
| | - Hans Martin Kjer
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Carsten Gundlach
- Department of Physics, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Amy McDermott
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (S.B.S.); (S.B.A.); (C.C.); (J.C.B.J.); (A.M.)
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark; (I.T.); (J.A.J.)
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Charlotte Mehlin Sørensen
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; (S.B.S.); (S.B.A.); (C.C.); (J.C.B.J.); (A.M.)
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17
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Chen D, Xiao C, Xiao W, Lou L, Gao Z, Li X. Prediction model for cognitive impairment in maintenance hemodialysis patients. BMC Neurol 2023; 23:367. [PMID: 37828422 PMCID: PMC10568884 DOI: 10.1186/s12883-023-03407-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: 05/18/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE To explore the risk factors for cognitive impairment in patients undergoing maintenance hemodialysis (MHD) and construct a predictive model for cognitive impairment. METHODS A total of 146 patients with end-stage renal disease (ESRD) undergoing MHD were recruited at our hospital between December 2021 and April 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and scores of < 26 were considered indicative of cognitive impairment. Risk factors were identified using a multivariate logistic regression model, and a receiver operating characteristic curve was applied to construct the prediction model. Cognitive impairment risk was categorized using a multifactorial prediction model based on the weight of evidence. RESULTS 46 patients with cognitive impairment were identified, with a prevalence of 31.5% in ESRD patients undergoing MHD. Multivariate logistic regression analyses indicated that the following factors were associated with an increased risk of cognitive impairment in patients undergoing MHD: aged 55.0-64.0 years (OR:6.24; 95%CI:1.81-21.48; P = 0.001), aged 65.0-74.0 years (OR:16.10; 95%CI:4.03-64.37; P < 0.001), aged ≥ 75.0 years (OR:90.22; 95%CI:16.86-482.86; P < 0.001), duration of dialysis ≥ 5 years (OR:3.99; 95%CI:1.58-10.04; P = 0.003), and current smoker (OR:4.61; 95%CI:1.46-14.57; P = 0.009). The predictive value of the constructed model based on the aforementioned factors for cognitive impairment was 84% (95%CI,77-91%). The prevalence of cognitive impairment for patients at low, moderately low, moderately high, and high risk was 0% (95%CI:0-17%), 10% (95%CI:3-22%), 32% (95%CI:16-52%), and 65% (95%CI:50-78%), respectively. CONCLUSIONS This study constructed a multifactorial prediction model with a high predictive value for cognitive impairment in patients with ESRD undergoing MHD.
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Affiliation(s)
- Ding Chen
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Chang Xiao
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Wangyan Xiao
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Linjing Lou
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Zhuo Gao
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China
| | - Xinlun Li
- Department of Nephrology, Air Force Medical Center, PLA, No.30, Fucheng Road, Haidian District, Beijing, 100037, China.
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18
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Palmer TC, Hunter RW. Using RNA-based therapies to target the kidney in cardiovascular disease. Front Cardiovasc Med 2023; 10:1250073. [PMID: 37868774 PMCID: PMC10587590 DOI: 10.3389/fcvm.2023.1250073] [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: 06/29/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
RNA-based therapies are currently used for immunisation against infections and to treat metabolic diseases. They can modulate gene expression in immune cells and hepatocytes, but their use in other cell types has been limited by an inability to selectively target specific tissues. Potential solutions to this targeting problem involve packaging therapeutic RNA molecules into delivery vehicles that are preferentially delivered to cells of interest. In this review, we consider why the kidney is a desirable target for RNA-based therapies in cardiovascular disease and discuss how such therapy could be delivered. Because the kidney plays a central role in maintaining cardiovascular homeostasis, many extant drugs used for preventing cardiovascular disease act predominantly on renal tubular cells. Moreover, kidney disease is a major independent risk factor for cardiovascular disease and a global health problem. Chronic kidney disease is projected to become the fifth leading cause of death by 2040, with around half of affected individuals dying from cardiovascular disease. The most promising strategies for delivering therapeutic RNA selectively to kidney cells make use of synthetic polymers and engineered extracellular vesicles to deliver an RNA cargo. Future research should focus on establishing the safety of these novel delivery platforms in humans, on developing palatable routes of administration and on prioritising the gene targets that are likely to have the biggest impact in cardiovascular disease.
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Affiliation(s)
- Trecia C. Palmer
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert W. Hunter
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Department of Renal Medicine, Royal Infirmary ofEdinburgh, Edinburgh, United Kingdom
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19
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Jomova K, Raptova R, Alomar SY, Alwasel SH, Nepovimova E, Kuca K, Valko M. Reactive oxygen species, toxicity, oxidative stress, and antioxidants: chronic diseases and aging. Arch Toxicol 2023; 97:2499-2574. [PMID: 37597078 PMCID: PMC10475008 DOI: 10.1007/s00204-023-03562-9] [Citation(s) in RCA: 148] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
A physiological level of oxygen/nitrogen free radicals and non-radical reactive species (collectively known as ROS/RNS) is termed oxidative eustress or "good stress" and is characterized by low to mild levels of oxidants involved in the regulation of various biochemical transformations such as carboxylation, hydroxylation, peroxidation, or modulation of signal transduction pathways such as Nuclear factor-κB (NF-κB), Mitogen-activated protein kinase (MAPK) cascade, phosphoinositide-3-kinase, nuclear factor erythroid 2-related factor 2 (Nrf2) and other processes. Increased levels of ROS/RNS, generated from both endogenous (mitochondria, NADPH oxidases) and/or exogenous sources (radiation, certain drugs, foods, cigarette smoking, pollution) result in a harmful condition termed oxidative stress ("bad stress"). Although it is widely accepted, that many chronic diseases are multifactorial in origin, they share oxidative stress as a common denominator. Here we review the importance of oxidative stress and the mechanisms through which oxidative stress contributes to the pathological states of an organism. Attention is focused on the chemistry of ROS and RNS (e.g. superoxide radical, hydrogen peroxide, hydroxyl radicals, peroxyl radicals, nitric oxide, peroxynitrite), and their role in oxidative damage of DNA, proteins, and membrane lipids. Quantitative and qualitative assessment of oxidative stress biomarkers is also discussed. Oxidative stress contributes to the pathology of cancer, cardiovascular diseases, diabetes, neurological disorders (Alzheimer's and Parkinson's diseases, Down syndrome), psychiatric diseases (depression, schizophrenia, bipolar disorder), renal disease, lung disease (chronic pulmonary obstruction, lung cancer), and aging. The concerted action of antioxidants to ameliorate the harmful effect of oxidative stress is achieved by antioxidant enzymes (Superoxide dismutases-SODs, catalase, glutathione peroxidase-GPx), and small molecular weight antioxidants (vitamins C and E, flavonoids, carotenoids, melatonin, ergothioneine, and others). Perhaps one of the most effective low molecular weight antioxidants is vitamin E, the first line of defense against the peroxidation of lipids. A promising approach appears to be the use of certain antioxidants (e.g. flavonoids), showing weak prooxidant properties that may boost cellular antioxidant systems and thus act as preventive anticancer agents. Redox metal-based enzyme mimetic compounds as potential pharmaceutical interventions and sirtuins as promising therapeutic targets for age-related diseases and anti-aging strategies are discussed.
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Affiliation(s)
- Klaudia Jomova
- Department of Chemistry, Faculty of Natural Sciences, Constantine the Philosopher University in Nitra, Nitra, 949 74, Slovakia
| | - Renata Raptova
- Faculty of Chemical and Food Technology, Slovak University of Technology, Bratislava, 812 37, Slovakia
| | - Suliman Y Alomar
- Zoology Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Saleh H Alwasel
- Zoology Department, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Sciences, University of Hradec Kralove, 50005, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Department of Chemistry, Faculty of Sciences, University of Hradec Kralove, 50005, Hradec Kralove, Czech Republic
| | - Marian Valko
- Faculty of Chemical and Food Technology, Slovak University of Technology, Bratislava, 812 37, Slovakia.
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20
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Jha V, Al-Ghamdi SMG, Li G, Wu MS, Stafylas P, Retat L, Card-Gowers J, Barone S, Cabrera C, Garcia Sanchez JJ. Global Economic Burden Associated with Chronic Kidney Disease: A Pragmatic Review of Medical Costs for the Inside CKD Research Programme. Adv Ther 2023; 40:4405-4420. [PMID: 37493856 PMCID: PMC10499937 DOI: 10.1007/s12325-023-02608-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a progressive disease of growing prevalence, posing serious concerns for global public health. While the economic burden of CKD is substantial, data on the cost of CKD is limited, despite growing pressures on healthcare systems. In this review, we summarise the available evidence in 31 countries and regions and compile a library of costing methodology and estimates of CKD management and disease-associated complications across 31 countries/regions within the Inside CKD programme. METHODS We collected country/region-specific CKD costs via a pragmatic rapid literature review of local literature and engagement with local experts. We extracted cost data and definitions from identified sources for CKD stages G3a-5, kidney failure with replacement therapy by modality, covering haemodialysis, peritoneal dialysis, and kidney transplants, and disease-associated complications in local currency, converted to United States dollars (USD) and inflated to 2022. RESULTS Annual direct costs associated with CKD management rose by an average factor of 4 in each country/region upon progression from stage G3a to G5. Mean annual costs per patient increased considerably more from early stages versus dialysis (stage G3a, mean: $3060 versus haemodialysis, mean: $57,334; peritoneal dialysis, mean: $49,490); with estimates for annual costs of transplant also substantially higher (incident: $75,326; subsequent: $16,672). The mean annual per patient costs of complications were $18,294 for myocardial infarction, $8463 for heart failure, $10,168 for stroke and $5975 for acute kidney injury. Costing definitions varied widely in granularity and/or definition across all countries/regions. CONCLUSION Globally, CKD carries a significant economic burden, which increases substantially with increasing disease severity. We identified significant gaps in published costs and inconsistent costing definitions. Cost-effective interventions that target primary prevention and disease progression are essential to reduce CKD burden. Our results can be used to guide cost collection and facilitate better comparisons across countries/regions to inform healthcare policy.
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Affiliation(s)
- Vivekanand Jha
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Saeed M G Al-Ghamdi
- Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Guisen Li
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Mai-Szu Wu
- Division of Nephrology, Taipei Medical University, Taipei, Taiwan
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21
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Echefu G, Stowe I, Burka S, Basu-Ray I, Kumbala D. Pathophysiological concepts and screening of cardiovascular disease in dialysis patients. FRONTIERS IN NEPHROLOGY 2023; 3:1198560. [PMID: 37840653 PMCID: PMC10570458 DOI: 10.3389/fneph.2023.1198560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Dialysis patients experience 10-20 times higher cardiovascular mortality than the general population. The high burden of both conventional and nontraditional risk factors attributable to loss of renal function can explain higher rates of cardiovascular disease (CVD) morbidity and death among dialysis patients. As renal function declines, uremic toxins accumulate in the blood and disrupt cell function, causing cardiovascular damage. Hemodialysis patients have many cardiovascular complications, including sudden cardiac death. Peritoneal dialysis puts dialysis patients with end-stage renal disease at increased risk of CVD complications and emergency hospitalization. The current standard of care in this population is based on observational data, which has a high potential for bias due to the paucity of dedicated randomized clinical trials. Furthermore, guidelines lack specific guidelines for these patients, often inferring them from non-dialysis patient trials. A crucial step in the prevention and treatment of CVD would be to gain better knowledge of the influence of these predisposing risk factors. This review highlights the current evidence regarding the influence of advanced chronic disease on the cardiovascular system in patients undergoing renal dialysis.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Semenawit Burka
- Department of Internal Medicine, University of Texas Rio Grande Valley, McAllen, TX, United States
| | - Indranill Basu-Ray
- Department of Cardiology, Memphis Veterans Affairs (VA) Medical Center, Memphis, TN, United States
| | - Damodar Kumbala
- Nephrology Division, Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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22
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Villarroel C, Karim G, Sehmbhi M, Debroff J, Weisberg I, Dinani A. Advanced Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease Is Independently Associated With Reduced Renal Function. GASTRO HEP ADVANCES 2023; 3:122-127. [PMID: 39132183 PMCID: PMC11307954 DOI: 10.1016/j.gastha.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/18/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims The large global population of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been shown to have an association with chronic kidney disease (CKD) due to a host of proposed mechanisms, one of which being lipoprotein dysmetabolism. Furthermore, metabolic comorbidities have been concurrently prevalent in MASLD and CKD independently. This study aimed at analyzing risk and predictive traits among an obese population for both MASLD and CKD. Methods A retrospective chart review of 546 obese patients with a diagnosis of either MASLD or metabolic dysfunction-associated steatohepatitis between January 2020 and June 2021 was performed. Markers of liver and kidney function in addition to demographic data and renoprotective medications were recorded. Both univariable and multivariable linear regression analyses were performed to understand possible associations between MASLD markers, renal function, and markers of metabolic derangements. Results Univariate analysis revealed that increased age (P < .001), elevated alanine aminotransferase (defined as alanine aminotransferase ≥ 30 IU/L, P = .01), low albumin (P = .011), and increasing fibrosis-4 (FIB-4) (P = .005) were statistically associated with a reduced renal function. A reduction in glomerular filtration was associated with an increase in FIB-4 (effect size [beta] of a one-unit increase in glomerular filtration on FIB-4 = -0.013, P < .001) in univariate linear regression. In multivariate linear regression, type 2 diabetes (T2D) was independently associated with increased liver fibrosis (effect size of T2D on FIB-4 = 0.387925, P < .02). Conclusion Our study shows that in a patient population with obesity and a diagnosis of MASLD, advanced fibrosis is independently associated with reduced renal function.
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Affiliation(s)
- Carolina Villarroel
- Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gres Karim
- Division of Gastroenterology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, New York
| | - Mantej Sehmbhi
- Department of Medicine, Mount Sinai Morningside and West Hospitals, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jake Debroff
- Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ilan Weisberg
- Division of Gastroenterology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, New York
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Gastroenterology, Duke University, Durham, North Carolina
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23
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Garrett ME, Soldano KL, Erwin KN, Zhang Y, Gordeuk VR, Gladwin MT, Telen MJ, Ashley-Koch AE. Genome-wide meta-analysis identifies new candidate genes for sickle cell disease nephropathy. Blood Adv 2023; 7:4782-4793. [PMID: 36399516 PMCID: PMC10469559 DOI: 10.1182/bloodadvances.2022007451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022] Open
Abstract
Sickle cell disease nephropathy (SCDN), a common SCD complication, is strongly associated with mortality. Polygenic risk scores calculated from recent transethnic meta-analyses of urinary albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) trended toward association with proteinuria and eGFR in SCD but the model fit was poor (R2 < 0.01), suggesting that there are likely unique genetic risk factors for SCDN. Therefore, we performed genome-wide association studies (GWAS) for 2 critical manifestations of SCDN, proteinuria and decreased eGFR, in 2 well-characterized adult SCD cohorts, representing, to the best of our knowledge, the largest SCDN sample to date. Meta-analysis identified 6 genome-wide significant associations (false discovery rate, q ≤ 0.05): 3 for proteinuria (CRYL1, VWF, and ADAMTS7) and 3 for eGFR (LRP1B, linc02288, and FPGT-TNNI3K/TNNI3K). These associations are independent of APOL1 risk and represent novel SCDN loci, many with evidence for regulatory function. Moreover, GWAS SNPs in CRYL1, VWF, ADAMTS7, and linc02288 are associated with gene expression in kidney and pathways important to both renal function and SCD biology, supporting the hypothesis that SCDN pathophysiology is distinct from other forms of kidney disease. Together, these findings provide new targets for functional follow-up that could be tested prospectively and potentially used to identify patients with SCD who are at risk, before onset of kidney dysfunction.
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Affiliation(s)
- Melanie E. Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | - Karen L. Soldano
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | - Kyle N. Erwin
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | - Yingze Zhang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Mark T. Gladwin
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marilyn J. Telen
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, NC
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24
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Kim DG, Cho DH, Kim K, Kim SH, Lee J, Huh KH, Kim MS, Kang DR, Yang JW, Han BG, Lee JY. Survival Benefit of Kidney Transplantation in Patients With End-Stage Kidney Disease and Prior Acute Myocardial Infarction. Transpl Int 2023; 36:11491. [PMID: 37692454 PMCID: PMC10483068 DOI: 10.3389/ti.2023.11491] [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: 04/18/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023]
Abstract
Patients with end stage kidney disease (ESKD) and a previous acute myocardial infarction (AMI) have less access to KT. Data on ESKD patients with an AMI history who underwent first KT or dialysis between January 2007 and December 2018 were extracted from the Korean National Health Insurance Service. Patients who underwent KT (n = 423) were chronologically matched in a 1:3 ratio with those maintained on dialysis (n = 1,269) at the corresponding dates, based on time-conditional propensity scores. The 1, 5, and 10 years cumulative incidences for all-cause mortality were 12.6%, 39.1%, and 60.1% in the dialysis group and 3.1%, 7.2%, and 14.5% in the KT group. Adjusted hazard ratios (HRs) of KT versus dialysis were 0.17 (95% confidence interval [CI], 0.12-0.24; p < 0.001) for mortality and 0.38 (95% CI, 0.23-0.51; p < 0.001) for major adverse cardiovascular events (MACE). Of the MACE components, KT was most protective against cardiovascular death (HR, 0.23; 95% CI, 0.12-0.42; p < 0.001). Protective effects of KT for all-cause mortality and MACE were consistent across various subgroups, including patients at higher risk (e.g., age >65 years, recent AMI [<6 months], congestive heart failure). KT is associated with lower all-cause mortality and MACE than maintenance dialysis patients with a prior AMI.
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Affiliation(s)
- Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Department of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kihyun Kim
- Department of Cardiology, Gangneung Dong-in Hospital, Gangneung, Republic of Korea
| | - Sung Hwa Kim
- National Health Big Data Clinical Research Institute, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Ryong Kang
- National Health Big Data Clinical Research Institute, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Byoung Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jun Young Lee
- National Health Big Data Clinical Research Institute, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol 2023; 22:195. [PMID: 37525273 PMCID: PMC10391899 DOI: 10.1186/s12933-023-01937-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023] Open
Abstract
Type 2 diabetes (T2D), cardiovascular disease (CVD) and chronic kidney disease (CKD), are recognized among the most disruptive public health issues of the current century. A large body of evidence from epidemiological and clinical research supports the existence of a strong interconnection between these conditions, such that the unifying term cardio-metabolic-renal (CMR) disease has been defined. This coexistence has remarkable epidemiological, pathophysiologic, and prognostic implications. The mechanisms of hyperglycemia-induced damage to the cardio-renal system are well validated, as are those that tie cardiac and renal disease together. Yet, it remains controversial how and to what extent CVD and CKD can promote metabolic dysregulation. The aim of this review is to recapitulate the epidemiology of the CMR connections; to discuss the well-established, as well as the putative and emerging mechanisms implicated in the interplay among these three entities; and to provide a pathophysiological background for an integrated therapeutic intervention aiming at interrupting this vicious crosstalks.
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Affiliation(s)
- Marella Marassi
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gian Paolo Fadini
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
- Veneto Institute of Molecular Medicine, 35129, Padua, Italy.
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Alvand S, Alatab S, Dalvand S, Shahraki-Sanavi F, Kaykhaei MA, Shahraki E, Barar E, Sepanlou SG, Ansari-Moghaddam A. Association of indoor use of pesticides with CKD of unknown origin. PLoS One 2023; 18:e0277151. [PMID: 37478079 PMCID: PMC10361486 DOI: 10.1371/journal.pone.0277151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/14/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a growing global health problem. Recently, an epidemic of CKD of unknown origin (CKDu), a form of CKD seen mostly in agricultural communities, has been emerged. One of the proposed causes of CKDu is pesticide use in farmers. On the other hand, the research on relation between indoor use of pesticides and CKDu is little. In this study, we aimed to investigate the association between indoor use of pesticide as well as the exposure time with CKDu. This study was done as part of the population-based cohort of Prospective Epidemiological Research Studies in Iran. We used the baseline data of the Zahedan Adult Cohort Study. All subjects with diabetes mellitus and/or hypertension, estimated glomerular filtration rate (eGFR) between 60-89 ml/min/1.73 m2, and unavailable creatinine measurement were excluded. Subjects with an eGFR of less than 60 ml/min/1.73 m2 were defined as having CKDu, and their data were compared with those with an eGFR of more than 90 ml/min/1.73 m2. Data regarding indoor pesticide use and duration of exposure were obtained through a questionnaire. After applying the exclusion criteria, 1079 subjects remained in the study. Female sex, single marital status, low physical activity, triglyceride (TG) levels of more than 150 mg/dl, body mass index (BMI) of more than 25 kg/m2, non-smokers, indoor pesticide use, and high pesticide exposure time were associated with CKDu. The effects of age, female sex, TG levels more than 150 mg/dl, pesticide use (OR 1.36; 95% CI 1.01-1.84), and high exposure time (third tertile of exposure time) compared to non-users (OR 1.64; 95% CI 1.07-2.51) remained significant in multivariable analysis. CONCLUSION We found a positive association between pesticide use, as well as longer exposure time to pesticides, and impaired kidney function in cases without diabetes mellitus and hypertension. Further longitudinal studies should be carried out to confirm these findings.
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Affiliation(s)
- Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sudabeh Alatab
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Dalvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmoud Ali Kaykhaei
- Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Science, Zahedan, Iran
| | - Elham Shahraki
- Health Promotion Research Center, Zahedan University of Medical Science, Zahedan, Iran
| | - Erfaneh Barar
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G Sepanlou
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Filipa Alexandre A, Stoelzel M, Kiran A, Garcia-Hernandez A, Morga A, Kalra PA. Clinical factors for predicting cardiovascular risk, need for renal replacement therapy, and mortality in patients with non-dialysis-dependent stage 3-5 chronic kidney disease from the Salford Kidney Study. J Nephrol 2023:10.1007/s40620-023-01626-8. [PMID: 37289366 PMCID: PMC10393868 DOI: 10.1007/s40620-023-01626-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Established cardiovascular risk assessment tools lack chronic kidney disease-specific clinical factors and may underestimate cardiovascular risk in non-dialysis-dependent chronic kidney disease (CKD) patients. METHODS A retrospective analysis of a cohort of patients with stage 3-5 non-dialysis-dependent chronic kidney disease in the Salford Kidney Study (UK, 2002-2016) was performed. Multivariable Cox regression models with backward selection and repeated measures joint models were used to evaluate clinical risk factors associated with cardiovascular events (individual and composite cardiovascular major adverse cardiovascular events), mortality (all-cause and cardiovascular-specific), and need for renal replacement therapy. Models were established using 70% of the cohort and validated on the remaining 30%. Hazard ratios ([95% CIs]) were reported. RESULTS Among 2192 patients, mean follow-up was 5.6 years. Cardiovascular major adverse cardiovascular events occurred in 422 (19.3%) patients; predictors included prior history of diabetes (1.39 [1.13-1.71]; P = 0.002) and serum albumin reduction of 5 g/L (1.20 [1.05-1.36]; P = 0.006). All-cause mortality occurred in 740 (33.4%) patients, median time to death was 3.8 years; predictors included reduction of estimated glomerular filtration of 5 mL/min/1.73 m2 (1.05 [1.01-1.08]; P = 0.011) and increase of phosphate of 0.1 mmol/L (1.04 [1.01-1.08]; P = 0.021), whereas a 10 g/L hemoglobin increase was protective (0.90 [0.85-0.95]; P < 0.001). In 394 (18.0%) patients who received renal replacement therapy, median time to event was 2.3 years; predictors included halving of estimated glomerular filtration rate (3.40 [2.65-4.35]; P < 0.001) and antihypertensive use (1.23 [1.12-1.34]; P < 0.001). Increasing age, albumin reduction, and prior history of diabetes or cardiovascular disease were risk factors for all outcomes except renal replacement therapy. CONCLUSIONS Several chronic kidney disease-specific cardiovascular risk factors were associated with increased mortality and cardiovascular event risk in patients with non-dialysis-dependent chronic kidney disease.
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Affiliation(s)
- Ana Filipa Alexandre
- Astellas Pharma Europe B.V., Leiden, The Netherlands.
- Pricing and Market Access, Santen Pharmaceutical, Alpha Tower, De Entree 11-97, 1101, Amsterdam, The Netherlands.
| | | | - Amit Kiran
- Astellas Pharma Europe Limited, Addlestone, UK
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Hong Y, Hess NR, Ziegler LA, Hickey GW, Huston JH, Mathier MA, McNamara DM, Keebler ME, Kaczorowski DJ. Clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation in the 2018 United States heart allocation system. J Heart Lung Transplant 2023; 42:795-806. [PMID: 36797078 PMCID: PMC10591214 DOI: 10.1016/j.healun.2023.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/08/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study evaluated the current clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation after the 2018 United States adult heart allocation policy change. METHODS The United Network for Organ Sharing (UNOS) registry was queried to analyze adult orthotopic heart transplant recipients after the October 18, 2018 heart allocation policy change. The cohort was stratified according to the need for post-transplant de novo dialysis. The primary outcome was survival. Propensity score-matching was performed to compare the outcomes between 2 similar cohorts with and without post-transplant de novo dialysis. The impact of post-transplant dialysis chronicity was evaluated. Multivariable logistic regression was performed to identify risk factors for post-transplant dialysis. RESULTS A total of 7,223 patients were included in this study. Out of these, 968 patients (13.4%) developed post-transplant renal failure requiring de novo dialysis. Both 1-year (73.2% vs 94.8%) and 2-year (66.3% vs 90.6%) survival rates were lower in the dialysis cohort (p < 0.001), and the lower survival rates persisted in a propensity-matched comparison. Recipients requiring only temporary post-transplant dialysis had significantly improved 1-year (92.5% vs 71.6%) and 2-year (86.6 % vs 52.2%) survival rates compared to the chronic post-transplant dialysis group (p < 0.001). Multivariable analysis demonstrated low pretransplant estimated glomerular filtration (eGFR) and bridge with extracorporeal membrane oxygenation (ECMO) were strong predictors of post-transplant dialysis. CONCLUSIONS This study demonstrates that post-transplant dialysis is associated with significantly increased morbidity and mortality in the new allocation system. Post-transplant survival is affected by the chronicity of post-transplant dialysis. Low pretransplant eGFR and ECMO are strong risk factors for post-transplant dialysis.
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Affiliation(s)
- Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas R Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Luke A Ziegler
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Gavin W Hickey
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica H Huston
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael A Mathier
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis M McNamara
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary E Keebler
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania.
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Vock DM, Helgeson ES, Mullan AF, Issa NS, Sanka S, Saiki AC, Mathson K, Chamberlain AM, Rule AD, Matas AJ. The Minnesota attributable risk of kidney donation (MARKD) study: a retrospective cohort study of long-term (> 50 year) outcomes after kidney donation compared to well-matched healthy controls. BMC Nephrol 2023; 24:121. [PMID: 37127560 PMCID: PMC10152793 DOI: 10.1186/s12882-023-03149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND There is uncertainty about the long-term risks of living kidney donation. Well-designed studies with controls well-matched on risk factors for kidney disease are needed to understand the attributable risks of kidney donation. METHODS The goal of the Minnesota Attributable Risk of Kidney Donation (MARKD) study is to compare the long-term (> 50 years) outcomes of living donors (LDs) to contemporary and geographically similar controls that are well-matched on health status. University of Minnesota (n = 4022; 1st transplant: 1963) and Mayo Clinic LDs (n = 3035; 1st transplant: 1963) will be matched to Rochester Epidemiology Project (REP) controls (approximately 4 controls to 1 donor) on the basis of age, sex, and race/ethnicity. The REP controls are a well-defined population, with detailed medical record data linked between all providers in Olmsted and surrounding counties, that come from the same geographic region and era (early 1960s to present) as the donors. Controls will be carefully selected to have health status acceptable for donation on the index date (date their matched donor donated). Further refinement of the control group will include confirmed kidney health (e.g., normal serum creatinine and/or no proteinuria) and matching (on index date) of body mass index, smoking history, family history of chronic kidney disease, and blood pressure. Outcomes will be ascertained from national registries (National Death Index and United States Renal Data System) and a new survey administered to both donors and controls; the data will be supplemented by prior surveys and medical record review of donors and REP controls. The outcomes to be compared are all-cause mortality, end-stage kidney disease, cardiovascular disease and mortality, estimated glomerular filtration rate (eGFR) trajectory and chronic kidney disease, pregnancy risks, and development of diseases that frequently lead to chronic kidney disease (e.g. hypertension, diabetes, and obesity). We will additionally evaluate whether the risk of donation differs based on baseline characteristics. DISCUSSION Our study will provide a comprehensive assessment of long-term living donor risk to inform candidate living donors, and to inform the follow-up and care of current living donors.
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Affiliation(s)
- David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200, Minneapolis, MN, 55414, USA
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200, Minneapolis, MN, 55414, USA.
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Naim S Issa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sujana Sanka
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alison C Saiki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kristin Mathson
- Surgery Clinical Trials Office, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Rule
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Chang G, Shih HM, Pan CF, Wu CJ, Lin CJ. Effect of Low Protein Diet Supplemented with Ketoanalogs on Endothelial Function and Protein-Bound Uremic Toxins in Patients with Chronic Kidney Disease. Biomedicines 2023; 11:biomedicines11051312. [PMID: 37238983 DOI: 10.3390/biomedicines11051312] [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: 03/31/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Studies have demonstrated that a low-protein diet supplemented with ketoanalogs (KAs) could significantly retard progression of renal function in patients with chronic kidney disease (CKD) stages 3-5. However, its effects on endothelial function and serum levels of protein-bound uremic toxins remain elusive. Therefore, this study explored whether a low-protein diet (LPD) supplemented with KAs affects kidney function, endothelial function, and serum uremic toxin levels in a CKD-based cohort. In this retrospective cohort, we enrolled 22 stable CKD stage 3b-4 patients on LPD (0.6-0.8 g/day). Patients were categorized into control (LPD only) and study groups (LPD + KAs 6 tab/day). Serum biochemistry, total/free indoxyl sulfate (TIS/FIS), total/free p-cresyl sulfate (TPCS/FPCS), and flow-mediated dilation (FMD) were measured before and after 6 months of KA supplementation. Before the trial, there were no significant differences in kidney function, FMD, or uremic toxin levels between the control and study groups. When compared with the control group, the paired t-test showed a significant decrease in TIS and FIS (all p < 0.05) and a significant increase in FMD, eGFR, and bicarbonate (all p < 0.05). In multivariate regression analysis, an increase in FMD (p < 0.001) and a decrease in FPCS (p = 0.012) and TIS (p < 0.001) remained persistent findings when adjusted for age, systolic blood pressure (SBP), sodium, albumin, and diastolic blood pressure (DBP). LPD supplemented with KAs significantly preserves kidney function and provides additional benefits on endothelial function and protein-bound uremic toxins in patients with CKD.
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Affiliation(s)
- George Chang
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Hong-Mou Shih
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei 100001, Taiwan
| | - Chi-Feng Pan
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 220001, Taiwan
| | - Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 220001, Taiwan
- Department of Medicine, Mackay Junior College of Medicine, Nursing and Management, Taipei 100001, Taiwan
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31
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Dahabiyeh LA, Nimer RM, Sumaily KM, Alabdaljabar MS, Jacob M, Sabi EM, Hussein MH, Abdel Rahman A. Metabolomics profiling distinctively identified end-stage renal disease patients from chronic kidney disease patients. Sci Rep 2023; 13:6161. [PMID: 37061630 PMCID: PMC10105740 DOI: 10.1038/s41598-023-33377-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023] Open
Abstract
Chronic kidney disease (CKD) is a serious public health problem characterized by progressive kidney function loss leading to end-stage renal disease (ESRD) that demands dialysis or kidney transplantation. Early detection can prevent or delay progression to ESRD. The study aimed to gain new insights into the perturbed biochemical reactions and to identify novel distinct biomarkers between ESRD and CKD. Serum samples of 32 patients with ESRD (n = 13) and CKD (n = 19) were analyzed using chemical isotope labeling liquid chromatography-mass spectrometry metabolomics approach. A total of 193 metabolites were significantly altered in ESRD compared to CKD and were mainly involved in aminoacyl-tRNA biosynthesis, branched-chain amino acid (BCAA) biosynthesis, taurine metabolism, and tryptophan metabolism. Three kynurenine derivatives, namely, 2-aminobenzoic acid, xanthurenic acid, and hydroxypicolinic acid were upregulated in ESRD compared to CKD due to the significant decrease in glomerular filtration rate with the progression of CKD to ESRD. N-Hydroxy-isoleucine, 2-aminobenzoic acid, and picolinic acid yielded AUC > 0.99 when analyzed using Receiver Operating Characteristic (ROC) analysis. Our findings suggest that inhibiting the kynurenine pathway might be a promising target to delay CKD progression and that metabolites with high discriminative ability might serve as potential prognostic biomarkers to monitor the progression of CKD to ESRD or used in combination with current markers to indicate the status of kidney damage better.
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Affiliation(s)
- Lina A Dahabiyeh
- Division of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, 11942, Jordan
| | - Refat M Nimer
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khalid M Sumaily
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
- Clinical Biochemistry Unit, Laboratory Medicine, King Saud University Medical City, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Mohamad S Alabdaljabar
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, 11211, Saudi Arabia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55902, USA
| | - Minnie Jacob
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, 11211, Saudi Arabia
| | - Essa M Sabi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Maged H Hussein
- Department of Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, 11211, Saudi Arabia
| | - Anas Abdel Rahman
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, 11211, Saudi Arabia.
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia.
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Lapi F, Marconi E, Piccinocchi G, Cricelli I, Medea G, Cricelli C. Early identification of chronic kidney disease: it is time to enhance patient and population-based informatics tools for general practitioners. Curr Med Res Opin 2023; 39:771-774. [PMID: 37005364 DOI: 10.1080/03007995.2023.2197498] [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] [Indexed: 04/04/2023]
Abstract
Chronic kidney disease (CKD) is a global public health issue that can lead to several complications such as, kidney failure, cerebro/cardiovascular disease, and death.There is a well-documented "awareness gap" among general practitioners (GPs) to recognize CKD. As shown by estimates stemming from the Health Search Database (HSD) of the Italian College of General Practitioners and Primary Care (SIMG), no substantial changes were observed in terms of the incident rate of CKD over the last 10 years. Namely, 10.3 to 9.5 per 1,000 new cases of CKD were estimated in 2012 and 2021, respectively. Thus, strategies to reduce under-recognized cases are needed. Early identification of CKD might improve patient's quality of life and clinical outcomes. In this context, patient- and population-based informatic tools may support both opportunistic and systematic screening of patients at greater risk of CKD. As such, the new effective pharmacotherapies for CKD would be proficiently administered. To this aim, these two complimentary tools have been developed and will be further implemented by GPs.The effectiveness of these instruments in identifying the condition at an early stage and reducing the burden of CKD on the national health system needs to be verified according to the new regulations on medical device (MDR: (EU) 2017/745).
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | | | - Gerardo Medea
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Weisbord SD, Mor MK, Hochheiser H, Kim N, Ho PM, Bhatt DL, Fine MJ, Palevsky PM. Utilization and Outcomes of Clinically Indicated Invasive Cardiac Care in Veterans with Acute Coronary Syndrome and Chronic Kidney Disease. J Am Soc Nephrol 2023; 34:694-705. [PMID: 36735537 PMCID: PMC10103279 DOI: 10.1681/asn.0000000000000067] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/08/2022] [Indexed: 02/04/2023] Open
Abstract
SIGNIFICANCE STATEMENT Of studies reporting an association of CKD with lower use of invasive cardiac care to treat acute coronary syndrome (ACS), just one accounted for the appropriateness of such care. However, its findings in patients hospitalized nearly 30 years ago may not apply to current practice. In a more recent cohort of 64,695 veterans hospitalized with ACS, CKD was associated with a 32% lower likelihood of receiving invasive care determined to be clinically indicated. Among patients with CKD, not receiving such care was associated with a 1.39-fold higher risk of 6-month mortality. Efforts to elucidate the reasons for this disparity in invasive care in patients with ACS and CKD and implement tailored interventions to enhance its use in this population may offer the potential to improve clinical outcomes. BACKGROUND Previous studies have shown that patients with CKD are less likely than those without CKD to receive invasive care to treat acute coronary syndrome (ACS). However, few studies have accounted for whether such care was clinically indicated or assessed whether nonuse of such care was associated with adverse health outcomes. METHODS We conducted a retrospective cohort study of US veterans who were hospitalized at Veterans Affairs Medical Centers from January 2013 through December 2017 and received a discharge diagnosis of ACS. We used multivariable logistic regression to investigate the association of CKD with use of invasive care (coronary angiography, with or without revascularization; coronary artery bypass graft surgery; or both) deemed clinically indicated based on Global Registry of Acute Coronary Events 2.0 risk scores that denoted a 6-month predicted all-cause mortality ≥5%. Using propensity scoring and inverse probability weighting, we examined the association of nonuse of clinically indicated invasive care with 6-month all-cause mortality. RESULTS Among 34,430 patients with a clinical indication for invasive care, the 18,780 patients with CKD were less likely than the 15,650 without CKD to receive such care (adjusted odds ratio, 0.68; 95% confidence interval, 0.65 to 0.72). Among patients with CKD, nonuse of invasive care was associated with higher risk of 6-month all-cause mortality (absolute risk, 21.5% versus 15.5%; absolute risk difference 6.0%; adjusted risk ratio, 1.39; 95% confidence interval, 1.29 to 1.49). Findings were consistent across multiple sensitivity analyses. CONCLUSIONS In contemporary practice, veterans with CKD who experience ACS are less likely than those without CKD to receive clinically indicated invasive cardiac care. Nonuse of such care is associated with increased mortality.
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Affiliation(s)
- Steven D. Weisbord
- From the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh Pennsylvania
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Maria K. Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nadejda Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - P. Michael Ho
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Michael J. Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Paul M. Palevsky
- From the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh Pennsylvania
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Hepatocyte Nuclear Factor-1α Increases Fibrinogen Gene Expression in Liver and Plasma Fibrinogen Concentration in Rats with Experimental Chronic Renal Failure. Int J Mol Sci 2023; 24:ijms24065733. [PMID: 36982805 PMCID: PMC10052989 DOI: 10.3390/ijms24065733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with elevated plasma fibrinogen concentration. However, the underlying molecular mechanism for elevated plasma fibrinogen concentration in CKD patients has not yet been clarified. We recently found that HNF1α was significantly upregulated in the liver of chronic renal failure (CRF) rats, an experimental model of CKD in patients. Given that the promoter region of the fibrinogen gene possesses potential binding sites for HNF1α, we hypothesized that the upregulation of HNF1α can increase fibrinogen gene expression and consequently plasma fibrinogen concentration in the experimental model of CKD. Here, we found the coordinated upregulation of Aα-chain fibrinogen and Hnfα gene expression in the liver and elevated plasma fibrinogen concentrations in CRF rats, compared with pair-fed and control animals. Liver Aα-chain fibrinogen and HNF1α mRNAs levels correlated positively with (a) liver and plasma fibrinogen levels and (b) liver HNF1α protein levels. The positive correlation between (a) liver Aα-chain fibrinogen mRNA level, (b) liver Aα-chain fibrinogen level, and (c) serum markers of renal function suggest that fibrinogen gene transcription is closely related to the progression of kidney disease. Knockdown of Hnfα in the HepG2 cell line by small interfering RNA (siRNA) led to a decrease in fibrinogen mRNA levels. Clofibrate, an anti-lipidemic drug that reduces plasma fibrinogen concentration in humans, decreased both HNF1α and Aα-chain fibrinogen mRNAs levels in (a) the liver of CRF rats and (b) HepG2 cells. The obtained results suggest that (a) an elevated level of liver HNF1α can play an important role in the upregulation of fibrinogen gene expression in the liver of CRF rats, leading to an elevated concentration of plasma fibrinogen, a protein related to the risk of cardiovascular disease in CKD patients, and (b) fibrates can decrease plasma fibrinogen concentration through inhibition of HNF1α gene expression.
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Positive Correlation between Relative Concentration of Spermine to Spermidine in Whole Blood and Skeletal Muscle Mass Index: A Possible Indicator of Sarcopenia and Prognosis of Hemodialysis Patients. Biomedicines 2023; 11:biomedicines11030746. [PMID: 36979725 PMCID: PMC10045508 DOI: 10.3390/biomedicines11030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Several mechanisms strictly regulate polyamine concentration, and blood polyamines are excreted in urine. This indicates polyamine accumulation in renal dysfunction, and studies have shown increased blood polyamine concentrations in patients with renal failure. Hemodialysis (HD) may compensate for polyamine excretion; however, little is known about polyamine excretion. We measured whole-blood polyamine levels in patients on HD and examined the relationship between polyamine concentrations and indicators associated with health status. Study participants were 59 hemodialysis patients (median age: 70.0 years) at Minami-Uonuma City Hospital and 26 healthy volunteers (median age: 44.5 years). Whole-blood spermidine levels were higher and spermine/spermidine ratio (SPM/SPD) was lower in hemodialysis patients. Hemodialysis showed SPD efflux into the dialysate; however, blood polyamine levels were not altered by hemodialysis and appeared to be minimally excreted. The skeletal muscle mass index (SMI), which was positively correlated with hand grip strength and serum albumin level, was positively correlated with SPM/SPD. Given that sarcopenia and low serum albumin levels are reported risk factors for poor prognosis in HD patients, whole blood SPM/SPD in hemodialysis patients may be a new indicator of the prognosis and health status of HD patients.
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Engelbertz C, Feld J, Makowski L, Kühnemund L, Fischer AJ, Lange SA, Günster C, Dröge P, Ruhnke T, Gerß J, Freisinger E, Reinecke H, Köppe J. Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction depending on renal function: a retrospective analysis. BMC Cardiovasc Disord 2023; 23:62. [PMID: 36732721 PMCID: PMC9896822 DOI: 10.1186/s12872-023-03084-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiovascular disease is often associated with chronic kidney disease (CKD), resulting in an increased risk for poor outcome. We sought to determine short-term mortality and overall survival in ST-elevation myocardial infarction (STEMI) patients with different stages of CKD. METHODS In our retrospective cohort study with health insurance claims data of the Allgemeine Ortskrankenkasse (AOK), anonymized data of all STEMI patients hospitalized between 2010 and 2017 were analyzed regarding presence and severity of concomitant CKD. RESULTS A total of 175,187 patients had an index-hospitalisation for STEMI (without CKD: 78.6% patients, CKD stage 1: 0.8%, CKD stage 2: 4.8%, CKD stage 3: 11.7%, CKD stage 4: 2.8%, CKD stage 5: 0.7%, CKD stage 5d: 0.6%). Patients with CKD were older and had more co-morbidities than patients without CKD. With increasing CKD severity, patients received less revascularization therapies (91.2%, 85.9%, 87.0%, 81.8%, 71.7%, 76.9% and 78.6% respectively, p < 0.001). After 1 year, guideline-recommended medications were prescribed less frequently in advanced CKD (83.4%, 79.3%, 81.5%, 74.7%, 65.0%, 59.4% and 53.7%, respectively, p < 0.001). CKD stages 4, 5 and 5d as well as chronic limb threatening ischemia (CLTI) were associated with decreased overall survival [CKD stage 4: hazard ratio (HR) 1.72; 95% CI 1.66-1.78; CKD stage 5: HR 2.55; 95% CI 2.37-2.73; CKD stage 5d: 5.64; 95% CI 5.42-5.86; CLTI: 2.06; 95% CI 1.98-2.13; all p < 0.001]. CONCLUSIONS CKD is a frequent co-morbidity in patients with STEMI and is associated with a worse prognosis especially in advanced stages. Guideline-recommended therapies in patients with STEMI and CKD are still underused.
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Affiliation(s)
- Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany.
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Lena Makowski
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Leonie Kühnemund
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Alicia Jeanette Fischer
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Stefan A Lange
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | | | | | | | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Eva Freisinger
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
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Liu H, Ng CY, Liu Q, Teo TL, Loh TP, Wong MS, Sethi SK, Tan JG, Heng PY, Saw S, Lam LCW, Lee JMY, Khaled KB, Phyu HP, Ong NWT. Commutability assessment of human urine certified reference materials for albumin and creatinine on multiple clinical analyzers using different statistical models. Anal Bioanal Chem 2023; 415:787-800. [PMID: 36562812 DOI: 10.1007/s00216-022-04472-y] [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: 09/13/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
Urine albumin concentration and albumin-creatinine ratio are important for the screening of early-stage kidney damage. Commutable urine certified reference materials (CRMs) for albumin and creatinine are necessary for standardization of urine albumin and accurate measurement of albumin-urine ratio. Two urine CRMs for albumin and creatinine with certified values determined using higher-order reference measurement procedures were evaluated for their commutability on five brands/models of clinical analyzers where different reagent kits were used, including Roche Cobas c702, Roche Cobas c311, Siemens Atellica CH, Beckman Coulter AU5800, and Abbott Architect c16000. The commutability study was conducted by measuring at least 26 authentic patient urine samples and the human urine CRMs using both reference measurement procedures and the routine methods. Both the linear regression model suggested by the Clinical and Laboratory Standard Institute (CLSI) guidelines and log-transformed model recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Commutability Working Group were used to evaluate the commutability of the human urine CRMs. The commutability of the human urine CRMs was found to be generally satisfactory on all five clinical analyzers for both albumin and creatinine, suggesting that they are suitable to be used routinely by clinical laboratories as quality control or for method validation of urine albumin and creatinine measurements.
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Affiliation(s)
- Hong Liu
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore
| | - Cheng Yang Ng
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore
| | - Qinde Liu
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore.
| | - Tang Lin Teo
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Moh Sim Wong
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sunil Kumar Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Jun Guan Tan
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Ping Ying Heng
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sharon Saw
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Khairee Bin Khaled
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Hnin Pwint Phyu
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Noel Wan Ting Ong
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
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Yoshida K, Mizukami T, Fukagawa M, Akizawa T, Morohoshi H, Sambe T, Ito H, Ogata H, Uchida N. Target phosphate and calcium levels in patients undergoing hemodialysis: a post-hoc analysis of the LANDMARK study. Clin Exp Nephrol 2023; 27:179-187. [PMID: 36303046 DOI: 10.1007/s10157-022-02288-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/10/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is necessary to re-examine the optimal phosphate (P) and calcium (Ca) target values in the contemporary management of chronic kidney disease-mineral and bone disorder to reduce the risks of cardiovascular events in patients receiving hemodialysis. METHODS We performed a post-hoc analysis of the LANDMARK study. The outcomes were defined as cardiovascular events and all-cause death. Data from 2135 patients receiving hemodialysis at risk of vascular calcification were analyzed using a time-dependent Cox proportional hazard model adjusted for background factors. RESULTS On the hazard ratio (HR) curve, the ranges where the lower 95% confidence interval (CI) were below the minimum of HR (= 1.00) were as follows: P = 3.5-5.5 mg/dL; albumin-adjusted Ca < 9.1 mg/dL for cardiovascular events; and P = 3.6-5.3 mg/dL; albumin-adjusted Ca < 9.1 mg/dL for all-cause mortality. In stratified analysis, the HRs for cardiovascular events in P < 3.5 mg/dL and P ≥ 5.5 mg/dL were similar to that of P = 3.5-5.5 mg/dL (P ≥ 0.05), and albumin-adjusted Ca ≥ 9.1 mg/dL had higher HR than values < 9.1 mg/dL [1.30 (95% CI 1.00-1.68; P = 0.046)]. For all-cause mortality, the HR in P < 3.6 mg/dL was higher than that in P = 3.6-5.3 mg/dL [1.76 (95% CI 1.25-2.48; P = 0.001)], while the HRs between P ≥ 5.3 mg/dL and P = 3.6-5.3 mg/dL as well as those between albumin-adjusted Ca ≥ 9.1 and < 9.1 mg/dL were not significantly different (P ≥ 0.05). CONCLUSIONS Managing albumin-adjusted Ca < 9.1 mg/dL may reduce the cardiovascular risk among patients undergoing hemodialysis. Hypophosphatemia < 3.6 mg/dL may be associated with mortality.
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Affiliation(s)
- Kiryu Yoshida
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan. .,Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigasaki-Chuo 35-1, Tsuzuki, Yokohama,, Kanagawa, 224-8503, Japan.
| | - Takuya Mizukami
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hokuto Morohoshi
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takehiko Sambe
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Hidetoshi Ito
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigasaki-Chuo 35-1, Tsuzuki, Yokohama,, Kanagawa, 224-8503, Japan
| | - Hiroaki Ogata
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigasaki-Chuo 35-1, Tsuzuki, Yokohama,, Kanagawa, 224-8503, Japan
| | - Naoki Uchida
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
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Jiang L, Chen S, Wu Y, Zhou D, Duan L. Prediction of coronary heart disease in gout patients using machine learning models. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:4574-4591. [PMID: 36896513 DOI: 10.3934/mbe.2023212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Growing evidence shows that there is an increased risk of cardiovascular diseases among gout patients, especially coronary heart disease (CHD). Screening for CHD in gout patients based on simple clinical factors is still challenging. Here we aim to build a diagnostic model based on machine learning so as to avoid missed diagnoses or over exaggerated examinations as much as possible. Over 300 patient samples collected from Jiangxi Provincial People's Hospital were divided into two groups (gout and gout+CHD). The prediction of CHD in gout patients has thus been modeled as a binary classification problem. A total of eight clinical indicators were selected as features for machine learning classifiers. A combined sampling technique was used to overcome the imbalanced problem in the training dataset. Eight machine learning models were used including logistic regression, decision tree, ensemble learning models (random forest, XGBoost, LightGBM, GBDT), support vector machine (SVM) and neural networks. Our results showed that stepwise logistic regression and SVM achieved more excellent AUC values, while the random forest and XGBoost models achieved more excellent performances in terms of recall and accuracy. Furthermore, several high-risk factors were found to be effective indices in predicting CHD in gout patients, which provide insights into the clinical diagnosis.
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Affiliation(s)
- Lili Jiang
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Sirong Chen
- School of Mathematical Sciences, Soochow University, Suzhou, China
| | - Yuanhui Wu
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Da Zhou
- School of Mathematical Sciences, Xiamen University, Xiamen, China
| | - Lihua Duan
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Shanah L, Mir T, Uddin MM, Hussain T, Parajuli T, Bhat Z. Clinical outcomes and 30-day readmissions for heart failure with reduced ejection fraction with cardiorenal syndrome: A National Cohort Study. Int J Cardiol 2023; 370:244-249. [PMID: 36328112 DOI: 10.1016/j.ijcard.2022.10.161] [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: 06/30/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Literature regarding outcomes of cardiorenal syndrome (CRS) among heart failure with reduced ejection fraction (HFrEF) is limited. OBJECTIVE To study the clinical outcomes and 30-day readmission rates of CRS patients with HFrEF. METHODS Data from the Nationwide Readmissions Database (NRD) that constitutes 49.1% of the stratified sample of all hospitals in the United States (US), representing >95% of the national population, was analyzed for the CRS with HFrEF visits from 2018 to 2019. CRS was defined by the ICD-10 codes. RESULTS Out of the 1,530,749 index CRS-related hospitalizations (mean age:64.37 ± 13.30 years; 38.6%females) 73,126 (6.0%) CKD I-II, 883,119 (72.6%) CKD III-IV, and 258,835 (21.3%) CKD V-and-more related encounters were recorded. Mortality was higher among CKD stage V-and-more in comparison to other subgroups(7.6%vs5.73%;p < 0.001). AKI with underlying CKD was more common among stage III-IV compared to other subgroups (55.9%vs43.7%;p < 0.001). Respiratory failure, the second major complication, was more common among stage V-and-more compared to other subgroups (32.5%vs30%;p < 0.001). The overall CRS-related 30-day readmission rate was 22.7%, with CKD V-and-more accounting for highest rates(29.89%), followed by CKD stage III-IV(20.05%) and CKD I-II(12.99%). The primary etiology for 30-day readmission was cardiovascular among all subgroups (54.2%, 54.6%, and 41.80%, which corresponds to CKD I-II, CKD III-IV and CKD V-and-more, respectively). CONCLUSION CRS among HFrEF accounts for substantial healthcare burden with high 30-day readmission rates. Higher all-cause mortality and 30-day readmissions were associated with worse renal disease. This would suggest that more vigilance is needed by physicians for discharge planning among this patient population.
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Affiliation(s)
- Layla Shanah
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Tanveer Mir
- Internal Medicine, Wayne State University, Detroit, MI, USA; Internal Medicine, Baptist Health System, Montgomery, AL, USA.
| | | | - Tanveer Hussain
- Internal Medicine, Wayne State University, Detroit, MI, USA; Critical Care Medicine, Summa Health System, Akron, OH, USA
| | | | - Zeenat Bhat
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
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ARIMA model for predicting chronic kidney disease and estimating its economic burden in China. BMC Public Health 2022; 22:2456. [PMID: 36585665 PMCID: PMC9801144 DOI: 10.1186/s12889-022-14959-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an important global public health issue. In China, CKD affects a large number of patients and causes a huge economic burden. This study provided a new way to predict the number of patients with CKD and estimate its economic burden in China based on the autoregressive integrated moving average (ARIMA) model. METHODS Data of the number of patients with CKD in China from 2000 to 2019 were obtained from the Global Burden of Disease. The ARIMA model was used to fit and predict the number of patients with CKD. The direct and indirect economic burden of CKD were estimated by the bottom-up approach and the human capital approach respectively. RESULTS The results of coefficient of determination (0.99), mean absolute percentage error (0.26%), mean absolute error (343,193.8) and root mean squared error (628,230.3) showed that the ARIMA (1,1,1) model fitted well. Akaike information criterion (543.13) and Bayesian information criterion (546.69) indicated the ARIMA (1,1,1) model was reliable when analyzing our data. The result of relative error of prediction (0.23%) also suggested that the model predicted well. The number of patients with CKD in 2020 to 2025 was predicted to be about 153 million, 155 million, 157 million, 160 million, 163 million and 165 million respectively, accounting for more than 10% of the Chinese population. The total economic burden of CKD from 2019 to 2025 was estimated to be $179 billion, $182 billion, $185 billion, $188 billion, $191 billion, $194 billion and $198 billion respectively. CONCLUSION The number of patients with CKD and the economic burden of CKD will continue to rise in China. The number of patients with CKD in China would increase by 2.6 million (1.6%) per year on average from 2020 to 2025. Meanwhile, the total economic burden of CKD in China would increase by an average of $3.1 billion per year. The ARIMA model is applicable to predict the number of patients with CKD. This study provides a new perspective for more comprehensive understanding of the future risk of CKD.
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Anxiety-depression levels and coping strategies among renal transplant waitlisted and non-waitlisted hemodialysis patients. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background/Aim: Although hemodialysis provides prolonged survival, patients face major challenges, including conflicts about life decisions, limited physical, mental, and lifestyle activities, psychological distress, high prevalence of anxiety and depression symptoms, and compromised health-related quality of life. This study aimed to compare anxiety-depression levels and coping strategies between renal transplant waitlisted and non-waitlisted hemodialysis patients.
Methods: A total of 75 hemodialysis patients were enrolled in this case-control analytical study, including renal transplant waitlisted (n = 35) and non-waitlisted (n = 40) patients. Patients were asked to fill out a questionnaire including socio-demographic characteristics, duration of hemodialysis, the Hospital Anxiety and Depression Scale, and the Ways of Coping Questionnaire. Comparative analyses were performed via Student's t-test and Pearson Correlation test.
Results: The mean age was 57.1 (15.3) years; 56% were males, and being under hemodialysis treatment was 7.3 (5.9) years. Waitlisted and non-waitlisted patients were matched. Overall, 28 patients (37.3%) had anxiety, and 34 patients (45.3%) had depression. There was no significant difference between the two groups regarding depression scores. Anxiety was more common among non-waitlisted than waitlisted patients (P = 0.043). The fatalistic approach was the most common coping strategy applied, and there was a significant negative correlation between anxiety scores and the problem-solving approach (P = 0.034) and a significant positive correlation between depression scores and the helplessness approach (r = 0.234, P = 0.043).
Conclusion: Both waitlisted and non-waitlisted hemodialysis patients have significantly higher levels of depression, with anxiety being higher in non-waitlisted patients. Since coping strategies differed concerning anxiety and depression but not transplant candidacy, psychiatric evaluation and counseling would be essential in hemodialysis patients to control the stressors.
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Chen F, Liu J, Han S, Xu T. Association between 10-Year Atherosclerotic Cardiovascular Disease Risk and Estimated Glomerular Filtration Rate in Chinese People with Normal to Slightly Reduced Kidney Function: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16300. [PMID: 36498373 PMCID: PMC9741051 DOI: 10.3390/ijerph192316300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/26/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Many studies suggest that cardiovascular-related mortality is higher in patients with end-stage renal disease, but few focus on the risk of atherosclerotic cardiovascular disease (ASCVD) in subjects with normal to slightly reduced kidney function. Our study aimed to explore the association between normal to slightly decreased estimated glomerular filtration rate (eGFR) and 10-year ASCVD risk levels among subjects with relative health conditions. A total of 12,986 subjects from the Chinese Physiological Constant and Health Condition survey were included. We used the Chronic Kidney Disease Epidemiology Collaboration equations to calculate eGFR and the 10-year ASCVD risk scores to assess the subjects' risk of 10-year ASCVD. Ordinal logistic regression analysis was conducted to explore the association between ASCVD risk levels and eGFR, and adjust the possible confounding factors. Results indicated that the 10-year ASCVD risk scores gradually increased following the decrease in eGFR. Subjects who had smaller eGFR were more likely to have a greater risk of 10-year ASCVD. Additionally, the association between eGFR and 10-year ASCVD risk level changed with varying eGFR. The risk of one or more levels increasing in the 10-year ASCVD risk group was 5.20 times (Quartile 2 [Q2], 95%CI: 3.90, 6.94), 9.47 times (Q3, 95%CI: 7.15, 12.53) and 11.41 times (Q4, 95%CI: 8.61, 15.12) higher compared with Q1. We found that eGFR was significantly associated with 10-year ASCVD risk among Chinese subjects with normal to slightly reduced kidney function. Therefore, clinicians should strengthen the monitoring of cardiovascular risk in patients with renal impairment (even if renal function is only mildly reduced), assess the patients' risk of ASCVD, and take early action in high-risk groups to reduce the risk of adverse atherosclerotic cardiovascular events.
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Affiliation(s)
- Feilong Chen
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Junting Liu
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing 100020, China
| | - Shaomei Han
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
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Airik M, Phua YL, Huynh AB, McCourt BT, Rush BM, Tan RJ, Vockley J, Murray SL, Dorman A, Conlon PJ, Airik R. Persistent DNA damage underlies tubular cell polyploidization and progression to chronic kidney disease in kidneys deficient in the DNA repair protein FAN1. Kidney Int 2022; 102:1042-1056. [PMID: 35931300 PMCID: PMC9588672 DOI: 10.1016/j.kint.2022.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
Defective DNA repair pathways contribute to the development of chronic kidney disease (CKD) in humans. However, the molecular mechanisms underlying DNA damage-induced CKD pathogenesis are not well understood. Here, we investigated the role of tubular cell DNA damage in the pathogenesis of CKD using mice in which the DNA repair protein Fan1 was knocked out. The phenotype of these mice is orthologous to the human DNA damage syndrome, karyomegalic interstitial nephritis (KIN). Inactivation of Fan1 in kidney proximal tubule cells sensitized the kidneys to genotoxic and obstructive injury characterized by replication stress and persistent DNA damage response activity. Accumulation of DNA damage in Fan1 tubular cells induced epithelial dedifferentiation and tubular injury. Characteristic to KIN, cells with chronic DNA damage failed to complete mitosis and underwent polyploidization. In vitro and in vivo studies showed that polyploidization was caused by the overexpression of DNA replication factors CDT1 and CDC6 in FAN1 deficient cells. Mechanistically, inhibiting DNA replication with Roscovitine reduced tubular injury, blocked the development of KIN and mitigated kidney function in these Fan1 knockout mice. Thus, our data delineate a mechanistic pathway by which persistent DNA damage in the kidney tubular cells leads to kidney injury and development of CKD. Furthermore, therapeutic modulation of cell cycle activity may provide an opportunity to mitigate the DNA damage response induced CKD progression.
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Affiliation(s)
- Merlin Airik
- Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yu Leng Phua
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy B Huynh
- Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Blake T McCourt
- Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brittney M Rush
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Roderick J Tan
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jerry Vockley
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Susan L Murray
- Department of Nephrology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony Dorman
- Department of Nephrology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rannar Airik
- Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Developmental Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Rios P, Sola L, Ferreiro A, Silvariño R, Lamadrid V, Ceretta L, Gadola L. Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes. PLoS One 2022; 17:e0266617. [PMID: 36240220 PMCID: PMC9565398 DOI: 10.1371/journal.pone.0266617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/23/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Renal Healthcare Program Uruguay (NRHP-UY) is a national, multidisciplinary program that provides care to chronic kidney disease (CKD) patients. In this study, we report the global results of CKD patient outcomes and a comparison between those treated at the NRHP-UY Units, with those patients who were initially included in the program but did not adhere to follow up. METHODS A cohort of not-on dialysis CKD patients included prospectively in the NRHP-UY between October 1st 2004 and September 30th 2017 was followed-up until September 30th 2019. Two groups were compared: a) Nephrocare Group: Patients who had at least one clinic visit during the first year on NRHP-UY (n = 11174) and b) Non-adherent Group: Patients who were informed and accepted to be included but had no subsequent data registered after admission (n = 3485). The study was approved by the Ethics Committee and all patients signed an informed consent. Outcomes were studied with Logistic and Cox´s regression analysis, Fine and Gray competitive risk and propensity-score matching tests. RESULTS 14659 patients were analyzed, median age 70 (60-77) years, 56.9% male. The Nephrocare Group showed improved achievement of therapeutic goals, ESKD was more frequent (HR 2.081, CI 95%1.722-2.514) as planned kidney replacement therapy (KRT) start (OR 2.494, CI95% 1.591-3.910), but mortality and the combined event (death and ESKD) were less frequent (HR 0.671, CI95% 0.628-0.717 and 0.777, CI95% 0.731-0.827) (p = 0.000) compared to the Non-adherent group. Results were similar in the propensity-matched group: ESKD (HR 2.041, CI95% 1.643-2.534); planned kidney replacement therapy (KRT) start (OR 2.191, CI95% 1.322-3.631) death (HR 0.692, CI95% 0.637-0.753); combined event (HR 0.801, CI95% 0.742-0.865) (p = 0.000). CONCLUSION Multidisciplinary care within the NRHP-UY is associated with timely initiation of KRT and lower mortality in single outcomes, combined analysis, and propensity-matched analysis.
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Affiliation(s)
- Pablo Rios
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Laura Sola
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Alejandro Ferreiro
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ricardo Silvariño
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Verónica Lamadrid
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Laura Ceretta
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Liliana Gadola
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- * E-mail:
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Lipidic profiles of patients starting peritoneal dialysis suggest an increased cardiovascular risk beyond classical dyslipidemia biomarkers. Sci Rep 2022; 12:16394. [PMID: 36180468 PMCID: PMC9525574 DOI: 10.1038/s41598-022-20757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 09/19/2022] [Indexed: 11/15/2022] Open
Abstract
Patients on peritoneal dialysis (PD) have an increased risk of cardiovascular disease (CVD) and an atherogenic lipid profile generated by exposure to high glucose dialysis solutions. In the general population, the reduction of classic lipids biomarkers is associated with improved clinical outcomes; however, the same results have not been seen in PD population, a lack of data this study aims to fulfill. Single-center prospective observational study of a cohort of CKD patients who started renal replacement therapy with continuous ambulatory peritoneal dialysis. The differences in the lipid profile and analytical variables before and 6 months after the start of peritoneal dialysis were analyzed. Samples were analyzed on an Ultra-Performance Liquid Chromatography system. Thirty-nine patients were enrolled in this study. Their mean age was 57.9 ± 16.3 years. A total of 157 endogenous lipid species of 11 lipid subclasses were identified. There were significant increases in total free fatty acids (p < 0.05), diacylglycerides (p < 0.01), triacylglycerides, (p < 0.01), phosphatidylcholines (p < 0.01), phosphatidylethanolamines (p < 0.01), ceramides (p < 0.01), sphingomyelins (p < 0.01), and cholesterol esters (p < 0.01) from baseline to 6 months. However, there were no differences in the classical lipid markers, neither lysophosphatidylcholines, monoacylglycerides, and sphingosine levels. 6 months after the start of the technique, PD patients present changes in the lipidomic profile beyond the classic markers of dyslipidemia.
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Yeh JP, Sung PH, Chiang JY, Huang CR, Chen YL, Lai JP, Sheu JJ. Rejuvenated endothelial progenitor cells through overexpression of cellular prion protein effectively salvaged the critical limb ischemia in rats with preexisting chronic kidney disease. Stem Cell Res Ther 2022; 13:447. [PMID: 36056416 PMCID: PMC9440498 DOI: 10.1186/s13287-022-03119-0] [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: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study tested the hypothesis that overexpression of cellular prion protein in endothelial progenitor cells (PrPcOE-EPCs), defined as "rejuvenated EPCs," was superior to EPCs for salvaging the critical limb ischemia (CLI) induced after 28-day chronic kidney disease (CKD) induction in rat. METHODS AND RESULTS Cell viability and flow cytometric analyses of early/late apoptosis/total-intracellular ROS/cell cycle (sub-G1, G2/M phase) were significantly higher in EPCs + H2O2 than in EPCs that were significantly reversed in PrPcOE-EPCs + H2O2 (all p < 0.001). The protein expressions of inflammation (IL-1ß/IL-6/MMP-9/p-NF-κB) were significantly increased in EPC + TNF-α than in EPCs that were significantly reversed in PrPcOE-EPCs + TNF-α (all p < 0.001). Adult-male SD rats (n = 8/each group) were categorized into group 1 (sham-operated control), group 2 (CKD + CLI), group 3 [CKD + CLI + EPCs by intravenous (0.6 × 105)/intra-muscular (0.6 × 105) injections at 3 h after CLI induction], group 4 (CKD + CLI + PrPcOE-EPCs/dose-administration as group 3) and group 5 (CKD + CLI + siPrnp-EPCs/dose-administration as group 3). By day 14 after CLI induction, the ratio of ischemia to normal blood flow (INBF) in CLI area was highest in group 1/lowest in group 2/significantly higher in group 4 than in groups 3/5 and significantly higher in group 3 than in group 5 (all p < 0.0001). Histopathology demonstrated that the angiogenesis (number of small vessels/CD31 + cells) exhibited a similar trend, whereas the fibrosis/kidney injury score exhibited an opposite pattern of INBF among the groups (all p < 0.0001). The protein expressions of angiogenesis (SDF-1α/VEGF/CXCR4)/cell-stress signaling (p-PI3K/p-Akt/p-m-TOR) were significantly and progressively increased from groups 1-4 that were reversed in group 5 (all p < 0.0001). The protein expressions of fibrotic (p-Smad3/TGF-ß)/oxidative-stress (NOX-1/NOX-2/oxidized-protein)/apoptotic (mitochondrial-Bax/cleaved caspase3/cleaved PARP)/mitochondrial-damaged (cytosolic-cytochrome-C) biomarkers displayed an opposite pattern of INBF among the groups (all p < 0.0001). CONCLUSION PrPcOE-EPCs were superior to EPCs only therapy for salvaging the CLI.
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Affiliation(s)
- Jui-Po Yeh
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City, 833253, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833253, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, 804201, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 807378, Taiwan
| | - Chi-Ruei Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833253, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833253, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan
| | - Jui-Pin Lai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City, 833253, Taiwan.
| | - Jiunn-Jye Sheu
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan. .,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833253, Taiwan. .,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung, 83301, Taiwan.
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Koshi-Ito E, Inaguma D, Ishii H, Yuzawa Y, Kabata D, Shintani A, Inaba M, Emoto M, Mori K, Morioka T, Nakatani S, Shoji T. Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: Results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial. Clin Kidney J 2022; 15:2281-2291. [DOI: 10.1093/ckj/sfac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
While the risk of exceeding the standard range of phosphorus levels has been investigated, the impact of the degree of fluctuations has not been investigated.
Methods
Data were derived from the Japan Dialysis Active Vitamin D trial, a 4-year prospective, randomized study involving 976 patients without secondary hyperparathyroidism undergoing hemodialysis in Japan. Laboratory data were collected every six months, and the primary outcome was the time to the occurrence of cardiovascular events. The effect of time-dependent changes in phosphorus levels was assessed using a time-varying Cox proportional hazard regression model.
Results
The median serum phosphorus levels at baseline and at the final observation were 4.70 [3.90–5.30] and 5.00 [4.20–5.80] mg/dL, respectively. Over each six-month period, phosphorus changes ranged from -7.1 to +6.7 mg/dL, with a median value of -0.1 to +0.3 mg/dL. During follow-up, composite cardiovascular events occurred in 103 of 964 patients. Although the p-value for the interaction between serum phosphorus level fluctuations and baseline phosphorus levels was insignificant, the following trends were observed. First, patients with relatively high initial phosphorus levels over a six-month period showed a trend towards a higher hazard with greater changes in the phosphorus level over the six-month period. Second, it was suggested that oral VDRAs could contribute to the relationship between fluctuating phosphorus levels and cardiovascular events.
Conclusions
Our results suggest the importance of maintaining stable phosphorus levels, not only in the normal range but also without fluctuations in the risk of cardiovascular events, among patients without secondary hyperparathyroidism undergoing maintenance hemodialysis.
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Affiliation(s)
- Eri Koshi-Ito
- Fujita Health University School of Medicine , Toyoake, Aichi , Japan
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine
| | - Daijo Inaguma
- Fujita Health University School of Medicine , Toyoake, Aichi , Japan
- The J-DAVID Investigators
- Department of Internal Medicine, Fujita Health University Bantane Hospital , Aichi , Japan
| | - Haruka Ishii
- Department of Medical Statistics, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Yukio Yuzawa
- Fujita Health University School of Medicine , Toyoake, Aichi , Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Masaaki Inaba
- The J-DAVID Investigators
- Vascular Science Centre for Translational Research, Osaka City University Graduate School of Medicine , Osaka , Japan
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
- Department of Nephrology, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Masanori Emoto
- The J-DAVID Investigators
- Vascular Science Centre for Translational Research, Osaka City University Graduate School of Medicine , Osaka , Japan
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
- Department of Nephrology, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Tetsuo Shoji
- The J-DAVID Investigators
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
- Vascular Science Centre for Translational Research, Osaka City University Graduate School of Medicine , Osaka , Japan
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Jose A, Zhou C, Baker R, Walker J, Kurek N, O'Donnell RE, Elwing JM, Gerson M. Predictive value of incidental right ventricular abnormalities identified on SPECT for mortality and pulmonary hypertension. J Nucl Cardiol 2022; 29:1903-1914. [PMID: 33851355 PMCID: PMC8043660 DOI: 10.1007/s12350-021-02612-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical significance of incidentally found RV abnormalities on low-risk SPECT studies is not well-defined. The objective of this study was to determine the predictive value of incidental right ventricular (RV) abnormalities identified on single photon emission computed tomography (SPECT) scans for mortality and pulmonary hypertension (PH). METHODS We retrospectively analyzed all low-risk SPECT studies in patients without known coronary artery or pulmonary vascular disease, performed at our institution, from 2007-2020. Adjusted Cox proportional hazards models were used to evaluate the association between incidental RV abnormalities on low-risk SPECT studies and outcomes. RESULTS Of the 4761 patients included in the analysis, mortality events were present in 494, and echocardiographic PH was present in 619. Incidental RV abnormalities on low-risk SPECT studies were significantly and independently associated with all-cause mortality (HR = 1.41, CI [1.07-1.86], P = 0.0152) and echocardiographic PH (HR = 2.06, CI [1.64-2.60], P < 0.0001). CONCLUSIONS These data suggest incidental RV abnormalities found on low-risk SPECT imaging studies are significantly and independently associated with increased mortality and risk of developing echocardiographic PH, and could identify high-risk patients for closer monitoring and additional diagnostic testing.
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Affiliation(s)
- Arun Jose
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, 6352-A, Medical Sciences Building, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
| | - Christine Zhou
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rachel Baker
- Undergraduate Studies, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
| | - Jackson Walker
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicholas Kurek
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert E O'Donnell
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean M Elwing
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, 6352-A, Medical Sciences Building, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Myron Gerson
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Indraratna P, Khasanova E, Gulsin GS, Tzimas G, Takagi H, Park KH, Lin FY, Shaw LJ, Lee SE, Narula J, Bax JJ, Chang HJ, Leipsic J. Plaque progression: Where, why, and how fast? A review of what we have learned from the analysis of patient data from the PARADIGM registry. J Cardiovasc Comput Tomogr 2022; 16:294-302. [PMID: 34824029 DOI: 10.1016/j.jcct.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/20/2021] [Accepted: 11/10/2021] [Indexed: 12/28/2022]
Abstract
Ischemic heart disease is the most common cause of mortality worldwide. The pathophysiology of myocardial infarction relates to temporal changes of atherosclerotic plaque culminating in plaque rupture, erosion or hemorrhage and the subsequent thrombotic response. Coronary computed tomographic angiography (CCTA) provides the ability to visualize and quantify plaque, and plaque progression can be measured on a per-patient basis by comparing findings of serial CCTA. The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry was established with the objective of identifying patterns of plaque progression in a large population. The registry comprises over 2000 patients with multiple CCTA scans performed at least two years apart. Unlike previous CCTA registries, a semi-automated plaque quantification technique permitting detailed analysis of plaque progression was performed on all patients with interpretable studies. Since the registry was established, 19 peer-reviewed publications were identified, and all are reviewed and summarized in this article.
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Affiliation(s)
- Praveen Indraratna
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada; Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia.
| | - Elina Khasanova
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada
| | - Gaurav S Gulsin
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada; Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Georgios Tzimas
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada; Department of Heart Vessels, Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hidenobu Takagi
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada; Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
| | - Keun-Ho Park
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada; Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, USA
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jonathon Leipsic
- University of British Columbia and Department of Radiology, St. Paul's Hospital, Vancouver, Canada
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