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Zhou C, Xie Q, Wang H, Wu F, He D, Huang Y, He Y, Dai S, Chen J, Kong L, Zhang Y. Biological variation in the estimated glomerular filtration rate of healthy individuals within 24 h calculated using 2021CKD-EPI equations. Ir J Med Sci 2024; 193:1613-1620. [PMID: 38308766 DOI: 10.1007/s11845-024-03621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND AND AIMS Use the MDRD (Modification of Diet in Renal Disease) and 2021 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation void of race coefficients (CKD-EPICrea, CKD-EPICys-C, and CKD-EPICrea+Cys-C) to estimate the BV (Biological variation) of eGFR (estimated glomerular filtration rate) within 24 h in a healthy population to help explain future studies using eGFR in the context of a known BV. METHODS Blood samples were collected from 30 healthy subjects at six time points within 24 h. Serum creatinine (S-Crea) and serum cystatin C (S-Cys-C) were measured, and the BV of eGFR was calculated. Outlier and variance homogeneity analyses were performed, followed by CV-ANOVA on trend-corrected data. RESULTS The eGFR CVI for the four equations (MDRD, CKD-EPICrea, CKD-EPICys-C, and CKD-EPICrea+Cys-C) were 8.39% (7.50-9.51%), 3.90% (3.49-4.42%), 6.58% (5.88-7.46%), and 5.03% (4.50-5.71%), respectively. The corresponding II and RCVpos/neg values were 0.69, 0.48, 0.51, and 0.31, and (29.30%, - 22.66%), (12.69%, - 11.2 6%), (20.97%, - 17.33%), and (15.88%, - 13.70%), respectively; RCVpos /neg of eGFR was highest in the MDRD equation and lowest in the CKD-EPI Crea equation. Additionally, the RCVpos/neg values of the individual was highest in the MDRD equation and lowest in the CKD-EPICrea+Cys-C equation; they are (56.51%, - 36.11%) and (5.01%, - 4.77%), respectively. CONCLUSIONS We present data on the 24 h BV eGFR of the 2021 CKD-EPI equations. The presence of BV has impact on the interpretation of GFR results, affecting CKD disease grading. The RCVpos/neg differences were large among the individuals. When using eGFRs based on the MDRD and CKD-EPI equations, it is necessary to combine RCVpos/neg values before interpreting the results.
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Affiliation(s)
- ChaoQiong Zhou
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - QianRong Xie
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
- Department of Clinical Laboratory, The Third People's Hospital of Chengdu, Chengdu, Sichuan, 610000, China
| | - HuaLi Wang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Feng Wu
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - DaHai He
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Ying Huang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Ying He
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - ShiRong Dai
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Jie Chen
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - LiRui Kong
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China.
| | - Yan Zhang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China.
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Lee S, Noh S, Lee WH. Association of obstructive sleep apnea and diurnal variation of cystatin C. BMC Nephrol 2024; 25:40. [PMID: 38287274 PMCID: PMC10823701 DOI: 10.1186/s12882-024-03472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
PURPOSE Obstructive sleep apnea is a known risk factor for the progression of chronic kidney disease. To find early signs of the progression in subjects with obstructive sleep apnea., we assessed the diurnal variation of kidney biomarkers. METHODS A prospective observational study was conducted at Kangwon National University Hospital, Chuncheon, South Korea. All participants underwent in-laboratory polysomnography and phlebotomy in the evening before the polysomnography and in the morning after the polysomnography. Kidney biomarkers, including serum creatinine, blood urea nitrogen, and serum cystatin C, were measured. Delta kidney biomarkers were calculated by subtracting the evening level of the biomarkers from the morning level. RESULTS Twenty-six of 50 participants had severe obstructive sleep apnea. Delta cystatin C was significantly correlated with apnea-hypopnea index, oxygen desaturation index, and total arousal index with coefficients of -0.314, -0.323, and -0.289, respectively. In participants without severe obstructive sleep apnea, the morning cystatin C level (0.84 ± 0.11 mg/L) was significantly higher than the evening cystatin C level (0.81 ± 0.11 mg/L) (P = 0.005). With severe obstructive sleep apnea, the cystatin C levels were not different between the morning (0.85 ± 0.11 mg/L) and the evening (0.85 ± 0.10 mg/L). CONCLUSIONS Cystatin C level was increased in the morning in participants without severe obstructive sleep apnea, but not in participants with severe obstructive sleep apnea.
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Affiliation(s)
- Seolhyun Lee
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Sungryong Noh
- Division of Pulmonary & Critical Care, Sleep Medicine, McCovern Medical School, University of Texas at Houston, Houston, TX, USA
| | - Woo Hyun Lee
- Department of Otolaryngology, Kangwon National University, Chuncheon, Korea.
- Departments of Otolaryngology, Kangwon National University Hospital, 156, Baengnyeong-Ro, Chuncheon-Si, Gangwon-Do, 24289, Republic of Korea.
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Yu Y, An D, Yang W, Verhamme P, Allegaert K, Nawrot TS, Staessen JA. Blood pressure and renal function responses in workers exposed to lead for up to six years. J Clin Hypertens (Greenwich) 2023; 25:1086-1095. [PMID: 37938055 PMCID: PMC10710557 DOI: 10.1111/jch.14748] [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: 08/21/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
The Study for Promotion of Health in Recycling Lead (SPHERL) assessed the blood pressure (BP) and renal function (RF) responses for up to 6 years in the workers without previous occupational lead exposure. BP was the average of five consecutive readings and the estimated glomerular filtration rate was derived from serum creatinine (eGFRcrt) and cystatin C (eGFRcys). Blood lead (BL) was measured by inductively coupled plasma mass spectrometry (detection limit 0.5 μg/dL). The statistical methods included multivariable-adjusted mixed models and interval-censored Cox regression analysis. The 234 workers analyzed were on average 28.5 years old and included 91.9% men. The baseline BL concentration was 4.35 μg/dL and increased 3.17-fold over follow-up (median: 2.03 years; range: 0.92-6.45 years). The changes in BP and RF were not significantly correlated with the follow-up-to-baseline BL ratio (p ≥ .51 and p ≥ .18, respectively). The fully-adjusted changes in systolic/diastolic BP associated with a doubling of BL were -0.25/-0.12 mm Hg (CI: -0.94 to 0.44/-0.66 to 0.42 mm Hg). Accordingly, the incidence of stage-1 or -2 hypertension was not associated with the BL change (p ≥ .063). Similarly, the changes in eGFRcrt and eGFRcys associated with a 3-fold BL increment were not significant, amounting to -0.70 mL/min/1.73 m2 (CI: -1.70 to 0.30 mL/min/1.73 m2 ) and -1.06 mL/min/1.73 m2 (-2.16 to 0.03 mL/min/1.73 m2 ). In conclusion, the BP and RF responses to an over 3-fold BL increment were small and not significant confirming the safety of modern lead-handing facilities operating under current safety rules.
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Affiliation(s)
- Yu‐Ling Yu
- Research Unit Environment and HealthKU Leuven Department of Public Health and Primary CareUniversity of LeuvenLeuvenBelgium
- Non‐Profit Research Association Alliance for the Promotion of Preventive MedicineMechelenBelgium
| | - De‐Wei An
- Research Unit Environment and HealthKU Leuven Department of Public Health and Primary CareUniversity of LeuvenLeuvenBelgium
- Non‐Profit Research Association Alliance for the Promotion of Preventive MedicineMechelenBelgium
- Department of Cardiovascular MedicineShanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical GenomicsNational Research Centre for Translational MedicineRuijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Wen‐Yi Yang
- Department of CardiologyShanghai General Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Peter Verhamme
- Center for Molecular and Vascular BiologyKU Leuven Department of Cardiovascular Sciences, University of LeuvenLeuvenBelgium
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological SciencesKU LeuvenLeuvenBelgium
- KU Leuven Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Hospital PharmacyErasmus Medical CenterRotterdamThe Netherlands
| | - Tim S. Nawrot
- Research Unit Environment and HealthKU Leuven Department of Public Health and Primary CareUniversity of LeuvenLeuvenBelgium
- Center for Environmental SciencesHasselt UniversityDiepenbeekBelgium
| | - Jan A. Staessen
- Non‐Profit Research Association Alliance for the Promotion of Preventive MedicineMechelenBelgium
- Biomedical Science GroupFaculty of MedicineUniversity of LeuvenLeuvenBelgium
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Ji S, Wu X, Wu J, Chen D, Chen Z. Serum iodine concentration and its associations with thyroid function and dietary iodine in pregnant women in the southeast coast of China: a cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1289572. [PMID: 38027098 PMCID: PMC10665901 DOI: 10.3389/fendo.2023.1289572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Iodine deficiency is a major public health problem in pregnant women. Serum iodine (SI) may represent a useful biomarker for iodine nutrition evaluation. We aimed to assess the relationship between serum iodine concentration (SIC) and urinary iodine concentration (UIC), dietary iodine, thyroid function, and thyroid diseases in pregnant women in the southeast coast of China, and to provide a normal reference range of SIC for pregnant women. Methods A multistage random sampling method was used to select the study population. We collected urine and blood samples from pregnant women and determined UIC and SIC as well as thyroid function using Arsenic-Cerium Catalytic Spectrophotometry, inductively coupled plasma mass spectrometry, and Beckman Coulter Access2 chemiluminescent immunoanalyzer and kit, respectively, and administered a questionnaire on dietary iodine intake in pregnant women. Results There was a significant negative correlation between SI and thyroid-stimulating hormone (TSH) (r = -0.141) and a significant positive correlation between SI and free triiodothyronine (FT3) (r = 0.106), free thyroxine (FT4) (r = 0.236), triiodothyronine (TT3) (r = 0.229), total thyroxine (TT4) (r = 0.433), and dietary iodine intake (r = 0.068). There was a significant difference in SI levels of pregnancy between the second (78.13 μg/L) and third trimester (75.37 μg/L) (p = 0.018). SI levels between inadequate intake (74.58 μg/L) and appropriate intake (77.92 μg/L) groups were statistically different (p = 0.036). Low SIC was a risk factor for the development of hypothyroxinemia (adjusted OR = 3.14, 95% confidence interval: 1.75-5.66). The reference range for SIC in normal pregnant women is 45.03-112.44 μg/L. Conclusion SI may be a composite indicator of iodine nutritional status and thyroid function.
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Affiliation(s)
| | | | | | | | - Zhihui Chen
- Department of Endemic Diseases, Fujian Center for Disease Control and Prevention, Fuzhou, China
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Lefèvre CR, Le Divenah F, Collet N, Pelletier R, Robert E, Ropert M, Pawlowski M, Gicquel T, Bendavid C. Avoiding falsely low creatinine concentrations measured in patients treated with N-acetylcysteine for acetaminophen intoxication using enzymo-amperometric method - An in vitro and in vivo study. Clin Chim Acta 2023; 551:117611. [PMID: 37865270 DOI: 10.1016/j.cca.2023.117611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Circulating creatinine is a biomarker of paramount importance in clinical practice. In cases of acetaminophen (APAP) intoxication, the antidote, N-acetylcysteine (NAC), interferes with commonly used creatininase-peroxidase methods. This study aimed to assess whether creatininase-amperometric methods were affected in this context. METHODS This study includes in vitro interference tests, involving four creatinine assays using NAC-spiked plasma pools and an in vivo retrospective study comparing creatininase-peroxidase and creatininase-amperometric measurements in patients presenting with NAC-treated APAP poisoning. RESULTS Creatininase-peroxidase method was impacted by NAC interference in a clinically-significant manner at therapeutic NAC levels (basal value recovery of 80 % and 70 % for 500 and 1000 mg.L-1 of NAC, respectively), surpassing the desirable Reference Change Value (RCV%). Enzymo-amperometric methods were not impacted. Among patients, a mean bias of -45.2 ± 28.0 % was observed for the peroxidase detection method compared to the amperometric in those who received NAC prior plasma sampling and -2.7 ± 5.4 % in those who did not. CONCLUSIONS Our findings indicate that enzymo-amperometric creatinine assays remain unaffected by NAC interference due to the absence of the peroxidase step in the analytical process. Therefore, these methods are suitable to prevent spurious hypocreatininemia in APAP intoxicated patients undergoing NAC therapy.
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Affiliation(s)
- Charles R Lefèvre
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France.
| | - Felipe Le Divenah
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Nicolas Collet
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Romain Pelletier
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - Eric Robert
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Martine Ropert
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - Maxime Pawlowski
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Thomas Gicquel
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - Claude Bendavid
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
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Kuwatsuru Y, Hirano T, Wakabayashi R, Ishisaki JY, Sokooshi H, Kuwatsuru R. Changes in renal function over time in outpatients with eGFR ≥ 30 mL/min/1.73 m 2: implication for timing of renal function testing before contrast-enhanced CT imaging. Jpn J Radiol 2023; 41:994-1006. [PMID: 37040025 PMCID: PMC10469099 DOI: 10.1007/s11604-023-01425-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the associations between comorbidities and kidney function decline at 6-month and 1-year follow-up in outpatients with initial estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2. MATERIALS AND METHODS Outpatients aged 18 and older with confirmed diagnosis, who had eGFR ≥ 30 mL/min/1.73 m2 measured between April 2017 and March 2019, were included in this retrospective observational study. Of them, 30,595 included outpatients had 6-month eGFR test and 27,698 included outpatients had 1-year eGFR test. The outpatients were further divided into two groups based on initial eGFR: between 30 and 59 and ≥ 60 mL/min/1.73 m2. Impaired renal function was defined as eGFR declined to below 30 mL/min/1.73 m2. The comorbidities with P values less than 0.1 identified in univariable logistic regression models were entered into the multivariable analysis with backward selection, thereby identifying comorbidities that increased the risk of eGFR decline at 6-month and 1-year follow-up. RESULTS Outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2 were 175.94 times more likely to have eGFR decline at 6 months, and were 94.10 times more likely to have eGFR decline at 1 year, compared with their corresponding initial eGFR ≥ 60 counterparts. Multivariable logistic regression analyses disclosed that chronic kidney disease, hypertension, and heart failure were independent risk factors for eGFR decline in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2. CONCLUSIONS Outpatients with initial eGFR ≥ 60 mL/min/1.73 m2 might not need routine eGFR test prior to contrast-enhanced CT scan for 1 year. In addition, chronic kidney disease, hypertension, and heart failure increased the risk of declined renal function, particularly, in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.
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Affiliation(s)
- Yoshiki Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takahiro Hirano
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Clinical Study Support Inc., 2F Daiei Bldg., 1-11-20 Nishiki, Naka-ku, Nagoya, 460-0003, Japan
| | - Ryozo Wakabayashi
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Clinical Study Support Inc., 2F Daiei Bldg., 1-11-20 Nishiki, Naka-ku, Nagoya, 460-0003, Japan
| | - Juliana Yumi Ishisaki
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hideaki Sokooshi
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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Li X, Tu P, Gu S, Mo Z, Wu L, Xing M, Chen Z, Wang X. Serum Iodine as a Potential Individual Iodine Status Biomarker: A Cohort Study of Mild Iodine Deficient Pregnant Women in China. Nutrients 2023; 15:3555. [PMID: 37630745 PMCID: PMC10460065 DOI: 10.3390/nu15163555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Iodine deficiency during pregnancy is a widespread public health concern, but indicators and methods for assessing iodine nutritional status are lacking. Serum iodine concentration (SIC) is an important iodine metabolism biomarker and can, to some extent, predict the risk of thyroid diseases, making it a potential biomarker for assessing individual iodine nutrition levels. Our study aimed to analyze the relationship between SIC and thyroid function in a cohort of mild iodine deficient pregnant women in China in order to explore the potential of SIC as a biomarker of individual iodine status in pregnancy. A total of 1540 early pregnant women (gestation < 10 weeks) aged 18 to 45 years old were included in the final study from a Zhejiang multicenter population-based mother and child cohort. Repeated measures of SIC, urinary iodine concentration (UIC), and thyroid function were taken at approximately 10, 17, and 32 weeks of gestation. The SIC was statistically correlated with all thyroid function indexes in the first trimester, and a very strong positive correlation with FT4 over three trimesters (r = 0.449, 0.550, and 0.544, respectively). Pregnant women with an SIC < 72.4 µg/L were at a higher risk of hypothyroxinemia (adjusted OR = 8.911, 95% CI = 5.141-15.447) and iodine deficiency (adjusted OR = 1.244, 95% CI = 1.031-1.502), while those with an SIC > 93.9 µg/L were at a higher risk of thyrotoxicosis (adjusted OR = 11.064, 95% CI = 6.324-19.357) and excessive iodine (adjusted OR = 11.064, 95% CI = 6.324-19.357). In contrast, the UIC was not correlated with thyroid diseases (p > 0.05). These findings indicate that the SIC is a potential biomarker for assessing individual iodine nutrition and thyroid dysfunction in pregnant women.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiaofeng Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China; (X.L.); (P.T.); (S.G.); (Z.M.); (L.W.); (M.X.); (Z.C.)
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Pierre CC, Marzinke MA, Ahmed SB, Collister D, Colón-Franco JM, Hoenig MP, Lorey T, Palevsky PM, Palmer OP, Rosas SE, Vassalotti J, Whitley CT, Greene DN. AACC/NKF Guidance Document on Improving Equity in Chronic Kidney Disease Care. J Appl Lab Med 2023:jfad022. [PMID: 37379065 DOI: 10.1093/jalm/jfad022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Kidney disease (KD) is an important health equity issue with Black, Hispanic, and socioeconomically disadvantaged individuals experiencing a disproportionate disease burden. Prior to 2021, the commonly used estimated glomerular filtration rate (eGFR) equations incorporated coefficients for Black race that conferred higher GFR estimates for Black individuals compared to non-Black individuals of the same sex, age, and blood creatinine concentration. With a recognition that race does not delineate distinct biological categories, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended the adoption of the CKD-EPI 2021 race-agnostic equations. CONTENT This document provides guidance on implementation of the CKD-EPI 2021 equations. It describes recommendations for KD biomarker testing, and opportunities for collaboration between clinical laboratories and providers to improve KD detection in high-risk populations. Further, the document provides guidance on the use of cystatin C, and eGFR reporting and interpretation in gender-diverse populations. SUMMARY Implementation of the CKD-EPI 2021 eGFR equations represents progress toward health equity in the management of KD. Ongoing efforts by multidisciplinary teams, including clinical laboratorians, should focus on improved disease detection in clinically and socially high-risk populations. Routine use of cystatin C is recommended to improve the accuracy of eGFR, particularly in patients whose blood creatinine concentrations are confounded by processes other than glomerular filtration. When managing gender-diverse individuals, eGFR should be calculated and reported with both male and female coefficients. Gender-diverse individuals can benefit from a more holistic management approach, particularly at important clinical decision points.
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Affiliation(s)
- Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark A Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Collister
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Melanie P Hoenig
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Thomas Lorey
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, United States
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Kidney Medicine Program and Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
- The National Kidney Foundation, Inc., New York, NY, United States
| | - Octavia Peck Palmer
- Departments of Pathology, Critical Care Medicine, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sylvia E Rosas
- The National Kidney Foundation, Inc., New York, NY, United States
- Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, MA, United States
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joseph Vassalotti
- The National Kidney Foundation, Inc., New York, NY, United States
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cameron T Whitley
- Department of Sociology, Western Washington University, Bellingham, WA, United States
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington Medicine, Seattle, WA, United States
- LetsGetChecked Laboratories, Monrovia, CA, United States
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Lorenzo-Lozano MC, Blázquez-Manzanera AL, Carnicero JA. How kidney clock works: circadian pattern of eGFR based on a population data group. J Physiol Biochem 2023:10.1007/s13105-023-00948-2. [PMID: 36808081 DOI: 10.1007/s13105-023-00948-2] [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: 04/18/2022] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
A circadian regulation of renal function it has been described in the last few years. An intradaily variation in glomerular filtration rate (eGFR) has also been discovered at the individual level. The aim of this study was to check if there exists a circadian pattern of eGFR at population data group level and to compare the population results with those described at individual level. We have studied a total of 446,441 samples analysed in the emergency laboratories of two Spanish hospitals between January 2015 and December 2019. We selected all the records of eGFR values between 60 and 140 mL/min/1.73 m2 using CKD-EPI formula from patients between 18 and 85 years. The intradaily intrinsic eGFR pattern was computed using the extraction time of day in four nested mixed linear and sinusoidal regression models. All models showed an intradaily eGFR pattern, but the estimated model coefficients differed depending on whether age was included. The inclusion of age improved the performance of the model. In this model, the acrophase occurred at 7:46 h. We describe the distribution of eGFR values depending on the time in two different populations. This distribution is adjusted to a circadian rhythm that behaves similarly to the individual rhythm. This pattern is similar in each of the years studied from each hospital as well as between both hospitals. The results found suggest the incorporation of the concept of "population circadian rhythm" into the scientific world.
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Affiliation(s)
- M C Lorenzo-Lozano
- Hospital Universitario de Toledo, Complejo Hospitalario Universitario de Toledo, Toledo, Spain. .,Spanish Research Group in Biological Rhythms and Laboratory Medicine, Toledo, Spain.
| | - A L Blázquez-Manzanera
- Spanish Research Group in Biological Rhythms and Laboratory Medicine, Toledo, Spain.,Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain.,Hospital General de Villarrobledo, Villarrobledo, Albacete, Spain
| | - J A Carnicero
- Spanish Research Group in Biological Rhythms and Laboratory Medicine, Toledo, Spain.,Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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10
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Yu YL, Yang WY, Hara A, Asayama K, Roels HA, Nawrot TS, Staessen JA. Public and occupational health risks related to lead exposure updated according to present-day blood lead levels. Hypertens Res 2023; 46:395-407. [PMID: 36257978 PMCID: PMC9899691 DOI: 10.1038/s41440-022-01069-x] [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: 07/01/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
Lead is an environmental hazard that should be addressed worldwide. Over time, human lead exposure in the western world has decreased drastically to levels comparable to those among humans living in the preindustrial era, who were mainly exposed to natural sources of lead. To re-evaluate the potential health risks associated with present-day lead exposure, a two-pronged approach was applied. First, recently published population metrics describing the adverse health effects associated with lead exposure at the population level were critically assessed. Next, the key results of the Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) were summarized and put in perspective with those of the published population metrics. To our knowledge, SPHERL is the first prospective study that accounted for interindividual variability between people with respect to their vulnerability to the toxic effects of lead exposure by assessing the participants' health status before and after occupational lead exposure. The overall conclusion of this comprehensive review is that mainstream ideas about the public and occupational health risks related to lead exposure urgently need to be updated because a large portion of the available literature became obsolete given the sharp decrease in exposure levels over the past 40 years.
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Affiliation(s)
- Yu-Ling Yu
- grid.5596.f0000 0001 0668 7884Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Azusa Hara
- grid.26091.3c0000 0004 1936 9959Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Kei Asayama
- grid.264706.10000 0000 9239 9995Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan ,grid.5596.f0000 0001 0668 7884Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium ,Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Harry A. Roels
- grid.12155.320000 0001 0604 5662Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tim S. Nawrot
- grid.5596.f0000 0001 0668 7884Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium ,grid.12155.320000 0001 0604 5662Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan A. Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium ,grid.5596.f0000 0001 0668 7884Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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11
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Tio MC, Shafi T, Zhu X, Kalantar-Zadeh K, Chan A, Nguyen L. Traditions and innovations in assessment of glomerular filtration rate using creatinine to cystatin C. Curr Opin Nephrol Hypertens 2023; 32:89-97. [PMID: 36444667 PMCID: PMC10278050 DOI: 10.1097/mnh.0000000000000854] [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] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Glomerular filtration rate (GFR) is the best index for kidney function and estimated GFR (eGFR) calculated from endogenous filtration markers like serum creatinine and cystatin C is widely used in clinical practice for chronic kidney disease diagnosis and prognostication. We sought to review the evolution of GFR estimating equations, nuances of eGFR interpretation, and utility of eGFR in drug dosing. RECENT FINDINGS The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) serum creatinine eGFR equation was recently updated to exclude the race variable and the CKD-EPI creatinine-cystatin C equation demonstrated the highest reliability. Although calculated creatinine clearance by Cockcroft Gault has been traditionally used for drug dosing, the use of eGFR is slowly being adapted by the Food and Drug Administration for pharmacokinetic studies. However, the individual-level accuracy of eGFR using the CKD-EPI 2021 equations remained low, with the distribution of measured GFR at a given eGFR value spanning several CKD stages. SUMMARY Although current methods of estimating GFR have improved in population measures of reliability, all have significant individual-level inaccuracies that can be an issue when clinical decision-making is contingent on the actual level of GFR. Modern methods of GFR measurements should be made widely available to enhance individualized patient decision-making.
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Affiliation(s)
- Maria Clarissa Tio
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Tariq Shafi
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Medicine, Division of Nephrology, Houston Methodist, Houston, Texas
| | - Xiaoqian Zhu
- The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kamyar Kalantar-Zadeh
- Department of Medicine, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of California Irvine, Irvine, California, USA
| | - Lee Nguyen
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of California Irvine, Irvine, California, USA
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12
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Thöni S, Keller F, Denicolò S, Buchwinkler L, Mayer G. Biological variation and reference change value of the estimated glomerular filtration rate in humans: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1009358. [PMID: 36275823 PMCID: PMC9583397 DOI: 10.3389/fmed.2022.1009358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Knowledge of the biological variation of serum or plasma creatinine (Cr) and the estimated glomerular filtration rate (eGFR) is important for understanding disease dynamics in Chronic Kidney Disease (CKD). The aim of our study was to determine the magnitude of random fluctuation of eGFR by determining its reference change value (RCV). Methods We performed a systematic review and meta-analysis of studies on biological variation of Cr. Relevant studies were identified by systematic literature search on PubMed. Additional studies were retrieved from the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Biological Variation Database. Random-effects meta-analysis was conducted to derive an overall estimate of intra-individual variation of creatinine (CVICr). Based on our estimate of CVICr and RCV for Cr, the RCV for the eGFR was determined. Results Among identified studies, 37 met our inclusion criteria. Meta-analysis of all studies yielded a CVICr of 5.2% (95% confidence interval [CI] 4.6–5.8%), however high between-study heterogeneity (I2 = 82.3%) was found. Exclusion of outliers led to a significant reduction of heterogeneity while still including 85% of all studies and resulted in a slightly lower CVICr of 5.0% (95% CI 4.7–5.4%). Assuming an analytical variation of CVA 1.1%, we found an overall RCV for eGFR of ±16.5%. After exclusion of outlier studies, we found a minimum conservative RCV for eGFR of ±12.5%. Conclusion The RCV of the eGFR represents a valuable tool for clinicians to discern true changes in kidney function from random fluctuation.
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13
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Breidthardt T, van Doorn WPTM, van der Linden N, Diebold M, Wussler D, Danier I, Zimmermann T, Shrestha S, Kozhuharov N, Belkin M, Porta C, Strebel I, Michou E, Gualandro DM, Nowak A, Meex SJR, Mueller C. Diurnal Variations in Natriuretic Peptide Levels: Clinical Implications for the Diagnosis of Acute Heart Failure. Circ Heart Fail 2022; 15:e009165. [PMID: 35670217 PMCID: PMC10004748 DOI: 10.1161/circheartfailure.121.009165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current guidelines recommend interpreting concentrations of NPs (natriuretic peptides) irrespective of the time of presentation to the emergency department. We hypothesized that diurnal variations in NP concentration may affect their diagnostic accuracy for acute heart failure. METHODS In a secondary analysis of a multicenter diagnostic study enrolling patients presenting with acute dyspnea to the emergency department and using central adjudication of the final diagnosis by 2 independent cardiologists, the diagnostic accuracy for acute heart failure of BNP (B-type NP), NT-proBNP (N-terminal pro-B-type NP), and MR-proANP (midregional pro-atrial NP) was compared among 1577 daytime presenters versus 908 evening/nighttime presenters. In a validation study, the presence of a diurnal rhythm in BNP and NT-proBNP concentrations was examined by hourly measurements in 44 stable individuals. RESULTS Among patients adjudicated to have acute heart failure, BNP, NT-proBNP, and MR-proANP concentrations were comparable among daytime versus evening/nighttime presenters (all P=nonsignificant). Contrastingly, among patients adjudicated to have other causes of dyspnea, evening/nighttime presenters had lower BNP (median, 44 [18-110] versus 74 [27-168] ng/L; P<0.01) and NT-proBNP (median, 212 [72-581] versus 297 [102-902] ng/L; P<0.01) concentrations versus daytime presenters. This resulted in higher diagnostic accuracy as quantified by the area under the curve of BNP and NT-proBNP among evening/nighttime presenters (0.97 [95% CI, 0.95-0.98] and 0.95 [95% CI, 0.93-0.96] versus 0.94 [95% CI, 0.92-0.95] and 0.91 [95% CI, 0.90-0.93]) among daytime presenters (both P<0.01). These differences were not observed for MR-proANP. Diurnal variation of BNP and NT-proBNP with lower evening/nighttime concentration was confirmed in 44 stable individuals (P<0.01). CONCLUSIONS BNP and NT-proBNP, but not MR-proANP, exhibit a diurnal rhythm that results in even higher diagnostic accuracy among evening/nighttime presenters versus daytime presenters. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT01831115, NCT02091427, and NCT02210897.
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Affiliation(s)
- Tobias Breidthardt
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - William P T M van Doorn
- General Clinical Chemistry and Hematology, Central Diagnostic Laboratory Maastricht University Medical Center, the Netherlands (W.P.T.M.v.D., N.v.d.L., S.J.R.M.)
| | - Noreen van der Linden
- General Clinical Chemistry and Hematology, Central Diagnostic Laboratory Maastricht University Medical Center, the Netherlands (W.P.T.M.v.D., N.v.d.L., S.J.R.M.)
| | - Matthias Diebold
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Desiree Wussler
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland
| | - Isabelle Danier
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Tobias Zimmermann
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Samyut Shrestha
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland.,and Department of Cardiology (N.K., C.M.), University Hospital Basel, Basel University, Switzerland.,Liverpool Heart and Chest Hospital, United Kingdom (N.K.)
| | - Maria Belkin
- Divison of Internal Medicine (T.B., D.W., T.Z., S.S., M.B.), University Hospital Basel, Basel University, Switzerland.,Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Caroline Porta
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Eleni Michou
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Danielle M Gualandro
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland
| | - Albina Nowak
- Division of Endocrinology, University Hospital Zurich, University of Zurich, Switzerland (A.N.)
| | - S J R Meex
- General Clinical Chemistry and Hematology, Central Diagnostic Laboratory Maastricht University Medical Center, the Netherlands (W.P.T.M.v.D., N.v.d.L., S.J.R.M.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel (T.B., M.D., D.W., I.D., T.Z., S.S., N.K., M.B., C.P.' I.S., E.M., D.M.G., C.M.), University Hospital Basel, Basel University, Switzerland.,and Department of Cardiology (N.K., C.M.), University Hospital Basel, Basel University, Switzerland
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14
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Kong LR, Wei F, He DH, Zhou CQ, Li HC, Wu F, Luo Y, Luo JW, Xie QR, Peng H, Zhang Y. Biological variation in the serum and urine kidney injury markers of a healthy population measured within 24 hours. BMC Nephrol 2022; 23:195. [PMID: 35610615 PMCID: PMC9131627 DOI: 10.1186/s12882-022-02819-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS To explore the biological variation (BV) of kidney injury markers in serum and urine of healthy subjects within 24 hours to assist with interpretation of future studies using these biomarkers in the context of known BV. MATERIALS AND METHODS Serum and urine samples were collected every 4 hours (0, 4, 8, 12, 16 and 20 hours) from 31 healthy subjects within 24 hours and serum creatinine (s-Crea), serum β2-microglobin (s-β2MG), serum cystatin C (s-CYSC), serum neutrophil gelatinase-associated lipoprotein (s-NGAL), urine creatinine (u-Crea), urine β2-microglobin (u-β2MG), urine cystatin C (u-CYSC), urine neutrophil gelatinase-associated lipoprotein (u-NGAL) were measured. Outlier and variance homogeneity analyses were performed, followed by CV-ANOVA analysis on trend-corrected data (if relevant), and analytical (CVA), within-subject (CVI), and between-subject (CVG) biological variation were calculated. RESULTS The concentration of kidney injury markers in male was higher than that in female, except for u-CYSC and u-NGAL. There were no significant difference in serum and urine kidney injury markers concentration at different time points. Serum CVI was lower than urine CVI, serum CVG was higher than CVI, and urine CVG was lower than CVI. The individual index (II) of serum kidney injury markers was less than 0.6, while the II of urinary kidney injury markers was more than 1.0. CONCLUSIONS This study provides new short-term BV data for kidney injury markers in healthy subjects within 24 hours, which are of great significance in explaining other AKI / CKD studies.
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Affiliation(s)
- Li-Rui Kong
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Fei Wei
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Da-Hai He
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Chao-Qiong Zhou
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Hong-Chuan Li
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Feng Wu
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Yu Luo
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Jian-Wei Luo
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Qian-Rong Xie
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Hai Peng
- Clinical Laboratory of Qinghai Provincial People's Hospital Xining, Xining, Qinghai, 810006, People's Republic of China
| | - Yan Zhang
- Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China.
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15
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Two-year responses of renal function to first occupational lead exposure. Kidney Int Rep 2022; 7:1198-1209. [PMID: 35685322 PMCID: PMC9171623 DOI: 10.1016/j.ekir.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Whether in advanced countries lead exposure still contributes to renal impairment is debated, because blood lead (BL) level is declining toward preindustrial levels and because longitudinal studies correlating renal function and BL changes over time are scarce. Methods The Study for Promotion of Health in Recycling Lead (SPHERL) evaluated the 2-year renal function responses in 251 workers (mean age, 29.7 years) transiting from environmental to occupational exposure. Main study end point was the estimated glomerular filtration rate (eGFR) derived from serum creatinine (eGFRcrt), cystatin C (eGFRcys), or both (eGFRcc). BL level was measured by inductively coupled plasma mass spectrometry (detection limit 0.5 μg/dl). Results In the follow-up, mean baseline BL level of 4.13 μg/dl increased 3.30-fold. In fully adjusted mixed models, additionally accounting for the within-participant clustering of the 1- and 2-year follow-up data, a 3-fold BL level increment was not significantly correlated with changes in eGFR with estimates amounting to −0.86 (95% CI: −2.39 to 0.67), −1.58 (−3.34 to 0.18), and −1.32 (−2.66 to 0.03) ml/min per 1.73 m2 for eGFRcrt, eGFRcys, or eGFRcc, respectively. Baseline BL level and the cumulative lead burden did not materially modify these estimates, but baseline eGFR was a major determinant of eGFR changes showing regression to the mean during follow-up. Responses of serum osmolarity, urinary gravity, or the urinary albumin-to-creatinine ratio (ACR) were also unrelated to the BL level increment. The age-related decreases in eGFRcrt, eGFRcys, and eGFRcc were −1.41, −0.96, and −1.10 ml/min per 1.73 m2, respectively. Conclusion In the current study, the 2-year changes in renal function were unrelated to the increase in BL level. However, given the CIs around the point estimates of the changes in eGFRcc and eGFRcys, a larger study with longer follow-up is being planned.
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16
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Enghard P, Hardenberg JH, Stockmann H, Hinze C, Eckardt KU, Schmidt-Ott KM. Long-term effects of COVID-19 on kidney function. Lancet 2021; 397:1806-1807. [PMID: 33992141 PMCID: PMC8118614 DOI: 10.1016/s0140-6736(21)00880-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Philipp Enghard
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Jan-Hendrik Hardenberg
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Helena Stockmann
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Christian Hinze
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Kai M Schmidt-Ott
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 12203 Berlin, Germany.
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17
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Dépret F, Hollinger A, Cariou A, Deye N, Vieillard-Baron A, Fournier MC, Jaber S, Damoisel C, Lu Q, Monnet X, Rennuit I, Darmon M, Leone M, Guidet B, Sonneville R, Montravers P, Pili-Floury S, Lefrant JY, Duranteau J, Laterre PF, Brechot N, Oueslati H, Cholley B, Struck J, Hartmann O, Mebazaa A, Gayat E, Legrand M. Incidence and Outcome of Subclinical Acute Kidney Injury Using penKid in Critically Ill Patients. Am J Respir Crit Care Med 2020; 202:822-829. [PMID: 32516543 DOI: 10.1164/rccm.201910-1950oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rationale: Subclinical acute kidney injury (sub-AKI) refers to patients with low serum creatinine but elevated alternative biomarkers of AKI. Its incidence and outcome in critically ill patients remain, however, largely unknown. Plasma proenkephalin A 119-159 (penKid) has been proposed as a sensitive biomarker of glomerular function.Objectives: In this ancillary study of two cohorts, we explored the incidence and outcome of sub-AKI based on penKid.Methods: A prospective observational study in ICUs was conducted. FROG-ICU (French and European Outcome Registry in ICUs) enrolled 2,087 critically ill patients, and AdrenOSS-1 (Adrenomedullin and Outcome in Severe Sepsis and Septic Shock-1) enrolled 583 septic patients. The primary endpoint was 28-day mortality after ICU admission. Sub-AKI was defined by an admission penKid concentration above the normal range (i.e., >80 pmol/L) in patients not meeting the definition of AKI. A sensitivity analysis was performed among patients with estimated glomerular filtration rate above 60 ml/min/1.73 m2 at ICU admission.Measurements and Main Results: In total, 6.1% (122/2,004) and 6.7% (39/583) of patients from the FROG-ICU and AdrenOSS-1 cohorts met the definition of sub-AKI (11.6% and 17.5% of patients without AKI). In patients without AKI or with high estimated glomerular filtration rate, penKid was associated with higher mortality (adjusted standardized hazard ratio [HR], 1.4 [95% confidence interval, 1.1-1.8]; P = 0.010; and HR, 1.6 [95% confidence interval, 1.3-1.8]; P < 0.0001, respectively) after adjustment for age, sex, comorbidities, diagnosis, creatinine, diuresis, and study. Patients with sub-AKI had higher mortality compared with no AKI (HR, 2.4 [95% confidence interval, 1.5-3.7] in FROG-ICU and 2.5 [95% confidence interval, 1.1-5.9] in AdrenOSS-1).Conclusions: Sub-AKI defined using penKid occurred in 11.6-17.5% of patients without AKI and was associated with a risk of death close to patients with AKI.
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Affiliation(s)
- François Dépret
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,INI-CRCT Network, Paris, France.,Paris University, Paris, France.,INSERM 942, FHU Promice, Paris, France
| | - Alexa Hollinger
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Paris, France
| | - Nicolas Deye
- UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,Medical Intensive Care Unit, Saint Louis-Lariboisière University Hospitals, AP-HP, Paris, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, University Hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France.,INSERM U-1018, CESP, Team 5, University of Versailles, Saint-Quentin en Yvelines, France.,Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles, Saint-Quentin en Yvelines, France
| | - Marie-Céline Fournier
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,INSERM 942, FHU Promice, Paris, France
| | - Samir Jaber
- Intensive Care Unit, Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Montpellier, France
| | - Charles Damoisel
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Qin Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpétrière Hospital, AP-HP, Paris, France.,Pierre and Marie Curie University, Paris 6, Paris, France
| | - Xavier Monnet
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France.,INSERM UMR S999, Paris, France.,Paris-Sud 5 University, Orsay, France
| | - Isabelle Rennuit
- Department of Anesthesiology and Critical Care, Beaujon Hospital, AP-HP, Clichy, France
| | - Michael Darmon
- Paris University, Paris, France.,Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France
| | - Marc Leone
- APHM, Department of Anesthesiology and Critical Care Medicine, Marseille, France.,Aix Marseille University, Marseille, France
| | - Bertrand Guidet
- Pierre and Marie Curie University, Paris 6, Paris, France.,Medical Intensive Care, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Romain Sonneville
- Paris University, Paris, France.,Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Philippe Montravers
- Paris University, Paris, France.,Department of Anesthesiology and Intensive Care, Bichat University Hospital, AP-HP, Paris, France
| | - Sébastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, Besançon University Hospital, EA 3920, Besançon, France.,University of Bourgogne Franche-Comté, Besançon, France
| | - Jean-Yves Lefrant
- Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Nimes University Hospital, Nîmes, France.,Research Unit EA 2992, Nîmes, France.,Montpellier 1 University, Nîmes, France
| | - Jacques Duranteau
- Department of Anesthesiology and Critical Care, Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Saint Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Nicolas Brechot
- INSERM, U833, Angiogenesis, Embryogenesis and Pathology Laboratory, Collège de France, Paris, France
| | - Haikel Oueslati
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Bernard Cholley
- Department of Anesthesiology and Intensive Care, European Hospital Georges Pompidou University Hospital, AP-HP, Paris, France.,Paris Descartes University-Paris 5, Paris, France
| | | | | | - Alexandre Mebazaa
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,INI-CRCT Network, Paris, France.,Paris University, Paris, France.,INSERM 942, FHU Promice, Paris, France
| | - Etienne Gayat
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,INI-CRCT Network, Paris, France.,Paris University, Paris, France.,INSERM 942, FHU Promice, Paris, France
| | - Matthieu Legrand
- Paris University, Paris, France.,Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
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18
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Intra-individual variability of eGFR trajectories in early diabetic kidney disease and lack of performance of prognostic biomarkers. Sci Rep 2020; 10:19743. [PMID: 33184434 PMCID: PMC7665005 DOI: 10.1038/s41598-020-76773-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
Studies reporting on biomarkers aiming to predict adverse renal outcomes in patients with type 2 diabetes and kidney disease (DKD) conventionally define a surrogate endpoint either as a percentage of decrease of eGFR (e.g. ≥ 30%) or an absolute decline (e.g. ≥ 5 ml/min/year). The application of those study results in clinical practise however relies on the assumption of a linear and intra-individually stable progression of DKD. We studied 860 patients of the PROVALID study and 178 of an independent population with a relatively preserved eGFR at baseline and at least 5 years of follow up. Individuals with a detrimental prognosis were identified using various thresholds of a percentage or absolute decline of eGFR after each year of follow up. Next, we determined how many of the patients met the same criteria at other points in time. Interindividual eGFR decline was highly variable but in addition intra-individual eGFR trajectories also were frequently non-linear. For example, of all subjects reaching an endpoint defined as a decrease of eGFR by ≥ 30% between baseline and 3 years of follow up, only 60.3 and 45.2% lost at least the same amount between baseline and year 4 or 5. The results were similar when only patients on stable medication or subpopulations based on baseline eGFR or albuminuria status were analyzed or an eGFR decline of ≥ 5 ml/min/1.73m2/year was used. Identification of reliable biomarkers predicting adverse prognosis is a strong clinical need given the large interindividual variability of DKD progression. However, it is conceptually challenging in early DKD because of non-linear intra-individual eGFR trajectories. As a result, the performance of a prognostic biomarker may be accurate after a specific time of follow-up in a single population only.
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19
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van Donge T, Welzel T, Atkinson A, van den Anker J, Pfister M. Age-Dependent Changes of Kidney Injury Biomarkers in Pediatrics. J Clin Pharmacol 2020; 59 Suppl 1:S21-S32. [PMID: 31502686 DOI: 10.1002/jcph.1487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
Currently used creatinine-based parameters for monitoring kidney function are not reliable for early detection of kidney injury (KI), particularly tubular damage. Several KI biomarkers allow for early detection of glomerular and tubular damage and may help to prevent drug-related chronic kidney diseases in pediatrics. This literature review describes the state of current research and investigates reference values for these KI biomarkers in neonates, infants, and children to better understand age-related changes. A total of 12 of 237 screened studies fulfilled predefined criteria, including 219 preterm neonates, 70 neonates, 596 infants, and 1726 children. KI biomarkers were analyzed in urine (6 studies), in serum/plasma (5 studies) and in serum and urine (1 study). Four studies (n = 555) measured urinary kidney injury molecule-1, whereas urinary neutrophil gelatinase-associated lipocalin was assessed in 5 studies (n = 888), and 2 studies (n = 203) investigated serum cystatin C. This review of KI biomarkers in different pediatric age groups indicates that (1) the majority of KI biomarkers are measured in urine; (2) the 3 most commonly analyzed KI biomarkers are urinary neutrophil gelatinase-associated lipocalin, urinary kidney injury molecule-1, and serum cystatin C; (3) values of KI biomarkers appear to decrease from prematurity to infancy; and (4) there is an unmet need to further enhance knowledge on age-dependent changes of KI biomarkers in pediatrics. Studies are needed to better characterize reference values for these key KI biomarkers in healthy pediatric populations and to evaluate the value of these markers in the early detection of drug-related KI in neonates, infants, and children.
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Affiliation(s)
- Tamara van Donge
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Andrew Atkinson
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - John van den Anker
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA.,Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
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20
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Almaani S, Bhatt U, Arriens C, Bonfa E, Dall’Era M, Houssiau F, Kalunian K, Mackay M, Sanchez-Guerrero J, Solomons N, Rovin BH. Creatinine Fluctuation in Patients With Lupus Nephritis: Considerations for Clinical Trial Endpoints. Kidney Int Rep 2020; 5:1302-1305. [PMID: 32775830 PMCID: PMC7403554 DOI: 10.1016/j.ekir.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 01/21/2023] Open
Affiliation(s)
- Salem Almaani
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Correspondence: Salem Almaani, 395 West 12th Avenue, Ground Floor, Division of Nephrology, University Wexner Medical Center, Columbus, Ohio 43210, USA.
| | - Udayan Bhatt
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cristina Arriens
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Eloisa Bonfa
- Hospital das Clinicas da Universidade de Sao Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Dall’Era
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Frederic Houssiau
- Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium
| | - Kenneth Kalunian
- Department of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Megan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | - Neil Solomons
- Aurinia Pharmaceuticals Inc., Victoria, British Columbia, Canada
| | - Brad H. Rovin
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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21
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van Donge T, Staub E, Atkinson A, Gotta V, van den Anker J, Risch L, Welzel T, Pfister M. Age appropriate reference intervals for eight kidney function and injury markers in infants, children and adolescents. Clin Chem Lab Med 2020; 59:373-382. [PMID: 32759403 DOI: 10.1515/cclm-2020-0781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/24/2020] [Indexed: 01/07/2023]
Abstract
Objectives The use of kidney function and injury markers for early detection of drug-related glomerular or tubular kidney injury in infants, children and adolescents requires age-specific data on reference intervals in a pediatric healthy population. This study characterizes serum values for eight kidney function and injury markers in healthy infants, children and adolescents. Methods A single center prospective observational study was conducted between December 2018 and June 2019. Serum samples from 142 healthy infants, children and adolescents aged between 0 and ≤15 years were collected. Statistical analyses for eight markers (albumin (ALB), β2-microglobulin (B2M), β-trace protein (BTP), creatinine (SCR), cystatin C (CYSC), kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), uromodulin (URO)) were performed to obtain reference intervals and associations with age, sex and weight were investigated (Pearson correlation, linear and piecewise regression). Results ALB and SCR increased with age (p<0.01), whereas B2M, BTP and KIM-1 values decreased with advancing age (p<0.05) in this healthy pediatric study population. CYSC showed dependency on sex (lower concentration in females) and decreased with age until reaching approximately 1.8 years; thereafter an increase with age was seen. NGAL and URO did not show any age-dependency. Conclusions This study provides age appropriate reference intervals for key serum kidney function and injury markers determined in healthy infants, children and adolescents. Such reference intervals facilitate the interpretation of changes in kidney function and injury markers in daily practice, and allow early detection of glomerular and tubular injury in infancy, childhood and adolescence.
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Affiliation(s)
- Tamara van Donge
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, Australia
| | - Andrew Atkinson
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - John van den Anker
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Health Hospital, Washington, DC, USA.,Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenz Risch
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Labormedizinisches Zentrum Dr. Risch, Vaduz, Liechtenstein.,University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
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22
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Shah KF, Stevens PE, Lamb EJ. The influence of a cooked-fish meal on estimated glomerular filtration rate. Ann Clin Biochem 2019; 57:182-185. [PMID: 31856580 DOI: 10.1177/0004563219899673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundIngestion of cooked meat increases circulating blood creatinine concentration due to conversion of creatine during cooking. This may cause falsely low estimated glomerular filtration rate. National Institute for Health and Care Excellence chronic kidney disease guidelines recommend meat avoidance prior to blood testing for estimated glomerular filtration rate. Fish muscle also contains creatine, but the influence of fish consumption on blood creatinine concentration has not been studied.MethodFour blood samples were collected from each of 20 healthy volunteers: one before and three (at 2, 4 and 20 h) after consuming cooked fish (200 g/person cod, approximately 35 g/person protein). Apart from this meal, for the study duration, subjects were asked to avoid eating meat or fish. Creatinine and cystatin C were measured and estimated glomerular filtration rate (CKD-EPI equations) was calculated.ResultsSerum creatinine concentration (mean) was increased relative to the preprandial concentration (71.8 μmol/L) in all subjects at 2 h (77.3 μmol/L) and in 17/20 subjects at 4 h (75.5 μmol/L) ( P < 0.0001) but was not significantly different from baseline after 20 h (73.6 μmol/L P = 0.1170). Mean cystatin C concentration remained unchanged throughout the study ( P > 0.05). Estimated glomerular filtration rate calculated using the CKD-EPI (creatinine) and CKD-EPI (creatinine and cystatin C) equations demonstrated significant declines at 2 and 4 h ( P < 0.0005), while the CKD-EPI (cystatin C) equation remained unchanged ( P > 0.05).ConclusionCooked fish consumption transiently increases blood creatinine concentration and consequently lowers the estimates of glomerular filtration rate derived from creatinine-based equations. Consideration should be given to avoidance of cooked fish consumption before glomerular filtration rate estimation.
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Affiliation(s)
- Kezah F Shah
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Paul E Stevens
- Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Edmund J Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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23
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Cui T, Wang W, Chen W, Pan Z, Gao S, Tan L, Pearce EN, Zimmermann MB, Shen J, Zhang W. Serum Iodine Is Correlated with Iodine Intake and Thyroid Function in School-Age Children from a Sufficient-to-Excessive Iodine Intake Area. J Nutr 2019; 149:1012-1018. [PMID: 31070733 DOI: 10.1093/jn/nxy325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 11/29/2018] [Accepted: 12/26/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND An alternative feasible and convenient method of assessing iodine intake is needed. OBJECTIVE The aim of this study was to examine the utility of serum iodine for assessing iodine intake in children. METHODS One blood sample and 2 repeated 24-h urine samples (1-mo interval) were collected from school-age children in Shandong, China. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), total iodine (StI), and non-protein-bound iodine (SnbI) concentrations and urine iodine (UIC) and creatinine (UCr) concentrations were measured. Iodine intake was estimated based on two 24-h urine iodine excretions (24-h UIE). Associations between serum iodine and other factors were analyzed using the Spearman rank correlation test. Receiver operating characteristic (ROC) curves were used to illustrate diagnostic ability of StI and SnbI. RESULTS In total, 1686 children aged 7-14 y were enrolled. The median 24-h UIC for the 2 collections was 385 and 399 μg/L, respectively. The median iodine intake was estimated to be 299 μg/d and was significantly higher in boys than in girls (316 μg/d compared with 283 μg/d; P < 0.001). StI and SnbI were both positively correlated with FT4 (ρ = 0.30, P < 0.001; and ρ = 0.21, P < 0.001), Tg (ρ = 0.21, P < 0.001; and ρ = 0.19, P < 0.001), 24-h UIC (ρ = 0.56, P < 0.001; and ρ = 0.47, P < 0.001), 24-h UIE (ρ = 0.46, P < 0.001; and ρ = 0.49, P < 0.001), urine iodine-to-creatinine ratio (ρ = 0.58, P < 0.001; and ρ = 0.62, P < 0.001), and iodine intake (ρ = 0.49, P < 0.001; and ρ = 0.53, P < 0.001). The areas under the ROC curves for StI and SnbI for the diagnosis of excessive iodine intake in children were 0.76 and 0.77, respectively. The optimal StI and SnbI threshold values for defining iodine excess in children were 101 and 56.2 μg/L, respectively. CONCLUSIONS Serum iodine was positively correlated with iodine intake and the serum FT4 concentration in children. It is a potential biomarker for diagnosing excessive iodine intake in children. This trial was registered at clinicaltrials.gov as NCT02915536.
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Affiliation(s)
- Tingkai Cui
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Wei Wang
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Wen Chen
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Ziyun Pan
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Shu Gao
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Long Tan
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA
| | - Michael B Zimmermann
- The Human Nutrition Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland
| | - Jun Shen
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Wanqi Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China.,Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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