1
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Parks AL, Stevens SM, Woller SC. Anticoagulant therapy in renal insufficiency theme: Anticoagulation in complex situations. Thromb Res 2024; 241:109097. [PMID: 39094333 DOI: 10.1016/j.thromres.2024.109097] [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: 12/08/2023] [Revised: 04/12/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
Many patients with impaired renal function have concurrent indications for anticoagulant therapy, including atrial fibrillation and venous thromboembolism. For mild chronic kidney disease, data from clinical trials and existing guidelines can be applied to clinical management. The benefits and harms of anticoagulation therapy in patients with more advanced renal impairment are nuanced, as both thrombotic and bleeding risk are increased. Until recently, data regarding anticoagulants in severe renal impairment were primarily observational, but emerging evidence includes a few small clinical trials and the emergence of novel agents hypothesized to have improved efficacy and safety in this population. In this review, we summarize existing data on anticoagulation in patients with chronic kidney disease. We suggest a framework for anticoagulation decision-making in the burgeoning worldwide population of patients with chronic kidney disease.
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Affiliation(s)
- Anna L Parks
- Division of Hematology & Hematologic Malignancies, Department of Internal Medicine, University of Utah, United States of America.
| | - Scott M Stevens
- Department of Medicine, Intermountain Medical Center, Intermountain Health, United States of America; Division of General Internal Medicine, Department of Internal Medicine, University of Utah, United States of America
| | - Scott C Woller
- Department of Medicine, Intermountain Medical Center, Intermountain Health, United States of America; Division of General Internal Medicine, Department of Internal Medicine, University of Utah, United States of America
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Ameen K, Airhihenbuwa C. Expanding Bystander Behavioral Approaches to Address Racial Violence in Health Research, Pedagogy, and Practice. Health Promot Pract 2024:15248399241269996. [PMID: 39138834 DOI: 10.1177/15248399241269996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
A bystander to racial violence is conventionally thought of as someone who witnesses an overt act of racial oppression at the interpersonal level, such as police brutality. However, racial violence in health research, pedagogy, and practice often shows up more covertly, like through epistemic injustice, deficits-based framing, and racial essentialism. We aim to expand how we think about bystanders and perpetrators of racial violence within health institutions, and how antiracism bystander behavioral approaches can be deployed to intervene against such violence. Existing public health antiracism frameworks, such as the Public Health Critical Race Praxis and the PEN-3 Cultural Model, offer valuable constructs and processes through which health practitioners, researchers, and academics can disrupt racial violence. Such antiracism frameworks are well suited to provide individuals within public health and health care with the knowledge, skills, and efficacy to intervene as engaged bystanders against racism within their contexts. To illustrate how constructs within antiracism frameworks can be applied by bystanders in various health settings, we outline case examples of antiracism bystander interventions across three scenarios. The more bystanders there are within health institutions that are equipped with antiracism tools, the more likely normative behaviors uplifting White supremacy within these institutions can be disrupted and health equity can be actualized.
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3
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Peled Y, Ducharme A, Kittleson M, Bansal N, Stehlik J, Amdani S, Saeed D, Cheng R, Clarke B, Dobbels F, Farr M, Lindenfeld J, Nikolaidis L, Patel J, Acharya D, Albert D, Aslam S, Bertolotti A, Chan M, Chih S, Colvin M, Crespo-Leiro M, D'Alessandro D, Daly K, Diez-Lopez C, Dipchand A, Ensminger S, Everitt M, Fardman A, Farrero M, Feldman D, Gjelaj C, Goodwin M, Harrison K, Hsich E, Joyce E, Kato T, Kim D, Luong ML, Lyster H, Masetti M, Matos LN, Nilsson J, Noly PE, Rao V, Rolid K, Schlendorf K, Schweiger M, Spinner J, Townsend M, Tremblay-Gravel M, Urschel S, Vachiery JL, Velleca A, Waldman G, Walsh J. International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024. J Heart Lung Transplant 2024:S1053-2498(24)01679-6. [PMID: 39115488 DOI: 10.1016/j.healun.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 08/18/2024] Open
Abstract
The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.
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Affiliation(s)
- Yael Peled
- Leviev Heart & Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Anique Ducharme
- Deparment of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
| | - Michelle Kittleson
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neha Bansal
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Diyar Saeed
- Heart Center Niederrhein, Helios Hospital Krefeld, Krefeld, Germany
| | - Richard Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Brian Clarke
- Division of Cardiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Maryjane Farr
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX; Parkland Health System, Dallas, TX, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | | | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Deepak Acharya
- Division of Cardiovascular Diseases, University of Arizona Sarver Heart Center, Tucson, Arizona, USA
| | - Dimpna Albert
- Department of Paediatric Cardiology, Paediatric Heart Failure and Cardiac Transplant, Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alejandro Bertolotti
- Heart and Lung Transplant Service, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Michael Chan
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Sharon Chih
- Heart Failure and Transplantation, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Monica Colvin
- Department of Cardiology, University of Michigan, Ann Arbor, MI; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Maria Crespo-Leiro
- Cardiology Department Complexo Hospitalario Universitario A Coruna (CHUAC), CIBERCV, INIBIC, UDC, La Coruna, Spain
| | - David D'Alessandro
- Massachusetts General Hospital, Boston; Harvard School of Medicine, Boston, MA, USA
| | - Kevin Daly
- Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Carles Diez-Lopez
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anne Dipchand
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Melanie Everitt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander Fardman
- Leviev Heart & Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Marta Farrero
- Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - David Feldman
- Newark Beth Israel Hospital & Rutgers University, Newark, NJ, USA
| | - Christiana Gjelaj
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew Goodwin
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kimberly Harrison
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eileen Hsich
- Cleveland Clinic Foundation, Division of Cardiovascular Medicine, Cleveland, OH, USA
| | - Emer Joyce
- Department of Cardiology, Mater University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Tomoko Kato
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Daniel Kim
- University of Alberta & Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Me-Linh Luong
- Division of Infectious Disease, Department of Medicine, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Haifa Lyster
- Department of Heart and Lung Transplantation, The Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Johan Nilsson
- Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden
| | | | - Vivek Rao
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Katrine Rolid
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kelly Schlendorf
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Joseph Spinner
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Madeleine Townsend
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Maxime Tremblay-Gravel
- Deparment of Medicine, Montreal Heart Institute, Université?de Montréal, Montreal, Quebec, Canada
| | - Simon Urschel
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Luc Vachiery
- Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Bruxelles, Belgium
| | - Angela Velleca
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Georgina Waldman
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - James Walsh
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane; Heart Lung Institute, The Prince Charles Hospital, Brisbane, Australia
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Alghannam K, Fine J, Howard B, Loza J, Goussous NM, Sageshima J, Mineyev NM, Wang AX, Perez RV, Than PA. Impact of Warm Ischemia Time on Donation After Circulatory Death Kidney Transplant Outcomes. Clin Transplant 2024; 38:e15436. [PMID: 39158959 DOI: 10.1111/ctr.15436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Efforts to address the shortage of donor organs include increasing the use of renal allografts from donors after circulatory death (DCD). While warm ischemia time (WIT) is thought to be an important factor in DCD kidney evaluation, few studies have compared the relationship between WIT and DCD kidney outcomes, and WIT acceptance practices remain variable. METHODS We conducted a single-center retrospective review of all adult patients who underwent deceased donor kidney transplantation from 2000 to 2021. We evaluated the impact of varied functional warm ischemia time (fWIT) in controlled DCD donors by comparing donor and recipient characteristics and posttransplant outcomes between high fWIT (>60 min), low fWIT (≤60 min), and kidneys transplanted from donors after brain death (DBD). RESULTS Two thousand eight hundred eleven patients were identified, 638 received low fWIT DCD, 93 received high fWIT DCD, and 2080 received DBD kidneys. There was no significant difference in 5-year graft survival between the DCD low fWIT, high fWIT, and DBD groups, with 84%, 83%, and 83% of grafts functioning, respectively. Five-year patient survival was 91% in the low fWIT group, 92% in the high fWIT group, and 90% in the DBD group. An increase in kidney donor risk index (KDRI) (HR 3.37, 95% CI = 2.1-5.7) and high CIT compared to low CIT (HR 2.12, 95% CI = 1.4-3.1) have higher hazard ratios for 1-year graft failure. CONCLUSIONS Increased acceptance of kidneys from selected DCD donors with prolonged fWIT may present an opportunity to increase kidney utilization while preserving outcomes. Our group specifically prioritizes the use of kidneys from younger donors, with lower KDPI, and without acute kidney injury, or risk factors for underlying chronic kidney disease.
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Affiliation(s)
- Karima Alghannam
- Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Brian Howard
- University of California Davis School of Medicine, Sacramento, California, USA
| | - Jennifer Loza
- Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA
| | - Naeem M Goussous
- Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA
| | - Junichiro Sageshima
- Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA
| | - Neal M Mineyev
- Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA
| | - Aileen X Wang
- Division of Transplant Nephrology, Department of Medicine, University of California Davis Health, Sacramento, California, USA
| | - Richard V Perez
- Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA
| | - Peter A Than
- Division of Transplantation & Hepatobiliary Surgery, Department of Surgery, University of California San Diego Health, La Jolla, California, USA
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Groothof D, Shehab NB, Erler NS, Post A, Kremer D, Polinder‐Bos HA, Gansevoort RT, Groen H, Pol RA, Gans RO, Bakker SJ. Creatinine, cystatin C, muscle mass, and mortality: Findings from a primary and replication population-based cohort. J Cachexia Sarcopenia Muscle 2024; 15:1528-1538. [PMID: 38898741 PMCID: PMC11294032 DOI: 10.1002/jcsm.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/04/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Serum creatinine is used as initial test to derive eGFR and confirmatory testing with serum cystatin C is recommended when creatinine-based eGFR is considered less accurate due to deviant muscle mass. Low muscle mass is associated with increased risk of premature mortality. However, the associations of serum creatinine and cystatin C with muscle mass and mortality remain unclear and require further investigation to better inform clinical decision-making. METHODS We included 8437 community-dwelling adults enrolled in the Dutch PREVEND study and 5033 in the US NHANES replication cohort. Associations of serum creatinine and/or cystatin C with muscle mass surrogates and mortality were quantified with linear and Cox proportional hazards regression, respectively. Missing observations in covariates were multiply imputed using Substantive Model Compatible Fully Conditional Specification. RESULTS Mean (SD) age of PREVEND and NHANES participants (50% and 48% male) were 49.8 (12.6) and 48.7 (18.7) years, respectively. Median (Q1-Q3) serum creatinine and cystatin C were 71 (61-80) and 80 (62-88) μmol/L and 0.87 (0.78-0.98) and 0.91 (0.80-1.10) mg/L, respectively. Higher serum creatinine was associated with greater muscle mass, while serum cystatin C was not associated with muscle mass. Adjusting both markers for each other strengthened the positive relationship between serum creatinine and muscle mass and revealed an inverse association between serum cystatin C and muscle mass. In the PREVEND cohort, 1636 (19%) deaths were registered over a median follow-up of 12.9 (5.8-16.3) years with a 10-year mortality rate (95% CI) of 7.6% (7.1-8.2%). In the NHANES, 1273 (25%) deaths were registered over a median follow-up of 17.9 (17.3-18.5) years with a 10-year mortality rate of 13.8% (12.8-14.7%). Both markers were associated with increased mortality. Notably, when adjusted for each other, higher serum creatinine was associated with decreased mortality, while the association between serum cystatin C and increased mortality strengthened. The shapes of the associations in the PREVEND study and NHANES were almost identical. CONCLUSIONS The strong association between serum creatinine and muscle mass challenges its reliability as GFR marker, necessitating a more cautious approach in its clinical use. The minimal association between serum cystatin C and muscle mass supports its increased use as a more reliable alternative in routine clinical practice.
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Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Naser B.N. Shehab
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Nicole S. Erler
- Department of BiostatisticsErasmus Medical Center, Erasmus University RotterdamRotterdamthe Netherlands
- Department of EpidemiologyErasmus Medical Center, Erasmus University RotterdamRotterdamthe Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Harmke A. Polinder‐Bos
- Department of Internal MedicineErasmus Medical Center, Erasmus University RotterdamRotterdamthe Netherlands
| | - Ron T. Gansevoort
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Henk Groen
- Department of EpidemiologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Robert A. Pol
- Department of Surgery, Division of Vascular and Transplantation SurgeryUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Reinold O.B. Gans
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
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6
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Tesfaye H, Wang KM, Zabotka LE, Wexler DJ, Schmedt N, Koeneman L, Seman L, Paik JM, Patorno E. Empagliflozin and Risk of Incident Gout: Analysis from the EMPagliflozin Comparative Effectiveness and SafEty (EMPRISE) Cohort Study. J Gen Intern Med 2024; 39:1870-1879. [PMID: 38710868 PMCID: PMC11282041 DOI: 10.1007/s11606-024-08793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Hyperuricemia is frequently observed in patients with type 2 diabetes (T2D) and is associated with increased risk of gout and cardiovascular disease (CVD). Empagliflozin lowers serum urate levels by enhancing its urinary excretion. OBJECTIVE To compare initiators of empagliflozin vs dipeptidyl peptidase-4 inhibitor (DPP4i) and initiators of empagliflozin vs glucagon-like peptide-1 receptor agonist (GLP-1RA) with respect to the risk of incident gout events. DESIGN AND PARTICIPANTS Using three claims-based datasets from 08/2014 to 09/2019, we generated two cohorts (cohort 1: empagliflozin vs DPP4i; cohort 2: empagliflozin vs GLP-1RA) of adult patients with T2D and without prior history of gout or gout-specific medication dispensing separately in each dataset. To assess the risk of incident gout, we estimated hazard ratios (HR) and rate differences (RD) per 1000 person-years (PY) with their 95% confidence intervals (CI) before and after 1:1 propensity score (PS) matching adjusting for 141 baseline covariates. KEY RESULTS We identified 102,262 pairs of 1:1 propensity score-matched adults in cohort 1 and 131,216 pairs in cohort 2. Over a mean follow-up period of 8 months on treatment, the risk of gout was lower in patients initiating empagliflozin compared to DPP4i (HR = 0.69: 95% CI (0.60-0.79); RD = - 2.27: 95% CI (- 3.08, 1.46)) or GLP-1RA (HR = 0.83: 95% CI (0.73-0.94); RD = - 0.99: 95% CI (- 1.66, - 0.32)). Results were consistent across subgroups (sex, age, body mass index, chronic kidney disease, heart failure, cardiovascular disease, and concurrent diuretic use) and sensitivity analyses. CONCLUSIONS Among adults with T2D, the initiation of empagliflozin vs a DPP4i or GLP-1RA was associated with lower risk of incident gout, complementing results from a post hoc analysis of the EMPA-REG OUTCOME trial and previously published observational research focusing on the sodium-glucose co-transporter-2 inhibitor class in more narrowly defined study populations.
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Affiliation(s)
- Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Katherine M Wang
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Luke E Zabotka
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Deborah J Wexler
- MGH Diabetes Center, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Niklas Schmedt
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Leo Seman
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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7
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Jones AC, Patki A, Srinivasasainagendra V, Tiwari HK, Armstrong ND, Chaudhary NS, Limdi NA, Hidalgo BA, Davis B, Cimino JJ, Khan A, Kiryluk K, Lange LA, Lange EM, Arnett DK, Young BA, Diamantidis CJ, Franceschini N, Wassertheil-Smoller S, Rich SS, Rotter JI, Mychaleckyj JC, Kramer HJ, Chen YDI, Psaty BM, Brody JA, de Boer IH, Bansal N, Bis JC, Irvin MR. Single-Ancestry versus Multi-Ancestry Polygenic Risk Scores for CKD in Black American Populations. J Am Soc Nephrol 2024:00001751-990000000-00377. [PMID: 39073889 DOI: 10.1681/asn.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
Key Points
The predictive performance of an African ancestry–specific polygenic risk score (PRS) was comparable to a European ancestry–derived PRS for kidney traits.However, multi-ancestry PRSs outperform single-ancestry PRSs in Black American populations.Predictive accuracy of PRSs for CKD was improved with the use of race-free eGFR.
Background
CKD is a risk factor of cardiovascular disease and early death. Recently, polygenic risk scores (PRSs) have been developed to quantify risk for CKD. However, African ancestry populations are underrepresented in both CKD genetic studies and PRS development overall. Moreover, European ancestry–derived PRSs demonstrate diminished predictive performance in African ancestry populations.
Methods
This study aimed to develop a PRS for CKD in Black American populations. We obtained score weights from a meta-analysis of genome-wide association studies for eGFR in the Million Veteran Program and Reasons for Geographic and Racial Differences in Stroke Study to develop an eGFR PRS. We optimized the PRS risk model in a cohort of participants from the Hypertension Genetic Epidemiology Network. Validation was performed in subsets of Black participants of the Trans-Omics in Precision Medicine Consortium and Genetics of Hypertension Associated Treatment Study.
Results
The prevalence of CKD—defined as stage 3 or higher—was associated with the PRS as a continuous predictor (odds ratio [95% confidence interval]: 1.35 [1.08 to 1.68]) and in a threshold-dependent manner. Furthermore, including APOL1 risk status—a putative variant for CKD with higher prevalence among those of sub-Saharan African descent—improved the score's accuracy. PRS associations were robust to sensitivity analyses accounting for traditional CKD risk factors, as well as CKD classification based on prior eGFR equations. Compared with previously published PRS, the predictive performance of our PRS was comparable with a European ancestry–derived PRS for kidney traits. However, single-ancestry PRSs were less predictive than multi-ancestry–derived PRSs.
Conclusions
In this study, we developed a PRS that was significantly associated with CKD with improved predictive accuracy when including APOL1 risk status. However, PRS generated from multi-ancestry populations outperformed single-ancestry PRS in our study.
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Affiliation(s)
- Alana C Jones
- Medical Scientist Training Program, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amit Patki
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Vinodh Srinivasasainagendra
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hemant K Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicole D Armstrong
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ninad S Chaudhary
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nita A Limdi
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bertha A Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brittney Davis
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - James J Cimino
- Department of Biomedical Informatics and Data Science, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Atlas Khan
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Leslie A Lange
- Department of Biomedical Informatics, University of Colorado-Anschutz, Aurora, Colorado
| | - Ethan M Lange
- Department of Biomedical Informatics, University of Colorado-Anschutz, Aurora, Colorado
| | - Donna K Arnett
- Office of the Provost, University of South Carolina, Columbia, South Carolina
| | - Bessie A Young
- Division of Nephrology, University of Washington, Seattle, Washington
| | | | - Nora Franceschini
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York
| | - Stephen S Rich
- Department of Genome Sciences, University of Virginia, Charlottesville, Virginia
| | - Jerome I Rotter
- Department of Pediatrics, The Institute for Translational Genomic and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbort-UCLA Medical Center, Torrance, California
| | - Josyf C Mychaleckyj
- Department of Genome Sciences, University of Virginia, Charlottesville, Virginia
| | - Holly J Kramer
- Departments of Public Health Sciences and Medicine, Loyola University Medical Center, Taywood, Illinois
| | - Yii-Der I Chen
- Department of Pediatrics, The Institute for Translational Genomic and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbort-UCLA Medical Center, Torrance, California
| | - Bruce M Psaty
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
| | - Ian H de Boer
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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8
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Tangri N, Alvarez CS, Arnold M, Barone S, Cebrián A, Chen H, De Nicola L, Järbrink K, Kanumilli N, Lim KS, Moriyama T, Pecoits Filho R, Ribeiro de Castro MC, Santamaria R, Schneider MP, Virgitti JB, Kushner P. Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real-world settings: Insights from REVEAL-CKD. Eur J Clin Invest 2024:e14282. [PMID: 39023418 DOI: 10.1111/eci.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Clinical practice guidelines for patients with chronic kidney disease (CKD) recommend regular monitoring and management of kidney function and CKD risk factors. However, the majority of patients with stage 3 CKD lack a diagnosis code, and data on the implementation of these recommendations in the real world are limited. AIM To assess the implementation of guideline-directed monitoring and management practices in the real world in patients with stage 3 CKD without a recorded diagnosis code. METHODS REVEAL-CKD (NCT04847531) is a multinational, observational study of patients with stage 3 CKD. Eligible patients had ≥2 consecutive estimated glomerular filtration rate (eGFR) measurements indicative of stage 3 CKD recorded >90 and ≤730 days apart, lacked an International Classification of Diseases 9/10 diagnosis code corresponding to CKD any time before and up to 6 months after the second eGFR measurement. Testing of key measures of care quality were assessed. RESULTS The study included 435,971 patients from 9 countries. In all countries, the prevalence of urinary albumin-creatinine ratio and albuminuria testing was low. Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker and statin prescriptions were highly variable, and sodium-glucose cotransporter-2 inhibitor prescriptions remained below 21%. Blood pressure measurements were recorded in 20.2%-89.9% of patients. CONCLUSIONS Overall, a large proportion of patients with evidence of stage 3 CKD did not receive recommended, guideline-directed monitoring and management. The variability in standard of care among countries demonstrates a clear opportunity to improve monitoring and management of these patients, most likely improving long-term outcomes.
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Affiliation(s)
- Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christian S Alvarez
- Cardiovascular, Renal and Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Matthew Arnold
- Real World Evidence Data & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Salvatore Barone
- Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Ana Cebrián
- Primary Care Center Cartagena Casco, Cartagena, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Hungta Chen
- Medical/Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Luca De Nicola
- Department of Advanced Medical and Surgical Sciences, Nephrology and Dialysis Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Krister Järbrink
- Cardiovascular, Renal and Metabolism Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Naresh Kanumilli
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kean-Seng Lim
- General Practice, Mt Druitt Medical Centre, Mount Druitt, New South Wales, Australia
| | | | - Roberto Pecoits Filho
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | | | - Rafael Santamaria
- Department of Nephrology, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Markus P Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Pamela Kushner
- Clinical Professor of Family Medicine, Department of Family Medicine, University of California Irvine Medical Center, Orange, California, USA
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9
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Cerdeña JP, Plaisime MV, Borrell LN. Race as a Risk Marker, Not a Risk Factor: Revising Race-Based Algorithms to Protect Racially Oppressed Patients. J Gen Intern Med 2024:10.1007/s11606-024-08919-z. [PMID: 38980468 DOI: 10.1007/s11606-024-08919-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
Emerging consensus in the medical and public health spheres encourages removing race and ethnicity from algorithms used in clinical decision-making. Although clinical algorithms remain appealing given their promise to lighten the cognitive load of medical practice and save time for providers, they risk exacerbating existing health disparities. Race is a strong risk marker of health outcomes, yet it is not a risk factor. The use of race as a factor in medical algorithms suggests that the effect of race is intrinsic to the patient or that its effects can be distinct or separated from other social and environmental variables. By contrast, incisive public health analysis coupled with a race-conscious perspective recognizes that race serves as a marker of countless other dynamic variables and that structural racism, rather than race, compromises the health of racially oppressed individuals. This perspective offers a historical and theoretical context for the current debates regarding the use of race in clinical algorithms, clinical and epidemiologic perspectives on "risk," and future directions for research and policy interventions that combat color-evasive racism and follow the principles of race-conscious medicine.
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Affiliation(s)
- Jessica P Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, CT, USA.
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
- Department of Anthropology, University of Connecticut, Storrs, CT, USA.
| | - Marie V Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Penn Program On Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, PA, USA
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
- Department of Surgery, Medical and Social Sciences, Universidad de Alcala, Henares Madrid, Spain
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10
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Harding JL, Gompers A, Di M, Drewery K, Pastan S, Rossi A, DuBay D, Gander JC, Patzer RE. Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation. Kidney Int Rep 2024; 9:2134-2145. [PMID: 39081771 PMCID: PMC11284440 DOI: 10.1016/j.ekir.2024.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Sex/gender inequities persist in access to kidney transplantation. Whether differences in preemptive referral (i.e., referral before dialysis start) explain this inequity remains unknown. Methods All adults (aged 18-79 years; N = 44,204) initiating kidney replacement therapy (KRT; dialysis or transplant) in Georgia (GA), North Carolina (NC), or South Carolina (SC) between 2015 and 2019 were identified from the United States Renal Data System (USRDS). Individuals were linked to the Early Steps to Kidney Transplant Access Registry (E-STAR) to obtain data on preemptive referral and followed-up with through November 13, 2020, for outcomes of waitlisting and living donor transplant. Logistic regression assessed the association between sex/gender and likelihood of preemptive referral among all KRT patients. Cox-proportional hazards assessed the association between sex/gender and waitlisting or living donor among preemptively referred patients. Results Overall, men and women were similarly likely to be preemptively referred (odds ratio [OR]: 0.99 [0.95-1.04]). Preemptively referred women (vs. men) were, on average, younger and with fewer comorbidities. There were no sex/gender differences in waitlisting once patients were preemptively referred (hazard ratio [HR]: 0.97 [0.91-1.03]); however, women (vs. men) who were preemptively referred remained 25% (HR: 0.75 [0.66-0.86]) less likely to receive a living donor transplant. Conclusion In the Southeast US, men and women initiating KRT are similarly likely to be preemptively referred for a kidney transplant, and this appears, at least in part, to mitigate known sex/gender inequities in access to waitlisting, but not living donor transplant. Despite this, preemptively referred women, on average, had a more favorable medical profile relative to preemptively referred men.
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Affiliation(s)
- Jessica L. Harding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Annika Gompers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mengyu Di
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kelsey Drewery
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Stephen Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia, USA
| | - Derek DuBay
- Prisma Healthcare, Charleston, South Carolina, USA
| | - Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Rachel E. Patzer
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
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11
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Nadim MK, Kellum JA, Forni L, Francoz C, Asrani SK, Ostermann M, Allegretti AS, Neyra JA, Olson JC, Piano S, VanWagner LB, Verna EC, Akcan-Arikan A, Angeli P, Belcher JM, Biggins SW, Deep A, Garcia-Tsao G, Genyk YS, Gines P, Kamath PS, Kane-Gill SL, Kaushik M, Lumlertgul N, Macedo E, Maiwall R, Marciano S, Pichler RH, Ronco C, Tandon P, Velez JCQ, Mehta RL, Durand F. Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting. J Hepatol 2024; 81:163-183. [PMID: 38527522 PMCID: PMC11193657 DOI: 10.1016/j.jhep.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
Patients with cirrhosis are prone to developing acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along with a risk of progression to chronic kidney disease. Whereas patients with cirrhosis are at increased risk of developing any phenotype of AKI, hepatorenal syndrome (HRS), a specific form of AKI (HRS-AKI) in patients with advanced cirrhosis and ascites, carries an especially high mortality risk. Early recognition of HRS-AKI is crucial since administration of splanchnic vasoconstrictors may reverse the AKI and serve as a bridge to liver transplantation, the only curative option. In 2023, a joint meeting of the International Club of Ascites (ICA) and the Acute Disease Quality Initiative (ADQI) was convened to develop new diagnostic criteria for HRS-AKI, to provide graded recommendations for the work-up, management and post-discharge follow-up of patients with cirrhosis and AKI, and to highlight priorities for further research.
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Affiliation(s)
- Mitra K Nadim
- Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lui Forni
- School of Medicine, University of Surrey and Critical Care Unit, Royal Surrey Hospital Guildford UK
| | - Claire Francoz
- Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France
| | | | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, London, UK
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jody C Olson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED, University and Hospital of Padova, Padova, Italy
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth C Verna
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Ayse Akcan-Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, University and Teaching Hospital of Padua, Italy
| | - Justin M Belcher
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Scott W Biggins
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akash Deep
- Pediatric Intensive Care Unit, King's College Hospital, London, UK
| | - Guadalupe Garcia-Tsao
- Digestive Diseases Section, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yuri S Genyk
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Abdominal Organ Transplantation at Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Pere Gines
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer and Ciber de Enfermedades Hepàticas y Digestivas, Barcelona, Catalonia, Spain
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Nuttha Lumlertgul
- Excellence Centre in Critical Care Nephrology and Division of Nephrology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California San Diego, CA, USA
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Raimund H Pichler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza-Italy
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Juan-Carlos Q Velez
- Department of Nephrology, Ochsner Health, New Orleans, LA, USA; Ochsner Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - François Durand
- Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France; University Paris Cité, Paris, France.
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12
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Luby SW. Evaluating Laboratory Communications to NKF-WG Recommended Stakeholders during Implementation of the CKD-EPI 2021 Equation. J Appl Lab Med 2024; 9:809-815. [PMID: 38507611 DOI: 10.1093/jalm/jfae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND In 2022, the National Kidney Foundation's Laboratory Engagement Working Group (NKF-WG) released recommendations for clinical implementation of the race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 estimated glomerular filtration rate (eGFR) equation.This study examined laboratory communications during CKD-EPI 2021 implementation including communication methods and delivery, content inclusion, and alignment with stakeholder inclusion as defined by the NKF-WG. METHODS An anonymous web-based survey was distributed to members of ADLM (AACC) and the American Society for Clinical Laboratory Science (ASCLS) in November 2022 to solicit laboratory directors of CLIA-licensed clinical laboratories in the United States. Seventeen questions covering topics related to implementation of CKD-EPI 2021, stakeholder inclusion, methods and timing of communications delivery, and content inclusion were surveyed. RESULTS All participating laboratories (n = 28) reported including physicians/advanced practitioners in implementation communications, while only 10.7% reported inclusion of patients. When reporting on methods of communication, 81.5% (n = 27) of respondents reported using multiple methods of communication with providers and 88.8% issued provider communications prior to implementation. In contrast, when patient communications were delivered, 87.5% (n = 8) issued these communications exclusively after CKD-EPI 2021 implementation and the majority (6 of 8) reported using only one method of communication during delivery. When reporting on content inclusion, 64.3% (n = 28) of laboratories reported including concerns regarding previous race-based eGFR equations in communications with physicians/advanced practitioners, while only 16.7% (n = 18) of those who included this information did so with patients. CONCLUSIONS Participants reported limited engagement in CKD-EPI 2021 laboratory-to-patient implementation communications as well as limited inclusion of additional stakeholder groups, as defined in the NKF-WG recommendations. Laboratories utilized multiple communication methods and deliveries in physician/advanced practitioner communications; however, this strategy was not replicated when engaging with additional NKF-WG stakeholder groups.
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Affiliation(s)
- Shawn W Luby
- Division of Clinical Laboratory Science, Department of Health Sciences, University of North Carolina at Chapell Hill, Chapel Hill, NC, United States
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13
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McDonald JS, McDonald RJ. Risk of Acute Kidney Injury Following IV Iodinated Contrast Media Exposure: 2023 Update, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol 2024; 223:e2330037. [PMID: 37791729 DOI: 10.2214/ajr.23.30037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Iodinated contrast material (ICM) has revolutionized the field of diagnostic radiology through improvements in diagnostic performance and the expansion of clinical indications for radiographic and CT examinations. Historically, nephrotoxicity was a feared complication of ICM use, thought to be associated with a significant risk of morbidity and mortality. Such fears often precluded the use of ICM in imaging evaluations, commonly at the expense of diagnostic performance and timely diagnosis. Over the past 20 years, the nephrotoxic risk of ICM has become a topic of debate, as more recent evidence from higher-quality studies now suggests that many cases of what was considered contrast-induced acute kidney injury (CI-AKI) likely were cases of mistaken causal attribution; most of these cases represented either acute kidney injury (AKI) caused by any of myriad other known factors that can adversely affect renal function and were coincidentally present at the time of contrast media exposure (termed "contrast-associated AKI" [CA-AKI]) or a manifestation of the normal variation in renal function that increases with worsening renal function. This Special Series Review discusses the current state of knowledge regarding CI-AKI and CA-AKI, including the incidence, risk factors, outcomes, and prophylactic strategies in the identification and management of these clinical conditions.
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Affiliation(s)
- Jennifer S McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Robert J McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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14
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Yin Y, Zhao C, Niu Y, Qi J, Zhang Y, Lu B. Associations between oxidative balance score and chronic kidney disease events in US adults: a population-based study. Sci Rep 2024; 14:13743. [PMID: 38877058 PMCID: PMC11178767 DOI: 10.1038/s41598-024-64147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
Oxidative Balance Scores (OBS) are utilized to assess an individual's antioxidant status, encompassing both dietary and lifestyle factors that contribute to oxidative balance. This study investigates the relationship between OBS and chronic kidney disease (CKD) prevalence among U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The study involved a cross-sectional analysis of 13,373 individuals from NHANES, focusing on adults aged 20 years or older. OBS was calculated using 20 components, including dietary and lifestyle factors. CKD was identified based on albumin-to-creatinine ratio and estimated glomerular filtration rate, with patients stratified into mild, moderate, and high-risk groups. Statistical analysis included logistic regression models and restricted cubic splines to explore the OBS-CKD relationship. Our findings indicate a statistically significant negative correlation between OBS and CKD prevalence, particularly in mild and moderate-risk groups. Higher OBS quartiles were associated with a decreased likelihood of CKD (OR 0.70; 95% CI 0.53-0.92; P = 0.013). Restricted cubic splines indicated a non-linear, inverse association between OBS and CKD odds for the overall population (P for nonlinearity = 0.017). For mild and moderate CKD risk groups, the relationships were less pronounced (P for nonlinearity = 0.053 and 0.184, respectively), suggesting variability in the OBS-CKD link across different risk levels. The study highlights the potential of elevated OBS as a primary prevention measure for CKD, particularly in individuals with mild to moderate risk. These findings underscore the importance of antioxidant status in CKD risk management and encourage further research into the role of dietary and lifestyle factors in CKD prevention.
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Affiliation(s)
- Yuewei Yin
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Chenming Zhao
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yalin Niu
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jinchun Qi
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yanping Zhang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Baosai Lu
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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15
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Diao JA, He Y, Khazanchi R, Nguemeni Tiako MJ, Witonsky JI, Pierson E, Rajpurkar P, Elhawary JR, Melas-Kyriazi L, Yen A, Martin AR, Levy S, Patel CJ, Farhat M, Borrell LN, Cho MH, Silverman EK, Burchard EG, Manrai AK. Implications of Race Adjustment in Lung-Function Equations. N Engl J Med 2024; 390:2083-2097. [PMID: 38767252 PMCID: PMC11305821 DOI: 10.1056/nejmsa2311809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. METHODS We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. RESULTS Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. CONCLUSIONS The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).
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Affiliation(s)
- James A Diao
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Yixuan He
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Rohan Khazanchi
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Max Jordan Nguemeni Tiako
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Jonathan I Witonsky
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Emma Pierson
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Pranav Rajpurkar
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Jennifer R Elhawary
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Luke Melas-Kyriazi
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Albert Yen
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Alicia R Martin
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Sean Levy
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Chirag J Patel
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Maha Farhat
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Luisa N Borrell
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Michael H Cho
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Edwin K Silverman
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Esteban G Burchard
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Arjun K Manrai
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
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16
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Whitney DG, Oliverio AL, Kreschmer J, Bolde S, Hurvitz EA, Wong KK. Feasibility and reliability of measured glomerular filtration rate with [I125]-iothalamate among young adults with mild-to-moderate cerebral palsy. Front Med (Lausanne) 2024; 11:1295104. [PMID: 38933110 PMCID: PMC11199527 DOI: 10.3389/fmed.2024.1295104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Objective Despite the need, measuring glomerular filtration rate (mGFR) is not routinely performed for adults with cerebral palsy (CP), possibly due to unknown feasibility given the secondary complications of CP. This study aimed to assess the feasibility and reliability of mGFR and explore factors associated with eGFR-mGFR discordance among young adults with mild-to-moderate CP. Methods This single-center, cross-sectional study included 18- to 40-year-olds with CP gross motor function classification system (GMFCS) I-III. The participants were excluded if they were pregnant/lactating, had cognitive impairments, or had contraindications to mGFR. A routine clinical protocol for mGFR and eGFR was used. mGFR feasibility was assessed based on the number of participants who completed testing. mGFR reliability was assessed using the coefficient of variation (CV) across the four 30 min intervals. The association between age, sex, and GMFCS and the percentage of eGFR-mGFR discordance was assessed. Results Of the 19 participants enrolled, 18 completed the testing [mean age (SD), 29.9 (7.4) years, n = 10 female participants, n = 10/3/5 for GMFCS I/II/III] and most (n = 15) of the participants had an mGFR >90 mL/min; 14 participants (77.8%) had a CV <20%, 2 had a CV between 20 and 25%, and 2 had a CV >50%. eGFR overestimated mGFR by a median (interquartile range) of approximately 17.5% (2-38%); the full range of mis-estimation was -20.5 to 174.3%. Increasing age and GMFCS levels exhibited notable, but weak-to-modest, associations with a larger eGFR-mGFR discordance. Discussion Obtaining mGFR was feasible and reasonably reliable within this small sample. eGFR overestimated mGFR by a notable amount, which may be associated with patient-level factors.
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Affiliation(s)
- Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Andrea L. Oliverio
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jodi Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Shannen Bolde
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, United States
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17
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Goldstein BA, Mohottige D, Bessias S, Cary MP. Enhancing Clinical Decision Support in Nephrology: Addressing Algorithmic Bias Through Artificial Intelligence Governance. Am J Kidney Dis 2024:S0272-6386(24)00791-1. [PMID: 38851444 DOI: 10.1053/j.ajkd.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 06/10/2024]
Abstract
There has been a steady rise in the use of clinical decision support (CDS) tools to guide nephrology as well as general clinical care. Through guidance set by federal agencies and concerns raised by clinical investigators, there has been an equal rise in understanding whether such tools exhibit algorithmic bias leading to unfairness. This has spurred the more fundamental question of whether sensitive variables such as race should be included in CDS tools. In order to properly answer this question, it is necessary to understand how algorithmic bias arises. We break down 3 sources of bias encountered when using electronic health record data to develop CDS tools: (1) use of proxy variables, (2) observability concerns and (3) underlying heterogeneity. We discuss how answering the question of whether to include sensitive variables like race often hinges more on qualitative considerations than on quantitative analysis, dependent on the function that the sensitive variable serves. Based on our experience with our own institution's CDS governance group, we show how health system-based governance committees play a central role in guiding these difficult and important considerations. Ultimately, our goal is to foster a community practice of model development and governance teams that emphasizes consciousness about sensitive variables and prioritizes equity.
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Affiliation(s)
- Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina; AI Health, School of Medicine, Duke University, Durham, North Carolina.
| | - Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophia Bessias
- AI Health, School of Medicine, Duke University, Durham, North Carolina
| | - Michael P Cary
- AI Health, School of Medicine, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina
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18
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Akbari A, El Wadia H, Knoll GA, White CA, Sood MM, Massicotte-Azarniouch D, McCudden C, Deschenes MJ, Salman M, Ramsay T, Hundemer GL. Comparison of eGFR Equations to Guide Dosing of Medications for Kidney Transplant Recipients. Transplantation 2024:00007890-990000000-00778. [PMID: 38831493 DOI: 10.1097/tp.0000000000005098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Clinicians caring for kidney transplant recipients (KTRs) most commonly use estimated glomerular filtration rate (eGFR) to guide medication dosing as it is the most readily available measure of kidney function. Which eGFR equations provide the most accurate medication dosing guidance for KTRs remains uncertain. METHODS We studied 415 stable KTRs in Canada and New Zealand. Participants completed same-day measurements of creatinine and cystatin C and measured GFR (diethylenetriaminepentaacetic acid). Chronic Kidney Disease Epidemiology Collaboration, European Kidney Function Consortium, and transplant-specific eGFR equations were compared with both Cockcroft-Gault creatinine clearance (CrCl) and measured GFR. eGFR equations were assessed both indexed to a standardized body surface area (BSA) of 1.73 m2 (milliliter per minute per 1.73 m2, as is conventional reporting from most clinical laboratories) and nonindexed (milliliter per minute) accounting for actual BSA. The primary outcome was the proportion of medication dosing discordance relative to Cockcroft-Gault CrCl or measured GFR for 8 commonly prescribed medications. Stratified analyses were performed on the basis of obesity status. RESULTS Nonindexed eGFR equations (milliliter per minute) resulted in substantially lower medication dosing discordance compared with indexed eGFR equations (milliliter per minute per 1.73 m2). These findings were most pronounced among KTRs with obesity, in whom underdosing was frequent. When compared with Cockcroft-Gault CrCl, the lowest proportion of discordance was found with the nonindexed 2023 transplant-specific equation. When compared with measured GFR, the lowest proportion of discordance was found with the nonindexed 2021 Chronic Kidney Disease Epidemiology CollaborationCr/CysC equation. CONCLUSIONS Nonindexed eGFR values accounting for actual BSA should be used by clinicians for medication dosing in KTRs. These findings may inform KT providers about which eGFR equations provide the safest, most accurate medication dosing guidance for KTRs.
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Affiliation(s)
- Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Hajar El Wadia
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Massicotte-Azarniouch
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher McCudden
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Josee Deschenes
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Maria Salman
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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19
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Handelsman Y, Anderson JE, Bakris GL, Ballantyne CM, Bhatt DL, Bloomgarden ZT, Bozkurt B, Budoff MJ, Butler J, Cherney DZI, DeFronzo RA, Del Prato S, Eckel RH, Filippatos G, Fonarow GC, Fonseca VA, Garvey WT, Giorgino F, Grant PJ, Green JB, Greene SJ, Groop PH, Grunberger G, Jastreboff AM, Jellinger PS, Khunti K, Klein S, Kosiborod MN, Kushner P, Leiter LA, Lepor NE, Mantzoros CS, Mathieu C, Mende CW, Michos ED, Morales J, Plutzky J, Pratley RE, Ray KK, Rossing P, Sattar N, Schwarz PEH, Standl E, Steg PG, Tokgözoğlu L, Tuomilehto J, Umpierrez GE, Valensi P, Weir MR, Wilding J, Wright EE. DCRM 2.0: Multispecialty practice recommendations for the management of diabetes, cardiorenal, and metabolic diseases. Metabolism 2024:155931. [PMID: 38852020 DOI: 10.1016/j.metabol.2024.155931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/10/2024]
Abstract
The spectrum of cardiorenal and metabolic diseases comprises many disorders, including obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), dyslipidemias, hypertension, and associated comorbidities such as pulmonary diseases and metabolism dysfunction-associated steatotic liver disease and metabolism dysfunction-associated steatohepatitis (MASLD and MASH, respectively, formerly known as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis [NAFLD and NASH]). Because cardiorenal and metabolic diseases share pathophysiologic pathways, two or more are often present in the same individual. Findings from recent outcome trials have demonstrated benefits of various treatments across a range of conditions, suggesting a need for practice recommendations that will guide clinicians to better manage complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. To meet this need, we formed an international volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM 2.0 Practice Recommendations, an updated and expanded revision of a previously published multispecialty consensus on the comprehensive management of persons living with DCRM. The recommendations are presented as 22 separate graphics covering the essentials of management to improve general health, control cardiorenal risk factors, and manage cardiorenal and metabolic comorbidities, leading to improved patient outcomes.
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Affiliation(s)
| | | | | | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Zachary T Bloomgarden
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Biykem Bozkurt
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | | - Stefano Del Prato
- Interdisciplinary Research Center "Health Science", Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | | | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Finnish Institute for Health and Helsinki University HospitalWelfare, Folkhälsan Research Center, Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Charles University, Prague, Czech Republic
| | | | - Paul S Jellinger
- The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA
| | | | - Samuel Klein
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Norman E Lepor
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Chantal Mathieu
- Department of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christian W Mende
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Morales
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Advanced Internal Medicine Group, PC, East Hills, NY, USA
| | - Jorge Plutzky
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus at the Technische Universität/TU Dresden, Dresden, Germany
| | - Eberhard Standl
- Munich Diabetes Research Group e.V. at Helmholtz Centre, Munich, Germany
| | - P Gabriel Steg
- Université Paris-Cité, Institut Universitaire de France, AP-HP, Hôpital Bichat, Cardiology, Paris, France
| | | | - Jaakko Tuomilehto
- University of Helsinki, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Paul Valensi
- Polyclinique d'Aubervilliers, Aubervilliers and Paris-Nord University, Paris, France
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John Wilding
- University of Liverpool, Liverpool, United Kingdom
| | - Eugene E Wright
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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20
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Hanna PE, Ouyang T, Tahir I, Katz‐Agranov N, Wang Q, Mantz L, Strohbehn I, Moreno D, Harden D, Dinulos JE, Cosar D, Seethapathy H, Gainor JF, Shah SJ, Gupta S, Leaf DE, Fintelmann FJ, Sise ME. Sarcopenia, adiposity and large discordance between cystatin C and creatinine-based estimated glomerular filtration rate in patients with cancer. J Cachexia Sarcopenia Muscle 2024; 15:1187-1198. [PMID: 38646842 PMCID: PMC11154767 DOI: 10.1002/jcsm.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/15/2023] [Accepted: 03/06/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Creatinine-based estimated glomerular filtration rate (eGFRCRE) may overestimate kidney function in patients with sarcopenia. While cystatin C-based eGFR (eGFRCYS) is less affected by muscle mass, it may underestimate kidney function in patients with obesity. We sought to evaluate the relationship between body composition defined by computed tomography (CT) scans and discordance between creatinine, eGFRCRE and eGFRCYS in adult patients with cancer. METHODS This study is a cross-sectional study of consecutive adults with cancer with an abdominal CT scan performed within 90 days of simultaneous eGFRCRE and eGFRCYS measurements between May 2010 and January 2022. Muscle and adipose tissue cross-sectional areas were measured at the level of the third lumbar vertebral body using a validated deep-learning pipeline. CT-defined sarcopenia was defined using independent sex-specific cut-offs for skeletal muscle index (<39 cm2/m2 for women and <55 cm2/m2 for men). High adiposity was defined as the highest sex-specific quartile of the total (visceral plus subcutaneous) adiposity index in the cohort. The primary outcome was eGFR discordance, defined by eGFRCYS > 30% lower than eGFRCRE; the secondary outcome was eGFRCYS > 50% lower than eGFRCRE. The odds of eGFR discordance were estimated using multivariable logistic regression modelling. Unadjusted spline regression was used to evaluate the relationship between skeletal muscle index and the difference between eGFRCYS and eGFRCRE. RESULTS Of the 545 included patients (mean age 63 ± 14 years, 300 [55%] females, 440 [80.7%] non-Hispanic white), 320 (58.7%) met the criteria for CT-defined sarcopenia, and 136 (25%) had high adiposity. A total of 259 patients (48%) had >30% eGFR discordance, and 122 (22.4%) had >50% eGFR discordance. After adjustment for potential confounders, CT-defined sarcopenia and high adiposity were both associated with >30% eGFR discordance (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI] 1.12-3.24; aOR 2.01, 95% CI 1.15-3.52, respectively) and >50% eGFR discordance (aOR 2.34, 95% CI 1.21-4.51; aOR 2.23, 95% CI 1.19-4.17, respectively). A spline model demonstrated that as skeletal muscle index decreases, the predicted difference between eGFRCRE and eGFRCYS widens considerably. CONCLUSIONS CT-defined sarcopenia and high adiposity are both independently associated with large eGFR discordance. Incorporating valuable information from body composition analysis derived from CT scans performed as a part of routine cancer care can impact the interpretation of GFR estimates.
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Affiliation(s)
- Paul E. Hanna
- Division of Nephrology, Department of MedicineMedical College of WisconsinMilwaukeeWIUSA
| | - Tianqi Ouyang
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Ismail Tahir
- Department of RadiologyMassachusetts General HospitalBostonMAUSA
| | - Nurit Katz‐Agranov
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Qiyu Wang
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Lea Mantz
- Department of RadiologyMassachusetts General HospitalBostonMAUSA
- Department of Diagnostic and Interventional RadiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Ian Strohbehn
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Daiana Moreno
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Destiny Harden
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - James E. Dinulos
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Duru Cosar
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Harish Seethapathy
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Justin F. Gainor
- Division of Hematology and Oncology, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Sachin J. Shah
- Division of General Internal Medicine, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Shruti Gupta
- Division of Renal Medicine, Department of MedicineBrigham and Women's HospitalBostonMAUSA
- Adult Survivorship ProgramDana‐Farber Cancer InstituteBostonMAUSA
| | - David E. Leaf
- Division of General Internal Medicine, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | | | - Meghan E. Sise
- Division of Nephrology, Department of MedicineMassachusetts General HospitalBostonMAUSA
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21
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Sampaio NZ, Faleiro MD, Vieira LVDS, Lech GE, Viana SW, Tavares CPO, Mattiazzi AD, Burke GW. Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables. Transpl Int 2024; 37:12750. [PMID: 38881801 PMCID: PMC11176494 DOI: 10.3389/ti.2024.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
Patients with end-stage heart disease who undergo a heart transplant frequently have simultaneous kidney insufficiency, therefore simultaneous heart and kidney transplantation is an option and it is necessary to understand its characteristics and long-term variables. The recipient characteristics and operative and long-term variables were assessed in a meta-analysis. A total of 781 studies were screened, and 33 were thoroughly reviewed. 15 retrospective cohort studies and 376 patients were included. The recipient's mean age was 51.1 years (95% CI 48.52-53.67) and 84% (95% CI 80-87) were male. 71% (95% CI 59-83) of the recipients were dialysis dependent. The most common indication was ischemic cardiomyopathy [47% (95% CI 41-53)] and cardiorenal syndrome [22% (95% CI 9-35)]. Also, 33% (95% CI 20-46) of the patients presented with delayed graft function. During the mean follow-up period of 67.49 months (95% CI 45.64-89.33), simultaneous rejection episodes of both organ allografts were described in 5 cases only. Overall survival was 95% (95% CI 88-100) at 30 days, 81% (95% CI 76-86) at 1 year, 79% (95% CI 71-87) at 3, and 71% (95% CI 59-83) at 5 years. Simultaneous heart and kidney transplantation is an important option for concurrent cardiac and renal dysfunction and has acceptable rejection and survival rates.
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Affiliation(s)
| | | | | | - Gabriele Eckerdt Lech
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Adela D. Mattiazzi
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - George W. Burke
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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22
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Zhang L, Nizhamuding X, Zheng H, Zeng J, Yuan X, Ma Z, Zhou W, Zhang C, Zhang T, Zhang C. An LC-MS/MS method for serum cystatin C quantification and its comparison with two commercial immunoassays. Clin Chem Lab Med 2024; 62:1092-1100. [PMID: 38253403 DOI: 10.1515/cclm-2023-0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES The standardization of cystatin C (CysC) measurement has received increasing attention in recent years due to its importance in estimating glomerular filtration rate (GFR). Mass spectrometry-based assays have the potential to provide an accuracy base for CysC measurement. However, a precise, accurate and sustainable LC-MS/MS method for CysC is still lacking. METHODS The developed LC-MS/MS method quantified CysC by detecting signature peptide (T3) obtained from tryptic digestion. Stable isotope labeled T3 peptide (SIL-T3) was spiked to control matrix effects and errors caused by liquid handling. The protein denaturation, reduction and alkylation procedures were combined into a single step with incubation time of 1 h, and the digestion lasted for 3.5 h. In the method validation, digestion time-course, imprecision, accuracy, matrix effect, interference, limit of quantification (LOQ), carryover, linearity, and the comparability to two routine immunoassays were evaluated. RESULTS No significant matrix effect or interference was observed with the CysC measurement. The LOQ was 0.21 mg/L; the within-run and total imprecision were 1.33-2.05 % and 2.18-3.90 % for three serum pools (1.18-5.34 mg/L). The LC-MS/MS method was calibrated by ERM-DA471/IFCC and showed good correlation with two immunoassays traceable to ERM-DA471/IFCC. However, significant bias was observed for immunoassays against the LC-MS/MS method. CONCLUSIONS The developed LC-MS/MS method is robust and simpler and holds the promise to provide an accuracy base for routine immunoassays, which will promote the standardization of CysC measurement.
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Affiliation(s)
- Li Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaerbanu Nizhamuding
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Hao Zheng
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Jie Zeng
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Xinyi Yuan
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Zijia Ma
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Weiyan Zhou
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Chao Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Tianjiao Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
| | - Chuanbao Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, P.R. China
- National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing, P.R. China
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23
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Podadera-Herreros A, Arenas-de Larriva AP, Gutierrez-Mariscal FM, Alcala-Diaz JF, Ojeda-Rodriguez A, Rodriguez-Cantalejo F, Cardelo MP, Rodriguez-Cano D, Torres-Peña JD, Luque RM, Ordovas JM, Perez-Martinez P, Delgado-Lista J, Lopez-Miranda J, Yubero-Serrano EM. Mediterranean diet as a strategy for preserving kidney function in patients with coronary heart disease with type 2 diabetes and obesity: a secondary analysis of CORDIOPREV randomized controlled trial. Nutr Diabetes 2024; 14:27. [PMID: 38755195 PMCID: PMC11099022 DOI: 10.1038/s41387-024-00285-3] [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: 11/15/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is recognized an independent risk factor for chronic kidney disease (CKD). The precise contribution and differential response to treatment strategies to reduce kidney dysfunction, depending on whether obesity is present alongside T2DM or not, remain to be fully clarified. Our objective was to improve our understanding of how obesity contributes to kidney function in patients with T2DM and coronary heart disease (CHD), who are highly predisposed to CKD, to assign the most effective dietary approach to preserve kidney function. METHODS 1002 patients with CHD and estimated glomerular filtration rate (eGFR)≥30 ml/min/1.73m2, were randomized to consume a Mediterranean diet (35% fat, 22% MUFA, < 50% carbohydrates) or a low-fat diet (28% fat, 12% MUFA, > 55% carbohydrates). Patients were classified into four groups according to the presence of T2DM and/or obesity at baseline: Non-Obesity/Non-T2DM, Obesity/Non-T2DM, Non-Obesity/T2DM and Obesity/T2DM. We evaluated kidney function using serum creatinine-based estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) before and after 5-years of dietary intervention. RESULTS Patients with Obesity/T2DM had the lowest baseline eGFR and the highest baseline uACR compared to non-diabetics (p < 0.05). After dietary intervention, the Mediterranean diet induced a lower eGFR decline in patients with Obesity/T2DM, compared to a low-fat diet but not in the other groups (p = 0.014). The Mediterranean diet, but not the low-fat diet, also reduced uACR only in patients with Obesity/T2DM (p = 0.024). CONCLUSIONS Obesity provided an additive effect to T2DM resulting in a more pronounced decline in kidney function compared to T2DM alone when compared to non-diabetics. In patients with concomitant presence of T2DM and obesity, with more metabolic complications, consumption of a Mediterranean diet seemed more beneficial than a low-fat diet in terms of preserving kidney function. These findings provide valuable insights for tailoring personalized lifestyle modifications in secondary prevention of cardiovascular disease. TRIAL REGISTRATION URL, http://www.cordioprev.es/index.php/en . CLINICALTRIALS gov number, NCT00924937.
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Affiliation(s)
- Alicia Podadera-Herreros
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
| | - Antonio P Arenas-de Larriva
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Francisco M Gutierrez-Mariscal
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Juan F Alcala-Diaz
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Ana Ojeda-Rodriguez
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | | | - Magdalena P Cardelo
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | | | - Jose D Torres-Peña
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Raul M Luque
- Department of Cell Biology, Physiology and Immunology, University of Córdoba, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, University of Córdoba, 14004, Córdoba, Spain
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, 02111, USA
- Precision Nutrition and Obesity Program, IMDEA Alimentación, 28049, Madrid, Spain
| | - Pablo Perez-Martinez
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Javier Delgado-Lista
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Jose Lopez-Miranda
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Elena M Yubero-Serrano
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, 14004 University of Córdoba, Córdoba, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.
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Lacquaniti A, Ceresa F, Campo S, Smeriglio A, Trombetta D, Patanè F, Monardo P. Surgical Aortic Valve Replacement and Renal Dysfunction: From Acute Kidney Injury to Chronic Disease. J Clin Med 2024; 13:2933. [PMID: 38792474 PMCID: PMC11122348 DOI: 10.3390/jcm13102933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Surgical aortic valve replacement (SAVR) is often complicated by acute kidney injury (AKI). Identifying patients at risk of AKI is important to start nephroprotective strategies or renal replacement therapy (RRT). This study investigated the incidence and risk factors of post-operative AKI in SAVR patients. Chronic kidney disease (CKD) developed in the post-cardiac-surgery follow-up period was also assessed. Methods: A total of 462 SAVR patients were retrospectively enrolled. The primary endpoint was the occurrence rate of AKI after surgery. Kidney recovery, during two planned outpatient clinic nephrological visits within 12 months after the surgery, was assessed. Results: A total of 76 patients experienced an AKI event. A Kaplan-Meier analysis revealed that subjects with CKD stage IV had a time to progression of 2.7 days, compared to patients with stages I-II, who were characterized by the slowest progression time, >11.2 days. A Cox regression indicated that CKD stages predicted a higher risk of AKI independently of other variables. During their ICU stay, 23 patients died, representing 5% of the population, most of them requiring RRT during their ICU stay. A severe CKD before the surgery was closely related to perioperative mortality. During the follow-up period, 21 patients with AKI worsened their CKD stage. Conclusions: AKI represents a common complication for SAVR patients in the early post-operative period, prolonging their ICU stay, with negative effects on survival, especially if RRT was required. Pre-operative CKD >3 stage is an independent risk factor for AKI in patients undergoing SAVR.
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Affiliation(s)
- Antonio Lacquaniti
- Nephrology and Dialysis Unit, Department of Internal Medicine, Papardo Hospital, 98158 Messina, Italy
| | - Fabrizio Ceresa
- Cardiac Surgery Unit, Papardo Hospital, 98158 Messina, Italy
| | - Susanna Campo
- Nephrology and Dialysis Unit, Department of Internal Medicine, Papardo Hospital, 98158 Messina, Italy
| | - Antonella Smeriglio
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina, Italy
| | - Domenico Trombetta
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina, Italy
| | | | - Paolo Monardo
- Nephrology and Dialysis Unit, Department of Internal Medicine, Papardo Hospital, 98158 Messina, Italy
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25
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He D, Gao B, Wang J, Yang C, Zhao MH, Zhang L. The Difference Between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate and Risk of Diabetic Microvascular Complications Among Adults With Diabetes: A Population-Based Cohort Study. Diabetes Care 2024; 47:873-880. [PMID: 38470988 PMCID: PMC11043223 DOI: 10.2337/dc23-2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The impact of the difference between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff) on diabetic microvascular complications (DMCs) remains unknown. We investigated the associations of eGFRdiff with overall DMCs and subtypes, including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). RESEARCH DESIGN AND METHODS This prospective cohort study included 25,825 participants with diabetes free of DMCs at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based calculations. Incidence of DMCs was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with overall DMCs and subtypes. RESULTS During a median follow-up of 13.6 years, DMCs developed in 5,753 participants, including 2,752 cases of DR, 3,203 of DKD, and 1,149 of DN. Each SD decrease of eGFRabdiff was associated with a 28% higher risk of overall DMCs, 14% higher risk of DR, 56% higher risk of DKD, and 29% higher risk of DN. For each 10% decrease in eGFRrediff, the corresponding hazard ratios (95% CIs) were 1.16 (1.14, 1.18) for overall DMCs, 1.08 (1.05, 1.11) for DR, 1.29 (1.26, 1.33) for DKD, and 1.17 (1.12, 1.22) for DN. The magnitude of associations was not materially altered in any of the sensitivity analyses. CONCLUSIONS Large eGFRdiff was independently associated with risk of DMCs and its subtypes. Our findings suggested monitoring eGFRdiff in the diabetes population has potential benefit for identification of high-risk patients.
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Affiliation(s)
- Daijun He
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- National Institute of Health Data Science at Peking University, Beijing, China
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26
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Hundemer GL, Sood MM, Akbari A. Beyond Creatinine: Is Cystatin C the New Global Standard for Estimated Glomerular Filtration Rate Evaluation? Kidney Med 2024; 6:100806. [PMID: 38495598 PMCID: PMC10943046 DOI: 10.1016/j.xkme.2024.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Gregory L. Hundemer
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ayub Akbari
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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27
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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28
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Rhee JJ, Han J, Montez-Rath ME, Chertow GM. Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes and mild/moderate chronic kidney disease. Diabetes Obes Metab 2024; 26:1273-1281. [PMID: 38186297 DOI: 10.1111/dom.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
AIM To determine the comparative effectiveness regarding major cardiovascular events of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). MATERIALS AND METHODS We assembled a cohort of commercially insured adult patients with T2DM in the United States (derived from Optum Clinformatics DataMart 2003-2021) who were new users of GLP-1 receptor agonists or SGLT-2 inhibitors. We compared risks of non-fatal myocardial infarction or stroke in patients with and without CKD, and further categorized by CKD stage: stages G1 or G2 [estimated glomerular filtration rate (eGFR) ≥60 ml/min] and A2 (urine albumin to creatinine ratio 30 to <300 mg/g) or A3 (urine albumin to creatinine ratio ≥300 mg/g), stage G3a (eGFR 45 to <60 ml/min/1.73 m2 ) and stage G3b (eGFR 30 to <45 ml/min/1.73 m2 ). We used proportional hazards regression after inverse probability of treatment weighting to compute hazard ratios and 95% confidence intervals. RESULTS After accounting for the probability of treatment, patients with T2DM and CKD treated with SGLT-2 inhibitors experienced a 14% lower risk of non-fatal myocardial infarction or stroke (hazard ratio 0.86, 95% confidence interval 0.78-0.94) relative to those treated with GLP-1 receptor agonists. CONCLUSIONS Recognizing the potential for residual confounding, selection bias and immortal time bias, commercially insured patients in the United States with T2DM and CKD treated with SGLT-2 inhibitors experienced significantly lower risks of non-fatal myocardial infarction or stroke relative to those treated with GLP-1 receptor agonists.
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Affiliation(s)
- Jinnie J Rhee
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
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29
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Powe NR. Race, Health Care Algorithms, and Precision Health Equity. Ann Intern Med 2024; 177:537-538. [PMID: 38466996 DOI: 10.7326/m24-0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Affiliation(s)
- Neil R Powe
- Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California San Francisco, San Francisco, California
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30
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Shahinfar S, Saganowich J, Misra A. Electrocution Injury after AED Use: Concern for Chronically "Elevated" Creatine Kinase? Curr Sports Med Rep 2024; 23:113-115. [PMID: 38578486 DOI: 10.1249/jsr.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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31
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Chagnac A, Friedman AN. Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio. Kidney Med 2024; 6:100804. [PMID: 38576526 PMCID: PMC10993191 DOI: 10.1016/j.xkme.2024.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
An increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an independent risk factor for moderately increased albuminuria (henceforth, moderate albuminuria). In this review, we describe how the ACR was developed and used to define moderate albuminuria. We then investigate how biases related to urinary creatinine excretion are introduced into the ACR measurement and how the use of the 30-mg/g threshold decreases the performance of the test in populations with higher muscle mass, with a primary focus on why and how this occurs in the obese population. The discussion then raises several strategies that can be used to mitigate such bias. This review provides a comprehensive overview of the medical literature on the uses and limitations of ACR in individuals with obesity and critically assesses related issues. It also raises into question the widely accepted 30-mg/g threshold as universally adequate for the diagnosis of moderate albuminuria. The implications of our review are relevant for clinicians, epidemiologists, and clinical trialists.
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Affiliation(s)
- Avry Chagnac
- Maccabi Healthcare Services, Ramat Hasharon Medical Center, Israel
| | - Allon N. Friedman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN
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32
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Kim YH, Lee W, Kim KY, Kim Y, Ko A, Weon B, Lee J, Jin W, Kim DK, Kim YS, Lim CS, Lee JP. The estimated mediating roles of anemia-related variables in the association between kidney function and mortality: a National Health and Nutrition Examination Survey (NHANES) study. Sci Rep 2024; 14:6621. [PMID: 38503784 PMCID: PMC10951385 DOI: 10.1038/s41598-024-56877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
Anemia is a common complication of chronic kidney disease (CKD), impacting long-term outcomes such as mortality and morbidity. Analyzing NHANES data from 1999 through 2016 for adults aged ≥ 20 years, we assessed the mediating effects of anemia biomarkers (hemoglobin, hematocrit, red cell distribution width [RDW], and mean corpuscular hemoglobin concentration [MCHC]) on CKD-related outcomes by using hazard ratios from a biomarker-adjusted model. Of 44,099 participants, 7463 experienced all-cause death. Cox proportional hazard models revealed a higher all-cause mortality risk in the > 45 years and CKD groups than in the early CKD group. Hemoglobin, hematocrit and MCHC were inversely related to all-cause mortality; RDW was related to mortality. Single mediation analysis showed greater mediating effects of anemia indicators on CKD and mortality in the elderly (> 65 years) population than those in the general population. In the multimediation analysis, the combined mediating effect of anemia was higher in the CKD population than in the general population. This study showed a proportional increase in the mediating effect of anemia with CKD stage, suggesting potential therapeutic avenues. However, further exploration of other mediating factors on kidney outcomes is necessary.
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Affiliation(s)
- Yae Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University College of Information and Biomedical Engineering, Pusan, Korea
| | - Kyun Young Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Taegu, Korea
| | - Ara Ko
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Boram Weon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wencheng Jin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Briguori C, Quintavalle C, Mariano E, D'Agostino A, Scarpelli M, Focaccio A, Zoccai GB, Evola S, Esposito G, Sangiorgi GM, Condorelli G. Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2024; 83:1059-1069. [PMID: 38479953 DOI: 10.1016/j.jacc.2024.01.016] [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: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention. OBJECTIVES Contrast media (CM) volume minimization has been advocated for prevention of AKI. The DyeVert CM diversion system (Osprey Medical, Inc) is designed to reduce CM volume during coronary procedures. METHODS In this randomized, single-blind, investigator-driven clinical trial conducted in 4 Italian centers from February 4, 2020 to September 13, 2022, 550 participants with ACS were randomly assigned in a 1:1 ratio to the following: 1) the contrast volume reduction (CVR) group (n = 276), in which CM injection was handled by the CM diversion system; and 2) the control group (n = 274), in which a conventional manual or automatic injection syringe was used. The primary endpoint was the rate of AKI, defined as a serum creatinine (sCr) increase ≥0.3 mg/dL within 48 hours after CM exposure. RESULTS There were 412 of 550 (74.5%) participants with ST-segment elevation myocardial infarction (211 of 276 [76.4%] in the CVR group and 201 of 274 [73.3%] in the control group). The CM volume was lower in the CVR group (95 ± 30 mL vs 160 ± 23 mL; P < 0.001). Seven participants (1 in the CVR group and 6 in the control group) did not have postprocedural sCr values. AKI occurred in 44 of 275 (16%) participants in the CVR group and in 65 of 268 (24.3%) participants in the control group (relative risk: 0.66; 95% CI: 0.47-0.93; P = 0.018). CONCLUSIONS CM volume reduction obtained using the CM diversion system is effective for prevention of AKI in patients with ACS undergoing invasive procedures. (REnal Insufficiency Following Contrast MEDIA Administration TriaL IV [REMEDIALIV]: NCT04714736).
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy.
| | - Cristina Quintavalle
- Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy
| | - Enrica Mariano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | | | - Mario Scarpelli
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy; Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Salvatore Evola
- Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology, Federico II University of Naples, Naples, Italy
| | | | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy; Scientific Institute for Research, Hospitalization, and Health Care-Mediterranean Neurological Institute (IRCCS Neuromed), Pozzilli, Italy
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Huang P, Mai Y, Zhao J, Yi Y, Wen Y. Association of systemic immune-inflammation index and systemic inflammation response index with chronic kidney disease: observational study of 40,937 adults. Inflamm Res 2024:10.1007/s00011-024-01861-0. [PMID: 38489048 DOI: 10.1007/s00011-024-01861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is linked to immunity and inflammation. Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) are novel measures for gauging an individual's systemic inflammatory activity. We aim to investigate the potential associations between them. METHODS This study encompassed a cohort of 40,937 adults from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. SII and SIRI were log2-transformed before conducting regression analysis, considering that these inflammatory markers were right skewed distributed. Weighted logistic regression models assessed the association of log2-SII and log2-SIRI levels with CKD prevalence. Weighted Cox regression models were utilized to estimate the risk of death. Subgroup analyses were performed to further clarify the effects of other covariates on the associations. Sensitivity analyses were performed to assess the robustness of our results. RESULTS 6986 participants with CKD were recorded, and 2818 patients died during a mean follow-up time of 100 months. After adjusting for all covariates, the highest level of log2-SII increased the CKD incidence (odds ratio [OR]: 1.47, 95% confidence intervals [CI]: 1.32-1.65, P < 0.001), as well as log2-SIRI (OR: 1.79, 95% CI 1.60-2.01, P < 0.001) when compared with the lowest level reference group. The highest level of log2-SII significantly increased all-cause mortality (hazard risk [HR]: 1.29; 95% CI 1.13-1.48, P < 0.001), cardiovascular mortality (HR: 1.61, 95% CI 1.25-2.09, P < 0.001), and hypertension mortality (HR: 1.73, 95% CI 1.23-2.42, P = 0.001) in CKD patients. Additionally, the positive associations were also found between log2-SIRI and all cause (HR: 1.54, 95% CI 1.35-1.76, P < 0.001), cardiovascular (HR: 1.90, 95% CI 1.38-2.60, P < 0.001), and hypertension mortality (HR: 2.15, 95% CI 1.56-2.94, P < 0.001). Subgroup analyses unveiled variations in these effects among different populations. CONCLUSION There existed a substantial association of SII and SIRI levels with CKD prevalence, as well as mortality in patients with CKD in the U.S. POPULATION
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Affiliation(s)
- Peixian Huang
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Yanpei Mai
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China.
| | - Jun Zhao
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Yushan Yi
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Yaqing Wen
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
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Boles SL, Pantazides BG, Perez JW, Sternberg MR, Crow BS, Blake TA. Establishing Population Values for Chlorine Exposure in the United States (2015-2016) Using 2 Chlorine Biomarkers, 3-Chlorotyrosine and 3,5-Dichlorotyrosine. J Appl Lab Med 2024; 9:342-349. [PMID: 38169366 DOI: 10.1093/jalm/jfad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND In the United States, 12 million short tons of chlorine are manufactured and transported each year. Due to the volume of this volatile chemical, large- and small-scale chemical exposures occur frequently. To diagnose and treat potentially exposed individuals, reference range values for confirmatory biomarkers are required to differentiate between normal and abnormal exposure levels. METHODS Serum surplus samples (n = 1780) from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 were measured for 2 chlorine biomarkers, 3-chlorotyrosine (Cl-Tyr) and 3,5-dichlorotyrosine (Cl2-Tyr), by liquid chromatography coupled to a triple quadrupole mass spectrometer. We evaluated demographic factors associated with elevated biomarker levels. RESULTS Participant samples were analyzed for the chlorine biomarkers Cl-Tyr and Cl2-Tyr. In the unweighted analysis of these samples, 1349 (75.8%) were under the limit of detection (< LOD) of 2.50 ng/mL for Cl-Tyr and 1773 (99.6%) were < LOD for Cl2-Tyr. Samples within the method reportable range were 2.50 to 35.6 ng/mL for Cl-Tyr and 2.69 to 11.2 ng/mL for Cl2-Tyr. Since only 7 of the 1780 participants had detectable Cl2-Tyr, statistical analysis was limited to Cl-Tyr. Of the demographic characteristics examined, age, body mass index (BMI), estimated glomerular filtration rate (eGFR), and sex exhibited statistically significant differences in the weighted prevalence of detectable Cl-Tyr. CONCLUSIONS This is the first reported set of Cl-Tyr and Cl2-Tyr population values for the United States. This population range coupled with NHANES demographic information could help healthcare professionals distinguish between normal and abnormal chlorine biomarker levels in an emergency. With this information, an inference could be made when determining acute chlorine exposure in individuals.
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Affiliation(s)
- Stephanie L Boles
- National Center for Environmental Health, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brooke G Pantazides
- National Center for Environmental Health, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jonas W Perez
- National Center for Environmental Health, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Maya R Sternberg
- National Center for Environmental Health, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brian S Crow
- National Center for Environmental Health, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Thomas A Blake
- National Center for Environmental Health, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Fu EL, Carrero JJ, Sang Y, Evans M, Ishigami J, Inker LA, Grams ME, Levey AS, Coresh J, Ballew SH. Association of Low Glomerular Filtration Rate With Adverse Outcomes at Older Age in a Large Population With Routinely Measured Cystatin C. Ann Intern Med 2024; 177:269-279. [PMID: 38285982 PMCID: PMC11079939 DOI: 10.7326/m23-1138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The commonly accepted threshold of glomerular filtration rate (GFR) to define chronic kidney disease (CKD) is less than 60 mL/min/1.73 m2. This threshold is based partly on associations between estimated GFR (eGFR) and the frequency of adverse outcomes. The association is weaker in older adults, which has created disagreement about the appropriateness of the threshold for these persons. In addition, the studies measuring these associations included relatively few outcomes and estimated GFR on the basis of creatinine level (eGFRcr), which may be less accurate in older adults. OBJECTIVE To evaluate associations in older adults between eGFRcr versus eGFR based on creatinine and cystatin C levels (eGFRcr-cys) and 8 outcomes. DESIGN Population-based cohort study. SETTING Stockholm, Sweden, 2010 to 2019. PARTICIPANTS 82 154 participants aged 65 years or older with outpatient creatinine and cystatin C testing. MEASUREMENTS Hazard ratios for all-cause mortality, cardiovascular mortality, and kidney failure with replacement therapy (KFRT); incidence rate ratios for recurrent hospitalizations, infection, myocardial infarction or stroke, heart failure, and acute kidney injury. RESULTS The associations between eGFRcr-cys and outcomes were monotonic, but most associations for eGFRcr were U-shaped. In addition, eGFRcr-cys was more strongly associated with outcomes than eGFRcr. For example, the adjusted hazard ratios for 60 versus 80 mL/min/1.73 m2 for all-cause mortality were 1.2 (95% CI, 1.1 to 1.3) for eGFRcr-cys and 1.0 (CI, 0.9 to 1.0) for eGFRcr, and for KFRT they were 2.6 (CI, 1.2 to 5.8) and 1.4 (CI, 0.7 to 2.8), respectively. Similar findings were observed in subgroups, including those with a urinary albumin-creatinine ratio below 30 mg/g. LIMITATION No GFR measurements. CONCLUSION Compared with low eGFRcr in older patients, low eGFRcr-cys was more strongly associated with adverse outcomes and the associations were more uniform. PRIMARY FUNDING SOURCE Swedish Research Council, National Institutes of Health, and Dutch Kidney Foundation.
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Affiliation(s)
- Edouard L. Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, and Division of Nephrology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Yingying Sang
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Marie Evans
- Department of Clinical Intervention and Technology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lesley A. Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Morgan E. Grams
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Andrew S. Levey
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Josef Coresh
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana H. Ballew
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Wang L, Larki NR, Dobkin J, Salgado S, Ahmad N, Kaplan DE, Yang W, Yang YX. A Clinical Prediction Model to Assess Risk for Pancreatic Cancer Among Patients With Acute Pancreatitis. Pancreas 2024; 53:e254-e259. [PMID: 38266222 PMCID: PMC11214820 DOI: 10.1097/mpa.0000000000002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVES We aimed to develop and validate a prediction model as the first step in a sequential screening strategy to identify acute pancreatitis (AP) individuals at risk for pancreatic cancer (PC). MATERIALS AND METHODS We performed a population-based retrospective cohort study among individuals 40 years or older with a hospitalization for AP in the US Veterans Health Administration. For variable selection, we used least absolute shrinkage and selection operator regression with 10-fold cross-validation to identify a parsimonious logistic regression model for predicting the outcome, PC diagnosed within 2 years after AP. We evaluated model discrimination and calibration. RESULTS Among 51,613 eligible study patients with AP, 801 individuals were diagnosed with PC within 2 years. The final model (area under the receiver operating curve, 0.70; 95% confidence interval, 0.67-0.73) included histories of gallstones, pancreatic cyst, alcohol use, smoking, and levels of bilirubin, triglycerides, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, and albumin. If the predicted risk threshold was set at 2% over 2 years, 20.3% of the AP population would undergo definitive screening, identifying nearly 50% of PC associated with AP. CONCLUSIONS We developed a prediction model using widely available clinical factors to identify high-risk patients with PC-associated AP, the first step in a sequential screening strategy.
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Affiliation(s)
- Louise Wang
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Navid Rahimi Larki
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jane Dobkin
- Columbia Irving Medical Center, New York City, NY
| | - Sanjay Salgado
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Nuzhat Ahmad
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, PA
| | - David E. Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Wei Yang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA
| | - Yu-Xiao Yang
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Delanaye P, Rule AD, Schaeffner E, Cavalier E, Shi J, Hoofnagle AN, Nyman U, Björk J, Pottel H. Performance of the European Kidney Function Consortium (EKFC) creatinine-based equation in United States cohorts. Kidney Int 2024; 105:629-637. [PMID: 38101514 DOI: 10.1016/j.kint.2023.11.024] [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: 06/27/2023] [Revised: 09/28/2023] [Accepted: 11/05/2023] [Indexed: 12/17/2023]
Abstract
Estimating glomerular filtration rate (GFR) is important in daily practice to assess kidney function and adapting the best clinical care of patients with and without chronic kidney disease. The new creatinine-based European Kidney Function Consortium (EKFC) equation is used to estimate GFR. This equation was developed and validated mainly in European individuals and based on a rescaled creatinine, with the rescaling factor (Q-value) defined as the median normal value of serum creatinine in a given population. The validation was limited in Non-Black Americans and absent in Black Americans. Here, our cross-sectional analysis included 12,854 participants from nine studies encompassing large numbers of both non-Black and Black Americans with measured GFR by clearance of an exogenous marker (reference method), serum creatinine, age, sex, and self-reported race available. Two strategies were considered with population-specific Q-values in Black and non-Black men and women (EKFCPS) or a race-free Q-value (EKFCRF). In the whole population, only the EKFCPS equation showed no statistical median bias (0.14, 95% confidence interval [-0.07; 0.35] mL/min/1.73m2), and the bias for the EKFCRF (0.74, [0.51; 0.94] mL/min/1.73m2) was closer to zero than that for the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI2021) equation (1.22, [0.99; 1.47]) mL/min/1.73m2]. The percentage of estimated GFR within 30% of measured GFR was similar for CKD-EPI2021 (79.2% [78.5%; 79.9%]) and EKFCRF (80.1% [79.4%; 80.7%]), but improved for the EKFCPS equation (81.1% [80.5%; 81.8%]). Thus, our EKFC equations can be used to estimate GFR in the United States incorporating either self-reported race or unknown race at the patient's discretion per hospital registration records.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Elke Schaeffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Junyan Shi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA; Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA; Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Groothof D, Shehab NBN, Post A, Gans ROB, Bakker SJL, Erler NS. Rounding creatinine, cystatin C or both: impact on discordance group assignment and GFR-estimating equation performance. Nephrol Dial Transplant 2024; 39:553-555. [PMID: 37852678 PMCID: PMC10899766 DOI: 10.1093/ndt/gfad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naser B N Shehab
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinold O B Gans
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Fuentes A, Espinoza UJ, Cobbs V. Follow the citations: Tracing pathways of "race as biology" assumptions in medical algorithms in eGFR and spirometry. Soc Sci Med 2024; 346:116737. [PMID: 38447335 DOI: 10.1016/j.socscimed.2024.116737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Despite overwhelming evidence to the contrary, the concept of 'race' as a biological unit continues to persist in various scientific disciplines, notably in the field of medicine. This paper explores the persistence of 'race as biology' in medical research via examining select citational practices that have perpetuated this problematic concept. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. By analyzing citation threads and historical patterns, we aim to shed light on the creation and perpetuation of false scientific truths and their impact on medical research, training, and practice. We focus on two prominent examples, eGFR and Spirometry, and trace key articles' citational histories, highlighting the flawed evidence in support of racial corrections in medical assessments. The eGFR equation incorporates 'race' as a factor based on the erroneous belief that Black individuals have higher muscle mass than white individuals. Our analysis reveals that key cited sources for this belief lack robust and well-developed datasets. Similarly, Spirometry measurements incorporate racial correction factors, relying on questionable evidence dating back to the Civil War era. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. They play a crucial role in shaping theoretical positions and validating data and assumed knowledge. Evaluating citation threads and key articles consistently referenced over time can reveal how falsehoods and erroneous assertions are constructed and maintained in scientific fields. This study underscores the need for critical examination of citational practices in medical research and urges a shift toward a more cautious approach when citing sources that support 'race as biology.' The paper calls for a reevaluation of pedagogical approaches and assigned readings in medical education to prioritize an anti-racist perspective in future research endeavors.
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Hirsch JS, Danna SC, Desai N, Gluckman TJ, Jhamb M, Newlin K, Pellechio B, Elbedewe A, Norfolk E. Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review. J Clin Med 2024; 13:1206. [PMID: 38592013 PMCID: PMC10932233 DOI: 10.3390/jcm13051206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. METHODS The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. RESULTS Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. CONCLUSIONS Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.
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Affiliation(s)
- Jamie S. Hirsch
- Northwell Health, Northwell Health Physician Partners, 100 Community Drive, Floor 2, Great Neck, NY 11021, USA
| | - Samuel Colby Danna
- VA Southeast Louisiana Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Nihar Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, 800 Howard Avenue, Ste 2nd Floor, New Haven, CT 06519, USA
| | - Ty J. Gluckman
- Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), 9205 SW Barnes Road, Suite 598, Portland, OR 97225, USA
| | - Manisha Jhamb
- Division of Renal-Electrolyte, University of Pittsburgh, 3550 Terrace St., Scaife A915, Pittsburgh, PA 15261, USA
| | - Kim Newlin
- Sutter Health, Sutter Roseville Medical Center, 1 Medical Plaza Drive, Roseville, CA 95661, USA
| | - Bob Pellechio
- RWJ Barnabas Health, Cooperman Barnabas Medical Center, 95 Old Short Hills Rd., West Orange, NJ 07052, USA
| | - Ahlam Elbedewe
- The Kinetix Group, 29 Broadway 26th Floor, New York, NY 10006, USA
| | - Evan Norfolk
- Geisinger Medical Center—Nephrology, 100 North Academy Avenue, Danville, PA 17822, USA
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Inker LA, Chami A, Levey AS. Do We Need a New Creatinine-Based Estimated GFR Equation for Kidney Transplant Recipients? Am J Kidney Dis 2024; 83:257-259. [PMID: 37844726 DOI: 10.1053/j.ajkd.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
| | - Ashtar Chami
- Division of Transplant Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Petersen JK, Østergaard L, Carlson N, Bager LGV, Strange JE, Schou M, Køber L, Fosbøl EL. Impact of Acute Kidney Injury After Transcatheter Aortic Valve Replacement: A Nationwide Study. J Am Heart Assoc 2024; 13:e031019. [PMID: 38156458 PMCID: PMC10863835 DOI: 10.1161/jaha.123.031019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND In patients undergoing transcatheter aortic valve replacement (TAVR), the impact of acute kidney injury (AKI) on the prognosis and especially on future kidney function has been sparsely examined, and data from large cohorts are warranted. METHODS AND RESULTS With Danish nationwide registries, we identified all patients undergoing TAVR from 2014 to 2021 with no previous dialysis treatment. According to 2 plasma creatinine samples, we identified those suffering a postprocedural AKI within 21 days after TAVR. With 1 year of follow-up, we compared the associated rates of dialysis treatment and death between patients with and without an AKI using multivariable Cox analysis. Finally, according to the lowest recorded creatinine sample, we assessed the kidney function among AKI survivors between 90 and 180 days after the index date. We identified 4091 TAVRs: 193 (4.7%) with AKI (55.4% men; median age, 82 years) and 3898 (95.3%) without AKI (57.0% men; median age, 81 years). Compared with those without AKI, patients with AKI showed increased associated 1-year rates of dialysis treatment (hazard ratio [HR], 7.20 [95% CI, 4.10-12.66]) and death (HR, 2.39 [95% CI, 1.59-3.58]). After 6 months, 74% of AKI survivors had complete kidney recovery, 14.7% had incomplete kidney recovery, 6.3% failed to recover, and 5.1% were on dialysis treatment. CONCLUSIONS We identified that AKI after TAVR was associated with an increased rate of future dialysis treatment and all-cause death. Among survivors, 74% had complete kidney recovery within 6 months.
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Affiliation(s)
- Jeppe Kofoed Petersen
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Lauge Østergaard
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Nicholas Carlson
- Department of NephrologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | | | - Jarl E. Strange
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Morten Schou
- Department of CardiologyHerlev and Gentofte University HospitalCopenhagenDenmark
| | - Lars Køber
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Emil Loldrup Fosbøl
- Department of CardiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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Gama R, Javeria Peracha, Kate Bramham, Cockwell P. Removal of ethnicity adjustment for creatinine-based estimated glomerular filtration rate equations. Ann Clin Biochem 2024; 61:8-18. [PMID: 36550595 DOI: 10.1177/00045632221149660] [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] [Indexed: 12/24/2022]
Abstract
Creatinine-based estimated glomerular filtration rate equations (eGFRcreatinine) are used to measure excretory kidney function in clinical practice. Despite inter and intra-patient variability, eGFRcreatinine has excellent clinical utility and provides the basis for the classification system for chronic kidney disease (CKD), for kidney function monitoring, treatment interventions and referral pathways. The 4-variable modification of diet in renal disease (MDRD) eGFRcreatinine equation was introduced in 2000 and recommended by the National Institute for Health and Care Excellence (NICE) in 2008. Subsequently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRcreatinine equation was introduced in 2009 and is more accurate than MDRD in patients with mild and moderate CKD. In 2014, NICE recommended that CKD-EPI eGFRcreatinine replace MDRD eGFRcreatinine in routine clinical practice across England. Both equations originally incorporated adjustments for age, gender and ethnicity. However, the evidence for ethnicity adjustment has been increasingly questioned, and in 2021 NICE recommended that kidney function should be estimated by CKD-EPI eGFRcreatinine without using ethnicity adjustment. Recently, a CKD-EPI equation has been presented without ethnicity adjustment; however, this has not been validated outside of North America and NICE continues to recommend CKD-EPI 2009. We review the status of eGFRcreatinine in clinical practice, including the limitations of eGFRcreatinine and the rationale for removal of ethnicity adjustment and the potential impact of this change on clinical care for patients with kidney disease.
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Affiliation(s)
- Rouvick Gama
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Javeria Peracha
- Renal Unit, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kate Bramham
- King's Kidney Care, King's College Hospital NHS Foundation Trust, London, UK
- Department of Renal Sciences, King's College London, London, UK
| | - Paul Cockwell
- Department of Nephrology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust and Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Naser JA, Luis SA, Pislaru SV, Michelena HI, Kennedy AM, Eleid MF, Crestanello JA, Chebib FT, Pellikka PA, Nkomo VT. Impact on Kidney Function and Medium-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease. Am J Cardiol 2024; 210:163-171. [PMID: 37863302 DOI: 10.1016/j.amjcard.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is now widely approved for the treatment of aortic stenosis, regardless of the patients' surgical risk. However, the outcomes of TAVR and their determinants in patients with chronic kidney disease (CKD) beyond 1 year of follow-up are unknown. We aimed to assess the medium-term outcomes of TAVR in CKD, develop a risk score to estimate the 2-year mortality in patients with CKD, and evaluate the changes in kidney function at discharge after TAVR. Adults who underwent TAVR were retrospectively identified. The CKD stage was determined using the Chronic Kidney Disease Epidemiology 2021 creatinine formula. Improved kidney function was defined as post-TAVR creatinine ≤50% of pre-TAVR creatinine or decrease in creatinine of ≥0.3 mg/100 ml compared with pre-TAVR creatinine. Overall, 1,523 patients (median age 82 years; 59% men; 735 with CKD stage II or less, 661 with CKD III, 83 with CKD IV, and 44 with CKD V [of whom 40 were on dialysis]) were included. The all-cause mortality was higher in CKD stages IV and V on the multivariable analysis (p <0.001) at median follow-up of 2.9 (interquartile range 2.0 to 4.2) years. Moderate or severe tricuspid regurgitation, anemia, right ventricular systolic pressure >40 mm Hg and CKD stages IV and V were independent predictors of 2-year mortality and were used to develop a risk score. At hospital discharge, persisting acute kidney injury after TAVR occurred in 88 of 1,466 patients (6%), whereas improved kidney function occurred in 170 of 1,466 patients (12%). In conclusion, CKD stage was an independent determinant of mortality beyond 2 years after TAVR. Kidney function was more likely to improve than worsen at the time of hospital discharge after TAVR.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Fouad T Chebib
- Department of Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Navaneethan SD, Mitch WE. Does Serum Creatinine Reflect Muscle Mass in Patients with Kidney Failure? J Am Soc Nephrol 2024; 35:1-2. [PMID: 38015564 PMCID: PMC10786607 DOI: 10.1681/asn.0000000000000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Sankar D. Navaneethan
- Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
- Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - William E. Mitch
- Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
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Augustine JJ, Liaqat A, Arrigain S, Schold JD, Poggio ED. Performance of estimated glomerular filtration rate equations in Black living kidney donor candidates. Clin Transplant 2024; 38:e15198. [PMID: 37964662 DOI: 10.1111/ctr.15198] [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: 06/03/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION New estimated glomerular filtration rate (eGFR) equations using serum creatinine and/or cystatin C have been derived to eliminate adjustment by perceived Black ancestry. We sought to analyze the performance of newer eGFR equations among Black living kidney donor candidates. METHODS Black candidates (n = 64) who had measured iothalamate GFR between January 2015 and October 2021 were included, and eGFR was calculated using race adjusted (eGFRcr2009 and eGFRcr-cys2012) and race unadjusted (eGFRcys2012, eGFRcr2021, and eGFRcr-cys2021) CKD-EPI equations. Bias and accuracy were calculated. RESULTS The eGFRcr2021 equation had a negative bias of 9 mL/min/1.73 m2 , while other equations showed a modest positive bias. Accuracy within 10% and 30% was greatest using the eGFRcr-cys2021 equation. With the eGFRcr2021 equation, 9.4% of donors with an mGFR > 80 mL/min/1.73 m2 were misclassified as having an eGFR < 80 mL/min/1.73 m2 . eGFR was also compared among 18 kidney donors at 6-24 months post-donation. Post-donation, the percentage of donors with an eGFR < 60 mL/min/1.73 m2 was 44% using the eGFRcr2021 equation compared to 11% using the eGFRcr-cys2021 equation. CONCLUSION The CKD-EPICr2021 equation appears to underestimate true GFR in Black living donor candidates. Alternatively, compared to CKD-EPICr2021, the CKD-EPICr-CysC2021 equation appears to perform with less bias and improved accuracy.
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Affiliation(s)
- Joshua J Augustine
- Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aimen Liaqat
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Susana Arrigain
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emilio D Poggio
- Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Schmeusser BN, Nicaise EH, Palacios AR, Ali A, Patil DH, Armas-Phan M, Ogan K, Master VA. Performance of Future Glomerular Filtration Rate Equation by Race in a Large, Racially Diverse Patient Cohort Undergoing Nephrectomy for Renal Cell Carcinoma. Urology 2024; 183:147-156. [PMID: 37852308 DOI: 10.1016/j.urology.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To examine the performance of the Palacios et al [Aguilar Palacios D, Wilson B, Ascha M, et al. New baseline renal function after radical or partial nephrectomy: a simple and accurate predictive model. J Urol. 2021;205:1310-1320] post-nephrectomy future glomerular function rate (fGFR) equation in a diverse cohort using both the Chronic Kidney Disease Epidemiology (CKD-EPI) 2009 equation with race, used in the creation of the formula, as well as the CKD-EPI 2021 equation without race. METHODS Patients who underwent partial or radical nephrectomy for renal cell carcinoma from 2005-2021 were identified in our institutional database. Patients with creatinine values preoperatively and 3-12 months postoperatively were included. Correlation/bias/accuracy/precision of the fGFR equation (fGFR = 35+ [preoperative eGFR × 0.65] - 18 [if radical] - [age × 0.25] + 3 [if tumor >7 cm] - 2 [if diabetes]) with observed postoperative eGFR was determined by both the CKD-EPI-2021 and CKD-EPI 2009 equations. RESULTS A total of 1443 patients were analyzed. Seventy-one percent (1024) were White and 22.9% (331) were Black. Most underwent radical nephrectomy (60.3%). 40% T3-T4 renal cell carcinoma (RCC), with 14.8% of patients having M1 disease. Median observed vs predicted fGFR was 58.0 vs 58.7 mL/min/1.73 m2 for CKD-EPI 2021 and 56.0 vs 57.5 for CKD-EPI 2009. For the total cohort, the correlation/bias/accuracy/precision of the fGFR equation was 0.805/-0.5/81.7/7.9-9.0 for CKD-EPI 2021 and 0.809/-0.8/81.3/-8.1 to 8 for CKD-EPI 2009. In Black patients, fGFR equation demonstrated >75% accuracy with both CKD-EPI equations; however, accuracy was lower in black patients with the CKD-EPI2021 equation (76.1% vs 83.4%, P = .003). CONCLUSION The fGFR equation performed well in our large, diverse cohort, though accuracy was relatively lower when using CKD-EPI 2021 compared to CKD-EPI 2009.
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Affiliation(s)
| | - Edouard H Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Arnold R Palacios
- Department of Urology, Creighton University School of Medicine, Omaha, NE
| | - Adil Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Manuel Armas-Phan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
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50
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Schmeusser BN, Nicaise EH, Ogan K, Master VA. AUTHOR REPLY. Urology 2024; 183:155-156. [PMID: 37985283 DOI: 10.1016/j.urology.2023.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
| | - Edouard H Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
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