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Alikhani R, Pai MP. Reconsideration of the current models of estimated kidney function-based drug dose adjustment in older adults: The role of biological age. Clin Transl Sci 2023; 16:2095-2105. [PMID: 37702349 PMCID: PMC10651638 DOI: 10.1111/cts.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
Human lifespan has increased from a median of 46.5 years in 1950 to 71.7 years in 2022. As people age, one of the inevitable consequences is a decline in kidney function and glomerular filtration rate (GFR) which can have direct or indirect effects on the pharmacokinetic and pharmacodynamic profiles of many drugs. Numerous equations have been developed to generate estimated GFR (eGFR) using the two principal biomarkers: serum creatinine and serum cystatin C. However, the trajectory of changes with aging is dissimilar in these equations. In addition, there is recognition that chronological age (lifespan) often does not reflect biological age (healthspan) as an essential parameter in kidney function equations. In the past decade, there has been an increasing interest in quantifying biological age and new commercially available assays have entered the marketplace. In this narrative review, we illustrate how dominant equations of eGFR model the fractional change in this parameter very differently across chronological age. In addition, we review various biological age indicators (aging clocks) and challenges to their application in clinical practice. Importantly, by comparing vancomycin's mean clearance as a drug with limited metabolism and unchanged elimination between two age milestones in some recent population pharmacokinetic models, we show how efforts to quantify kidney function in older adults optimally remain under-explored, particularly those at the upper end of their lifespan. We also propose considering new models that integrate biological age as a new pathway to improve precision drug dosing in older adults.
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Affiliation(s)
- Radin Alikhani
- Department of Clinical Pharmacy, College of PharmacyUniversity of MichiganAnn ArborMichiganUSA
| | - Manjunath P. Pai
- Department of Clinical Pharmacy, College of PharmacyUniversity of MichiganAnn ArborMichiganUSA
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Jiang Y, Lin X, Mao Y, Zhao J, Zhang G, Yu J, Dong R, Zha Y. Acteoside Alleviates Renal Fibrosis by Inhibiting β-Catenin/CTGF Signaling Pathway in UUO Rats. Nat Prod Commun 2022. [DOI: 10.1177/1934578x221134880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Acteoside (ACT) has been reported to regulate the inflammation and immune response. The study aims to explore the effect of ACT on renal fibrosis in unilateral ureteral obstruction (UUO) rats. Methods: Eighteen Sprague-Dawley rats were randomly divided into 3 groups: sham group, opened the abdominal cavity and sutured abdominal; UUO group, performed UUO surgery; and ACT + UUO group, ACT (40 mg/kg) was given by gavage every day after UUO surgery. After 2 weeks of rat model construction, urine and blood samples were collected for biochemical analysis, while kidney tissues were harvested for hematoxylin and eosin (H&E), Masson's trichrome, and immunohistochemistry staining. The expression of connective tissue growth factor (CTGF), alpha smooth muscle actin (α-SMA), collagen III, heat shock protein 47 (HSP47), and β-catenin in the renal tissue was detected and the correlation between these proteins was analyzed. Results: ACT improved the parameters of renal function in UUO rats, including decreased creatinine and urea nitrogen, and declined urinary protein. Pathological analysis suggested that ACT improved the conditions of renal tubule lesion (including structure destruction, atrophy and lumen obstruction), renal interstitial fibrosis and inflammatory cell infiltration in UUO rats. It also down-regulated the expressions of fibrin-related proteins β-catenin, CTGF, α-SMA, collagen III, and HSP47. Correlation analysis found that β-catenin and CTGF were correlated with the expressions of α-SMA, collagen III, and HSP47. Conclusions: ACT could alleviate renal fibrosis in UUO rats probably via inhibiting β-catenin/CTGF signaling pathway.
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Affiliation(s)
| | - Xin Lin
- Department of Nephrology, Guizhou Provincial People's Hospital & Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, China
| | - Yan Mao
- School of Medicine, Guizhou University, Guiyang, China
| | - Jianqiu Zhao
- Department of Nephrology, Guizhou Provincial People's Hospital & Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, China
| | - Guihua Zhang
- Department of Nephrology, Guizhou Provincial People's Hospital & Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, China
| | - Jiali Yu
- Department of Nephrology, Guizhou Provincial People's Hospital & Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, China
| | - Rong Dong
- Department of Nephrology, Guizhou Provincial People's Hospital & Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, China
| | - Yan Zha
- Graduate School, Zunyi Medical University, Zunyi, China
- Department of Nephrology, Guizhou Provincial People's Hospital & Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, China
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Wee Z, Ganguly S, Tham KW, Lim CH, Tan JTH, Lee PC. Renal Outcomes 1 Year After Metabolic Bariatric Surgery in a Multi-ethnic Asian Cohort. Obes Surg 2021; 31:5358-5366. [PMID: 34586568 DOI: 10.1007/s11695-021-05732-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Obesity increases the risk of incident chronic kidney disease (CKD) and is one of the strongest risk factors for new-onset CKD even in the absence of metabolic risk factors. Weight loss has been shown to reduce renal hyperfiltration and proteinuria. Metabolic bariatric surgery (MBS) remains an effective treatment for obesity and its metabolic-related complications. However, literature on its impact on renal function remains limited. MATERIALS AND METHODS This was an observational retrospective study in a tertiary centre in Singapore. MBS cases performed at the centre between 2008 and 2019 were included. The primary outcome measures were estimated glomerular filtration rate (eGFR), calculated using the CKD epidemiology collaboration equation, and albuminuria (defined as urine albumin-creatinine ratio (uACR) > 3.5 mg/mmol) at baseline and 1-year post-MBS. RESULTS Five hundred fifty-seven patients were included. One-year post-MBS, median eGFR increased from 110.9 mL/min/1.73 m2 (IQR 92.4 to 121.5) to 112.6 mL/min/1.73 m2 (IQR 97.3 to 122.3), p < 0.001. Median uACR decreased from 1.00 mg/mmol (IQR 0.40 to 3.55) to 0.70 mg/mmol (IQR 0.40 to 1.80) 1-year post-MBS (p = 0.001). 12.9% of patients had improved CKD staging. The proportion of patients with albuminuria decreased from 24.8% at baseline to 1.89% 1-year post-MBS (p < 0.001). One-year post-MBS, the subgroup with reduced eGFR had significant increases in eGFR (p < 0.001), with a trend towards a reduction in uACR. CONCLUSIONS MBS had a positive impact on renal function with modest but statistically significant improvement in eGFR and reduction in albuminuria at 1-year post-surgery. Longer-term data is required to investigate the durability of this impact.
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Affiliation(s)
- Zongwen Wee
- Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore.
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Kwang Wei Tham
- Singapore Association for the Study of Obesity, 6 Napier Road #09-17, Singapore, 258449, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Jeremy Tian Hui Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
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Zhang G, Yu F, Dong R, Yu J, Luo M, Zha Y. Verbascoside alleviates renal fibrosis in unilateral ureteral obstruction rats by inhibiting macrophage infiltration. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2021; 24:752-759. [PMID: 34630952 PMCID: PMC8487594 DOI: 10.22038/ijbms.2021.52759.11903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/19/2021] [Indexed: 12/29/2022]
Abstract
Objective(s): To explore the effect of verbascoside on renal fibrosis in unilateral ureteral obstruction (UUO) rats. Materials and Methods: Twenty Sprague-Dawley rats were randomly distributed into sham-operated, UUO, and UUO+Verbascoside groups. After two weeks of rat model construction, urine and blood samples were collected for biochemical analysis while kidney tissues were harvested for hematoxylin and eosin (H&E), Masson’s Trichrome, and immunohistochemistry staining. Pearson coefficient was used to analyze the correlation between the two proteins. Results: Verbascoside improved UUO-induced renal dysfunction as detected by decreased serum creatinine, urea nitrogen, and urinary protein excretion rate. In UUO rats, H&E staining result revealed increased total nucleated cell number, and Masson’s Trichrome staining results showed tubular interstitial fibrosis with the deposition of collagen fibrils. Besides, expressions of fibrosis-related proteins including collagen type I (COL-I), α-smooth muscle actin (a-SMA), and tissue inhibitor of metalloproteinase 2 (TIMP2) expressed higher in the UUO group. Moreover, macrophage infiltration-related factors such as CD68+, F4/80+ cells, and suppressor of cytokine signaling-3 (SOCS3) were significantly higher in the UUO group than in sham-operated rats. However, after administration with verbascoside, the accumulation of collagen fibrils and total nucleated cell numbers were mitigated. Likewise, macrophage infiltration was extenuated and fibrosis-related proteins were down-regulated in the UUO+Verbascoside rats. Correlation analysis indicated that macrophage infiltration-related markers were related to fibrosis-related factors. Conclusion: Verbascoside could alleviate renal fibrosis in UUO rats probably through ameliorating macrophage infiltration.
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Affiliation(s)
- Guihua Zhang
- Guizhou University School of Medicine, Guizhou University, Gui Yang, Gui Zhou, China
| | - Fuxun Yu
- The NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, Gui Yang, Gui Zhou, China
| | - Rong Dong
- Guizhou University School of Medicine, Guizhou University, Gui Yang, Gui Zhou, China.,Department of Nephrology, Guizhou Provincial People's Hospital, Gui Yang, Gui Zhou, China
| | - Jiali Yu
- Guizhou University School of Medicine, Guizhou University, Gui Yang, Gui Zhou, China.,Department of Nephrology, Guizhou Provincial People's Hospital, Gui Yang, Gui Zhou, China
| | - Meng Luo
- Guizhou University School of Medicine, Guizhou University, Gui Yang, Gui Zhou, China.,Department of Thoracic Surgery, Guizhou Provincial People's Hospital, Gui Yang, Gui Zhou, China
| | - Yan Zha
- Guizhou University School of Medicine, Guizhou University, Gui Yang, Gui Zhou, China.,Department of Nephrology, Guizhou Provincial People's Hospital, Gui Yang, Gui Zhou, China
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