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Kawano R, Haze T, Fujiwara A, Haruna A, Ozawa M, Kobayashi Y, Saka S, Hirawa N, Tamura K. Favorable changes in the eGFR slope after dapagliflozin treatment and its association with the initial dip. Clin Exp Nephrol 2024:10.1007/s10157-024-02532-4. [PMID: 38970649 DOI: 10.1007/s10157-024-02532-4] [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: 01/31/2024] [Accepted: 06/19/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Renoprotective effects of sodium glucose transporter 2 (SGLT2) inhibitors, including dapagliflozin, were observed in randomized controlled trials (RCTs). The suspected underlying mechanism is a correction of hyperfiltration, observed as an "initial dip". Whether SGLT2 inhibitors can attenuate the rate of decline in the estimated glomerular filtration rate (eGFR) in clinical settings, even when considering the pre-treatment decline rate, is unknown. Although several RCTs identified an association between the initial dip and long-term renal prognoses, a conclusion has not been reached. METHODS We collected the eGFR data of patients for whom dapagliflozin was initiated in our hospital and then calculated their eGFR slopes before and after the start of the treatment. We investigated the changes in the eGFR slopes (ΔeGFR slope) and the association between the ΔeGFR slope and the initial dip. Risks for rapid eGFR decliners (eGFR slope < - 3 mL/min/1.73 m2/year) were also examined. RESULTS The eGFR slope was significantly milder after dapagliflozin treatment (p < 0.01). A deeper initial dip was associated with a milder rate of eGFR decline (adjusted beta: - 0.29, p < 0.001). Dapagliflozin treatment reduced the proportion of rapid eGFR decliners from 52.9 to 14.7%, and a smaller initial dip was identified as a significant risk for post-treatment rapid eGFR decline (adjusted odds ratio: 1.73, p < 0.05). CONCLUSIONS Compared to before the administration of dapagliflozin, the rate of eGFR decline was significantly milder after its administration. The initial dip was significantly associated with long-term renoprotective effects and may be a useful predictor of treatment response.
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Affiliation(s)
- Rina Kawano
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Tatsuya Haze
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan
| | - Akira Fujiwara
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Aiko Haruna
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Moe Ozawa
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yusuke Kobayashi
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan
| | - Sanae Saka
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Nobuhito Hirawa
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Jiang Y, Cao Q, Hong W, Xu T, Tang M, Li Y, Xu R. Age and estimated glomerular filtration rate in Chinese older adults: a cohort study from 2014 to 2020. Front Public Health 2024; 12:1392903. [PMID: 38983263 PMCID: PMC11231386 DOI: 10.3389/fpubh.2024.1392903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024] Open
Abstract
Objectives This study aimed to fill the data gap of the course of renal function decline in old age and explore changes in renal function across different health states with increasing age. Methods This observational, retrospective, single-center cohort study included 5,112 Chinese older adults (3,321 men and 1,791 women, range 60-104 years). The individual rate of estimated glomerular filtration rate (eGFR) decline was analyzed using linear mixed-effects model to account for repeated measures over the years. Results The median age was 66 years, median BMI was 24.56 kg/m2, and median eGFR was 89.86 mL/min.1.73 m2. For every 1-year increase in age, women's eGFR decreased by 1.06 mL/min/1.73 m2 and men's by 0.91 mL/min/1.73 m2. We observed greater age-related eGFR decline in men and women with high systolic blood pressure (SBP). Men with high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C), had greater age-related eGFR decline. In women, different BMI groups showed significant differences in age-related eGFR decline, with the highest decline in those with obesity. Additionally, participants with normal baseline eGFR had a faster age-related decline than those with low baseline eGFR. Conclusion The eGFR declined linearly with age in Chinese older adults, with women exhibiting a slightly faster decline than men. Both men and women should be cautious of SBP. Older adults with normal baseline renal function experienced a faster eGFR decline. Men with high TG, LDL-C, and low HDL-C levels, as well as obese women, should be vigilant in monitoring renal function.
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Affiliation(s)
- Ying Jiang
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Cao
- Health Management Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqi Hong
- Shanghai Pudong New Area Caolu Community Health Center, Shanghai, China
| | - Tianwei Xu
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Molian Tang
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nutrition, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ito J, Fukagawa M. Slope of the estimated glomerular filtration rate and its associated factors among individuals with chronic kidney disease in the general Japanese population. Clin Exp Nephrol 2024; 28:522-530. [PMID: 38340246 PMCID: PMC11116171 DOI: 10.1007/s10157-024-02466-x] [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: 07/01/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND To suppress the incidence of end-stage kidney disease, we need to identify chronic kidney disease (CKD) patients with a high risk of rapid decline in the estimated glomerular filtration rate (eGFR). However, the current status of eGFR slope and its associated factors in the Japanese population have not been fully elucidated. METHODS Among examinees aged 40-70 years in the 2014 Specific Health Checkup conducted by the National Health Insurance in Kobe, Japan (n = 61,985), we prospectively observed 7291 examinees with CKD stage G3 from 2014 to 2018. RESULTS Until 2018, 4221 examinees continued to undergo annual SHCs for a total of five checkups per subject and had available records of all necessary data. The median eGFR change was -0.22 ml/min/1.73 m2/year. Only 9.2% of those subjects showed rapid eGFR decline (faster than -2.0 ml/min/1.73 m2/year). Logistic regression analysis identified diabetes, smoking habits, high urinary protein levels, older age, high systolic blood pressure, and low serum low-density lipoprotein cholesterol levels as independent predictors for rapid eGFR decline. Hemoglobin A1c levels did not contribute to the eGFR slope in CKD stage-G3 subjects with diabetes and proteinuria. CONCLUSION Most Japanese CKD stage-G3 subjects had a very slow decline in eGFR. A small proportion of CKD individuals who have a predictive factor of rapid eGFR decline should receive considerable attention from a nephrologist.
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Affiliation(s)
- Jun Ito
- Faculty of Nursing, Hyogo University, 2301, Hiraokacho-Shinzaike, Kakogawa, Hyogo, 675-0195, Japan.
- Division of Nephrology, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan.
- Division of Nephrology, Endocrinology and Metabolism, School of Medicine, Tokai University, 143, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, School of Medicine, Tokai University, 143, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Gohda T, Murakoshi M, Suzuki Y, Kagimura T, Wada T, Narita I. Effect of proteinuria on the rapid kidney function decline in chronic kidney disease depends on the underlying disease: A post hoc analysis of the BRIGHTEN study. Diabetes Res Clin Pract 2024; 212:111682. [PMID: 38677368 DOI: 10.1016/j.diabres.2024.111682] [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: 01/19/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
AIMS It is unclear whether the effect of proteinuria on rapid kidney function decline is equivalent among diabetic kidney disease (DKD), non-DKD with diabetes (NDKD+DM), and nephrosclerosis without diabetes (NS-DM), particularly in advanced chronic kidney disease patients. METHODS In total, 1038 chronic kidney disease patients who participated in the BRIGHTEN study were included in the present study. A linear mixed effect model was applied to estimate the annual estimated glomerular filtration rate decline in each disease group. RESULTS The prevalence of rapid decliners (rapid kidney function decline, defined as an eGFR loss of > 5 mL/min/1.73 m2/year) in the DKD group (44.6 %) was significantly higher compared with the NDKD+DM (27.9 %) and NS-DM (27.0 %) groups. By contrast, the prevalence of rapid decliners in different urine total protein to creatinine ratio (UPCR) categories (<0.5, 0.5 to < 1.0, 1.0 to < 3.5, and ≥ 3.5 g/g) were equivalent between the DKD and NS-DM groups. Moreover, the prevalence of a UPCR < 1.0 g/g in rapid decliners of the NS-DM group was more than double than in those of the DKD and NDKD+DM groups. CONCLUSIONS The risk of rapid kidney function decline in NS-DM patients with low levels of proteinuria may be greater than initially predicted.
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Affiliation(s)
- Tomohito Gohda
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Maki Murakoshi
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Tatsuo Kagimura
- Translational Research Centre for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | | | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Hundemer GL, Akbari A, Sood MM. Has the time come for age-adapted glomerular filtration rate criteria to define chronic kidney disease: how soon is now? Curr Opin Nephrol Hypertens 2024; 33:318-324. [PMID: 38411155 DOI: 10.1097/mnh.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW The conventional definition of chronic kidney disease (CKD) primarily relies on the identification of albuminuria or a decline in estimated glomerular filtration rate (eGFR). For many years, a straightforward eGFR threshold of <60 ml/min/1.73 m 2 has been widely adopted as the standard for defining CKD. Nonetheless, this criterion fails to consider the natural aging process of the kidney, and this oversight may affect the accurate diagnosis of kidney disease particularly at the extremes of age. RECENT FINDINGS The fixed eGFR threshold of <60 ml/min/1.73 m 2 for defining CKD misses crucial opportunities for risk prevention. Studies have revealed that the eGFR threshold at which the risks for adverse long-term health outcomes such as mortality, cardiovascular events, and kidney failure begin to rise varies substantially by age. Specifically, this threshold is lower for the elderly and higher for young adults. Consequently, this results in the over-diagnosis of kidney disease in the elderly and the under-diagnosis of kidney disease in young adults. SUMMARY To address these limitations of the current CKD definition, we discuss a number of proposed age-adapted eGFR criteria and weigh their pros and cons against the current, simple, and universally accepted approach.
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Affiliation(s)
- Gregory L Hundemer
- Department of Medicine, Division of Nephrology, University of Ottawa
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ayub Akbari
- Department of Medicine, Division of Nephrology, University of Ottawa
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Manish M Sood
- Department of Medicine, Division of Nephrology, University of Ottawa
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Trujillo J, Alotaibi M, Seif N, Cai X, Larive B, Gassman J, Raphael KL, Cheung AK, Raj DS, Fried LF, Sprague SM, Block G, Chonchol M, Middleton JP, Wolf M, Ix JH, Prasad P, Isakova T, Srivastava A. Associations of Kidney Functional Magnetic Resonance Imaging Biomarkers with Markers of Inflammation in Individuals with CKD. KIDNEY360 2024; 5:681-689. [PMID: 38570905 PMCID: PMC11146641 DOI: 10.34067/kid.0000000000000437] [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: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Key Points Lower baseline apparent diffusion coefficient, indicative of greater cortical fibrosis, correlated with higher baseline concentrations of serum markers of inflammation. No association between baseline cortical R2* and baseline serum markers of inflammation were found. Baseline kidney functional magnetic resonance imaging biomarkers of fibrosis and oxygenation were not associated with changes in inflammatory markers over time, which may be due to small changes in kidney function in the study. Background Greater fibrosis and decreased oxygenation may amplify systemic inflammation, but data on the associations of kidney functional magnetic resonance imaging (fMRI) measurements of fibrosis (apparent diffusion coefficient [ADC]) and oxygenation (relaxation rate [R2*]) with systemic markers of inflammation are limited. Methods We evaluated associations of baseline kidney fMRI-derived ADC and R2* with baseline and follow-up serum IL-6 and C-reactive protein (CRP) in 127 participants from the CKD Optimal Management with Binders and NicotinamidE trial, a randomized, 12-month trial of nicotinamide and lanthanum carbonate versus placebo in individuals with CKD stages 3–4. Cross-sectional analyses of baseline kidney fMRI biomarkers and markers of inflammation used multivariable linear regression. Longitudinal analyses of baseline kidney fMRI biomarkers and change in markers of inflammation over time used linear mixed-effects models. Results Mean±SD eGFR, ADC, and R2* were 32.2±8.7 ml/min per 1.73 m2, 1.46±0.17×10−3 mm2/s, and 20.3±3.1 s−1, respectively. Median (interquartile range) IL-6 and CRP were 3.7 (2.4–4.9) pg/ml and 2.8 (1.2–6.3) mg/L, respectively. After multivariable adjustment, IL-6 and CRP were 13.1% and 27.3% higher per 1 SD decrease in baseline cortical ADC, respectively. Baseline cortical R2* did not have a significant association with IL-6 or CRP. Mean annual IL-6 and CRP slopes were 0.98 pg/ml per year and 0.91 mg/L per year, respectively. Baseline cortical ADC and R2* did not have significant associations with change in IL-6 or CRP over time. Conclusions Lower cortical ADC, suggestive of greater fibrosis, was associated with higher systemic inflammation. Baseline kidney fMRI biomarkers did not associate with changes in systemic markers of inflammation over time.
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Affiliation(s)
- Jacquelyn Trujillo
- The Graduate School, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Manal Alotaibi
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nay Seif
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xuan Cai
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Dominic S. Raj
- Division of Renal Diseases and Hypertension, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Linda F. Fried
- Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stuart M. Sprague
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | | | - Michel Chonchol
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - John Paul Middleton
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Joachim H. Ix
- Renal Section, Department of Medicine, University of California San Diego School of Medicine, San Diego, California
| | - Pottumarthi Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois
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Kim M, Han K, Joo KW, Cho JM, Lee S, Kim Y, Cho S, Huh H, Kim SG, Kang E, Kim DK, Park S. Cardiovascular and Mortality Risks in Young Health Screening Examinees With Marginal Estimated GFR. Kidney Int Rep 2023; 8:2709-2719. [PMID: 38106592 PMCID: PMC10719598 DOI: 10.1016/j.ekir.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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/07/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Additional evidence is necessary to interpret kidney function parameters in young adults, particularly in those with marginal estimated glomerular filtration rate (eGFR) values. Therefore, we aimed to investigate the association between eGFR and adverse outcomes in general young adults. Methods We performed a nationwide retrospective cohort study using the health-screening database of South Korea. We included young adults aged 20-39 years without a history of major adverse cardiovascular events (MACE) or kidney failure, who underwent nationwide health screening in 2012. The study exposure was eGFR categorized into 15 ml/min per 1.73 m2 intervals. The risks of all-cause mortality and MACE were calculated using Cox regression analysis, adjusted for various clinicodemographic characteristics. Results In total, 3,132,409 young adults were included in this study. During a median follow-up of 7.3 years, marginal eGFR (60-75 ml/min per 1.73 m2) was not significantly associated with a higher risk of all-cause mortality (adjusted hazard ratio [aHR], 0.80 [0.74-0.87]). The results were similar for MACE outcomes (aHR, 0.94 [0.87-1.01]). Although the presence of dipstick albuminuria had a significant interaction with the association between eGFR categories and all-cause mortality (interaction term P = 0.028), the risks of all-cause mortality were not significantly higher (aHR, 0.98 [0.62, 1.55]) in those with albuminuria and eGFR 60-75 ml/min per 1.73 m2. Conclusion Marginal eGFR was not associated with higher risks of all-cause mortality and MACE in general young adults. Additional clinical investigations for incidentally found marginal eGFR values may be discouraged in general young adults.
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Affiliation(s)
- Minsang Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Jeong Min Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Semin Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Korea
| | - Hyuk Huh
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Seong Geun Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Sehoon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Alhummiany B, Sharma K, Buckley DL, Soe KK, Sourbron SP. Physiological confounders of renal blood flow measurement. MAGMA (NEW YORK, N.Y.) 2023:10.1007/s10334-023-01126-7. [PMID: 37971557 DOI: 10.1007/s10334-023-01126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/26/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Renal blood flow (RBF) is controlled by a number of physiological factors that can contribute to the variability of its measurement. The purpose of this review is to assess the changes in RBF in response to a wide range of physiological confounders and derive practical recommendations on patient preparation and interpretation of RBF measurements with MRI. METHODS A comprehensive search was conducted to include articles reporting on physiological variations of renal perfusion, blood and/or plasma flow in healthy humans. RESULTS A total of 24 potential confounders were identified from the literature search and categorized into non-modifiable and modifiable factors. The non-modifiable factors include variables related to the demographics of a population (e.g. age, sex, and race) which cannot be manipulated but should be considered when interpreting RBF values between subjects. The modifiable factors include different activities (e.g. food/fluid intake, exercise training and medication use) that can be standardized in the study design. For each of the modifiable factors, evidence-based recommendations are provided to control for them in an RBF-measurement. CONCLUSION Future studies aiming to measure RBF are encouraged to follow a rigorous study design, that takes into account these recommendations for controlling the factors that can influence RBF results.
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Affiliation(s)
- Bashair Alhummiany
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, LS2 9NL, UK.
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David L Buckley
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Kywe Kywe Soe
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Steven P Sourbron
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
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Ekberg J, Hjelmberg M, Norén Å, Brännström M, Herlenius G, Baid-Agrawal S. Long-term Course of Kidney Function in Uterus Transplant Recipients Under Treatment With Tacrolimus and After Transplantectomy: Results of the First Clinical Cohort. Transplant Direct 2023; 9:e1525. [PMID: 37781170 PMCID: PMC10540914 DOI: 10.1097/txd.0000000000001525] [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: 02/18/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 10/03/2023] Open
Abstract
Background Chronic kidney disease is common after non-renal solid organ transplantation, mainly secondary to calcineurin inhibitors toxicity. Uterus transplantation (UTx) is an innovative treatment for women with absolute uterine factor infertility. UTx is exclusive because it is transient with the absence of lifelong immunosuppression and is performed in young healthy participants. Therefore, UTx provides a unique setting for evaluating the effect of time-limited calcineurin inhibitors treatment on recipients' kidney function. Methods In the first UTx cohort worldwide, we studied kidney function using estimated glomerular filtration rate (eGFR) in 7 women over a median follow-up of 121 (119-126) mo. Results Median eGFR (mL/min/1.73 m2) of the cohort was 113 at UTx, which declined to 74 during month 3, 71 at months 10-12, 76 at hysterectomy (HE), and 83 at last follow-up. Median duration of tacrolimus exposure was 52 (22-83) mo, and median trough levels (µg/L) were 10 during month 3 and 5.8 at HE. Between UTx and month 3, decline in kidney function was observed in all 7 participants with a median eGFR slope for the whole cohort of -24 mL/min/1.73 m2, which declined further by -4 mL/min/1.73 m2 until months 10-12. Thereafter, eGFR slope improved in 3 participants, remained stable in 3, and worsened in 1 until HE/tacrolimus discontinuation, after which it improved in 2. Eventually, between UTx and last follow-up, 4 of 7 participants had a decline in their eGFR, the median annual eGFR slope being negative at -1.9 mL/min/1.73 m2/y for the whole group. Conclusions Kidney function declined in all recipients early after UTx followed by a persistent long-term decrease in majority, despite transplantectomy and discontinuation of immunosuppression. Thus, UTx may incur an increased risk of chronic kidney disease even in this young and healthy population, highlighting the importance of close surveillance of kidney function and minimization of tacrolimus exposure.
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Affiliation(s)
- Jana Ekberg
- Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Hjelmberg
- Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Norén
- Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf Herlenius
- Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Seema Baid-Agrawal
- Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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van der Veen SJ, el Sayed M, Hollak CE, Brands MM, Snelder CKS, Boekholdt SM, Vogt L, Goorden SM, van Kuilenburg AB, Langeveld M. Early Risk Stratification for Natural Disease Course in Fabry Patients Using Plasma Globotriaosylsphingosine Levels. Clin J Am Soc Nephrol 2023; 18:1272-1282. [PMID: 37499686 PMCID: PMC10578638 DOI: 10.2215/cjn.0000000000000239] [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: 01/13/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Fabry disease is a very heterogeneous X-linked lysosomal storage disease. Disease manifestations in the kidneys, heart, and brain vary greatly, even between patients of the same sex and with the same disease classification (classical or nonclassical). A biomarker with a strong association with the development of disease manifestations is needed to determine the need for Fabry-specific treatment and appropriate frequency of follow-up because clinical manifestations of the disorder may take decennia to develop. METHODS We investigated the levels of plasma lysoGb3 levels over time and its association with disease manifestations and disease course in 237 untreated patients with Fabry disease (median age 42 years, 38% male) using linear mixed-effect models. RESULTS LysoGb3 levels are stable over time in plasma of untreated patients with Fabry disease. Higher levels of lysoGb3 were associated with steeper decline in eGFR ( P = 0.05) and a faster increase in albuminuria (measured as the urinary albumin-to-creatinine ratio, P < 0.001), left ventricular mass (measured on echocardiography, P < 0.001), left atrial volume index ( P = 0.003), and Fazekas score ( P = 0.003). In addition, regardless of age, higher lysoGb3 levels were associated with higher relative wall thickness ( P < 0.001) and unfavorable functional markers on echocardiography, including septal mitral annular early diastolic velocity (e', P < 0.001) and the ratio of early transmitral velocity (E) to e' (E/e', P = 0.001). CONCLUSIONS In an individual patient with Fabry disease, the plasma lysoGb3 level reached a specific level in early childhood which, in the absence of Fabry-specific treatment, remained stable throughout life. The level of lysoGb3 in untreated patients was associated with nearly all Fabry-specific disease manifestations, regardless of the sex of the patient.
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Affiliation(s)
- Sanne J. van der Veen
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mohamed el Sayed
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Carla E.M. Hollak
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Marion M. Brands
- Division of Metabolic Diseases, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - C. Khya S. Snelder
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - S. Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Nephrology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Susan M.I. Goorden
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Laboratory Genetic Metabolic Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - André B.P. van Kuilenburg
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Laboratory Genetic Metabolic Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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11
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Hummel B, Yerkes MA, Harskamp RE, Galenkamp H, Kunst AE, Lok A, van Valkengoed IGM. The COVID-19 pandemic and temporal change in metabolic risk factors for cardiovascular disease: A natural experiment within the HELIUS study. SSM Popul Health 2023; 23:101432. [PMID: 37234865 PMCID: PMC10195766 DOI: 10.1016/j.ssmph.2023.101432] [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: 02/24/2023] [Revised: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures taken to reduce the spread of the virus, negatively affected people's health behavior. We explored whether the pandemic also had an effect on metabolic risk factors for cardiovascular disease (CVD) in women and men. We conducted a natural experiment, using data from 6962 participants without CVD at baseline (2011-2015) of six ethnic groups of the HELIUS study in Amsterdam, the Netherlands. We studied whether participants whose follow-up measurements were taken within the 11 months before the pandemic (control group) differed from those whose measurements were taken taken within 6 months after the first lockdown (exposed group). Using sex-stratified linear regressions with inverse probability weighting, we compared changes in baseline- and follow-up data between the control and exposed group in six metabolic risk factors: systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR). Next, we explored the mediating effect of changes in body-mass index (BMI), alcohol, smoking, depressive symptoms and negative life events at follow-up. We observed less favorable changes in SBP (+1.12mmHg for women, +1.38mmHg for men), DBP (+0.85mmHg, +0.80mmHg) and FPG (only in women, +0.12 mmol/L) over time in the exposed group relative to the control group. Conversely, changes in HbA1c (-0.65 mmol/mol, -0.84 mmol/mol) and eGFR (+1.06 mL/min, +1.04 mL/min) were more favorable in the exposed compared to the control group, respectively. Changes in SBP, DBP, and FPG were partially mediated by changes in behavioral factors, in particular BMI and alcohol consumption. Concluding, the COVID-19 pandemic, in particular behavioral changes associated with restrictive lockdown measures, may have negatively affected several CVD risk factors, in both women and men.
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Affiliation(s)
- Bryn Hummel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Mara A Yerkes
- Department of Interdisciplinary Social Sciences, Utrecht University, Heidelberglaan 8, 3584, CS, Utrecht, the Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
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12
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Jin J, Yang X, Gong H, Li X. Time- and Gender-Dependent Alterations in Mice during the Aging Process. Int J Mol Sci 2023; 24:12790. [PMID: 37628974 PMCID: PMC10454612 DOI: 10.3390/ijms241612790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Compared to young people and adults, there are differences in the ability of elderly people to resist diseases or injuries, with some noticeable features being gender-dependent. However, gender differences in age-related viscera alterations are not clear. To evaluate a potential possibility of gender differences during the natural aging process, we used three age groups to investigate the impact on spleens, kidneys, and adrenal glands. The immunofluorescence results showed that male-specific p21 proteins were concentrated in the renal tubule epithelial cells of the kidney. Histological staining revealed an increase in the frequencies of fat vacuoles located in the renal tubule epithelial cells of the cortex, under the renal capsule in the kidneys of male mice with age. In female mice, we found that the width of the globular zone in the adrenal gland cortex was unchanged with age. On the contrary, the male displayed a reduction in width. Compared to females, the content of epinephrine in adrenal gland tissue according to ELISA analysis was higher in adults, and a greater decline was observed in aged males particularly. These data confirmed the age-dependent differences between female and male mice; therefore, gender should be considered one of the major factors for personalized treatment in clinical diagnosis and treatment.
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Affiliation(s)
- Jing Jin
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan 430074, China (H.G.)
| | - Xiaoquan Yang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan 430074, China (H.G.)
- Research Unit of Multimodal Cross Scale Neural Signal Detection and Imaging, HUST-Suzhou Institute for Brainsmatics, JITRI, Chinese Academy of Medical Sciences, Suzhou 215004, China
| | - Hui Gong
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan 430074, China (H.G.)
- Research Unit of Multimodal Cross Scale Neural Signal Detection and Imaging, HUST-Suzhou Institute for Brainsmatics, JITRI, Chinese Academy of Medical Sciences, Suzhou 215004, China
| | - Xiangning Li
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan 430074, China (H.G.)
- Research Unit of Multimodal Cross Scale Neural Signal Detection and Imaging, HUST-Suzhou Institute for Brainsmatics, JITRI, Chinese Academy of Medical Sciences, Suzhou 215004, China
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou 570228, China
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13
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Jin G, Seong SW, Kim MJ, Ahn KT, Jin SA, Hahn JY, Gwon HC, Hur SH, Rha SW, Yoon CH, Jeong MH, Bae JW, Song PS, Jeong JO. Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction. Am J Cardiol 2023; 200:40-46. [PMID: 37295178 DOI: 10.1016/j.amjcard.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/17/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
We sought to investigate the relation between worsening renal function (WRF) at 1-year follow-up and clinical outcomes at 3 years after acute myocardial infarction (AMI). We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and rehospitalization for heart failure at 1-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to 1-year follow-up. The primary outcome was 3-year major adverse cardiac events, a composite of all-cause death, re-MI, and rehospitalization for heart failure. On average, a -1.5 ml/min/1.73 m2/y rate of decrease in eGFR was exhibited, and 575 patients (9.2%) exhibited WRF at 1-year follow-up. After multiple adjustments, WRF at 1-year follow-up was independently associated with increased risks of major adverse cardiac events (adjusted hazard ratio 1.498, 95% confidence interval 1.113 to 2.016, p = 0.01), all-cause death, and re-MI at 3-year follow-up. Older age, female, diabetes mellitus, hypertension, non-ST-segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction <35%, and baseline eGFR <30 ml/min/1.73 m2 were identified as independent predictors of WRF after AMI. In conclusion, WRF at 1-year follow-up after AMI intuitively seems like a risk marker indicating multiple co-morbidities. Monitoring serum creatinine in patients at 1-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.
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Affiliation(s)
- Guiyue Jin
- Division of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic China; Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Seok-Woo Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Mi Joo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Kye Taek Ahn
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Seon-Ah Jin
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Hur
- Cardiovascular Medicine, Keimyung, University Dongsan Medical Center, Deagu, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jang-Whan Bae
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Pil Sang Song
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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14
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Ghasemi S, Wuttke M. Genetic Association Analysis of Chronic Kidney Disease Progression in a Small Korean Cohort Study. J Am Soc Nephrol 2023; 34:729-731. [PMID: 37126668 PMCID: PMC10371272 DOI: 10.1681/asn.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Sahar Ghasemi
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, Germany
| | - Matthias Wuttke
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, Germany
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15
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Fujii M, Ohno Y, Ikeda A, Godai K, Li Y, Nakamura Y, Yabe D, Tsushita K, Kashihara N, Kamide K, Kabayama M. Current status of the rapid decline in renal function due to diabetes mellitus and its associated factors: analysis using the National Database of Health Checkups in Japan. Hypertens Res 2023; 46:1075-1089. [PMID: 36732668 PMCID: PMC10164644 DOI: 10.1038/s41440-023-01185-2] [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: 09/03/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 02/04/2023]
Abstract
The increasing number of patients undergoing dialysis due to diabetes mellitus (DM) is causing serious economic problems, and its reduction is an urgent policy issue in developed countries, including Japan. We aimed to assess the association between the annual rapid decline in renal function and health checkup measures, including blood pressure, to identify health guidance targets for preventing diabetic nephropathy (DN) and diabetic kidney disease (DKD) among individuals in a medical checkup system ("Tokuteikenshin" program) in 2018. This longitudinal analysis included 3,673,829 individuals who participated in the "Tokuteikenshin" program in 2018, had hemoglobin A1c (HbA1c) levels ≥5.6%, were available for follow-up, and underwent estimated glomerular filtration rate (eGFR) evaluation. We estimated the incidence of the relative annual decrease in eGFR ≥10% per 1000 person-years and odds ratios to evaluate the rapid decline in renal function and determine health guidance goals and their role in preventing DN and DKD. Overall, 20.83% of patients with DM had a rapid decline in renal function within the observation period. A rapid decline in renal function was associated with high systolic blood pressure, poor or strict DM control, increased urinary protein excretion, and decreased blood hemoglobin levels. The incidence of rapid decline in renal function is higher in DM, and appropriate systolic blood pressure and glycemic control are important to prevent the progression to DN or DKD. Our findings will be useful for researchers, clinicians, and other public health care members in establishing effective health guidance and guidelines for CKD prevention.
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Affiliation(s)
- Makoto Fujii
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yuko Ohno
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Asuka Ikeda
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kayo Godai
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yaya Li
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuko Nakamura
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1193, Japan
| | - Kazuyo Tsushita
- Graduate Schools of Nutrition Sciences, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado, Saitama, 350-0288, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kei Kamide
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
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16
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Ohashi Y, Kuriyama S, Nakano T, Sekine M, Toyoda Y, Nakayama A, Takada T, Kawamura Y, Nakamura T, Matsuo H, Yokoo T, Ichida K. Urate Transporter ABCG2 Function and Asymptomatic Hyperuricemia: A Retrospective Cohort Study of CKD Progression. Am J Kidney Dis 2023; 81:134-144.e1. [PMID: 35810827 DOI: 10.1053/j.ajkd.2022.05.010] [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: 10/25/2021] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE Treatment of asymptomatic hyperuricemia is not commonly implemented. However, it is unclear whether urate deposition that begins during asymptomatic hyperuricemia can induce nephropathy. Dysfunction of ATP-binding cassette subfamily G member 2 (ABCG2), a urate efflux transporter, leads to elevated serum uric acid concentration (SUA). We investigated the association between asymptomatic hyperuricemia and decreased estimated glomerular filtration rate (eGFR), and the impact of ABCG2 on this relationship. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 1,885 Japanese adults undergoing routine health care follow-up between 2007 and 2017 who had eGFR ≥60 mL/min/1.73 m2, of which 311 had asymptomatic hyperuricemia (SUA >7.0 mg/dL). Study participants were classified into 3 categories of estimated ABCG2 function (full, 75%, and ≤50% function). PREDICTORS Baseline SUA and estimated ABCG2 function. OUTCOME Change in eGFR over time. ANALYTICAL APPROACH Linear mixed-effect models were used to analyze the relationship between asymptomatic hyperuricemia, ABCG2 function, and eGFR decline. RESULTS Asymptomatic hyperuricemia was negligibly associated with eGFR decline overall. However, among those with eGFR 60-89 mL/min/1.73 m2 and ≤50% ABCG2 function, eGFR decline was associated with asymptomatic hyperuricemia (P = 0.03). ABCG2 was not associated with eGFR reductions when the SUA was <6.0 mg/dL. Among participants with SUA ≥6.0 mg/dL and eGFR 60-89 mL/min/1.73 m2, ≤50% ABCG2 function was associated with approximately 1.2-fold faster eGFR decline compared with fully functional ABCG2 (P = 0.02). Among the participants with SUA ≥6.0 mg/dL and eGFR 60-89 mL/min/1.73 m2, the adjusted eGFR slopes (given as mean ± standard error of the mean, in mL/min/1.73 m2 per year) were -0.946 ± 0.049, -1.040 ± 0.046, and -1.148 ± 0.069 for full, 75%, and ≤50% ABCG2 function, respectively. LIMITATIONS Lack of measurement of urinary urate and uremic toxins that are known to be transported by ABCG2, and no independent validation cohort. CONCLUSIONS Asymptomatic hyperuricemia was not associated with eGFR decline, except when in the presence of ≤50% ABCG2 function. PLAIN-LANGUAGE SUMMARY The urate transporter ABCG2 is a protein that regulates serum urate concentrations; when dysfunctional, it can lead to elevated serum concentrations of this compound (ie, hyperuricemia). Although persistent hyperuricemia induces gout and kidney injury, the effects on organs during the asymptomatic phase have yet to be established. Therefore, to clarify the relationship between ABCG2, asymptomatic hyperuricemia, and kidney function, we conducted a retrospective cohort study of 1,885 healthy participants, including 311 participants with asymptomatic hyperuricemia. We found that the coexistence of asymptomatic hyperuricemia and severe ABCG2 dysfunction was associated with the age-dependent decline in kidney function. We concluded that asymptomatic hyperuricemia represents a risk factor for chronic kidney disease, at least in individuals with highly dysfunctional ABCG2. This new finding highlights the potential importance of ABCG2 in the pathogenesis of hyperuricemia-induced kidney injury.
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Affiliation(s)
- Yuki Ohashi
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
| | | | | | - Mai Sekine
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yu Toyoda
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Akiyoshi Nakayama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan; Third Division, Aeromedical Laboratory, Japan Air Self-Defense Force, Saitama, Japan
| | - Tappei Takada
- Department of Pharmacy, University of Tokyo Hospital, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yusuke Kawamura
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Laboratory for Mathematics, National Defense Medical College, Saitama, Japan
| | - Hirotaka Matsuo
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan
| | - Takashi Yokoo
- Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kimiyoshi Ichida
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan; Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
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17
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Chen CH, Shen CH, Wei KL, Xu HW, Chen WM, Chang KC, Huang YT, Hsieh YY, Lu SN, Hung CH, Chang TS. Factors Associated with Large Renal Function Decline in Patients with Chronic Hepatitis C Successfully Treated with Direct-Acting Antiviral Therapy. Diagnostics (Basel) 2023; 13:diagnostics13030473. [PMID: 36766578 PMCID: PMC9914858 DOI: 10.3390/diagnostics13030473] [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: 12/25/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
The findings regarding changes in renal function in patients with hepatitis C virus (HCV) infection treated with direct-acting antivirals (DAAs) are controversial. This study attempted to identify the factors associated with the large decline in renal function following DAA treatment. This retrospective cohort study included patients treated with DAAs at Chiayi and Yunlin Chang Gung Hospitals, Taiwan, from 1 January 2017 to 31 October 2020. Estimated glomerular filtration rate (eGFR) data were collected within 90 days prior to DAA therapy and 2 years after the confirmation of a sustained virologic response (SVR). We performed multiple logistic regression to evaluate the clinical or laboratory parameters associated with a large eGFR decline (≥10%). Among the enrolled 606 patients, the mean eGFR at the baseline and endpoint were 84.11 ± 24.38 and 78.88 ± 26.30 mL/min/1.73 m2, respectively (p < 0.001). The factors associated with a large eGFR decline 2 years after the SVR included hypertension (OR: 1.481; 95% CI: 1.010-2.173, p = 0.044) and a higher baseline eGFR (OR: 1.016; 95% CI: 1.007-1.024, p < 0.001). A higher albumin level reduced the risk of a large eGFR decline (OR: 0.546; 95% CI: 0.342-0.872, p = 0.011). In the patients with HCV treated with DAAs, a larger renal function decline was more commonly observed in those with hypertension, a lower (but within normal range) albumin level, and a higher baseline eGFR, while DAA treatment had no effect. The clinical significance of these findings has to be further defined. Although some risk factors associated with chronic kidney disease may be alleviated after DAA treatment, the regular control and follow-up of risk factors and renal function are still recommended in at-risk patients after HCV eradication.
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Affiliation(s)
- Chun-Hsien Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Chien-Heng Shen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Kuo-Liang Wei
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Huang-Wei Xu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Kao-Chi Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Yu-Ting Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Yung-Yu Hsieh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Sheng-Nan Lu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chao-Hung Hung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Te-Sheng Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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18
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Tan RYP, Rao NN, Horwood CM, Passaris G, Juneja R. Recurrent nephrolithiasis and loss of kidney function: a cohort study. Int Urol Nephrol 2023; 55:1539-1547. [PMID: 36645570 DOI: 10.1007/s11255-023-03463-x] [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: 08/10/2021] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate whether symptomatic recurrent nephrolithiasis leads to loss of kidney function. METHODS Adults who presented to the Emergency Department at least twice with symptomatic and radiologically confirmed nephrolithiasis were retrospectively recruited. Primary endpoint was the change in glomerular filtration rate (GFR) between baseline and at the time of data collection. Secondary endpoints include GFR slope defined as the mean rate of change in GFR from baseline to the end of the study period. RESULTS 240 patients had recurrent symptomatic nephrolithiasis. Median follow-up was 5.4 years. The median age of first acute presentation was 51.6 years and the median baseline serum creatinine (bsCr) was 85.5 umol/l. 17.5% (n = 42) had worsening GFR, with the average change in GFR of - 8.64 ml/min/1.73 m2 per year. Four patients progressed to ESKD requiring haemodialysis. 14.5% (n = 35) had calcium oxalate stones. Univariate analysis showed older patients (p < 0.001), more symptomatic stone episodes (p < 0.001) and non-calcium-containing stones (p < 0.001) were strongly associated with deteriorating kidney function. Age (p = 0.002) and number of acute stone episodes (p = 0.011) were significant predictive factors when unadjusted to co-morbidities. Age (p = 0.018) was the only predictive factor of worsening GFR when adjusted for co-morbidities. Average mean GFR slope was - 2.83/min/1.73 m2 per year. CONCLUSIONS Recurrent symptomatic nephrolithiasis is associated with loss of kidney function, in older patients, increased episodes of symptomatic nephrolithiasis and non-calcium-containing stones. Age is the only predictive factor for progression to chronic kidney disease in this subgroup.
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Affiliation(s)
- Rachel Yi Ping Tan
- Renal Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia. .,College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Nitesh N Rao
- Renal Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Renal Unit, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher M Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - George Passaris
- Renal Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Rajiv Juneja
- Renal Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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19
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Hemmersbach-Miller M, Balevic SJ, Winokur PL, Landersdorfer CB, Gu K, Chan AW, Cohen-Wolkowiez M, Conrad T, An G, Kirkpatrick CMJ, Swamy GK, Walter EB, Schmader KE. Population Pharmacokinetics of Piperacillin/Tazobactam Across the Adult Lifespan. Clin Pharmacokinet 2023; 62:127-139. [PMID: 36633812 PMCID: PMC9969806 DOI: 10.1007/s40262-022-01198-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Piperacillin/tazobactam is one of the most frequently used antimicrobials in older adults. Using an opportunistic study design, we evaluated the pharmacokinetics of piperacillin/tazobactam as a probe drug to evaluate changes in antibacterial drug exposure and dosing requirements, including in older adults. METHODS A total of 121 adult patients were included. The population pharmacokinetic models that best characterized the observed plasma concentrations of piperacillin and tazobactam were one-compartment structural models with zero-order input and linear elimination. RESULTS Among all potential covariates, estimated creatinine clearance had the most substantial impact on the elimination clearance for both piperacillin and tazobactam. After accounting for renal function and body size, there was no remaining impact of frailty on the pharmacokinetics of piperacillin and tazobactam. Monte Carlo simulations indicated that renal function had a greater impact on the therapeutic target attainment than age, although these covariates were highly correlated. Frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale, was assessed in 60 patients who were ≥ 65 years of age. CONCLUSIONS The simulations suggested that adults ≤ 50 years of age infected with organisms with higher minimum inhibitory concentrations may benefit from continuous piperacillin/tazobactam infusions (12 g/day of piperacillin component) or extended infusions of 4 g every 8 hours. However, for a target of 50% fT + minimum inhibitory concentration, dosing based on renal function is generally preferable to dosing by age, and simulations suggested that patients with creatinine clearance ≥ 120 mL/min may benefit from infusions of 4 g every 8 hours for organisms with higher minimum inhibitory concentrations.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- ICON Plc, North Wales, PA, USA
| | - Stephen J Balevic
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Patricia L Winokur
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Kenan Gu
- Division of Microbiology and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Austin W Chan
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Guohua An
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Carl M J Kirkpatrick
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Obstetrics Clinical Research, Duke University Medical System, Durham, NC, USA
| | - Emmanuel B Walter
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Duke Box 3469, Durham, NC, 27710, USA.
- Geriatric Research Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA.
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20
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Jaques DA, Vollenweider P, Bochud M, Ponte B. Aging and hypertension in kidney function decline: A 10 year population-based study. Front Cardiovasc Med 2022; 9:1035313. [PMID: 36277793 PMCID: PMC9582457 DOI: 10.3389/fcvm.2022.1035313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Aging is associated with a physiological decline in kidney function (KFD). In this study, we aimed to describe the impact of age on the rate of KFD and its interplay with risk factors for chronic kidney disease (CKD), considering mainly hypertension (HT), in the general population. Materials and methods Participants of European descent, aged 35-75, were recruited from a populational cohort in Lausanne, Switzerland. Participants with a 10 year follow-up were selected. KFD was defined as the difference in estimated glomerular filtration rate (eGFR) between baseline and follow-up, divided by the observation period. Multivariate linear regressions were used with KFD as the outcome and age as the main predictor. HT was tested as a modifying factor. Results We included 4,163 participants with mean age 52.2 ± 10.4, 44.7% men, 31.9% HT, and 5.0% diabetics. Mean baseline eGFR was 85.9 ± 14.6 ml/min/1.73 m2. Mean KFD was -0.49 ± 1.08 ml/min/1.73 m2 per year with 70% of participants decreasing their eGFR during follow-up. The relationship between age and KFD was non-linear and age was divided in tertiles. Old participants had faster rates of KFD as compared to young and middle-age participants (p < 0.001). A significant interaction was found between age and HT on KFD prediction (p < 0.001). In HT participants, KFD was significantly different across tertiles of age (p < 0.001). On contrary, KFD was not different across tertiles of age in non-HT participants. Conclusion A physiological KFD is present over time in the general population. Age contributes non-linearly to the rate of this decline with older subjects declining the fastest. The presence of HT is a major contributing factor in this setting as KFD worsened with age only in hypertensive participants. Thus, HT represents an important pathological factor aggravating the age-related physiological decline in eGFR in the general population.
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Affiliation(s)
- David A. Jaques
- Division of Nephrology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland,*Correspondence: David A. Jaques,
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Belen Ponte
- Division of Nephrology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland,Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland,Belen Ponte,
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21
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Melsom T, Norvik JV, Enoksen IT, Stefansson V, Mathisen UD, Fuskevåg OM, Jenssen TG, Solbu MD, Eriksen BO. Sex Differences in Age-Related Loss of Kidney Function. J Am Soc Nephrol 2022; 33:1891-1902. [PMID: 35977806 PMCID: PMC9528336 DOI: 10.1681/asn.2022030323] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND CKD is more prevalent in women, but more men receive kidney replacement therapy for kidney failure. This apparent contradiction is not well understood. METHODS We investigated sex differences in the loss of kidney function and whether any sex disparities could be explained by comorbidity or CKD risk factors. In the Renal Iohexol Clearance Survey (RENIS) in northern Europe, we recruited 1837 persons (53% women, aged 50-62 years) representative of the general population and without self-reported diabetes, CKD, or cardiovascular disease. Participants' GFR was measured by plasma iohexol clearance in 2007-2009 (n=1627), 2013-2015 (n=1324), and 2018-2020 (n=1384). At each study visit, healthy persons were defined as having no major chronic diseases or risk factors for CKD. We used generalized additive mixed models to assess age- and sex-specific GFR decline rates. RESULTS Women had a lower GFR than men at baseline (mean [SD], 90.0 [14.0] versus 98.0 [13.7] ml/min per 1.73 m2; P<0.001). The mean GFR change rate was -0.96 (95% confidence interval [CI], -0.88 to -1.04) ml/min per 1.73 m2 per year in women and -1.20 (95% confidence interval [CI], -1.12 to -1.28) in men. Although the relationship between age and GFR was very close to linear in women, it was curvilinear in men, with steeper GFR slopes at older ages (nonlinear effect; P<0.001). Healthy persons had a slower GFR decline, but health status did not explain the sex difference in the GFR decline. CONCLUSION Among middle-aged and elderly individuals in the general population, decline in the mean GFR in women was slower than in men, independent of health status.
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Affiliation(s)
- Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Jon Viljar Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Vidar Stefansson
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Trond G. Jenssen
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
- Department of Transplant Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marit D. Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Bjørn O. Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
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22
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Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne) 2022; 9:769329. [PMID: 36186775 PMCID: PMC9519889 DOI: 10.3389/fmed.2022.769329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/24/2022] [Indexed: 12/11/2022] Open
Abstract
In the last decades, improvements in the average life expectancy in the world population have been associated with a significant increase in the proportion of elderly people, in parallel with a higher prevalence of non-communicable diseases, such as hypertension and diabetes. As the kidney is a common target organ of a variety of diseases, an adequate evaluation of renal function in the approach of this population is of special relevance. It is also known that the kidneys undergo aging-related changes expressed by a decline in the glomerular filtration rate (GFR), reflecting the loss of kidney function, either by a natural senescence process associated with healthy aging or by the length of exposure to diseases with potential kidney damage. Accurate assessment of renal function in the older population is of particular importance to evaluate the degree of kidney function loss, enabling tailored therapeutic interventions. The present review addresses a relevant topic, which is the effects of aging on renal function. In order to do that, we analyze and discuss age-related structural and functional changes. The text also examines the different options for evaluating GFR, from the use of direct methods to the implementation of several estimating equations. Finally, this manuscript supports clinicians in the interpretation of GFR changes associated with age and the management of the older patients with decreased kidney function.
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Affiliation(s)
- Irene L. Noronha
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Irene L. Noronha
| | | | - Lucia Andrade
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Venceslau A. Coelho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rosilene M. Elias
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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23
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Structural modeling for Oxford histological classifications of immunoglobulin A nephropathy. PLoS One 2022; 17:e0268731. [PMID: 36084046 PMCID: PMC9462802 DOI: 10.1371/journal.pone.0268731] [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: 05/07/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
In immunoglobulin A nephropathy (IgAN), Cox regression analysis can select independent prognostic variables for renal functional decline (RFD). However, the correlation of the selected histological variables with clinical and/or treatment variables is unknown, thereby making histology-based treatment decisions unreliable. We prospectively followed 946 Japanese patients with IgAN for a median of 66 mo. and applied structural equation modeling (SEM) to identify direct and indirect effects of histological variables on RFD as a regression line of estimated glomerular filtration rate (eGFR) via clinical variables including amount of proteinuria, eGFR, mean arterial pressure (MAP) at biopsy, and treatment variables such as steroid therapy with/without tonsillectomy (ST) and renin–angiotensin system blocker (RASB). Multi-layered correlations between the variables and RFD were identified by multivariate linear regression analysis and the model’s goodness of fit was confirmed. Only tubular atrophy/interstitial fibrosis (T) had an accelerative direct effect on RFD, while endocapillary hypercellularity and active crescent (C) had an attenuating indirect effect via ST. Segmental sclerosis (S) had an attenuating indirect effect via eGFR and mesangial hypercellularity (M) had accelerative indirect effect for RFD via proteinuria. Moreover, M and C had accelerative indirect effect via proteinuria, which can be controlled by ST. However, both T and S had additional indirect accelerative effects via eGFR or MAP at biopsy, which cannot be controlled by ST. SEM identified a systemic path links between histological variables and RFD via dependent clinical and/or treatment variables. These findings lead to clinically applicable novel methodologies that can contribute to predict treatment outcomes using the Oxford classifications.
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24
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Schaeffner ES, Ebert N, Kuhlmann MK, Martus P, Mielke N, Schneider A, van der Giet M, Huscher D. Age and the Course of GFR in Persons Aged 70 and Above. Clin J Am Soc Nephrol 2022; 17:1119-1128. [PMID: 35850785 PMCID: PMC9435992 DOI: 10.2215/cjn.16631221] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES In older adults, data on the age-related course of GFR are scarce, which might lead to misjudgment of the clinical relevance of reduced GFR in old age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To describe the course of eGFR in older adults and derive reference values in population-based individuals, we used the longitudinal design of the Berlin Initiative Study (BIS) with a repeated estimation of GFR over a median of 6.1 years of follow-up. In 2069 community-dwelling older individuals (mean inclusion age 80 years, range 70-99), GFR was estimated biennially with the BIS-2 equation, including standardized creatinine and cystatin C levels, sex, and age. We described the crude and adjusted course using a mixed-effects model and analyzed the influence of death on the GFR course applying joint models. GFR slopes were compared using GFR equations on the basis of creatinine and/or cystatin C. RESULTS We observed a decreasing, thus nonlinear, eGFR decline with increasing age in a population of old adults. The estimated 1-year slope for ages 75 and 90 diminished for men from -1.67 to -0.99 and for women from -1.52 to -0.97. The modeled mean eGFR for men aged ≥79 and women ≥78 was below 60 ml/min per 1.73 m2. Multivariable adjustment attenuated slopes only minimally. Taking death into account by applying joint models did not alter the nonlinear eGFR decline. Using eGFR equations on the basis of creatinine only showed linear slope patterns in contrast to nonlinear patterns for equations including cystatin C. CONCLUSIONS The eGFR decline depended on sex and age and changed only marginally after multivariable adjustment but decelerated with increasing age. Equations including cystatin C demonstrated a nonlinear slope challenging the previously assumed linearity of the decline of eGFR in old age.
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Affiliation(s)
- Elke S. Schaeffner
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K. Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, Friedrich Karls-University, Tübingen, Germany
| | - Nina Mielke
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Schneider
- Institute of Biometry and Clinical Epidemiology, and Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus van der Giet
- Division of Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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25
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Domislović M, Domislović V, Stevanović R, Fuček M, Dika Ž, Karanović S, Kos J, Jelaković A, Premužić V, Leko N, Josipović J, Brzić I, Željković Vrkić T, Capak K, Jelaković B. CHRONIC KIDNEY DISEASE IN RURAL POPULATION. Acta Clin Croat 2022; 61:228-238. [PMID: 36818921 PMCID: PMC9934033 DOI: 10.20471/acc.2022.61.02.09] [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: 09/02/2020] [Accepted: 12/21/2020] [Indexed: 02/10/2023] Open
Abstract
The aims of the study were to provide data on chronic kidney disease (CKD) prevalence in rural population and to analyze the association with cardiovascular risk factors and aging. A random sample of 2193 farmers (1333 female (F) and 860 male (M), mean age 50.61±17.12) were enrolled. Questionnaire and clinical examination were conducted. Participants provided a spot urine and fasting blood sample. Estimated glomerular filtration rate (eGFR) was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Subjects were classified according to the KDIGO guidelines. The overall prevalence of CKD (eGFR <60 mL/min/1.73 m2) was 8.83% (F vs. M 9.9% vs. 6.3%; p<0.001). Albuminuria (albumin-to-creatinine ratio >30 mg/g) was found in 8.45% (F vs. M p>0.05). Sharp increase in CKD prevalence was found to begin after the sixth decade (29.44% in subjects older than 65 years; F vs. M 30.9% vs. 26.8%; p<0.01). The strongest predictor factors for CKD were age >65 years (OR 22.12), hypertension (OR 6.53), albuminuria (OR 5.71), fasting blood glucose >7 mmol/L (OR 5.49), diabetes (OR 3.07), abdominal obesity (OR 2.05) and non-smoking (OR 0.41). In multivariate analysis, age (OR 1.13), female gender (OR 0.60) and diabetes (OR 1.75) were the independent predictor factors for CKD. In conclusion, CKD prevalence is high in rural population, being higher in women than in men. In both genders, eGFR significantly decreased with aging. Aging is a significant independent predictor of CKD.
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Affiliation(s)
| | | | | | | | - Živka Dika
- University of Zagreb School of Medicine, Zagreb, Croatia;,Zagreb University Hospital Center, Zagreb, Croatia
| | - Sandra Karanović
- University of Zagreb School of Medicine, Zagreb, Croatia;,Zagreb University Hospital Center, Zagreb, Croatia
| | - Jelena Kos
- Zagreb University Hospital Center, Zagreb, Croatia
| | | | | | - Ninoslav Leko
- Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | | | - Ivan Brzić
- Municipality of Bebrina, Bebrina, Croatia
| | | | | | - Bojan Jelaković
- University of Zagreb School of Medicine, Zagreb, Croatia;,Zagreb University Hospital Center, Zagreb, Croatia
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26
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Masuda T, Katakami N, Taya N, Miyashita K, Takahara M, Kato K, Kuroda A, Matsuhisa M, Shimomura I. Comparison of continuous subcutaneous insulin infusion treatment and multiple daily injection treatment on the progression of diabetic complications in Japanese patients with juvenile-onset type 1 diabetes mellitus. J Diabetes Investig 2022; 13:1528-1532. [PMID: 35474612 PMCID: PMC9434575 DOI: 10.1111/jdi.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
To evaluate whether continuous subcutaneous insulin infusion attenuates the progression of diabetic complications, we retrospectively extracted data from 35 individuals who had developed type 1 diabetes mellitus aged ≤20 years and whose treatment had been changed from multiple daily injections to continuous subcutaneous insulin infusion. The annual changes in estimated glomerular filtration rate, urinary albumin excretion rate, carotid intima‐media thickness and brachial‐ankle pulse wave velocity during each treatment period were calculated. Although mean glycated hemoglobin under the continuous subcutaneous insulin infusion treatment was lower than that under the multiple daily injection treatment, there were no significant differences in annual changes in diabetic nephropathy and atherosclerosis between the two treatment periods. This pilot study showed that, in Japanese patients with juvenile‐onset type 1 diabetes mellitus, there was no significant difference in the progression of diabetic nephropathy and atherosclerosis, at least in the early stage, between the two treatments.
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Affiliation(s)
| | | | | | | | - Mitsuyoshi Takahara
- Department of Metabolic Medicine.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Ken Kato
- Diabetes center, NHO, National Hospital, 2-1-14 Hoenzaka, Chuo-ku Osaka City, Osaka, Osaka, 540-0006, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advance Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advance Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
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27
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Zsom L, Zsom M, Salim SA, Fülöp T. Estimated Glomerular Filtration Rate in Chronic Kidney Disease: A Critical Review of Estimate-Based Predictions of Individual Outcomes in Kidney Disease. Toxins (Basel) 2022; 14:toxins14020127. [PMID: 35202154 PMCID: PMC8875627 DOI: 10.3390/toxins14020127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is generally regarded as a final common pathway of several renal diseases, often leading to end-stage kidney disease (ESKD) and a need for renal replacement therapy. Estimated GFR (eGFR) has been used to predict this outcome recognizing its robust association with renal disease progression and the eventual need for dialysis in large, mainly cross-sectional epidemiological studies. However, GFR is implicitly limited as follows: (1) GFR reflects only one of the many physiological functions of the kidney; (2) it is dependent on several non-renal factors; (3) it has intrinsic variability that is a function of dietary intake, fluid and cardiovascular status, and blood pressure especially with impaired autoregulation or medication use; (4) it has been shown to change with age with a unique non-linear pattern; and (5) eGFR may not correlate with GFR in certain conditions and disease states. Yet, many clinicians, especially our non-nephrologist colleagues, tend to regard eGFR obtained from a simple laboratory test as both a valid reflection of renal function and a reliable diagnostic tool in establishing the diagnosis of CKD. What is the validity of these beliefs? This review will critically reassess the limitations of such single-focused attention, with a particular focus on inter-individual variability. What does science actually tell us about the usefulness of eGFR in diagnosing CKD?
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Affiliation(s)
- Lajos Zsom
- Fresenius Medical Care, Cegléd Dialysis Center, Törteli u 1-3, 2700 Cegléd, Hungary
- Correspondence: (L.Z.); (T.F.)
| | - Marianna Zsom
- Department of Medicine, St. Rókus Hospital, Rókus u 10, 6500 Baja, Hungary;
| | - Sohail Abdul Salim
- Department of Medicine, Division of Nephrology, University of Mississippi, 2500 N State St., Jackson, MS 39216, USA;
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 629, CSB 822, Charleston, SC 29425, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, 109 Bee St., Charleston, SC 29401, USA
- Correspondence: (L.Z.); (T.F.)
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Abstract
The reality of life in modern times is that our internal circadian rhythms are often out of alignment with the light/dark cycle of the external environment. This is known as circadian disruption, and a wealth of epidemiological evidence shows that it is associated with an increased risk for cardiovascular disease. Cardiovascular disease remains the top cause of death in the United States, and kidney disease in particular is a tremendous public health burden that contributes to cardiovascular deaths. There is an urgent need for new treatments for kidney disease; circadian rhythm-based therapies may be of potential benefit. The goal of this Review is to summarize the existing data that demonstrate a connection between circadian rhythm disruption and renal impairment in humans. Specifically, we will focus on chronic kidney disease, lupus nephritis, hypertension, and aging. Importantly, the relationship between circadian dysfunction and pathophysiology is thought to be bidirectional. Here we discuss the gaps in our knowledge of the mechanisms underlying circadian dysfunction in diseases of the kidney. Finally, we provide a brief overview of potential circadian rhythm-based interventions that could provide benefit in renal disease.
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Affiliation(s)
- Rajesh Mohandas
- Department of Medicine, Division of Nephrology.,Center for Integrative Cardiovascular and Metabolic Diseases
| | | | - Yogesh Scindia
- Department of Medicine, Division of Nephrology.,Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine.,Department of Pathology, and
| | - Michelle L Gumz
- Department of Medicine, Division of Nephrology.,Center for Integrative Cardiovascular and Metabolic Diseases.,Department of Biochemistry and Molecular Biology.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
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29
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de Rouw N, de Boer M, Boosman RJ, van den Heuvel MM, Burger DM, Lieverse JE, Derijks HJ, Frederix GWJ, Ter Heine R. The pharmacoeconomic benefits of pemetrexed dose individualization in lung cancer patients. Clin Pharmacol Ther 2022; 111:1103-1110. [PMID: 35048355 PMCID: PMC9304220 DOI: 10.1002/cpt.2529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/05/2022] [Indexed: 11/06/2022]
Abstract
Neutropenia is a dose-related treatment-limiting and costly adverse event of pemetrexed. We postulate that individualized dosing reduces the incidence of neutropenia. The aims of this study were to 1) investigate the costs of pemetrexed-related neutropenia and 2) to determine the pharmacoeconomic benefits of individualized dosing of pemetrexed in terms of budget impact, yearly cost savings and reduction in severe neutropenia. Retrospective data on the treatment of ≥grade 3 neutropenia during pemetrexed-based chemotherapy were collected from three Dutch hospitals to determine the mean health care consumption during a neutropenic episode. Subsequently, Monte Carlo simulations were performed using a validated pharmacokinetic/pharmacodynamic (PK/PD) model to predict the neutropenia incidence during four cycles for standard dosing of pemetrexed and individualized dosing. The mean costs per neutropenia and the expected neutropenia incidence were combined to calculate the budget impact and cost savings. We found that the average costs per pemetrexed-associated neutropenic episode to be € 1,490. The neutropenia incidence for the standard and individualized pemetrexed dosing strategies were 12.7 and 9.9%, respectively. This resulted in total expected neutropenia-related costs of approximately € 3.0 million and €2.4 million, respectively. Taking the number of patients eligible for pemetrexed treatment into account, individualized dosing could result in saving €686,000 on a yearly basis in the Netherlands alone. Individualized dosing of pemetrexed can decrease the incidence of neutropenia and thus result in a significant decrease in neutropenia-related costs and decreased risk of hospitalization or even death while maintaining therapeutic exposure.
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Affiliation(s)
- Nikki de Rouw
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Merel de Boer
- Utrecht University, School of Pharmacy, Utrecht, The Netherlands
| | - René J Boosman
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel M van den Heuvel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pulmonary Diseases, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joris E Lieverse
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - Hieronymus J Derijks
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rob Ter Heine
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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30
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Srinivasan R, Gokulakrishnan K, Lourdusamy R, Nilavan E, Balaji N. Prevalence of rapid renal decliner phenotype in south India: A retrospective study. Diabetes Metab Syndr 2022; 16:102334. [PMID: 34920201 DOI: 10.1016/j.dsx.2021.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The burden of chronic kidney disease (CKD) in India is extremely high with the prevalent twin epidemic of diabetes and hypertension. Fast declining phenotype of renal function has yet not been reported in Indian context. Here, we report the prevalence of rapid decliners phenotype in Indian population. METHODS Between the period 2014-2019, electronic records of 104636 subjects were reviewed. Subjects with serum creatinine values of at least one year apart were selected for further analysis. The study population was categorized based on eGFR, non-decliners < 1 mL/min/1.73 m2/year; progressive decliners 1-5 mL/min/1.73 m2/year and rapid decliners >5 mL/min/1.73 m2/year. Data on diabetes, hypertension, coronary artery disease and cerebrovascular disease were analyzed. RESULTS During the mean follow up of 4 years, the prevalence of non-decliners, progressive and rapid decliners were 61%, 20% and 19% respectively. Diabetes was higher at 44% in rapid decliners when compared to non-decliners (35.1%); progressive decliners (39.2%). The progression of CKD to end stage renal disease (ESRD) was higher in rapid decliners (32%) in comparison to progressive decliners (19%) CONCLUSIONS: There is a high prevalence of rapid decliner phenotype in India and progression to ESRD is greater and probably is a risk factor for early progression to ESRD.
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Affiliation(s)
| | - Kuppan Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Ezhil Nilavan
- Sri Narayani Hospital & Research Centre, Vellore, India
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31
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Iversen E, Kallemose T, Hornum M, Bengaard AK, Nehlin JO, Rasmussen LJH, Sandholdt H, Tavenier J, Feldt-Rasmussen B, Andersen O, Eugen-Olsen J, Houlind MB. OUP accepted manuscript. Clin Kidney J 2022; 15:1534-1541. [PMID: 35892012 PMCID: PMC9308102 DOI: 10.1093/ckj/sfac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Capital Region Pharmacy, Herlev, Denmark
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Haakon Sandholdt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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32
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Bielopolski D, Bentur OS, Singh N, Vaughan RD, Charytan DM, Kost RG, Tobin JN. Effect of Normalizing eGFR to Standard Body Surface Area on Rates of Obesity-Related Hyperfiltration among Diverse Female Adolescents. Am J Nephrol 2022; 53:282-289. [PMID: 35378531 PMCID: PMC9746671 DOI: 10.1159/000522475] [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: 12/08/2021] [Accepted: 02/04/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Obesity is more prevalent among African American individuals, increasing the risk for cardiorenal morbidity. We explored interactions between race, BMI, and the risk of hyperfiltration associated with obesity-related glomerulopathy (ORG). METHODS We created a cohort of female adolescents from electronic health records. Glomerular filtration rate (GFR) was estimated in two ways: (A) using standard age recommended formulae and (B) absolute eGFR - adjusted to individual body surface area (BSA). Multivariate logistic regression was used to analyze the contribution of risk factors for ORG-associated hyperfiltration defined as 135 mL/min/1.73 m2 or 135 mL/min, according to BMI group. Pearson's coefficient was used to assess correlation with creatinine clearance (CrCl). RESULTS The final cohort included 7,315 African American and 15,102 non-African American adolescent females, with CrCl available for internal validation in 207 non-African American and 107 African American individuals. Compared with non-African American ethnicity, African American ethnicity was independently associated with a lower risk of hyperfiltration with standard eGFR calculations (odds ratio [OR] = 0.57, 95% confidence intervals [CIs] 0.45-0.71), associations were enhanced for absolute eGFR (OR = 0.81, 95% CI 0.69-0.95). Absolute eGFR values agreed better with CrCl (r = 0.63), compared to standard indexed eGFR formulae. Proportions classified as hyperfiltration changed with standard versus absolute eGFR; they were similar across BMI groups with the first and reflected obesity with the later. CONCLUSION Adjusting to individual BSA improves estimation of GFR and identification of obesity-related hyperfiltration. More accurate and earlier ascertainment of obesity-related hyperfiltration may have important consequences for preservation of kidney function.
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Affiliation(s)
- Dana Bielopolski
- The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Ohad S. Bentur
- The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Neha Singh
- The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Roger D. Vaughan
- The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - David M. Charytan
- Nephrology Division, New York University Langone Medical Center and Grossman School of Medicine, New York, NY, USA
| | - Rhonda G. Kost
- The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Jonathan N. Tobin
- The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA,Clinical Directors Network (CDN), New York, NY, USA
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33
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Nephron overload as a therapeutic target to maximize kidney lifespan. Nat Rev Nephrol 2021; 18:171-183. [PMID: 34880459 DOI: 10.1038/s41581-021-00510-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/27/2022]
Abstract
Kidney lifespan is a patient-oriented outcome that provides much needed context for understanding chronic kidney disease (CKD). Nephron endowment, age-associated decline in nephron number, kidney injury history and the intrinsic capacity of nephrons to adapt to haemodynamic and metabolic overload vary widely within the population. Defining percentiles of kidney function might therefore help to predict individual kidney lifespan and distinguish healthy ageing from progressive forms of CKD. In response to nephron loss, the remaining nephrons undergo functional and structural adaptations to meet the ongoing haemodynamic and metabolic demands of the organism. When these changes are no longer sufficient to maintain kidney cell homeostasis, remnant nephron demise occurs and CKD progression ensues. An individual's trajectory of glomerular filtration rate and albuminuria reflects the extent of nephron loss and adaptation of the remaining nephrons. Nephron overload represents the final common pathway of CKD progression and is largely independent of upstream disease mechanisms. Thus, interventions that efficiently attenuate nephron overload in early disease stages can protect remnant kidney cells and nephrons, and delay CKD progression. This Review provides a conceptual framework for individualized diagnosis, monitoring and treatment of CKD with the goal of maximizing kidney lifespan.
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34
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Vejlgaard M, Maibom SL, Stroomberg HV, Poulsen AM, Thind PO, Røder MA, Joensen UN. Long-Term Renal Function Following Radical Cystectomy for Bladder Cancer. Urology 2021; 160:147-153. [PMID: 34838541 DOI: 10.1016/j.urology.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate long-term renal function following radical cystectomy (RC) for bladder cancer and identify risk factors associated with postoperative decline in renal function. METHODS The study included patients who underwent RC at a single centre in Denmark between 2009 and 2019. Data was collected through national electronic medical records. Renal function was evaluated by estimated glomerular filtration rate (eGFR) using pre- and postoperative creatinine measurements. Cumulative incidence and Cox Proportional Hazards models were used to describe the loss of renal function and its association with clinicopathological variables, as well as its effect on mortality. RESULTS After exclusions, 670 patients were eligible for analyses. Median follow-up time was 6.2 years (interquartile range 4.0 -8.4). The proportion of patients with renal insufficiency (eGFR<45 mL/min) increased from 8.9% before RC to 19% 5 years after surgery. A total of 610 patients with preoperative eGFR≥45 were included in survival analyses. The absolute risk of renal function decline to CKD stage G3b or worse (eGFR<45 mL/min) was 17% (95% CI 14 -20) at 5 years postoperatively. Loss of renal function was not significantly associated with higher all-cause mortality. In multivariate analysis lower preoperative eGFR, diabetes mellitus, prior pelvic radiation therapy, continent urinary diversion types, and postoperative ureteral stricture were all independently associated with renal function decline. CONCLUSION The long-term renal function decreases considerably for a large number of RC patients. Recognizing preoperative risk factors could identify patients who benefit from enhanced renal surveillance or early intervention for modifiable factors to minimize renal insufficiency following RC.
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Affiliation(s)
- Maja Vejlgaard
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Sophia L Maibom
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein V Stroomberg
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Alicia M Poulsen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter O Thind
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin A Røder
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulla N Joensen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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35
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Rastelli F, Baragetti I, Buzzi L, Ferrario F, Benozzi L, Di Nardo F, Devoti E, Cancarini G, Mezzina N, Napodano P, Gallieni M, Santoro D, Buemi M, Pecchini P, Malberti F, Colombo V, Colussi G, Sabadini E, Remuzzi G, Argentiero L, Gesualdo L, Gatti G, Trevisani F, Slaviero G, Spotti D, Baraldi O, La Manna G, Pignone E, Saltarelli M, Heidempergher M, Tedesco M, Genderini A, Ferro M, Rollino C, Roccatello D, Guzzo G, Clari R, Barbara Piccoli G, Comotti C, Brunori G, Cameli P, Bargagli E, Rottoli P, Dugo M, Cristina Maresca M, Bertoli M, Giozzet M, Brugnano R, Giovanni Nunzi E, D'Amico M, Minoretti C, Acquistapace I, Colturi C, Minola E, Camozzi M, Tosoni A, Nebuloni M, Ferrario F, Dell'Antonio G, Cusinato S, Feriozzi S, Pozzi C. Renal involvement in sarcoidosis: histological patterns and prognosis, an Italian survey. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021017. [PMID: 34744417 PMCID: PMC8552569 DOI: 10.36141/svdld.v38i3.11488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Background Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent, but in <1% causes acute kidney injury (AKI). Methods This Italian multicentric retrospective study included 39 sarcoidosis-patients with renal involvement at renal biopsy: 31 sGIN-AKI, 5 with other patterns (No-sGIN-AKI), 3 with nephrotic proteinuria. We investigate the predictive value of clinical features, laboratory, radiological parameters and histological patterns regarding steroid response. Primary endpoint: incident chronic kidney disease (CKD) beyond the 1°follow-up (FU) year; secondary endpoint: response at 1°line steroid therapy; combined endpoint: the association of initial steroid response and outcome at the end of FU. Results Complete recovery in all 5 No-sGIN-AKI-patients, only in 45% (13/29) sGIN-AKI-patients (p=0.046) (one lost in follow-up, for another not available renal function after steroids). Nobody had not response. Primary endpoint of 22 sGIN-AKI subjects: 65% (13/20) starting with normal renal function developed CKD (2/22 had basal CKD; median FU 77 months, 15-300). Combined endpoint: 29% (6/21) had complete recovery and final normal renal function (one with renal relapse), 48% (10/21) had partial recovery and final CKD (3 with renal relapse, of whom one with basal CKD) (p=0.024). Acute onset and hypercalcaemia were associated to milder AKI and better recovery than subacute onset and patients without hypercalcaemia, women had better endpoints than men. Giant cells, severe interstitial infiltrate and interstitial fibrosis seemed negative predictors in terms of endpoints. Conclusions sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.
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Affiliation(s)
- Francesco Rastelli
- Nephrology SS. Trinità Hospital, Borgomanero, Italy.,Nephrology Bassini Hospital, Cinisello Balsamo, Italy
| | | | - Laura Buzzi
- Nephrology Bassini Hospital, Cinisello Balsamo, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giuseppe Remuzzi
- Nephrology Papa Giovanni XXIII Hospital, Bergamo, Italy.,Clinical Research Centre for Rare Diseases, Mario Negri Institute for Pharmacological Research, Pediatric Nephrology Department Bergamo, Italy
| | | | | | - Guido Gatti
- Nephrology S.Raffaele Hospital, Milano, Italy
| | | | | | | | - Olga Baraldi
- Nephrology Policlino Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Giorgina Barbara Piccoli
- Nephrology S.Luigi Hospital, Orbassano, Italy.,Nephrologie Centre Hospitalier du Mans, Le Mans, France
| | | | | | - Paolo Cameli
- Pneumology S.Maria alle Scotte Hospital, Siena, Italy
| | | | - Paola Rottoli
- Pneumology S.Maria alle Scotte Hospital, Siena, Italy
| | - Mauro Dugo
- Nephrology S.Maria dei Battuti Hospital, Treviso, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Claudio Pozzi
- Nephrology Bassini Hospital, Cinisello Balsamo, Italy
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36
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Trajectories of kidney function in diabetes: a clinicopathological update. Nat Rev Nephrol 2021; 17:740-750. [PMID: 34363037 DOI: 10.1038/s41581-021-00462-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
Diabetic nephropathy has been traditionally diagnosed based on persistently high albuminuria and a subsequent decline in glomerular filtration rate (GFR), which is widely recognized as the classical phenotype of diabetic kidney disease (DKD). Several studies have emphasized that trajectories of kidney function in patients with diabetes (specifically, changes in GFR and albuminuria over time) can differ from this classical DKD phenotype. Three alternative DKD phenotypes have been reported to date and are characterized by albuminuria regression, a rapid decline in GFR, or non-proteinuric or non-albuminuric DKD. Although kidney biopsies are not typically required for the diagnosis of DKD, a few studies of biopsy samples from patients with DKD have demonstrated that changes in kidney function associate with specific histopathological findings in diabetes. In addition, various clinical and biochemical parameters are related to trajectories of GFR and albuminuria. Collectively, pathological and clinical characteristics can be used to predict trajectories of GFR and albuminuria in diabetes. Furthermore, cohort studies have suggested that the risks of kidney and cardiovascular outcomes might vary among different phenotypes of DKD. A broader understanding of the clinical course of DKD is therefore crucial to improve risk stratification and enable early interventions that prevent adverse outcomes.
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37
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Surachman A, Santos AR, Daw JK, Alexander L, Almeida DM, Coe CL. Life course pathways from parental education to age-related decrements in kidney function among Black and white American adults. Psychoneuroendocrinology 2021; 131:105291. [PMID: 34091404 PMCID: PMC8405562 DOI: 10.1016/j.psyneuen.2021.105291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Using cross-sectional data on Black and white adults, this analysis examined whether age-related decrements in kidney function across adulthood were associated with parental education, and whether the association was differentially influenced by race. Further, this study assessed racial differences in life course pathways from parental education to age-related decrements in kidney function, through current SES and health-related risk factors. METHOD Data from the main survey and the Biomarker Project of the Midlife in the United States (MIDUS) Wave 2 and Refresher samples were combined, resulting in 1861 adults (54.5% female; age 25-84, Mage = 53.37) who self-identified as non-Hispanic Black (n = 326) and non-Hispanic white (n = 1535). Estimated glomerular filtration rate (eGFR) was based on serum creatinine, calculated using the CKD-EPI formula. Adults SES was based on education, income, and financial strains. Health-related risk factors included obesity, elevated blood pressure (BP), and insulin resistance. Hypotheses were tested by utilizing multiple linear regression and regression-based moderated mediation analysis. RESULTS Lower parental education was associated with steeper age-related decrements in eGFR (B = 0.38, SE = 0.15, p = .013, 95%CI = 0.08, 0.68), due to higher eGFR among younger participants and lower eGFR among older participants. In addition, age-related decrements in kidney function were steeper among Black relative to white adults (B = 0.41, SE = 0.13, p < .01, 95%CI = 0.16, 0.66), driven by higher proportion of younger Black adults that met criterion for renal hyperfiltration. Furthermore, parental education and race were associated with age-related decrements in kidney function in an additive rather than interactive way. There were some racial differences in the life course pathways from parental education to age-related differences in eGFR, glucoregulation, and hypertension. Among Black adults, lower parental education was associated with elevated eGFR among younger participants through insulin resistance. Among white adults, lower parental education was linked to higher eGFR among younger adults and lower eGFR among older adults, and the association was mediated by current SES, elevated BP, and insulin resistance. DISCUSSION Early life SES can have a long-lasting influence on the preclinical renal senescence that is associated with the normal biology of aging for both Black and white adults.
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Affiliation(s)
- Agus Surachman
- Department of Human Development and Family Studies, The Pennsylvania State University, USA; Center for Healthy Aging, The Pennsylvania State University, USA.
| | - Alexis R Santos
- Department of Human Development and Family Studies, The Pennsylvania State University, USA; Center for Healthy Aging, The Pennsylvania State University, USA
| | - Jonathan K Daw
- Department of Sociology and Criminology, The Pennsylvania State University, USA
| | - Lacy Alexander
- Center for Healthy Aging, The Pennsylvania State University, USA; Department of Kinesiology, The Pennsylvania State University, USA
| | - David M Almeida
- Department of Human Development and Family Studies, The Pennsylvania State University, USA; Center for Healthy Aging, The Pennsylvania State University, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, USA; Harlow Center for Biological Psychology, University of Wisconsin-Madison, USA
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38
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Bichet DG, Torra R, Wallace E, Hughes D, Giugliani R, Skuban N, Krusinska E, Feldt-Rasmussen U, Schiffmann R, Nicholls K. Long-term follow-up of renal function in patients treated with migalastat for Fabry disease. Mol Genet Metab Rep 2021; 28:100786. [PMID: 34401344 PMCID: PMC8353473 DOI: 10.1016/j.ymgmr.2021.100786] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022] Open
Abstract
The effect of migalastat on long-term renal outcomes in enzyme replacement therapy (ERT)-naive and ERT-experienced patients with Fabry disease is not well defined. An integrated posthoc analysis of the phase 3 clinical trials and open-label extension studies was conducted to evaluate long-term changes in renal function in patients with Fabry disease and amenable GLA variants who were treated with migalastat for ≥2 years during these studies. The analysis included ERT-naive (n = 36 [23 females]; mean age 45 years; mean baseline estimated glomerular filtration rate (eGFR), 91.4 mL/min/mL/1.73 m2) and ERT-experienced (n = 42 [24 females]; mean age, 50 years; mean baseline eGFR, 89.2 mL/min/1.73m2) patients with amenable variants who received migalastat 123 mg every other day for ≥2 years. The annualized rate of change from baseline to last observation in estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI) was calculated by both simple linear regression and a random coefficient model. In ERT-naive patients, mean annualized rates of change from baseline in eGFRCKD-EPI were - 1.6 mL/min/1.73 m2 overall and - 1.8 mL/min/1.73 m2 and - 1.4 mL/min/1.73 m2 in male and female patients, respectively, as estimated by simple linear regression. In ERT-experienced patients, mean annualized rates of change from baseline in eGFRCKD-EPI were - 1.6 mL/min/1.73 m2 overall and - 2.6 mL/min/1.73 m2 and - 0.8 mL/min/1.73 m2 in male and female patients, respectively. Mean annualized rate of change in eGFRCKD-EPI in ERT-naive patients with the classic phenotype (defined by white blood cell alpha galactosidase A [α-Gal A] activity of <3% of normal and multiorgan system involvement) was -1.7 mL/min/1.73 m2. When calculated using the random coefficient model, which adjusted for sex, age, and baseline renal function, the annualized eGFRCKD-EPI change was minimal (mean: -0.1 and 0.1 mL/min/1.73 m2 in ERT-naive and ERT-experienced patients, respectively). In conclusion, patients with Fabry disease and amenable GLA variants receiving long-term migalastat treatment (≤8.6 years) maintained renal function irrespective of treatment status, sex, or phenotype.
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Affiliation(s)
- Daniel G Bichet
- Department of Medicine, Hôpital du Sacré-Coeur, University of Montréal, Montreal, Quebec, Canada
| | - Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, REDINREN, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eric Wallace
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Roberto Giugliani
- Medical Genetics Service, Department of Genetics, Institute of Biosciences, Institute of Basic Health Sciences, Faculty of Medicine, Faculty of Pharmacy (UFRGS) and, National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Nina Skuban
- Amicus Therapeutics, Inc., Cranbury, NJ, USA
| | | | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Kathy Nicholls
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Fujii R, Yamada H, Tsuboi Y, Ando Y, Munetsuna E, Yamazaki M, Ohashi K, Ishikawa H, Ishihara Y, Hashimoto S, Hamajima N, Suzuki K. Association between circulating microRNAs and changes in kidney function: A five-year prospective study among Japanese adults without CKD. Clin Chim Acta 2021; 521:97-103. [PMID: 34242639 DOI: 10.1016/j.cca.2021.07.002] [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: 06/09/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although a number of microRNAs (miRNA) reflecting kidney function has been identified, prospective studies are now urgently needed to determine a clinical utility of these miRNAs among general populations. The purpose of this study was to examine the associations between serum miRNAs and kidney function in a population-based study. METHODS We conducted a five-year prospective study (2012-2017) of 169 individuals without chronic kidney disease (CKD) at the baseline survey (mean age, 62.5; 96 women). The real-time qPCR was used to measure serum levels of five previously reported miRNAs. Participants with eGFR < 60 mL/min/1.73 m2 were defined as having CKD. Changes in eGFR were defined as eGFR2017 - eGFR2012. RESULTS After adjusting for covariates including baseline eGFR, lower serum levels (1st tertile) of miR-126 were associated with a greater decline of eGFR (β [SE] = -3.18 [1.50]) and a higher odds ratio (OR) of CKD onset over five years (OR [95% CI] = 3.85 [1.01-16.8]), compared with the 3rd tertile. CONCLUSIONS We found baseline serum miR-126 levels were associated with changes in eGFR and new CKD cases in a five-year prospective study. This result suggests that miR-126 may be a potential biomarker of CKD even among general populations.
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Affiliation(s)
- Ryosuke Fujii
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Hiroya Yamada
- Department of Hygiene, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Yoshiki Tsuboi
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Yoshitaka Ando
- Department of Biomedical and Analytical Sciences, Fujita Health University School of Medical Sciences, Toyoake 470-1192, Japan
| | - Eiji Munetsuna
- Department of Biochemistry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Mirai Yamazaki
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 281-1 Hara, Mure-cho, Takamatsu 761-0123, Japan
| | - Koji Ohashi
- Department of Biomedical and Analytical Sciences, Fujita Health University School of Medical Sciences, Toyoake 470-1192, Japan
| | - Hiroaki Ishikawa
- Department of Biomedical and Analytical Sciences, Fujita Health University School of Medical Sciences, Toyoake 470-1192, Japan
| | - Yuya Ishihara
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan.
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The distribution of eGFR by age in a community-based healthy population: the Japan specific health checkups study (J-SHC study). Clin Exp Nephrol 2021; 25:1303-1310. [PMID: 34216288 DOI: 10.1007/s10157-021-02107-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Renal function gradually declines with age. However, the association between changes in renal function and healthy aging has not been determined. This study examined the distribution of estimated glomerular filtration rate (eGFR) values in healthy subjects by age using large-scale cross-sectional data of health check-up participants in Japan. METHODS Among the 394,180 health check-up participants, 75,217 (19.1%) subjects without hypertension, diabetes, hyperlipidemia, obesity, proteinuria, smoking, past history of cardiovascular diseases, and renal failure/not undergoing dialysis were included in the healthy group. The distribution of eGFR values was determined at each age between 39 and 74 years. RESULTS in healthy subjects, the mean (± 2 SD range) values of eGFR (mL/min/1.73 m2) at ages 40, 50, 60, and 70 were 88.0 (55.4-121.7), 82.3 (51.2-113.3), 77.8 (48.1-107.6), and 72.9 (44.7-101.1), respectively. The difference in the mean eGFR by age was almost constant across all ages. In the linear regression analysis adjusted for sex, the regression coefficient of mean eGFR for a one-year increase in age was -0.46 mL/min/1.73 m2 in healthy subjects (P < 0.001). By sex, the distribution of eGFR and the 1-year change in eGFR showed similar results in both men and women. CONCLUSIONS Renal function slowly declined with age in a healthy population; however, it was relatively preserved until the mid 70 s. This result suggests that a decline in renal function often observed in the elderly does not attribute to aging alone, and further examination might be required to clarify the cause of renal impairment.
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van Westing AC, Eckl MR, Küpers LK, Pertiwi K, Hoogeveen EK, Geleijnse JM. Plasma fatty acids and kidney function decline in post-myocardial infarction patients of the Alpha Omega Cohort. Nutr Metab Cardiovasc Dis 2021; 31:1467-1476. [PMID: 33744039 DOI: 10.1016/j.numecd.2021.01.012] [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: 09/11/2020] [Revised: 12/18/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Age-related kidney function decline is accelerated in patients with coronary heart disease (CHD). CHD and chronic kidney disease may share common etiologies. We examined plasma fatty acids (FAs) as novel biomarkers of kidney function decline after myocardial infarction (MI). METHODS AND RESULTS The analysis included 2329 Dutch post-MI patients aged 60-80y (Alpha Omega Cohort) most receiving state-of-the-art medications. Plasma FAs (% total FAs) in cholesteryl esters were assessed at baseline (2002-2006), and ∼40 months change in creatinine-cystatin C based glomerular filtration rate was estimated (eGFR, in ml/min per 1.73 m2). Beta coefficients for annual eGFR change in relation to plasma linoleic acid (LA; 50.1% of total FAs in CE), omega-3 FAs (EPA + DHA; 1.7%), odd-chain FAs (C15:0 and C17:0; 0.2%), and C14:0 (0.7%) were obtained from linear regression analyses adjusted for age, sex, smoking, and alcohol intake. Mean baseline eGFR ±SD was 78.5 ± 18.7, which declined by 4.7 ± 13.1 during follow-up, or 1.4 ± 3.9 per year. The annual decline in eGFR was less in patients with higher plasma LA (adjusted beta: 0.40 for LA >47 vs ≤ 47%, 95% CI: 0.01; 0.78; p = 0.046). Associations of plasma LA with annual eGFR decline were stronger in 437 patients with diabetes (1.21, 0.24; 2.19) and in 402 patients with CKD (eGFR<60; 0.90, -0.09; 1.89). Weaker, non-significant associations with kidney function decline were observed for the other plasma FAs. CONCLUSION Higher plasma LA may be a good predictor of less kidney function decline after MI, particularly in patients with diabetes. The Alpha Omega Cohort is registered with clinicaltrials.gov, NCT03192410.
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Affiliation(s)
- Anniek C van Westing
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
| | - Marion R Eckl
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Leanne K Küpers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Kamalita Pertiwi
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
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Tuğcu M, Barutçu Ataş D. Chronic kidney disease progression in aged patients. Int Urol Nephrol 2021; 53:2619-2625. [PMID: 33677699 DOI: 10.1007/s11255-021-02806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Chronic kidney disease (CKD) is a major morbidity, and its prevalence increases with age. However, there appears to be some confusion about the prognosis of CKD in aged patients, because, it has its own characteristics different from youngers. In this study, we investigated the progression of CKD and related factors in aged patients. METHODS This was a retrospective study including 334 patients over 80 years of age that were diagnosed with stage 3-4 CKD at our CKD clinic. CKD progression was assessed as an annual decline in the estimated glomerular filtration rate (eGFR). Comorbidities were globally categorized with the Charlson comorbidity index (CCI), but diabetes mellitus, hypertension, and cardiac morbidities were evaluated separately. Patients were grouped as either 'progression to end-stage renal disease (ESRD)' or 'others'. RESULTS During the follow-up period, 191 (57.2%) patients exhibited progression; the annual median eGFR declined by 0.8 ml/min/1.73 m2. Only 27 (8.1%) of these patients progressed to ESRD. In univariant and multivariate models, respectively, progressing to ESRD was significantly associated with cardiac comorbidities (p < 0.001, p < 0.001), proteinuria (p < 0.001, p = 0.03), and the baseline eGFR value (p < 0.001, p < 0.001). CONCLUSION In aged patients, CKD progressed slowly, but particularly high initial creatinine levels and proteinuria could be indicator of progression. In addition, cardiac comorbidities may facilitate progression to ESRD.
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Affiliation(s)
- Murat Tuğcu
- Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District, Muhsin Yazıcıoğlu Street No:10 Pendik, 34899, Istanbul, Turkey.
| | - Dilek Barutçu Ataş
- Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District, Muhsin Yazıcıoğlu Street No:10 Pendik, 34899, Istanbul, Turkey
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Costas L, Herz CT, Höbaus C, Koppensteiner R, Schernthaner GH. Vascular peroxidase 1 is independently associated with worse kidney function in patients with peripheral artery disease. J Nephrol 2021; 34:165-172. [PMID: 32813143 PMCID: PMC7881961 DOI: 10.1007/s40620-020-00818-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/25/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oxidative stress is involved in cardiovascular disease such as peripheral artery disease (PAD). Vascular Peroxidase 1 (VPO1), a novel heme-containing peroxidase mainly expressed in the cardiovascular system, aggravates oxidative stress. Evidence in humans is limited. Current work aims to measure VPO1 in patients suffering from PAD, and to evaluate the association of VPO1 with conventional markers of cardiovascular risk factors (CVRF), including the estimated glomerular filtration rate (eGFR) and albuminuria categories. METHODS This study is part of a longitudinal observational study. At baseline, 236 PAD-patients were included. VPO1 plasma levels (ng/mL) were measured by commercially available ELISA kits. A two-sided p level of < 0.05 was considered statistically significant. RESULTS In the cross-sectional analysis (n = 236), VPO1 associated with ageing (p = 0.035) as well as with eGFR and albuminuria category, the markers of chronic kidney disease (CKD)-progression (p = 0.042). The longitudinal 18-months follow-up analysis (n = 152) demonstrated that baseline VPO1 predicts rapid kidney function decline (RKFD) (n = 49), defined as more than - 3 mL/min/1.73m2 eGFR loss per year, (OR per one SD VPO1 1.60 (1.11-2.30); p = 0.009). This association between VPO1 and kidney function withstood the multivariable adjustment for traditional CVRF including baseline eGFR and urine albumin-to-creatinine ratio (UACR), (adjOR per one SD VPO1 1.73 (1.14-2.61); p = 0.046). CONCLUSION This study is first to reveal that VPO1 is independently associated with declining kidney function in patients with PAD. VPO1 shows a tighter association to kidney function than to other CVRF. This finding points to VPO1 as a potential target protein to assess CKD-progression.
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Affiliation(s)
- Lavinia Costas
- Division of Angiology, Department of Medicine II, Medical University and General Hospital of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Carsten Thilo Herz
- Division of Angiology, Department of Medicine II, Medical University and General Hospital of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University and General Hospital of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Clemens Höbaus
- Division of Angiology, Department of Medicine II, Medical University and General Hospital of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Renate Koppensteiner
- Division of Angiology, Department of Medicine II, Medical University and General Hospital of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Gerit-Holger Schernthaner
- Division of Angiology, Department of Medicine II, Medical University and General Hospital of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
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Kidney function and the prognostic value of myocardial performance index. Int J Cardiovasc Imaging 2021; 37:1637-1647. [PMID: 33475871 DOI: 10.1007/s10554-020-02149-0] [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: 06/10/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A decreased glomerular filtration rate (GFR) is a risk factor for cardiovascular disease even after adjustment for conventional risk factors. The myocardial performance index (MPI) is defined as (isovolumetric relaxation time (IVRT) + isovolumetric contraction time (IVCT))/ejection time (ET). It has been shown to be an independent predictor of cardiovascular events. We hypothesized the MPI could prove valuable for assessing cardiac risk in subjects of the general population with decreased estimated GFR (eGFR). MPI was measured in 1915 subjects from a large general population prospective cohort study using color tissue Doppler imaging (TDI) M-mode through the mitral valve. We compared the prognostic capabilities of the MPI between subjects with eGFR ≥ 75 mL/min/1.73 m2 and subjects with eGFR < 75 mL/min/1.73 m2 using multivariable adjusted Cox regression models. The composite endpoint was heart failure, myocardial infarction or cardiovascular death. Mean age was 58 years (SD 16.2), 58% were women, 42% had hypertension and 8.3% diabetes. During a median follow-up time of 12.4 years [IQR 10.6-12.7 years] 269 participants reached the combined endpoint. eGFR modified the prognostic capability of MPI (p-value for interaction < 0.001): After multivariable adjustment, MPI remained an independent predictor of the composite endpoint only in participants with eGFR < 75 mL/min/1.73 m2: HR 1.18 (95% CI 1.02-1.38), p = 0.03, vs. in subjects with eGFR ≥ 75 mL/min/1.73 m2: HR 1.14 (95% CI 0.94-1.39), p = 0.17. These results suggest the MPI could be particularly valuable for identifying elevated cardiac risk in individuals from the general population with decreased eGFR.
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Kohsaka S, Okami S, Kanda E, Kashihara N, Yajima T. Cardiovascular and Renal Outcomes Associated With Hyperkalemia in Chronic Kidney Disease: A Hospital-Based Cohort Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:274-285. [PMID: 33997627 PMCID: PMC8105529 DOI: 10.1016/j.mayocpiqo.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To examine the association between hyperkalemia and long-term cardiovascular and renal outcomes in patients with chronic kidney disease. Patients and Methods An observational retrospective cohort study was performed using a Japanese hospital claims registry, Medical Data Vision (April 1, 2008, to September 30, 2018). Of 1,208,894 patients with at least 1 potassium measurement, 167,465 patients with chronic kidney disease were selected based on International Classification of Diseases, Tenth Revision codes or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Hyperkalemia was defined as at least 2 potassium measurements of 5.1 mmol/L or greater within 12 months. Normokalemic controls were patients without a record of potassium levels of 5.1 mmol/L or greater and 3.5 mmol/L or less. Changes in eGFRs and hazard ratios of death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction were assessed between propensity score–matched hyperkalemic patients and normokalemic controls. Results Of 16,133 hyperkalemic patients and 11,898 normokalemic controls eligible for analyses, 5859 (36.3%) patients and 5859 (49.2%) controls were selected after propensity score matching. The mean follow-up period was 3.5 years. The 3-year eGFR change in patients and controls was −5.75 and −1.79 mL/min/1.73 m2, respectively. Overall, hyperkalemic patients had higher risks for death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction than controls, with hazard ratios of 4.40 (95% CI, 3.74 to 5.18), 1.95 (95% CI, 1.59 to 2.39), 5.09 (95% CI, 4.17 to 6.21), and 7.54 (95% CI, 5.73 to 9.91), respectively. Conclusion Hyperkalemia was associated with significant risks for mortality and adverse clinical outcomes, with more rapid decline of renal function. These findings underscore the significance of hyperkalemia as a predisposition to future adverse events in patients with chronic kidney disease.
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Key Words
- ACEi, angiotensin-converting enzyme inhibitor
- ARB, angiotensin receptor blocker
- CKD, chronic kidney disease
- DM, diabetes mellitus
- HDL, high-density lipoprotein
- HF, heart failure
- ICD-10, International Classification of Diseases, Tenth Revision
- LDL, low-density lipoprotein
- MDV, Medical Data Vision
- MRA, mineralocorticoid receptor antagonist
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitor
- RRT, renal replacement therapy
- S-K, serum potassium
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Suguru Okami
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshitaka Yajima
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
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Abstract
Rationale & Objective Previous studies have suggested that microRNA-21 (miR-21) plays an important role in kidney fibrosis. We examined the relationship between intrarenal miR-21 level and rate of kidney function loss in immunoglobulin A nephropathy (IgAN). Study Design Prospective cohort study. Setting & Participants 40 patients with IgAN and 10 with hypertensive nephrosclerosis as controls. Predictors miR-21 levels in kidney biopsy specimen and urinary sediment, quantified as ratio to the housekeeping gene. Outcomes Kidney event–free survival and rate of kidney function decline. Analytic Approach Time-to-event and correlation analysis. Results The IgAN group had significantly higher intrarenal miR-21 expression compared with the hypertensive nephrosclerosis group (1.71 [IQR, 0.99-2.77] vs 0.31 [IQR, 0.25-1.32]; P < 0.0001), but urinary miR-21 levels were similar. Intrarenal miR-21 expression had significant but modest correlation with severity of glomerulosclerosis (r = 0.293; P = 0.05) and tubulointerstitial fibrosis (r = 0.341; P = 0.03). Patients with high intrarenal miR-21 expression had significantly higher risk for developing kidney end points compared with those with low expression (log-rank test, P = 0.017). Univariate Cox analysis showed that intrarenal miR-21 expression significantly predicted the development of kidney end points (unadjusted HR, 1.586; 95% CI, 1.179-2.134; P = 0.002). However, the result was just short of statistical significance after adjusting for the severity of histologic damage (P = 0.06). There was also a significant correlation between intrarenal miR-21 expression and the slope of kidney function decline by univariate analysis (r = −0.399; P = 0.02). Limitations Small sample size; uncertain cellular origin of miR-21. Conclusions We found that intrarenal miR-21 expression is increased in patients with IgAN, modestly correlated with the severity of histologic damage, and predictive of subsequent kidney function loss.
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Baig S, Paisey R, Dawson C, Barrett T, Maffei P, Hodson J, Rambhatla SB, Chauhan P, Bolton S, Dassie F, Francomano C, Marshall RP, Belal M, Skordilis K, Hayer M, Price AM, Cramb R, Edwards N, Steeds RP, Geberhiwot T. Defining renal phenotype in Alström syndrome. Nephrol Dial Transplant 2020; 35:994-1001. [PMID: 30307515 DOI: 10.1093/ndt/gfy293] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Alström syndrome (AS) is a rare autosomal recessive ciliopathy with a wide spectrum of clinical features, including cone-rod retinal dystrophy, neuronal deafness, severe insulin resistance and major organ failure. The characteristics of renal disease in the syndrome have not been systematically described. The aim of this study is to define the onset and progression of renal disease in AS. METHOD Prospective observational cohort study. SETTING AND PARTICIPANTS Thirty-two adult subjects from a national specialist clinic in UK and 86 subjects from an international AS registry were studied. OUTCOMES First, an international registry cross-sectional study across all age groups to determine change in kidney function was performed. Secondly, a detailed assessment was carried out of adult AS patients with serial follow-up to determine incidence, aetiology and progression of renal disease. ANALYTICAL APPROACH Generalized estimating equations were used to evaluate the relationship between age and estimated glomerular filtration rate (eGFR). Associations between patient factors and eGFR levels were then assessed in the adult AS cohort. RESULTS The international registry study of the renal function of 118 subjects with AS (median age 21 years) showed a rapid decline with age, at an average of -16.7 and -10.9 mL/min/1.73 m2 per decade in males and females, respectively. In a UK national cohort of 32 patients with AS (median age 22 years), 20/32 (63%) had chronic kidney disease (CKD) Stage 3 or above based on eGFR <60 mL/min/1.73 m2 or evidence of albuminuria. Hyperuricaemia was noted in 25/32 (79%). Structural abnormalities such as nephrocalcinosis without hypercalcaemia and cysts were observed in 20/32 (63%) subjects. Lower urinary tract symptoms were frequent in 17/19 (70%) of AS patients. Histological evidence showed mixed tubulo-interstitial and glomerular disease. CONCLUSIONS This is the first study to demonstrate that renal disease is the hallmark of AS, which starts early and progresses with age, leading to a high prevalence of advanced CKD at young age. AS should be considered in the differential diagnosis of rare genetic renal diseases.
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Affiliation(s)
- Shanat Baig
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Richard Paisey
- Diabetes Research Unit, Horizon Centre, Torbay Hospital, Torquay, UK
| | - Charlotte Dawson
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Department of Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Pietro Maffei
- Department of Medical and Surgical Sciences (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | | | - Priyesh Chauhan
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Shaun Bolton
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Francesca Dassie
- Department of Medical and Surgical Sciences (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Clair Francomano
- Adult Genetics, Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore, MD, USA
| | | | - Mohammed Belal
- Department of Urology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Kassiani Skordilis
- Department of Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Manvir Hayer
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Anna M Price
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Robert Cramb
- Department of Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Nicola Edwards
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Tarekegn Geberhiwot
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
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48
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Vasquez-Rios G, Nadkarni GN. SGLT2 Inhibitors: Emerging Roles in the Protection Against Cardiovascular and Kidney Disease Among Diabetic Patients. Int J Nephrol Renovasc Dis 2020; 13:281-296. [PMID: 33149657 PMCID: PMC7604253 DOI: 10.2147/ijnrd.s268811] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is a prevalent disease with the severe clinical implications including myocardial infarction, stroke, and kidney disease. Therapies focusing on glycemic control in T2DM such as biguanides, sulfonylureas, thiazolidinediones, and insulin-based regimens have largely failed to substantially improve cardiovascular and kidney outcomes. We review the recent findings on sodium-glucose co-transporter type 2 (SGLT2) inhibitors which have shown to have beneficial cardiovascular and kidney-related effects. RECENT FINDINGS SGLT2 inhibitors are a new class of diabetic medications that reduce the absorption of glucose in the kidney, decrease proteinuria, control blood pressure, and are associated with weight loss. SGLT2 inhibitors provide complementary therapy independent of insulin secretion or action with proved glucose-lowering effects. Recent placebo-controlled clinical trials have demonstrated that these medications can decrease cardiovascular death, progression of kidney disease, and all-cause mortality in diabetic and non-diabetic patients. Interestingly, SGT2 inhibitors such as dapagliflozin have also proven to decrease heart failure admissions and cardiovascular endpoints in non-diabetic patients, suggesting pleiotropic effects. The exact mechanisms responsible for reductions in atherosclerotic heart disease, need for kidney replacement therapy, and progressive kidney disease remain unknown. While regulation of glomerular hyperfiltration, albuminuria, and natriuresis may be part of the explanation, it is possible that complex cellular effects including energy balance optimization, downregulation of oxidative stress, and modulation of pro-inflammatory signaling pathways are associated with favorable outcomes observed in large clinical studies. CONCLUSION SGLT2 inhibitors are novel antidiabetic medications with immense utility in the management of patients with T2DM. Furthermore, SGLT2 inhibitors have demonstrated to reduce the progression to advanced forms of kidney disease and its associated complications. These medications should be front and center in the management of patients with diabetic kidney disease with and without chronic kidney disease as they confer protection against cardiovascular/renal death and improve all-cause mortality. Future studies should evaluate the benefits and implications of early initiation of SGLT2 inhibitors, as well as the long-term effects of this therapy.
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Affiliation(s)
- George Vasquez-Rios
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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49
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Roberti R, Palleria C, Nesci V, Tallarico M, Di Bonaventura C, Cerulli Irelli E, Morano A, De Sarro G, Russo E, Citraro R. Pharmacokinetic considerations about antiseizure medications in the elderly. Expert Opin Drug Metab Toxicol 2020; 16:983-995. [DOI: 10.1080/17425255.2020.1806236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Valentina Nesci
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Martina Tallarico
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Human Neurosciences, “Sapienza” University, Rome, Italy
| | | | - Alessandra Morano
- Neurology Unit, Department of Human Neurosciences, “Sapienza” University, Rome, Italy
| | | | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
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50
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Oziębło D, Pazik J, Stępniak I, Skarżyński H, Ołdak M. Two Novel Pathogenic Variants Confirm RMND1 Causative Role in Perrault Syndrome with Renal Involvement. Genes (Basel) 2020; 11:E1060. [PMID: 32911714 PMCID: PMC7564844 DOI: 10.3390/genes11091060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
RMND1 (required for meiotic nuclear division 1 homolog) pathogenic variants are known to cause combined oxidative phosphorylation deficiency (COXPD11), a severe multisystem disorder. In one patient, a homozygous RMND1 pathogenic variant, with an established role in COXPD11, was associated with a Perrault-like syndrome. We performed a thorough clinical investigation and applied a targeted multigene hearing loss panel to reveal the cause of hearing loss, ovarian dysfunction (two cardinal features of Perrault syndrome) and chronic kidney disease in two adult female siblings. Two compound heterozygous missense variants, c.583G>A (p.Gly195Arg) and c.818A>C (p.Tyr273Ser), not previously associated with disease, were identified in RMND1 in both patients, and their segregation with disease was confirmed in family members. The patients have no neurological or intellectual impairment, and nephrological evaluation predicts a benign course of kidney disease. Our study presents the mildest, so far reported, RMND1-related phenotype and delivers the first independent confirmation that RMND1 is causally involved in the development of Perrault syndrome with renal involvement. This highlights the importance of including RMND1 to the list of Perrault syndrome causative factors and provides new insight into the clinical manifestation of RMND1 deficiency.
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Affiliation(s)
- Dominika Oziębło
- Department of Genetics, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (D.O.); (I.S.)
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Joanna Pazik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Iwona Stępniak
- Department of Genetics, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (D.O.); (I.S.)
| | - Henryk Skarżyński
- Oto-Rhino-Laryngology Surgery Clinic, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland;
| | - Monika Ołdak
- Department of Genetics, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (D.O.); (I.S.)
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