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Wang H, Guo Y, Zhang H, Wang X, Zheng X. The U-shaped association between remnant cholesterol and risk of all-cause and cardiovascular deaths in diabetic adults: Findings from NHANES 1999-2018. Nutr Metab Cardiovasc Dis 2024; 34:2282-2288. [PMID: 38866618 DOI: 10.1016/j.numecd.2024.05.011] [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: 02/22/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND AIMS We aimed to explore the association between remnant cholesterol (RC) level and risks of all-cause and cardiovascular deaths among American diabetic adults. METHODS AND RESULTS The data of 4,095 diabetic participants from the National Health and Nutrition Examination Survey (1999-2018) were included for analysis. Deaths were ascertained till December 31, 2019. RC level associated with death was assessed on a continuous scale with restricted cubic splines and by pre-defined quartile groups with Cox regression analysis. After a median follow-up of 6.9 years, 1,060 all-cause and 289 cardiovascular deaths occurred. Association between RC and death was U-shaped, and RC level correlated with the lowest risks of both all-cause and cardiovascular deaths was 0.85 mmol/L. After adjusting for confounders, compared with Quartile 3 (0.66-0.93 mmol/L), hazard ratios for all-cause deaths were 1.43 (95%CI 1.18-1.72, P = 0.0002) in Quartile 1 (≤0.47 mmol/L), 1.20 (95%CI 1.00-1.44, P = 0.05) in Quartile 2 (0.47-0.66 mmol/L), and 1.25 (95%CI 1.05-1.49, P = 0.02) in Quartile 4 (>0.93 mmol/L). Higher risk was also observed for cardiovascular deaths in Quartile 1 (HR 1.66, 95%CI 1.15-2.41, P = 0.007), Quartile 2 (HR 1.39, 95%CI 0.97-2.00, P = 0.08), and Quartile 4 (HR 1.54, 95% CI 1.08-2.19, P = 0.02), as compared with Quartile 3. CONCLUSION In US adults with diabetes, low and high levels of RC were associated with increased risks of all-cause and cardiovascular deaths, and the lowest risk was observed at RC level of 0.85 mmol/L. These findings suggested that maintaining appropriate RC level may help reduce risk of death in diabetic patients.
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Affiliation(s)
- Haixu Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuanlin Guo
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xiuling Wang
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, China; Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China.
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Mizerska A, Durlik M, Kędzierska-Kapuza K. Nutritional Risk of Candidates for Simultaneous Pancreatic-Kidney Transplantation-A Narrative Review. Nutrients 2023; 15:4179. [PMID: 37836461 PMCID: PMC10574362 DOI: 10.3390/nu15194179] [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: 09/04/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Not much is known about the significance of nutritional status and support in transplant surgery, least of all in simultaneous pancreatic and kidney transplantation. Malnutrition in the context of simultaneous pancreatic-kidney transplantation seems to be complex and a still poorly investigated problem. Since SPKTX is highly qualified and also has a small volume procedure, it is difficult to obtain data from large cohorts of patients. The aim of this article is to gather existing evidence and information about the subject, as well as to elicit some questions and goals for the future. METHODS We searched through the Pub-Med database using the keywords "pancreas and kidney transplantation" combined with "nutritional risk", "nutritional status", "malnutrition", "nutritional intervention", and "frailty", finding a total of 4103 matching results. We then narrowed it down to articles written in English with the full text available. We also researched through the references of articles most accurately matching our researched terms. RESULTS There are numerous tools that have been investigated for the screening of malnutrition, such as the NRI index, PNI index, NLR, SGA scale, and NRS-2002 scale, each of which proved to be of some use in predicting patient outcomes in different surgical settings. Since all of them differed in components and assessed parameters and, in the absence of more sensitive or infallible indicators, the most reasonable approach seems to evaluate them jointly. CONCLUSION It is important to underline the necessity of nutritional screening and the subsequent introduction of adequate therapy while awaiting transplantation in an attempt to improve results. Considering the complexity of surgical procedures and the severity of underlying diseases with their intense metabolic components, the patient's nutritional status seems to significantly influence results. Consequently, nutritional risk assessments should be a part of the routine care of patients qualified for transplantation.
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Affiliation(s)
- Agnieszka Mizerska
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute of the Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland;
| | - Marek Durlik
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute of the Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland;
| | - Karolina Kędzierska-Kapuza
- Department of Gastroenterological Surgery and Transplantology, Centre of Postgraduate Medical Education, Marymoncka St. 99/103, 01-813 Warsaw, Poland
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Yu YJ, Li ZC, Zhou Y, Dong CY, Kuang HX, Zheng T, Xiang MD, Chen XC, Li HY, Zeng XW, Xu SL, Hu LW, Dong GH. Associations between trace level thallium and multiple health effects in rural areas: Chinese Exposure and Response Mapping Program (CERMP). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 862:160466. [PMID: 36436652 DOI: 10.1016/j.scitotenv.2022.160466] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 06/16/2023]
Abstract
Thallium (Tl) is a cumulative high toxicant in the environment, but few studies have investigated the comprehensive health effects underlying chronic Tl exposure at trace levels. This study aims to evaluate the liver, kidney, lung and other potential health effects associated with chronic Tl exposure at trace levels in rural areas of China. Urinary Tl concentrations of 2883 adults from rural areas of 12 provinces in China were measured and 2363 participants were involved in the final analysis. Indicators of liver and kidney functions in the serum, as well as the lung function indicators, were determined in the participants. General linear regression and restricted cubic spline regression were combined to study the associations between urinary Tl and health indicators or outcomes. In this study, the detected rate of Tl in the urine of the participants was 97.28 %. When the urinary Tl concentration was ranged at the fourth quintile, the risk of having liver function disorder was 70 % higher [Odds ratio (OR) = 1.70 (95 % confidence intervals (CI): 1.30, 2.22)] in all the participants, whereas the farmers were more likely to have the disorder [OR = 2.08 (95 % CI: 1.49, 2.92)] than the non-farmers [OR = 1.20 (95 % CI: 0.77, 1.88)]. Nonlinear associations between most of the liver health indicators and urinary Tl were identified, of which serum bilirubin was strongly associated with the elevation of urinary Tl when its concentration was >0.40 μg/g creatinine. Besides, urinary Tl was negatively associated with lung health indicators. Our study proposes the safety re-assessment of the current exposure level of Tl in the environment, especially in rural areas of China.
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Affiliation(s)
- Yun-Jiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China.
| | - Zhen-Chi Li
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China.
| | - Yang Zhou
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Chen-Yin Dong
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Hong-Xuan Kuang
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Tong Zheng
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Ming-Deng Xiang
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Xi-Chao Chen
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Hong-Yan Li
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, PR China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shu-Li Xu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Huang Y, Yan MQ, Zhou D, Chen CL, Feng YQ. The U-shaped association of non-high-density lipoprotein cholesterol with all-cause and cardiovascular mortality in general adult population. Front Cardiovasc Med 2023; 10:1065750. [PMID: 36844732 PMCID: PMC9945232 DOI: 10.3389/fcvm.2023.1065750] [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: 10/10/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
Background Non-high-density lipoprotein cholesterol (non-HDL-C) has been associated with atherosclerosis. However, the association between non-HDL-C and mortality in adult population remains unclear. We intended to investigate the association of non-HDL-C with cardiovascular and all-cause mortality using national representative data. Methods The study included 32,405 participants from the National Health and Nutrition Examination Survey (1999-2014). Mortality outcomes were ascertained by linkage to National Death Index records through December 31, 2015. Multivariable-adjusted Cox regression models were used to evaluate hazard ratio (HR) and 95% confidence interval (CI) of non-HDL-C concentrations in quintiles. Two-piecewise linear regression and restricted cubic spline analyzes were performed to test dose-response associations. Results After a median follow-up of 98.40 months, 2,859 (8.82%) all-cause and 551 (1.70%) cardiovascular deaths occurred. Compared with the highest group, the multivariable-adjusted hazard ratio (HR) of the first quintile for all-cause mortality was 1.53 (95%CI, 1.35-1.74). Higher non-HDL-C above a cutoff value of 4.9 mmol/L was related with cardiovascular mortality (HR = 1.33, 95%CI, 1.13-1.57). A U-shaped relationship between non-HDL-C and all-cause mortality was found in spline analysis with a cutoff value around 4 mmol/L. Similar results in subgroups analyzes were found among male, non-white population, participants who were not taking lipid-lowering drugs, and with body mass index (BMI) <25 kg/m2. Conclusion Our findings suggest a U-shaped association between non-HDL-C and mortality among adult population.
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Affiliation(s)
- Yu Huang
- School of Medicine, South China University of Technology, Guangzhou, China,Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Meng Qi Yan
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dan Zhou
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chao Lei Chen
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ying Qing Feng
- School of Medicine, South China University of Technology, Guangzhou, China,Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China,*Correspondence: Ying Qing Feng,
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Li T, Wang X, Liu Z, Zhang Z, Zhang Y, Wang Z, Feng Y, Wang Q, Guo X, Tang X, Xu J, Song Y, Chen Y, Xu N, Yao Y, Liu R, Zhu P, Han Y, Yuan J. Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China. Nutrients 2023; 15:nu15030732. [PMID: 36771438 PMCID: PMC9920677 DOI: 10.3390/nu15030732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
This study sought to investigate the prevalence and prognostic significance of malnutrition in patients with an abnormal glycemic status and coronary artery disease (CAD). This secondary analysis of a multicenter prospective cohort included 5710 CAD patients with prediabetes and 9328 with diabetes. Four objective tools were applied to assess the nutritional status of the study population. The primary endpoint was all-cause death. The association of malnutrition with clinical outcomes was examined using Cox proportional hazards regression. The proportion of malnutrition varied from 8% to 57% across the assessment tools. Diabetic patients were more likely to be malnourished than prediabetic patients. During a median follow-up of 2.1 years, 456 all-cause deaths occurred. The adjusted hazard ratios and 95% confidence interval for all-cause deaths of moderate-severe malnutrition defined by different tools ranged from 1.59 (1.03, 2.46) to 2.08 (0.92, 4.73) in prediabetic patients and 1.51 (1.00, 2.34) to 2.41 (1.78, 3.27) in diabetic patients. In conclusion, malnutrition is not rare in CAD patients with abnormal glycemic status. Moderate-severe malnutrition strongly predicted all-cause death regardless of the assessment tool. Assessing the nutritional status for all CAD patients with prediabetes and diabetes to identify individuals at high risk of all-cause death may help the risk assessment and prognosis improvement.
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Affiliation(s)
- Tianyu Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaozeng Wang
- Cardiovascular Research Institute & Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Zhenyu Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zheng Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Yongzhen Zhang
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453002, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510100, China
| | - Qingsheng Wang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University, Hangzhou 314400, China
| | - Xiaofang Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingjing Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yan Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Na Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ru Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Pei Zhu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yaling Han
- Cardiovascular Research Institute & Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
- Correspondence: (Y.H.); (J.Y.)
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Y.H.); (J.Y.)
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Non-High-Density Lipoprotein Cholesterol and Cardiovascular Outcomes in Chronic Kidney Disease: Results from KNOW-CKD Study. Nutrients 2022; 14:nu14183792. [PMID: 36145167 PMCID: PMC9505887 DOI: 10.3390/nu14183792] [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: 09/06/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 02/07/2023] Open
Abstract
As non-high-density lipoprotein cholesterol (non-HDL-C) levels account for all atherogenic lipoproteins, serum non-HDL-C level has been suggested to be a marker for cardiovascular (CV) risk stratification. Therefore, to unveil the association of serum non-HDL-C levels with CV outcomes in patients with non-dialysis chronic kidney disease (ND-CKD), the patients at stages 1 to 5 (n = 2152) from the Korean Cohort Study for Outcomes in Patients with Chronic Kidney Disease (KNOW-CKD) were prospectively analyzed. The subjects were divided into quintiles by serum non-HDL-C level. The primary outcome was a composite of all-cause death or non-fatal CV events. The median duration of follow-up was 6.940 years. The analysis using the Cox proportional hazard model unveiled that the composite CV event was significantly increased in the 5th quintile (adjusted hazard ratio 2.162, 95% confidence interval 1.174 to 3.981), compared to that of the 3rd quintile. A fully adjusted cubic spline model depicted a non-linear, J-shaped association between non-HDL-C and the risk of a composite CV event. The association remained robust in a series of sensitivity analyses, including the analysis of a cause-specific hazard model. Subgroup analyses reveled that the association is not significantly altered by clinical conditions, including age, gender, body mass index, estimated glomerular filtration rate, and albuminuria. In conclusion, high serum non-HDL-C level increased the risk of adverse CV outcomes among the patients with ND-CKD. Further studies are warranted to define the optimal target range of non-HDL-C levels in this population.
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Lee N, Park SJ, Kang D, Jeon JY, Kim HJ, Kim DJ, Lee KW, Boyko EJ, Han SJ. Characteristics and Clinical Course of Diabetes of the Exocrine Pancreas: A Nationwide Population-Based Cohort Study. Diabetes Care 2022; 45:1141-1150. [PMID: 35226735 DOI: 10.2337/dc21-1659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The natural course of diabetes of the exocrine pancreas (DEP) is not well established. We aimed to compare the risk of insulin initiation, diabetic complications, and mortality between DEP and type 2 diabetes. RESEARCH DESIGN AND METHODS Using the Korean National Health Insurance Service-Health Screening Cohort between 2012 and 2017, we divided patients with diabetes into those with diabetes without prior pancreatic disease (indicated type 2 diabetes, n = 153,894) and diabetes with a prior diagnosis of pancreatic disease (indicated DEP, n = 3,629). ICD-10 codes and pharmacy prescription information were used to define type 2 diabetes, DEP, and acute and chronic diabetes complications. Kaplan-Meier curves were produced to compare insulin use over time between groups. We created logistic regression models for odds of progression to diabetic complications and mortality. RESULTS DEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% CI 1.30-1.47], P < 0.0001). Individuals with DEP showed higher risks of hypoglycemia (odds ratio 1.85 [1.54-2.21], P < 0.0001), diabetic neuropathy (1.38 [1.28-1.49], P < 0.0001), nephropathy (1.38 [1.27-1.50], P < 0.0001), retinopathy (1.10 [1.01-1.20], P = 0.0347), coronary heart disease (1.59 [1.48-1.70], P < 0.0001), cerebrovascular disease (1.38 [1.28-1.49], P < 0.0001), and peripheral arterial disease (1.34 [1.25-1.44], P < 0.0001). All-cause mortality was higher in those with DEP (1.74 [1.57-1.93], P < 0.0001) than in those with type 2 diabetes. CONCLUSIONS DEP is more likely to require insulin therapy than type 2 diabetes. Hypoglycemia, micro- and macrovascular complications, and all-cause mortality events are higher in DEP compared with type 2 diabetes.
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Affiliation(s)
- Nami Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - So Jeong Park
- Data Science Team, Hanmi Pharmaceutical Co., Ltd, Seoul, South Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharmaceutical Co., Ltd, Seoul, South Korea
| | - Ja Young Jeon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Kwan-Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Edward J Boyko
- Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
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Zoccali C, Mallamaci F. Tales of two study designs in patients with chronic kidney failure: The case of the protein-energy wasting - inflammation syndromic complex. J Intern Med 2021; 290:937-940. [PMID: 33882621 DOI: 10.1111/joim.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- C Zoccali
- From the, Associazione Ipertensione, Nefrologia e Trapianto renale (IPNET) c/o CNR e Nefrologia, Ospedali Riuniti CNR-IFC, Clinical Epidemiology of Renal Disease and Hypertension, Reggio Calabria, Italy
| | - F Mallamaci
- Nephrology, Dialysis and Renal Transplantation Unit, Grande Ospedaliera Metropolitano, Reggio Calabria, Italy
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Ebert T, Qureshi AR, Lamina C, Fotheringham J, Froissart M, Eckardt KU, Wheeler DC, Floege J, Kronenberg F, Stenvinkel P. Time-dependent lipid profile inversely associates with mortality in hemodialysis patients - independent of inflammation/malnutrition. J Intern Med 2021; 290:910-921. [PMID: 33998741 DOI: 10.1111/joim.13291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/02/2021] [Accepted: 02/18/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with end-stage kidney disease have an extremely high cardiovascular mortality rate, but there is a paradoxical relationship between lipid profile and survival in haemodialysis patients. To investigate whether inflammation/malnutrition confounds the associations between lipids and mortality, we studied a full lipid profile comprising of five clinically well-established lipid parameters and its associations with mortality in a large, multinational European cohort with a median follow-up >3 years. METHODS The association between quartiles of total, high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL) cholesterol, as well as triglyceride, levels and the end-points of all-cause, cardiovascular and non-cardiovascular mortality was assessed in a cohort of 5,382 incident, adult haemodialysis patients from >250 Fresenius Medical Care dialysis centres out of 14 participating countries using baseline and time-dependent Cox models. Analyses were fully adjusted and stratified for inflammation/malnutrition status and other patient-level variables. RESULTS Time-dependent quartiles of total, HDL, non-HDL and LDL cholesterol were inversely associated with the hazard for all-cause, cardiovascular and non-cardiovascular mortality. Compared with the lowest quartile of the respective lipid parameter, hazard ratios of other quartiles were <0.86. Similar, albeit weaker, associations were found with baseline lipid profile and mortality. Neither time-dependent nor baseline associations between lipid profile and mortality were affected by inflammation/malnutrition, statin use or geography. CONCLUSIONS Baseline and time-dependent lipid profile are inversely associated with mortality in a large, multicentre cohort of incident haemodialysis patients. Inflammation/malnutrition is not a confounder nor effect modificator of the associations between lipid profile and mortality in European haemodialysis patients.
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Affiliation(s)
- T Ebert
- From the, Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - A R Qureshi
- From the, Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - C Lamina
- Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Fotheringham
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.,School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Froissart
- Centre de Recherche Clinique (CRC), Lausanne University Hospital, Lausanne, Switzerland
| | - K-U Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - D C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - J Floege
- Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany
| | - F Kronenberg
- Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - P Stenvinkel
- From the, Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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10
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Kim JY, Park JT, Kim HW, Chang TI, Kang EW, Ahn C, Oh KH, Lee J, Chung W, Kim YS, Kim SW, Yoo TH, Kang SW, Han SH. Inflammation Alters Relationship Between High-Density Lipoprotein Cholesterol and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From KNOW-CKD. J Am Heart Assoc 2021; 10:e021731. [PMID: 34369187 PMCID: PMC8475026 DOI: 10.1161/jaha.120.021731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The function of high‐density lipoprotein can change from protective to proatherosclerotic under inflammatory conditions. Herein, we studied whether inflammation could modify the relationship between high‐density lipoprotein level and risk of adverse outcomes in patients with chronic kidney disease . Methods and Results In total, 1864 patients from the prospective KNOW‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) were enrolled. The main predictor was high‐density lipoprotein cholesterol (HDL‐C) level. Presence of inflammation was defined by hs‐CRP (high‐sensitivity C‐reactive protein) level of ≥1.0 mg/L. The primary outcome was extended major adverse cardiovascular events. During 9231.2 person‐years of follow‐up, overall incidence of the primary outcome was 15.8 per 1000 person‐years. In multivariable Cox analysis after adjusting for confounders, HDL‐C level was not associated with the primary outcome. There was a significant interaction between the inflammatory status and HDL‐C for risk of extended major adverse cardiovascular events (P=0.003). In patients without inflammation, the hazard ratios (HRs) (95% CIs) for HDL‐C levels <40, 50 to 59, and ≥60 mg/dL were 1.10 (0.50–1.82), 0.95 (0.50–1.82), and 0.42 (0.19–0.95), respectively, compared with HDL‐C of 40 to 49 mg/dL. However, the significant association for HDL‐C ≥60 mg/dL was not seen after Bonferroni correction. In patients with inflammation, we observed a trend toward increased risk of extended major adverse cardiovascular events in higher HDL‐C groups (HRs [95% CIs], 0.73 [0.37–1.43], 1.24 [0.59–2.61], and 1.56 [0.71–3.45], respectively), but without statistical significance. Conclusions The association between HDL‐C level and adverse cardiovascular outcomes showed reverse trends based on inflammation status in Korean patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.
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Affiliation(s)
- Jae Young Kim
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea.,Division of Nephrology Department of Internal Medicine National Health Insurance Service Medical CenterIlsan Hospital Goyang-si Gyeonggi-do Korea
| | - Jung Tak Park
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Hyung Woo Kim
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Tae-Ik Chang
- Division of Nephrology Department of Internal Medicine National Health Insurance Service Medical CenterIlsan Hospital Goyang-si Gyeonggi-do Korea
| | - Ea Wha Kang
- Division of Nephrology Department of Internal Medicine National Health Insurance Service Medical CenterIlsan Hospital Goyang-si Gyeonggi-do Korea
| | - Curie Ahn
- Department of Internal Medicine Seoul National University Seoul Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine Seoul National University Seoul Korea
| | - Joongyub Lee
- Department of Prevention and Management School of Medicine Inha University Incheon Korea
| | - Wookyung Chung
- Department of Internal Medicine Gachon University, Gil Hospital Incheon Korea
| | - Yong-Soo Kim
- Department of Internal Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea
| | - Soo Wan Kim
- Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Shin-Wook Kang
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Seung Hyeok Han
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
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11
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Siga MM, Ducher M, Florens N, Roth H, Mahloul N, Fouque D, Fauvel JP. Prediction of all-cause mortality in haemodialysis patients using a Bayesian network. Nephrol Dial Transplant 2020; 35:1420-1425. [PMID: 32040147 DOI: 10.1093/ndt/gfz295] [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: 07/11/2019] [Accepted: 11/27/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND All-cause mortality in haemodialysis (HD) is high, reaching 15.6% in the first year according to the European Renal Association. METHODS A new clinical tool to predict all-cause mortality in HD patients is proposed. It uses a post hoc analysis of data from the prospective cohort study Photo-Graph V3. A total of 35 variables related to patient characteristics, laboratory values and treatments were used as predictors of all-cause mortality. The first step was to compare the results obtained using a logistic regression to those obtained by a Bayesian network. The second step aimed to increase the performance of the best prediction model using synthetic data. Finally, a compromise between performance and ergonomics was proposed by reducing the number of variables to be entered in the prediction tool. RESULTS Among the 9010 HD patients included in the Photo-Graph V3 study, 4915 incident patients with known medical status at 2 years were analysed. All-cause mortality at 2 years was 34.1%. The Bayesian network provided the most reliable prediction. The final optimized models that used 14 variables had areas under the receiver operating characteristic curves of 0.78 ± 0.01, sensitivity of 72 ± 2%, specificity of 69 ± 2%, predictive positive value of 70 ± 1% and negative predictive value of 71 ± 2% for the prediction of all-cause mortality. CONCLUSIONS Using artificial intelligence methods, a new clinical tool to predict all-cause mortality in incident HD patients is proposed. The latter can be used for research purposes before its external validation at: https://www.hed.cc/? a=twoyearsallcausemortalityhemod&n=2-years%20All-cause%20Mortality%20Hemodialysis.neta.
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Affiliation(s)
- Marleine Mefeugue Siga
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Néphrologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Michel Ducher
- Pharmacie, Hospices Civils de Lyon, EMR3738 Ciblage thérapeutique en oncologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Nans Florens
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Néphrologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Hubert Roth
- Faculté de médecine, Université Grenoble Alpes, Domaine de la merci Place du Commandant Nal, La Tronche, France
| | | | - Denis Fouque
- Hospices Civils de Lyon, Hôpital Lyon-Sud, Service de Néphrologie, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - Jean-Pierre Fauvel
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Néphrologie, Université Claude Bernard Lyon 1, Lyon, France
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12
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Chiu H, Wu PY, Huang JC, Tu HP, Lin MY, Chen SC, Chang JM. There is a U shaped association between non high density lipoprotein cholesterol with overall and cardiovascular mortality in chronic kidney disease stage 3-5. Sci Rep 2020; 10:12749. [PMID: 32728174 PMCID: PMC7392750 DOI: 10.1038/s41598-020-69794-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/20/2020] [Indexed: 01/30/2023] Open
Abstract
Dyslipidemia is common in patients with chronic kidney disease (CKD), however the relationship between dyslipidemia and mortality in patients with moderate to severe CKD remains controversial. Non-high-density lipoprotein (HDL) cholesterol has been reported to be a more accurate predictor of clinical outcomes than conventional lipid measurements. Hence, the aim of this study was to investigate associations between non-HDL cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3–5. We enrolled 429 pre-dialysis patients with stage 3 to 5 CKD from May 2006 to January 2010. The patients were divided into four groups according to quartiles of non-HDL cholesterol. The patients were followed until death or until January 2020. During a median 11.6 years of follow-up, there were 78 (18.2%) deaths overall and 32 (7.5%) cardiovascular deaths. In adjusted models, the patients in quartile 1 (hazard ratio [HR] 3.368; 95% confidence interval [CI] 1.388–8.176; p = 0.007), quartile 3 (HR 3.666; 95% CI 1.486–9.044; p = 0.005), and quartile 4 (HR 2.868; 95% CI 1.136–7.240; p = 0.026) of non-HDL cholesterol had a higher risk of overall mortality (vs. quartile 2). In addition, the patients in quartile 1 (HR 19.503; 95% CI 2.185–174.0925 p = 0.008), quartile 3 (HR 28.702; 95% CI 2.990–275.559; p = 0.004), and quartile 4 (HR 11.136; 95% CI 1.126–110.108; p = 0.039) had a higher risk of cardiovascular mortality (vs. quartile 2). Our study showed a U-shaped relationship between non-HDL cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3–5. Assessing non-HDL cholesterol may help to identify subjects at high-risk of adverse outcomes.
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Affiliation(s)
- Hsuan Chiu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung, 812, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung, 812, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung, 812, Taiwan, ROC. .,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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13
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Ren M, Sheng Q, Xie X, Zhang X, Han F, Chen J. Geriatric nutritional risk index is associated with mortality in peritoneal dialysis patients. Intern Med J 2019; 50:470-476. [PMID: 31707748 DOI: 10.1111/imj.14680] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 10/01/2019] [Accepted: 11/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Malnutrition is one of the most common complications among dialysis patients. The Geriatric Nutritional Risk Index (GNRI) is rarely used in dialysis patients, especially peritoneal dialysis (PD). AIM To use the GNRI to evaluate the initial nutritional state of PD patients and to examine the association between the GNRI and mortality in chronic PD patients. METHODS We retrospectively examined the medical records at our centre to identify all adults (≥18 years) who had undergone PD for over 3 months before recruitment from January 2005 to December 2017. The correlation between the GNRI and mortality was examined by Kaplan-Meier and Cox proportional hazards analyses. RESULTS A total of 1804 patients was enrolled in the study. Significant correlations were noted between the initial GNRI and Charlson index, uric acid, blood calcium, potassium, triglycerides, low-density lipoprotein cholesterol, haemoglobin and so on. Multivariate Cox proportional hazards analyses demonstrated that the GNRI was associated with all-cause mortality (hazard ratio = 0.96, P < 0.001, 95% confidence interval: 0.95-0.98) after adjustment. Compared with the lowest GNRI group, all-cause mortality decreased significantly for each level of GNRI after adjusting for various influencing factors, and the mortality risk of the highest GNRI grade decreased by 66%. The Kaplan-Meier analysis survival rate was significantly different among the four groups in terms of all-cause mortality and cardiovascular and cerebrovascular mortality (log-rank test, P < 0.05). CONCLUSIONS These results demonstrated that the GNRI is significantly associated with mortality and can be a simple, clinically useful marker for the assessment of nutritional status in PD patients.
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Affiliation(s)
- Mian Ren
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qilin Sheng
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xishao Xie
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohui Zhang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fei Han
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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14
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de la Iglesia D, Vallejo-Senra N, López-López A, Iglesias-Garcia J, Lariño-Noia J, Nieto-García L, Domínguez-Muñoz JE. Pancreatic exocrine insufficiency and cardiovascular risk in patients with chronic pancreatitis: A prospective, longitudinal cohort study. J Gastroenterol Hepatol 2019; 34:277-283. [PMID: 30156337 DOI: 10.1111/jgh.14460] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Previous studies have suggested that chronic pancreatitis (CP) is associated with increased risk of cardiovascular (CV) disease independently of other major risk factors. We evaluated the risk of CV events in a well-phenotyped cohort of patients with CP and its association with pancreatic exocrine insufficiency (PEI) among other CV risk factors. METHODS This was a prospective, longitudinal cohort study of patients with CP, followed up at the Pancreas Unit of the University Hospital of Santiago de Compostela, Spain. RESULTS Four hundred thirty patients were included (mean 47.8 ± 14.4 years of age, 79.1% male). Mean follow-up was 8.6 ± 4.6 years. CP etiology was toxic (alcohol and/or smoking) in 290 patients (67.4%). PEI and pancreatogenic diabetes mellitus (DM) were present in 29.3% and 29.5% of the patients, respectively. A total of 45 CV events was recorded (10.5%); 21 patients had a major CV event (stroke or myocardial infarction) and 27 developed clinically relevant peripheral arterial disease. A higher incidence of CV events was recorded in patients with PEI than in those without (incidence rate ratio 3.67, 95% confidence interval [CI] 1.92-7.24; P < 0.001). In the multivariate analysis, PEI without DM (OR 4.96; 95% CI 1.68 to 14.65), coexistence of PEI and DM (OR 6.54; 95% CI 2.71 to 15.77), arterial hypertension (OR 3.40; 95% CI 1.50 to 7.72), and smoking (OR 2.91, 95% CI 1.07 to 7.97) were independently associated with increased CV risk. CONCLUSIONS Together with known major CV risk factors like smoking and hypertension, PEI is significantly associated with the risk of CV events in patients with CP.
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Affiliation(s)
- Daniel de la Iglesia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nicolau Vallejo-Senra
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrea López-López
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Nieto-García
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Enrique Domínguez-Muñoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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15
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Lin YH, Huang JC, Wu PY, Chen SC, Chiu YW, Chang JM, Chen HC. Greater low-density lipoprotein cholesterol variability is associated with increased progression to dialysis in patients with chronic kidney disease stage 3. Oncotarget 2017; 9:3242-3253. [PMID: 29423043 PMCID: PMC5790460 DOI: 10.18632/oncotarget.23228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023] Open
Abstract
Increasing evidence suggests that lipid variability may be a predictor of cardiovascular events. However, few studies have evaluated the association between lipid variability and renal outcomes in patients with moderate-to-advanced chronic kidney disease (CKD). Therefore, the aims of this study were to assess whether lipid variability is associated with progression to dialysis in patients with CKD stage 3–5, and to evaluate the risk factors of lipid variability. This longitudinal study enrolled 725 patients with CKD stage 3–5. Intra-individual lipid variability was defined as the standard deviations (SDs) of lipid levels. The renal end-point was defined as commencing dialysis. During a mean follow-up period of 3.2 years, 208 patients (28.7%) started dialysis. The patients with CKD stage 3 with high low-density lipoprotein (LDL) cholesterol SD (per 1 mg/dL; hazard ratio, 1.035; 95% confidence interval, 1.003 to 1.067; p = 0.003) were associated with an increased risk of progression to dialysis, however this association was not seen in the patients with CKD stage 4 or 5. Furthermore, in the patients with CKD stage 3, a high urine protein-to-creatinine ratio (p < 0.001) and the use of statins (p < 0.001) were significantly associated with an increased LDL-cholesterol SD. Greater LDL-cholesterol variability was associated with an increased risk of progression to dialysis in patients with CKD stage 3, but not in those with CKD stage 4 or 5. These findings support the potential role of aggressive lipid control on clinical outcomes and highlight its importance in patients with CKD stage 3.
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Affiliation(s)
- Yu-Hsuan Lin
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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16
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Palazhy S, Viswanathan V. Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy. Diabetes Metab J 2017; 41:128-134. [PMID: 28447439 PMCID: PMC5409011 DOI: 10.4093/dmj.2017.41.2.128] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 11/07/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with and without nephropathy and analyzed the factors associated with nephropathy among them. METHODS In this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n=89) and without nephropathy were enrolled in the control group (n=92). Both groups were matched for age and duration of diabetes. Data on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea and creatinine were collected from the case sheets. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL) and estimated glomerular filtration rate (eGFR) were calculated using equations. Multivariate analysis was done to determine the factors associated with eGFR. RESULTS Dyslipidemia was present among 56.52% of control subjects and 75.28% of nephropathy subjects (P=0.012). The percentage of subjects with atherogenic dyslipidemia (high TG+low HDL-C+sdLDL) was 14.13 among controls and 14.61 among nephropathy subjects. Though serum creatinine was not significantly different, mean eGFR value was significantly lower among nephropathy patients (P=0.002). Upon multivariate analysis, it was found that TC (P=0.007) and HDL-C (P=0.06) were associated with eGFR among our study subjects. CONCLUSION Our results show that dyslipidemia was highly prevalent among subjects with nephropathy. Regular screening for dyslipidemia may be beneficial in controlling the risk for adverse events among diabetic nephropathy patients.
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Affiliation(s)
- Sabitha Palazhy
- M.V. Hospital for Diabetes & Prof. M. Viswanathan Diabetes Research Centre, Chennai, India.
| | - Vijay Viswanathan
- M.V. Hospital for Diabetes & Prof. M. Viswanathan Diabetes Research Centre, Chennai, India
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17
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Wang IK, Liu CH, Yen TH, Jeng JS, Hsu SP, Chen CH, Lien LM, Lin RT, Chen AC, Lin HJ, Chi HY, Lai TC, Sun Y, Lee SP, Sung SF, Chen PL, Lee JT, Chiang TR, Lin SK, Muo CH, Ma H, Wen CP, Sung FC, Hsu CY. Cholesterol Levels Are Associated with 30-day Mortality from Ischemic Stroke in Dialysis Patients. J Stroke Cerebrovasc Dis 2017; 26:1349-1356. [PMID: 28341198 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/19/2017] [Accepted: 02/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients. METHODS From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013. RESULTS Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of <120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of <120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. CONCLUSIONS Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or <120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.
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Affiliation(s)
- I-Kuan Wang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsiang Liu
- Departmemt of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital and Taipei Medical University College of Medicine, Taipei, Taiwan
| | - Ruey-Tay Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - An-Chih Chen
- Department Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsin-Yi Chi
- Show Chwan Memorial Hospital, Changhua. Taiwan
| | | | - Yu Sun
- En Chu Kong Hospital, New Taipei City, Taiwan
| | - Siu-Pak Lee
- Department of Neurology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Sheng-Feng Sung
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Po-Lin Chen
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Henry Ma
- Monash University, Melbourne, Victoria, Australia
| | - Chi-Pang Wen
- Institute of Population Science, National Health Research Institute, Zhunan, Taiwan
| | - Fung-Chang Sung
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
| | - Chung Y Hsu
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Departmemt of Neurology, China Medical University Hospital, Taichung, Taiwan
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Kaysen GA. Lipid-Lowering Therapy in CKD: Should We Use It and in Which Patients. Blood Purif 2017; 43:196-199. [PMID: 28114129 DOI: 10.1159/000452727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease is associated with a 15-fold increase in the risk of death and a 30-fold increase in the risk of cardiovascular events even prior to dialysis initiation, and this situation remains unchanged following the initiation of the dialysis procedure. Lipoprotein structure and function, especially the anti-oxidative properties of high-density lipoprotein, are altered. In this study, the effectiveness of lipid-lowering therapy on mortality and cardiovascular outcomes is explored. SUMMARY Mortality is inversely associated with the cholesterol level. The degree of inflammation and wasting is a stronger predictor of mortality than are cholesterol levels. Treatment with statins reduces the risk of death and cardiovascular outcomes among patients not yet requiring renal replacement therapy, but is not effective once dialysis is initiated, most likely because other processes, such as inflammation, not affected by lipid-lowering therapy, dominate in the causal pathway leading to adverse outcomes. Fenofibrate is also useful in reducing cardiovascular outcomes and the progression of renal disease among patients with type 2 diabetes not yet requiring dialysis. While the lipid-lowering therapy is effective in patients with the nephrotic syndrome, no long-term outcome studies regarding hard outcomes are available. KEY POINTS The great increase in cardiovascular outcomes in patients with kidney disease is likely due to a consequence of properties that are unresponsive to the lipid-lowering therapy, most likely inflammation. The lipid-lowering therapy is useful in patients who are not yet in need of dialysis but does not reduce mortality in dialysis patients.
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Affiliation(s)
- George A Kaysen
- Department of Medicine, Division of Nephrology, University of California Davis, Davis, CA, USA
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Anker SD, Gillespie IA, Eckardt KU, Kronenberg F, Richards S, Drueke TB, Stenvinkel P, Pisoni RL, Robinson BM, Marcelli D, Froissart M, Floege J. Development and validation of cardiovascular risk scores for haemodialysis patients. Int J Cardiol 2016; 216:68-77. [DOI: 10.1016/j.ijcard.2016.04.151] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/17/2016] [Accepted: 04/17/2016] [Indexed: 01/07/2023]
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Ananthakrishnan S, Kaysen GA. Treatment of Hyperlipidemia Changes With Level of Kidney Function-Rationale. Adv Chronic Kidney Dis 2016; 23:247-54. [PMID: 27324678 DOI: 10.1053/j.ackd.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 09/20/2015] [Accepted: 12/29/2015] [Indexed: 12/17/2022]
Abstract
Lipoprotein abnormalities such as low levels of high-density lipoprotein (HDL) and high triglycerides (TGs), associated with the metabolic syndrome, are also associated with subsequent decline in kidney function. Patients with end-stage kidney disease also exhibit low HDL and high TGs and a modest reduction in low-density lipoprotein (LDL), although the mechanisms responsible for these changes differ when patients with end-stage kidney disease are compared with those having metabolic syndrome with normal kidney function, as do lipoprotein structures. Among dialysis patients, oxidized LDL, levels of TG-rich intermediate-density lipoprotein, and low HDL are associated with aortic pulsewave velocity and other markers of atherosclerosis. Statins are effective in reducing LDL and do decrease risk of cardiovascular events in patients with CKD not requiring dialysis but have no significant effect on outcomes, including all-cause mortality among dialysis patients. Similarly gemfibrozil and other fibrates lower TGs, increase HDL, and reduce cardiovascular events, but not mortality, among patients with CKD not requiring dialysis but have no significant effect on cardiovascular outcomes in dialysis patients. There is potential clinical benefit in treating elevated LDL, TGs, and low HDL in patients with CKD using statins or fibrates in those not yet requiring dialysis.
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Association of Increased Serum Leptin with Ameliorated Anemia and Malnutrition in Stage 5 Chronic Kidney Disease Patients after Parathyroidectomy. Sci Rep 2016; 6:27918. [PMID: 27307101 PMCID: PMC4910047 DOI: 10.1038/srep27918] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/26/2016] [Indexed: 01/11/2023] Open
Abstract
Leptin is an adipokine that regulates various metabolism, but its association with secondary hyperparathyroidism (SHPT), a clinical manifestation of chronic kidney disease-mineral and bone disorder (CKD-MBD), remains obscure. Parathyroidectomy (PTX) is recommended for severe SHPT patients. Here, the associations between circulating leptin and clinical characteristics in CKD patients were investigated. Effects of PTX on leptin production were analyzed in vivo and in vitro. Controls and CKD patients had approximate serum leptin levels in that a larger proportion of CKD patients with body mass index (BMI) <23 kg/m2. Serum leptin was related to anemia, albumin, and bone metabolism disorders in CKD patients. Lower intact parathyroid hormone (PTH) was related with higher leptin in PTX patients group. Severe SHPT inhibited uremia-enhanced leptin production in 3T3-L1 adipocytes, which was attenuated after PTX. High levels of PTH were found to reduce Akt phosphorylation and leptin production in vitro but high levels of calcium and phosphorus were not. Successful PTX was found to improve anemia and malnutrition in severe SHPT patients, and this was correlated with increased circulating leptin levels via up-regulated Akt signaling in adipocytes. These findings indicated the therapeutic potential of leptin and related target pathway for improving survival and quality of life in CKD.
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Guo T, Yin RX, Lin WX, Wang W, Huang F, Pan SL. Association of the variants and haplotypes in the DOCK7, PCSK9 and GALNT2 genes and the risk of hyperlipidaemia. J Cell Mol Med 2016; 20:243-65. [PMID: 26493351 PMCID: PMC4727555 DOI: 10.1111/jcmm.12713] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/07/2015] [Indexed: 01/09/2023] Open
Abstract
Little is known about the association between the single nucleotide polymorphisms (SNPs) and haplotypes of the dedicator of cytokinesis 7 (DOCK7), pro-protein convertase subtilisin/kexin type 9 (PCSK9) and polypeptide N-acetylgalactosaminyltransferase 2 (GALNT2) and serum lipid traits in the Chinese populations. This study was to determine the association between nine SNPs in the three genes and their haplotypes and hypercholesterolaemia (HCH)/hypertriglyceridaemia (HTG), and to identify the possible gene-gene interactions among these SNPs. Genotyping was performed in 733 HCH and 540 HTG participants. The haplotype of C-C-G-C-T-G-C-C-G [in the order of DOCK7 rs1168013 (G>C), rs10889332 (C>T); PCSK9 rs615563 (G>A), rs7552841 (C>T), rs11206517 (T>G); and GALNT2 rs1997947 (G>A), rs2760537 (C>T), rs4846913 (C>A) and rs11122316 (G>A) SNPs] was associated with increased risk of HCH and HTG. The haplotypes of C-C-G-C-T-G-C-C-A and G-C-G-T-T-G-T-C-G were associated with a reduced risk of HCH and HTG. The haplotypes of G-C-G-C-T-G-C-C-A and G-C-G-C-T-G-T-C-G were associated with increased risk of HCH. The haplotypes of C-T-G-C-T-G-C-C-G, G-C-A-C-T-G-C-C-G and G-C-G-C-T-G-C-C-A were associated with an increased risk of HTG. The haplotypes of G-C-G-C-T-G-T-C-A and G-C-G-T-T-G-T-C-G were associated with a reduced risk of HTG. In addition, possible inter-locus interactions among the DOCK7, PCSK9 and GALNT2 SNPs were also noted. However, further functional studies of these genes are still required to clarify which SNPs are functional and how these genes actually affect the serum lipid levels.
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Affiliation(s)
- Tao Guo
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Wei-Xiong Lin
- Department of Molecular Genetics, Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Wang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Feng Huang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Shang-Ling Pan
- Department of Pathophysiology, School of Premedical Sciences, Guangxi Medical University, Nanning, Guangxi, China
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Naik AA, Patro IK, Patro N. Slow Physical Growth, Delayed Reflex Ontogeny, and Permanent Behavioral as Well as Cognitive Impairments in Rats Following Intra-generational Protein Malnutrition. Front Neurosci 2015; 9:446. [PMID: 26696810 PMCID: PMC4672086 DOI: 10.3389/fnins.2015.00446] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/09/2015] [Indexed: 01/04/2023] Open
Abstract
Environmental stressors including protein malnutrition (PMN) during pre-, neo- and post-natal age have been documented to affect cognitive development and cause increased susceptibility to neuropsychiatric disorders. Most studies have addressed either of the three windows and that does not emulate the clinical conditions of intra-uterine growth restriction (IUGR). Such data fail to provide a complete picture of the behavioral alterations in the F1 generation. The present study thus addresses the larger window from gestation to F1 generation, a new model of intra-generational PMN. Naive Sprague Dawley (SD) dams pre-gestationally switched to LP (8% protein) or HP (20% protein) diets for 45 days were bred and maintained throughout gestation on same diets. Pups born (HP/LP dams) were maintained on the respective diets post-weaningly. The present study aimed to show the sex specific differences in the neurobehavioral evolution and behavioral phenotype of the HP/LP F1 generation pups. A battery of neurodevelopmental reflex tests, behavioral (Open field and forelimb gripstrength test), and cognitive [Elevated plus maze (EPM) and Morris water maze (MWM)] assays were performed. A decelerated growth curve with significantly restricted body and brain weight, delays in apparition of neuro-reflexes and poor performance in the LP group rats was recorded. Intra-generational PMN induced poor habituation-with-time in novel environment exploration, low anxiety and hyperactive like profile in open field test in young and adult rats. The study revealed poor forelimb neuromuscular strength in LP F1 pups till adulthood. Group occupancy plots in MWM test revealed hyperactivity with poor learning, impaired memory retention and integration, thus modeling the signs of early onset Alzehemier phenotype. In addition, a gender specific effect of LP diet with severity in males and favoring female sex was also noticed.
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Affiliation(s)
- Aijaz A Naik
- School of Studies in Neuroscience, Jiwaji University Gwalior, India ; School of Studies in Zoology, Jiwaji University Gwalior, India
| | - Ishan K Patro
- School of Studies in Neuroscience, Jiwaji University Gwalior, India ; School of Studies in Zoology, Jiwaji University Gwalior, India
| | - Nisha Patro
- School of Studies in Neuroscience, Jiwaji University Gwalior, India
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Chen TK, Estrella MM, Astor BC, Greene T, Wang X, Grams ME, Appel LJ. Longitudinal changes in hematocrit in hypertensive chronic kidney disease: results from the African-American Study of Kidney Disease and Hypertension (AASK). Nephrol Dial Transplant 2015; 30:1329-35. [PMID: 25817226 DOI: 10.1093/ndt/gfv037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/28/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anemia is common in chronic kidney disease (CKD) and associated with poor outcomes. In cross-sectional studies, lower estimated glomerular filtration rate (eGFR) has been associated with increased risk for anemia. The aim of this study was to determine how hematocrit changes as eGFR declines and what factors impact this longitudinal association. METHODS We followed 1094 African-Americans with hypertensive nephropathy who participated in the African-American Study of Kidney Disease and Hypertension. Mixed effects models were used to determine longitudinal change in hematocrit as a function of eGFR. Interaction terms were used to assess for differential effects of age, gender, baseline eGFR, baseline proteinuria, malnutrition and inflammation on eGFR-associated declines in hematocrit. In sensitivity analyses, models were run using iGFR (by renal clearance of I(125) iothalamate) in place of eGFR. RESULTS At baseline, mean hematocrit was 39% and 441 (40%) individuals had anemia. The longitudinal relationship between eGFR and hematocrit differed by baseline eGFR and was steeper when baseline eGFR was <45 mL/min/1.73 m(2). For example, the absolute decline in hematocrit per 10 mL/min/1.73 m(2) decline in longitudinal eGFR was -3.7, -1.3 and -0.5% for baseline eGFR values of 20, 40 and 60 mL/min/1.73 m(2), respectively (P < 0.001 comparing the longitudinal association between baseline eGFR = 40 or 60 versus baseline eGFR = 20 mL/min/1.73 m(2)). Similarly, male sex, younger age (<65 years) and higher baseline proteinuria (protein-to-creatinine ratio >0.22) were associated with greater hematocrit declines per unit decrease in longitudinal eGFR compared with female sex, older age and low baseline proteinuria, respectively (P-interaction <0.05 for each comparison). The longitudinal eGFR-hematocrit association did not differ by body mass index, serum albumin or C-reactive protein. CONCLUSIONS Men, younger individuals and those with low baseline eGFR (<45 mL/min/1.73 m(2)) or baseline proteinuria are particularly at risk for eGFR-related declines in hematocrit.
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Affiliation(s)
- Teresa K Chen
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle M Estrella
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Brad C Astor
- Division of Nephrology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Tom Greene
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Xuelei Wang
- Center for Clinical Investigation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Morgan E Grams
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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Kim CH, Kim SJ, Lee MJ, Kwon YE, Kim YL, Park KS, Ryu HJ, Oh HJ, Han SH, Yoo TH, Kim YL, Kim YS, Yang CW, Kim NH, Kang SW, Park JT. LDL Cholesterol Affects Clinical Outcomes in Incident Hemodialysis Patients During the Early Stages of Dialysis. Blood Purif 2014; 38:131-9. [DOI: 10.1159/000367803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022]
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Peev V, Nayer A, Contreras G. Dyslipidemia, malnutrition, inflammation, cardiovascular disease and mortality in chronic kidney disease. Curr Opin Lipidol 2014; 25:54-60. [PMID: 24345987 DOI: 10.1097/mol.0000000000000045] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Dyslipidemia, malnutrition and inflammation are common in patients with chronic kidney disease (CKD) and are strongly associated with cardiovascular disease (CVD) and increased mortality. The epidemiology of dyslipidemia and its interactions with malnutrition and inflammation in CKD patients have been the subject of much interest in the past decade. Recent clinical trials have explored the effects of statins on CVD specifically in CKD patients. RECENT FINDINGS Whereas the risk relationship between total cholesterol level and CVD morbidity and mortality is direct, strong and progressive in CKD patients without malnutrition and inflammation, it is inconsistent and often paradoxical in those with malnutrition and inflammation. Accumulating evidence demonstrates that statins reduce significantly the risk of CVD in CKD patients before the initiation of dialysis. However, the beneficial effect of statins in CKD patients on dialysis is uncertain. In CKD patients on dialysis, malnutrition and inflammation pose a higher risk for CVD than dyslipidemia. SUMMARY In CKD patients, the risk of CVD associated to dyslipidemia is complex and is modified by malnutrition and inflammation.
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Affiliation(s)
- Vasil Peev
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Chen SC, Hung CC, Tsai YC, Huang JC, Kuo MC, Lee JJ, Chiu YW, Chang JM, Hwang SJ, Chen HC. Association of cholesterol levels with mortality and cardiovascular events among patients with CKD and different amounts of proteinuria. Clin J Am Soc Nephrol 2013; 8:1915-26. [PMID: 23929929 PMCID: PMC3817903 DOI: 10.2215/cjn.02350213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/12/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Malnutrition and/or inflammation may modify the risk relationship of total cholesterol with cardiovascular disease in CKD patients. However, it is unclear whether the relationship of total cholesterol with cardiovascular events and mortality varies by proteinuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study enrolled 3303 patients with CKD stages 3-5 from a medical center and a regional hospital between November of 2002 and May of 2009 and followed the patients until July of 2010. RESULTS During a median 2.8-year follow-up, there were 471 (14.3%) deaths and 545 (16.5%) cardiovascular events. In an adjusted Cox model, the two highest quartiles of total cholesterol (hazard ratio, 1.90; 95% confidence interval, 1.16 to 3.13 and hazard ratio, 2.00; 95% confidence interval, 1.18 to 3.39 versus quartile 1, respectively) were associated with a significant higher risk of all-cause mortality in patients with urine protein-to-creatinine ratio<1 g/g (n=1535), but this higher risk was not seen in those patients with urine protein-to-creatinine ratio ≥ 1 g/g (n=1768; hazard ratio, 0.75; 95% confidence interval, 0.53 to 1.07 and hazard ratio, 0.70; 95% confidence interval, 0.49 to 1.02 versus quartile 1, respectively). The interaction between total cholesterol and proteinuria with all-cause mortality was significant (interaction, P=0.05). However, the relationship between total cholesterol and cardiovascular events did not significantly differ by proteinuria (interaction, P=0.91). CONCLUSIONS The association between cholesterol and mortality is different among patients with different levels of proteinuria. Large-scale clinical trials to evaluate the mortality benefit should specifically target lowering hypercholesterolemia in CKD patients with different levels of proteinuria.
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Affiliation(s)
- Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
- Faculties of Medicine and
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculties of Medicine and
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
| | - Mei-Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculties of Medicine and
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
- Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hung SC, Lin YP, Huang HL, Pu HF, Tarng DC. Aldosterone and mortality in hemodialysis patients: role of volume overload. PLoS One 2013; 8:e57511. [PMID: 23469009 PMCID: PMC3585342 DOI: 10.1371/journal.pone.0057511] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/22/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Elevated aldosterone is associated with increased mortality in the general population. In patients on dialysis, however, the association is reversed. This paradox may be explained by volume overload, which is associated with lower aldosterone and higher mortality. METHODS We evaluated the relationship between aldosterone and outcomes in a prospective cohort of 328 hemodialysis patients stratified by the presence or absence of volume overload (defined as extracellular water/total body water >48%, as measured with bioimpedance). Baseline plasma aldosterone was measured before dialysis and categorized as low (<140 pg/mL), middle (140 to 280 pg/mL) and high (>280 pg/mL). RESULTS Overall, 36% (n = 119) of the hemodialysis patients had evidence of volume overload. Baseline aldosterone was significantly lower in the presence of volume overload than in its absence. During a median follow-up of 54 months, 83 deaths and 70 cardiovascular events occurred. Cox multivariate analysis showed that by using the low aldosterone as the reference, high aldosterone was inversely associated with decreased hazard ratios for mortality (0.49; 95% confidence interval, 0.25-0.76) and first cardiovascular event (0.70; 95% confidence interval, 0.33-0.78) in the presence of volume overload. In contrast, high aldosterone was associated with an increased risk for mortality (1.97; 95% confidence interval, 1.69-3.75) and first cardiovascular event (2.01; 95% confidence interval, 1.28-4.15) in the absence of volume overload. CONCLUSIONS The inverse association of aldosterone with adverse outcomes in hemodialysis patients is due to the confounding effect of volume overload. These findings support treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control.
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Affiliation(s)
- Szu-Chun Hung
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, and Immunology Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Lei Huang
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Fung Pu
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, and Immunology Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Association of dyslipidemia with renal outcomes in chronic kidney disease. PLoS One 2013; 8:e55643. [PMID: 23390545 PMCID: PMC3563532 DOI: 10.1371/journal.pone.0055643] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/28/2012] [Indexed: 11/19/2022] Open
Abstract
Dyslipidemia is highly prevalent in patients with chronic kidney disease (CKD) and the relationship between dyslipidemia with renal outcomes in patients with moderate to advanced CKD remains controversial. Hence, our objective is to determine whether dyslipidemia is independently associated with rapid renal progression and progression to renal replacement therapy (RRT) in CKD patients. The study analyzed the association between lipid profile, RRT, and rapid renal progression (estimated glomerular filtration rate [eGFR] slope <-6 ml/min/1.73 m(2)/yr) in 3303 patients with stages 3 to 5 CKD. During a median 2.8-year follow-up, 1080 (32.3%) participants commenced RRT and 841 (25.5%) had rapid renal progression. In the adjusted models, the lowest quintile (hazard ratios [HR], 1.23; 95% confidence interval [CI], 1.01 to 1.49) and the highest two quintiles of total cholesterol (HR, 1.25; 95% CI, 1.02 to 1.52 and HR, 1.35; 95% CI, 1.11 to 1.65 respectively) increased risks for RRT (vs. quintile 2). Besides, the highest quintile of total cholesterol was independently associated with rapid renal progression (odds ratio, 1.36; 95% CI, 1.01 to 1.83). Our study demonstrated that certain levels of dyslipidemia were independently associated with RRT and rapid renal progression in CKD stage 3-5. Assessment of lipid profile may help identify high risk groups with adverse renal outcomes.
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Lamprea-Montealegre JA, Astor BC, McClelland RL, de Boer IH, Burke GL, Sibley CT, O'Leary D, Sharrett AR, Szklo M. CKD, plasma lipids, and common carotid intima-media thickness: results from the multi-ethnic study of atherosclerosis. Clin J Am Soc Nephrol 2012; 7:1777-85. [PMID: 22879436 DOI: 10.2215/cjn.02090212] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Altered levels of atherogenic lipoproteins have been shown to be common in mild kidney dysfunction. This study sought to determine the associations between plasma lipids (including LDL particle distribution) and subclinical atherosclerosis measured by the common carotid intima-media thickness (IMT) across levels of estimated GFR (eGFR) and to assess whether inflammation modifies these associations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Cross-sectional analyses of 6572 participants in the Multi-Ethnic Study of Atherosclerosis enrolled from 2000 to 2002 were performed. RESULTS CKD, defined as eGFR <60 ml/min per 1.73 m(2), was present in 853 individuals (13.0%). Associations of total cholesterol and LDL cholesterol (LDL-C) with IMT were J shaped, particularly among participants with CKD (P value for interaction, P=0.01). HDL cholesterol (HDL-C) and small-dense LDL-C were consistently and linearly associated with IMT across levels of eGFR. The results showed differences in IMT of -21.41 (95% confidence interval, -41.00, -1.57) in eGFR ≥60 and -58.49 (-126.61, 9.63) in eGFR <60 per unit difference in log-transformed HDL-C, and 4.83 (3.16, 6.50) in eGFR ≥60 and 7.48 (1.45, 13.50) in eGFR <60 per 100 nmol/L difference in small-dense LDL. Among participants with CKD, inflammation significantly modified the associations of total cholesterol and LDL-C with IMT (P values for interaction, P<0.01 and P<0.001, respectively). CONCLUSIONS Compared with total cholesterol and LDL-C, abnormalities in HDL-C and small-dense LDL-C are more strongly and consistently associated with subclinical atherosclerosis in CKD. Inflammation modifies the association between total cholesterol and LDL-C with IMT.
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Statins and kidney disease: is the study of heart and renal protection at the cutting edge of evidence? Curr Opin Cardiol 2012; 27:429-40. [PMID: 22678410 DOI: 10.1097/hco.0b013e328353b988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Dyslipidaemias are noted in all stages of chronic kidney disease (CKD). Currently most evidence for their treatment comes from secondary retrospective analyses of patient subgroups with CKD recruited into clinical trials powered of hypertensive and dyslipideamic cohorts powered for cardiovascular endpoints.These analyses suggest a number of different beneficial effects of statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) on renal, cardiovascular and mortality outcomes. However, there is disagreement on the impact of interventions at different CKD stages, and on treatment targets. RECENT FINDINGS The Study of Heart and Renal Protection (SHARP) trial published in June 2011 was the first trial specifically powered to investigate atherosclerotic outcomes in CKD patients. It found a 17% overall reduction in major adverse cardiac events in the statin-treated group compared with placebo, yet no effect on any renal outcomes of proteinuria and progressive decline of glomerular filtration rate. Furthermore, the Swedish Web-system for Enhancement and Development of Evidencebased care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) investigators provided further important observational data on the beneficial effect of statins in CKD stages I-IV. SUMMARY The evidence that statins have a cardiovascular and mortality benefit in CKD stages I-IV has been reinforced by SHARP, which also definitively shows that there are no special safety concerns for their administration in CKD. However, the utility of the use of statins in patients on dialysis is far from clear, at least in our opinion. The effect of statins on renal outcomes is unconvincing and the evidence does not presently support their use for these indications alone.
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Chertow GM, Correa-Rotter R, Block GA, Drueke TB, Floege J, Goodman WG, Herzog CA, Kubo Y, London GM, Mahaffey KW, Mix TC, Moe SM, Wheeler DC, Parfrey PS. Baseline characteristics of subjects enrolled in the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) trial. Nephrol Dial Transplant 2012; 27:2872-9. [PMID: 22529163 DOI: 10.1093/ndt/gfr777] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (sHPT) and other abnormalities associated with chronic kidney disease-mineral bone disorder can contribute to dystrophic (including vascular) calcification. Dietary modification and variety of medications can be used to attenuate the severity of sHPT. However, it is unknown whether any of these approaches can reduce the high risks of death and cardiovascular disease in patients with end-stage renal disease. METHODS The Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) trial was designed to test the hypothesis that treatment with the calcimimetic agent cinacalcet compared with placebo (on a background of conventional therapy including phosphate binders +/- vitamin D sterols) reduces time to death or non-fatal cardiovascular events (specifically myocardial infarction, unstable angina, heart failure and peripheral arterial disease events) among patients on hemodialysis with sHPT. This report describes baseline characteristics of enrolled subjects with a focus on regional variation. RESULTS There were 3883 subjects randomized from 22 countries, including the USA, Canada, Australia, three Latin American nations, Russia and 15 European nations. The burden of overt cardiovascular disease at baseline was high (e.g. myocardial infarction 12.4%, heart failure 23.3%). The median plasma parathyroid hormone concentration at baseline was 692 pg/mL (10%, 90% range, 363-1694 pg/mL). At baseline, 87.2% of subjects were prescribed phosphate binders and 57.5% were prescribed activated vitamin D derivatives. Demographic data, comorbid conditions and baseline laboratory data varied significantly across regions. CONCLUSIONS EVOLVE enrolled 3883 subjects on hemodialysis with moderate to severe sHPT. Inclusion of subjects from multiple global regions with varying degrees of disease severity will enhance the external validity of the trial results.
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Choi SR, Lim JH, Kim MY, Hong YA, Chung BH, Chung S, Choi BS, Yang CW, Kim YS, Chang YS, Park CW. Cinacalcet Improves Endothelial Dysfunction and Cardiac Hypertrophy in Patients on Hemodialysis with Secondary Hyperparathyroidism. ACTA ACUST UNITED AC 2012; 122:1-8. [DOI: 10.1159/000347145] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/15/2013] [Indexed: 11/19/2022]
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Inflammation as a risk factor and target for therapy in chronic kidney disease. Curr Opin Nephrol Hypertens 2011; 20:662-8. [DOI: 10.1097/mnh.0b013e32834ad504] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bonanni A, Mannucci I, Verzola D, Sofia A, Saffioti S, Gianetta E, Garibotto G. Protein-energy wasting and mortality in chronic kidney disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:1631-54. [PMID: 21655142 PMCID: PMC3108132 DOI: 10.3390/ijerph8051631] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 02/06/2023]
Abstract
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome.
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Affiliation(s)
- Alice Bonanni
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy; E-Mails: (A.B.); (I.M.); (D.V.); (A.S.); (S.S.)
| | - Irene Mannucci
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy; E-Mails: (A.B.); (I.M.); (D.V.); (A.S.); (S.S.)
| | - Daniela Verzola
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy; E-Mails: (A.B.); (I.M.); (D.V.); (A.S.); (S.S.)
| | - Antonella Sofia
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy; E-Mails: (A.B.); (I.M.); (D.V.); (A.S.); (S.S.)
| | - Stefano Saffioti
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy; E-Mails: (A.B.); (I.M.); (D.V.); (A.S.); (S.S.)
| | - Ezio Gianetta
- Department of Surgery, Azienda Ospedale Università San Martino, Genoa University, Largo R. Benzi, Genoa, Italy; E-Mail:
| | - Giacomo Garibotto
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa University, Viale Benedetto XV 6, Genoa, Italy; E-Mails: (A.B.); (I.M.); (D.V.); (A.S.); (S.S.)
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