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Cai SS, Zheng TY, Wang KY, Zhu HP. Clinical study of different prediction models in predicting diabetic nephropathy in patients with type 2 diabetes mellitus. World J Diabetes 2024; 15:43-52. [PMID: 38313855 PMCID: PMC10835501 DOI: 10.4239/wjd.v15.i1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/25/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Among older adults, type 2 diabetes mellitus (T2DM) is widely recognized as one of the most prevalent diseases. Diabetic nephropathy (DN) is a frequent complication of DM, mainly characterized by renal microvascular damage. Early detection, aggressive prevention, and cure of DN are key to improving prognosis. Establishing a diagnostic and predictive model for DN is crucial in auxiliary diagnosis. AIM To investigate the factors that impact T2DM complicated with DN and utilize this information to develop a predictive model. METHODS The clinical data of 210 patients diagnosed with T2DM and admitted to the First People's Hospital of Wenling between August 2019 and August 2022 were retrospectively analyzed. According to whether the patients had DN, they were divided into the DN group (complicated with DN) and the non-DN group (without DN). Multivariate logistic regression analysis was used to explore factors affecting DN in patients with T2DM. The data were randomly split into a training set (n = 147) and a test set (n = 63) in a 7:3 ratio using a random function. The training set was used to construct the nomogram, decision tree, and random forest models, and the test set was used to evaluate the prediction performance of the model by comparing the sensitivity, specificity, accuracy, recall, precision, and area under the receiver operating characteristic curve. RESULTS Among the 210 patients with T2DM, 74 (35.34%) had DN. The validation dataset showed that the accuracies of the nomogram, decision tree, and random forest models in predicting DN in patients with T2DM were 0.746, 0.714, and 0.730, respectively. The sensitivities were 0.710, 0.710, and 0.806, respectively; the specificities were 0.844, 0.875, and 0.844, respectively; the area under the receiver operating characteristic curve (AUC) of the patients were 0.811, 0.735, and 0.850, respectively. The Delong test results revealed that the AUC values of the decision tree model were lower than those of the random forest and nomogram models (P < 0.05), whereas the difference in AUC values of the random forest and column-line graph models was not statistically significant (P > 0.05). CONCLUSION Among the three prediction models, random forest performs best and can help identify patients with T2DM at high risk of DN.
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Affiliation(s)
- Sha-Sha Cai
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
| | - Teng-Ye Zheng
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
| | - Kang-Yao Wang
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
| | - Hui-Ping Zhu
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
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Greenhall GHB, Robb M, Johnson RJ, Ibrahim M, Hilton R, Tomlinson LA, Callaghan CJ, Watson CJE. Utilisation and clinical outcomes of kidney transplants from deceased donors with albuminuria in the UK: a national cohort study. Nephrol Dial Transplant 2022; 37:2275-2283. [PMID: 36066902 DOI: 10.1093/ndt/gfac250] [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: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urinalysis is a standard component of potential deceased kidney donor assessment in the UK. The value of albuminuria as a biomarker for organ quality is uncertain. We examined the relationship between deceased donor albuminuria and kidney utilisation, survival, and function. METHODS We performed a national cohort study on adult deceased donors and kidney transplant recipients between 2016 and 2020, using data from the UK Transplant Registry. We examined the influence of donor albuminuria, defined as ≥ 2 + on dipstick testing, on kidney utilisation, early graft function, graft failure, and estimated glomerular filtration rate (eGFR). RESULTS Eighteen % (1681/9309) of consented donors had albuminuria. After adjustment for confounders, kidneys from donors with albuminuria were less likely to be accepted for transplantation (74% vs 82%; OR 0.70, 95% CI 0.61 to 0.81). Of 9834 kidney transplants included in our study, 1550 (16%) came from donors with albuminuria. After a median follow-up of 2 years, 8% (118/1550) and 9% (706/8284) of transplants from donors with and without albuminuria failed, respectively. There was no association between donor albuminuria and graft failure (HR 0.91, 95% CI 0.74 to 1.11). There was also no association with delayed graft function, patient survival, or eGFR at 1 or 3 years. CONCLUSIONS Our study suggests reluctance in the UK to utilise kidneys from deceased donors with dipstick albuminuria but no evidence of an association with graft survival or function. This may represent a potential to expand organ utilisation without negatively impacting transplant outcomes.
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Affiliation(s)
- George H B Greenhall
- Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Matthew Robb
- Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK
| | - Rachel J Johnson
- Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK
| | - Maria Ibrahim
- Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Rachel Hilton
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris J Callaghan
- School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Nephrology and Transplantation, Guy's Hospital, London, UK
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge, Cambridge, UK.,NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK
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Lee DY, Han K, Yu JH, Park S, Heo JI, Seo JA, Kim NH, Yoo HJ, Kim SG, Kim SM, Choi KM, Baik SH, Park YG, Kim NH. Gamma-glutamyl transferase variability can predict the development of end-stage of renal disease: a nationwide population-based study. Sci Rep 2020; 10:11668. [PMID: 32669624 PMCID: PMC7363906 DOI: 10.1038/s41598-020-68603-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of this study is to investigate whether GGT variability is able to predict the risk of end-stage renal disease (ESRD). The study subjects were Koreans who conducted health exams supported by the Korean National Health Insurance Corporation during 2009-2012 (baseline). After excluding individuals aged < 40 years, heavy alcoholics, or those with histories of chronic liver disease or ESRD, we followed 6,058,995 individuals. We calculated the average successive variability (ASV) of GGT values during the 5 years before the baseline as a parameter of variability. Using Cox proportional analyses, we evaluated the risk of ESRD according to GGT ASV quartiles, defined as the initiation of renal replacement therapy or kidney transplantation, or December 31, 2016. During 38,663,279.3 person-years of follow-up, 12,057 cases of ESRD were identified. Compared with GGT ASV quartile 1, the risk of ESRD was higher in ASV quartiles 3-4 and increased serially, even after adjustment for several metabolic parameters, baseline renal function, presence of comorbidities, low income, and baseline GGT and hemoglobin level. The fully adjusted hazard ratios (95% confidence intervals) of GGT ASV quartiles 3 and 4 were 1.06 (1.01-1.12) and 1.12 (1.06-1.18), respectively. In conclusion, GGT variability is a putative risk factor for ESRD in Koreans.
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Affiliation(s)
- Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sanghyun Park
- Department of Biostatics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jee-In Heo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
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Liu L, Wang Y, Zhang W, Chang W, Jin Y, Yao Y. Waist height ratio predicts chronic kidney disease: a systematic review and meta-analysis, 1998-2019. Arch Public Health 2019; 77:55. [PMID: 31867106 PMCID: PMC6918668 DOI: 10.1186/s13690-019-0379-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/18/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The incidence of chronic kidney disease (CKD) increases each year, and obesity is an important risk factor for CKD. The main anthropometric indicators currently reflecting obesity are body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), but the rationality and merits of various indicators vary. This article aims to find whether the WHtR is a more suitable physical measurement that can predict CKD. METHODS Pubmed, embase, the cochrane library, and web of science were systematically searched for articles published between 1998 and 2019 screening CKD through physical indicators. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the methodology included in the study. Meta-analysis used the Stata 12.0 software. RESULTS Nine studies were included, with a total of 202,283 subjects. Meta-analysis showed that according to the analysis of different genders in 6 studies, regardless of sex, WHtR was the area with the largest area under the curve (AUC). Except WHtR and visceral fat index (VFI) in women which showed no statistical difference, WHtR and other indicators were statistically different. In three studies without gender-based stratification, the area under the curve AUC for WHtR remained the largest, but only the difference between WHtR and BMI was statistically significant. When the Chinese population was considered as a subgroup, the area under the curve AUC for WHtR was the largest. Except for WHtR and VFI which showed no statistical difference in women, there was a statistically significant difference between WHtR and other indicators in men and women. CONCLUSION WHtR could be better prediction for CKD relative to other physical measurements. It also requires higher-quality prospective studies to verify the clinical application of WHtR.
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Affiliation(s)
- Ling Liu
- School of Public Health,Wannan Medical College, Wenchang West Road 22, Wuhu, China
| | - Yanqiu Wang
- School of Public Health,Wannan Medical College, Wenchang West Road 22, Wuhu, China
| | - Wanjun Zhang
- School of Public Health,Wannan Medical College, Wenchang West Road 22, Wuhu, China
| | - Weiwei Chang
- School of Public Health,Wannan Medical College, Wenchang West Road 22, Wuhu, China
| | - Yuelong Jin
- School of Public Health,Wannan Medical College, Wenchang West Road 22, Wuhu, China
| | - Yingshui Yao
- School of Public Health,Wannan Medical College, Wenchang West Road 22, Wuhu, China
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5
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Duan Y, Wang X, Zhang J, Ye P, Cao R, Yang X, Bai Y, Wu H. Body mass index is an independent predictive factor for kidney function evaluated by glomerular filtration rate in a community-dwelling population. Eat Weight Disord 2019; 24:731-738. [PMID: 28871501 DOI: 10.1007/s40519-017-0434-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The effects of overweight and obesity on kidney function have since been identified and become a subject of increased study and concern. But the association between body mass index (BMI) and estimated glomerular filtration rate (eGFR) is not well characterized. The aim of this study was to determine the relationship between BMI and eGFR. METHODS To better understand the relationship between BMI and kidney function, we investigated the association between BMI and eGFR using both the baseline BMI level and the follow-up eGFR level and investigated the relationship between the change in BMI and the change in eGFR in 1447 patients from a 4.8-year prospective study in Beijing, People's Republic of China. RESULTS In multiple linear regression analysis, age, antihypertensive treatment, and BMI were negatively associated with the follow-up eGFR levels in all participants (R = -0.622, -0.926, and -0.266, respectively; P < 0.05), or in the elderly (R = -0.883, -1.035, and -0.630, respectively; P < 0.05); sex was found to be associated with the follow-up eGFR levels independently not only in all participants (R = 6.783; P < 0.001), but also in the elderly (R = 3.518; P < 0.05). In addition, the change in eGFR levels was positively related to age, the change in LDL-C, the change in TC, and the change in SBP, but negatively related to the change in BMI and the change in HDL-C (all P < 0.05). CONCLUSIONS The present study clearly indicated that BMI is an independent predictive factor for kidney function evaluated by the eGFR level during a median 4.8 years of follow-up in Chinese population. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- Yuanyuan Duan
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaona Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jiao Zhang
- Department of Cardiology, Chinese People's Armed Police Forces General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
| | - Ruihua Cao
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xu Yang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hongmei Wu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
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Long-term risk for end-stage kidney disease and death in a large population-based cohort. Sci Rep 2018; 8:7729. [PMID: 29769597 PMCID: PMC5955909 DOI: 10.1038/s41598-018-26087-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/04/2018] [Indexed: 01/07/2023] Open
Abstract
Knowledge of metabolic risk factors for end-stage kidney disease (ESKD) in the general population is limited when considering the competing event death in risk analysis. The aim of our prospective observational study was to investigate how blood pressure and metabolic factors might influence the risks for ESKD and death before ESKD in a large Austrian population-based cohort with long-term follow-up. 177,255 participants (53.8% women; mean age 42.5 years) were recruited between 1988 and 2005 and linked to the Austrian Dialysis and Transplant Registry and the National Mortality Registry. Over a mean follow-up of 16 years 358 participants reached ESKD and 19,512 participants died. Applying fully adjusted cause-specific Cox proportional hazards models elevated fasting blood glucose, hypertension, hypertrigylceridemia and hypercholesterolemia were associated with a higher relative risk for ESKD than for death before ESKD, whereas elevated γ-glutamyltransferase was associated with an increased relative risk of death but not ESKD. Results were similar using continuous or categorical exposure variable measures in the general cohort but differed in selected high-risk populations. These findings might help improve the design of renal risk factor modification trials and kidney disease awareness and prevention programs in the general population, which may ultimately decrease the burden of ESKD.
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Zhou X, Wang L, Wang G, Cheng X, Hu S, Ke W, Li M, Zhang Y, Song Z, Zheng Q. A new plasma biomarker enhance the clinical prediction of postoperative acute kidney injury in patients with hepatocellular carcinoma. Clin Chim Acta 2017; 475:128-136. [PMID: 29031454 DOI: 10.1016/j.cca.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/07/2017] [Accepted: 10/10/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The ratio of serum γ-glutamyl transferase (GGT) to alanine aminotransferase (ALT) (GGT/ALT) is a marker for evaluating effects to antivirotic treatment and a helpful predictive factor for the prognosis of Child-Pugh A hepatocellular carcinoma (HCC) patients after surgery. The relationship between the incidence of postoperative acute kidney injury (AKI) and preoperative GGT/ALT is studied in hepatectomized hepatitis B- or C- associated HCC patients. METHODS A total of 253 hepatitis B or C virus-related HCC patients undergoing hepatectomy between September 2012 and August 2016 at our hospital were included in the retrospective study. Serum ALT and GGT value were recorded, and the GGT/ALT was computed. AKI was defined that based on the "Kidney Disease Improving Global Outcomes (KDIGO) criteria". RESULTS AKI was observed in 22 (8.7%) patients. Mean GGT/ALT of patients with AKI was significantly higher than in those without it (6.0 vs 2.1, P<0.001). Multivariate analysis revealed an increase in GGT/ALT as an independent risk factor for AKI in hepatitis B- or C- associated HCC patients, particularly in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A staged HCC (odds ratio (OR) 1.400, P<0.001). Multivariate analysis showed that ALT (OR 0.966, P=0.044) was somewhat inversely associated with the incidence of AKI in hepatitis B- or C- associated HCC patients. The best cutoff point of GGT/ALT was 2.92. Multivariate analysis showed that preoperative GGT/ALT ≥2.92 predicted poor prognosis of postoperative AKI in patients with HCC after hepatectomy (odds ratio 17.697, P<0.001). After propensity score matching, preoperative GGT/ALT ≥2.92 remained an independent risk factor for AKI in HCC patients (OR 13.947, P=0.003). CONCLUSIONS The GGT/ALT of patients with AKI was significantly higher than those without it. Evaluation of GGT/ALT before surgery can be a helpful predictive tool for postoperative AKI in hepatitis B- or C- associated HCC patients undergoing hepatectomy, particularly in patients with BCLC stage 0 or A staged HCC. Hepatitis B- or C- associated HCC patients with low ALT especially within the normal range may have a high risk of AKI. However, the reason remains to be elucidated.
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Affiliation(s)
- Xing Zhou
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Liyu Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guoliang Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiang Cheng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shaobo Hu
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wenbo Ke
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Min Li
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yong Zhang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zifang Song
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qichang Zheng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Hoy WE, Mott SA, Mc Donald SP. An expanded nationwide view of chronic kidney disease in Aboriginal Australians. Nephrology (Carlton) 2017; 21:916-922. [PMID: 27075933 PMCID: PMC5157727 DOI: 10.1111/nep.12798] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/31/2022]
Abstract
We summarize new knowledge that has accrued in recent years on chronic kidney disease (CKD) in Indigenous Australians. CKD refers to all stages of preterminal kidney disease, including end‐stage kidney failure (ESKF), whether or not a person receives renal replacement therapy (RRT). Recently recorded rates of ESKF, RRT, non‐dialysis CKD hospitalizations and CKD attributed deaths were, respectively, more than sixfold, eightfold, eightfold and threefold those of non‐Indigenous Australians, with age adjustment, although all except the RRT rates are still under‐enumerated. However, the nationwide average Indigenous incidence rate of RRT appears to have stabilized. The median age of Indigenous people with ESKF was about 30 years less than for non‐Indigenous people, and 84% of them received RTT, while only half of non‐Indigenous people with ESKF did so. The first‐ever (2012) nationwide health survey data showed elevated levels of CKD markers in Indigenous people at the community level. For all CKD parameters, rates among Indigenous people themselves were strikingly correlated with increasing remoteness of residence and socio‐economic disadvantage, and there was a female predominance in remote areas. The burden of renal disease in Australian Indigenous people is seriously understated by Global Burden of Disease Mortality methodology, because it employs underlying cause of death only, and because deaths of people on RRT are frequently attributed to non‐renal causes. These data give a much expanded view of CKD in Aboriginal people. Methodologic approaches must be remedied for a full appreciation of the burden, costs and outcomes of the disease, to direct appropriate policy development. Excellent review on the kidney health in the Aboriginal communities in Australia, describing the challenges and important priorities.
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Affiliation(s)
- Wendy E Hoy
- Centre for Chronic Disease, School of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
| | - Susan A Mott
- Centre for Chronic Disease, School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Stephen P Mc Donald
- University of Adelaide and Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, South Australia, Australia
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He Y, Liu D, Tan W, Ma X, Lian F, Xu X. Association Between Body Mass Index and Mildly Decreased Estimated Glomerular Filtration Rate in Chinese Adults With Early Chronic Kidney Disease. J Ren Nutr 2016; 26:367-372. [DOI: 10.1053/j.jrn.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/07/2016] [Accepted: 04/24/2016] [Indexed: 01/16/2023] Open
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Zitt E, Pscheidt C, Concin H, Kramar R, Lhotta K, Nagel G. Anthropometric and Metabolic Risk Factors for ESRD Are Disease-Specific: Results from a Large Population-Based Cohort Study in Austria. PLoS One 2016; 11:e0161376. [PMID: 27537361 PMCID: PMC4990261 DOI: 10.1371/journal.pone.0161376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/04/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anthropometric and metabolic risk factors for all-cause end-stage renal disease (ESRD) may vary in their impact depending on the specific primary renal disease. METHODS In this Austrian population-based prospective cohort study (n = 185,341; 53.9% women) the following data were collected between 1985 and 2005: age, sex, body mass index (BMI), fasting blood glucose (FBG) from 1988, blood pressure, total cholesterol (TC), triglycerides (TG), gamma-glutamyl transferase (GGT) and smoking status. These data were merged with the Austrian Dialysis and Transplant Registry to identify ESRD patients. Cox proportional hazards models were applied to calculate hazard ratios (HR) for all-cause ESRD as well as for cause-specific ESRD due to the following primary renal diseases: autosomal dominant polycystic kidney disease (ADPKD), vascular nephropathy (VN), diabetic nephropathy (DN) and other diseases (OD). RESULTS During a mean follow-up of 17.5 years 403 participants developed ESRD (ADPKD 36, VN 97, DN 86, and OD 184). All parameters except TG and GGT were significantly associated with all-cause ESRD risk. Particular cause-specific ESRD risk factor patterns were found: for ADPKD increased risk from hypertension (HR 11.55); for VN from smoking (HR 1.81), hypertension (HR 2.37), TG (≥5.70 vs. <1.17 mmol/L: HR 9.27); for DN from smoking (HR 1.77), BMI (≥30 vs. 18.5-24.9 kg/m2: HR 7.55), FBG (≥6.94 vs. <5.55 mmol/L: HR 7.67), hypertension (HR 1.08), TG (≥5.70 vs. <1.17 mmol/L: HR 2.02), GGT (HR 2.14); and for OD from hypertension (HR 2.29), TG (≥5.70 vs. <1.17 mmol/L: HR 6.99) and TC (≥6.22 vs. <5.18 mmol/L: HR 1.56). CONCLUSIONS Particular anthropometric and metabolic ESRD risk factors differ in importance depending on the primary renal disease. This needs to be considered for future preventive and therapeutic strategies addressing cause-specific ESRD.
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Affiliation(s)
- Emanuel Zitt
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Constanze Pscheidt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Reinhard Kramar
- Austrian Dialysis and Transplant Registry, Rohr im Kremstal, Austria
| | - Karl Lhotta
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- * E-mail:
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Kanda E, Muneyuki T, Suwa K, Nakajima K. Effects of Weight Loss Speed on Kidney Function Differ Depending on Body Mass Index in Nondiabetic Healthy People: A Prospective Cohort. PLoS One 2015; 10:e0143434. [PMID: 26599331 PMCID: PMC4658128 DOI: 10.1371/journal.pone.0143434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022] Open
Abstract
Background Obesity is associated with diabetes mellitus and cardiovascular diseases. However, it has been reported that weight loss is associated with incident chronic kidney disease (CKD) in healthy males. The purpose of this prospective cohort study is to investigate the effects of weight loss on kidney function in healthy people in terms of body mass index (BMI) and gender. Methods A total of 8447 nondiabetic healthy people were enrolled in the Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. Relationships between estimated glomerular filtration rate (eGFR) change, BMI, and BMI change were evaluated using 3D-scatter plots with spline and generalized additive models (GAMs) adjusted for baseline characteristics. Results The subjects were stratified into four groups according to BMI. The mean±standard deviations for males and females were, respectively, 40.11±9.49, and 40.3±9.71 years for age and 76.39±17.72 and 71.49±18.4 ml/min/1.73m2 for eGFR. GAMs showed that a decreasing BMI change (<-1 kg/m2/year) was associated with a decreasing eGFR change in males with high normal BMIs (22 kg/m2≤BMI<25 kg/m2). A decreasing BMI change (<-2 kg/m2/year) was associated with an increasing eGFR change in overweight males (25 kg/m2≤BMI). Among underweight females (BMI<18.5 kg/m2), decreasing BMI was observed with decreasing eGFR. Conclusions These findings suggest that the benefit and risk of weight loss in relation to kidney function differs depending on BMI and weight loss speed, especially in males.
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Affiliation(s)
- Eiichiro Kanda
- Department of Nephrology, Tokyo Kyosai Hospital, Meguro, Tokyo, Japan
- Center for life science and bioethics, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
- * E-mail:
| | - Toshitaka Muneyuki
- Department of Rehabilitation, Funabashi City Rehabilitation Hospital, Funabashi, Chiba, Japan
| | - Kaname Suwa
- Saitama Health Promotion Corporation, Hikigun, Saitama, Japan
| | - Kei Nakajima
- Department of Metabolism, Kuki General Hospital, Kuki, Saitama, Japan
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Oksuz F, Yarlioglues M, Cay S, Celik IE, Mendi MA, Kurtul A, Cankurt T, Kuyumcu S, Canpolat U, Turak O. Predictive Value of Gamma-Glutamyl Transferase Levels for Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention. Am J Cardiol 2015; 116:711-6. [PMID: 26116992 DOI: 10.1016/j.amjcard.2015.05.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/23/2015] [Accepted: 05/23/2015] [Indexed: 11/19/2022]
Abstract
Contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PPCI) is associated with adverse short- and long-term outcomes. The aim of this study was to evaluate the predictive value of gamma-glutamyl transferase (GGT) for risk of CIN in patients with ST-segment elevation myocardial infarction who underwent PPCI. A total of 473 patients were enrolled in the study. A relative increase in serum creatinine ≥25%, or an absolute increase ≥0.5 mg/dl, from the baseline within 72 hours of contrast exposure was defined as CIN. Patients were divided into 3 groups according to GGT tertiles (tertile 1, GGT <19 U/L; tertile 2, GGT 19 to 33 U/L; and tertile 3, GGT >33 U/L) on admission. Demographics, clinical risk factors, laboratory parameters, CIN incidence, and other inhospital clinical outcomes were compared among GGT tertiles. CIN incidence was significantly higher in tertile 3 (29%) compared with tertiles 1 (11%) and 2 (11%, p <0.001). Inhospital death incidence was significantly increased across tertiles (from tertile 1 to tertiles 2 and 3, 1%, 4%, and 5%, respectively, p <0.05). In receiver operating characteristic analysis, a threshold value of GGT >26.5 U/L had 70% sensitivity and 60% specificity for CIN. After including variables found significant in univariate analysis, the presence of diabetes mellitus (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.22 to 2.31, p <0.001), C-reactive protein (for each 1 mg/L increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.007), contrast volume (for each 1-ml increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.012), and GGT >26.5 U/L (OR 2.59, 95% CI 1.48 to 4.53, p <0.001) were found as independent associates of CIN in multivariate regression analysis. Each 1 U/L increase in GGT was also associated with CIN risk (OR 1.04, 95% CI 1.03 to 1.06, p <0.001). In conclusion, GGT on admission was a significant and independent predictor of CIN after PPCI in patients with ST-segment elevation myocardial infarction.
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Affiliation(s)
- Fatih Oksuz
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
| | - Mikail Yarlioglues
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Ibrahim Ethem Celik
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Mendi
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Tayyar Cankurt
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Serdar Kuyumcu
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Osman Turak
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Sex- and Time-Dependent Patterns in Risk Factors of End-Stage Renal Disease: A Large Austrian Cohort with up to 20 Years of Follow-Up. PLoS One 2015; 10:e0135052. [PMID: 26322515 PMCID: PMC4555650 DOI: 10.1371/journal.pone.0135052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/16/2015] [Indexed: 11/21/2022] Open
Abstract
Objective We investigated the association between metabolic factors and End-Stage Renal Disease (ESRD) and quantified the magnitude of their influence dependent on sex and time of exposure up to 20 years. Material and Methods A prospective cohort study was conducted to determine risk factors for the development of ESRD. From 1988 to 2005 185,341 persons (53.9% women) participated in the “Vorarlberg Health Monitoring and Promotion Programme” (VHM&PP). Data on body mass index (BMI), fasting blood glucose (FBG), systolic (BPsys) and diastolic (BPdia) blood pressure, total cholesterol (TC), triglycerides (TG), gamma-glutamyltransferase (GGT) and smoking status were collected. Data of the population-based VHM&PP were merged with the Austrian Dialysis and Transplant Registry. Cox proportional hazards models were applied to calculate hazard ratios (HRs) for ESRD, stratified by sex and 5-year time intervals. Results During a mean follow-up of 17.5 years 403 patients (39.1% women) developed ESRD. Significant risk factors were: BMI (per 1 kg/m2) HR 1.04 (95% CI 1.01–1.06), FBG (per 1 mmol/L) HR 1.09 (1.05–1.12), BPsys (per 5 mmHg) HR 1.10 (1.07–1.14), BPdia (per 5 mmHg) HR 1.09 (1.03–1.15), TG (per 1 mmol/L) HR 1.07 (1.02–1.13), TC (per 1 mmol/L) HR 1.22 (1.13–1.32). We observed a sex-specific risk pattern with an increased ESRD risk for men for increasing TG and smoking, and for women for increasing BMI and GGT. In time interval analyses BPsys and TC were associated with early ESRD onset, whereas BMI, FBG, BPdia and GGT were associated with later onset. Conclusions Anthropometric and metabolic factors are differentially associated with the long-term risk for ESRD in a sex- and time-dependent manner. Consideration of these patterns in preventive and therapeutic strategies could have an impact on ESRD incidence.
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Jang CM, Hyun YY, Lee KB, Kim H. The association between underweight and the development of albuminuria is different between sexes in relatively healthy Korean subjects. Nephrol Dial Transplant 2014; 29:2106-13. [PMID: 24944210 DOI: 10.1093/ndt/gfu221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are limited data on the association between underweight and albuminuria. The aim of this study is to verify the effect of underweight on the development of albuminuria. METHODS Participants who underwent two health check-ups with a 2-year interval at a tertiary hospital in Korea between 2002 and 2009 were studied. After exclusion of participants with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) or dipstick albuminuria ≥1+ at the first check-up, 53 876 participants were enrolled. We measured the incidence of albuminuria at the second check-up and calculated the odds ratio (OR) for the development of albuminuria according to body mass index (BMI). RESULTS After 2 years, 746 cases of incident albuminuria were observed among 53 876 participants. The effect of BMI on the development of albuminuria was modified by sex in a multivariate logistic model with adjustment for age, diabetes, hypertension, dyslipidaemia, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, uric acid, eGFR, current smoking status and alcohol intake (P-value for interaction <0.001). Compared with participants in the normal weight range (BMI, 18.5-22.9), the ORs for incident albuminuria were 1.93 [95% confidence interval (CI), 1.35-2.76; P ≤ 0.001], 1.19 (0.84-1.67; P = 0.329) and 0.71 (0.43-1.17; P = 0.177) in underweight (BMI, <18.5), overweight (BMI, 23.0-24.9) and obese (BMI, ≥25) women. However, the ORs were 0.9 (95% CI, 0.39-2.05; P = 0.794), 1.08 (0.84-1.38; P = 0.567) and 1.38 (1.09-1.75; P = 0.007) for each corresponding group of men. CONCLUSIONS Underweight was significantly associated with the development of albuminuria after 2 years in relatively healthy Korean females, but this relationship was not significant in males. This study suggests the need for more studies on the role of underweight in renal injury in men and women.
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Affiliation(s)
- Cheol Min Jang
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Kyu Beck Lee
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hyang Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
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