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Zhao J, Gu S, McDermaid A. Predicting outcomes of chronic kidney disease from EMR data based on Random Forest Regression. Math Biosci 2019; 310:24-30. [PMID: 30768948 DOI: 10.1016/j.mbs.2019.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/26/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) is prevalent across the world, and kidney function is well defined by an estimated glomerular filtration rate (eGFR). The progression of kidney disease can be predicted if the future eGFR can be accurately estimated using predictive analytics. In this study, we developed and validated a prediction model of eGFR by data extracted from a regional health system. This dataset includes demographic, clinical and laboratory information from primary care clinics. The model was built using Random Forest regression and evaluated using Goodness-of-fit statistics and discrimination metrics. After data preprocessing, the patient cohort for model development and validation contained 61,740 patients. The final model included eGFR, age, gender, body mass index (BMI), obesity, hypertension, and diabetes, which achieved a mean coefficient of determination of 0.95. The estimated eGFRs were used to classify patients into CKD stages with high macro-averaged and micro-averaged metrics. In conclusion, a model using real-world electronic medical records (EMR) data can accurately predict future kidney functions and provide clinical decision support.
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Affiliation(s)
- Jing Zhao
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA; Sanford Research, Sioux Falls, SD 57104, USA.
| | - Shaopeng Gu
- Bioinformatics and Mathematical Biosciences Lab, Department of Mathematics and Statistics, South Dakota State University, Brookings, SD 57006, USA.
| | - Adam McDermaid
- Bioinformatics and Mathematical Biosciences Lab, Department of Mathematics and Statistics, South Dakota State University, Brookings, SD 57006, USA.
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Menet A, Ranque B, Diop IB, Kingue S, N'guetta R, Diarra M, Diallo D, Diop S, Diagne I, Sanogo I, Chelo D, Wamba G, Deme-Ly I, Faye BF, Seck M, Tolo A, Boidy K, Koffi G, Abough EC, Diakite CO, Traore Y, Legueun G, Kamara I, Offredo L, Marechaux S, Mirabel M, Jouven X. Subclinical Cardiac Dysfunction Is Associated With Extracardiac Organ Damages. Front Med (Lausanne) 2018; 5:323. [PMID: 30525039 PMCID: PMC6262341 DOI: 10.3389/fmed.2018.00323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 10/31/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Several studies conducted in America or Europe have described major cardiac remodeling and diastolic dysfunction in patients with sickle cell disease (SCD). We aimed at assessing cardiac involvement in SCD in sub-Saharan Africa where SCD is the most prevalent. Methods: In Cameroon, Mali and Senegal, SCD patients and healthy controls of the CADRE study underwent transthoracic echocardiography if aged ≥10 years. The comparison of clinical and echocardiographic features between patients and controls, and the associations between echocardiographic features and the vascular complications of SCD were assessed. Results: 612 SCD patients (483 SS or Sβ0, 99 SC, and 19 Sβ+) and 149 controls were included. The prevalence of dyspnea and congestive heart failure was low and did not differ significantly between patients and controls. While left ventricular ejection fraction did not differ between controls and patients, left and right cardiac chambers were homogeneously more dilated and hypertrophic in patients compared to controls and systemic vascular resistances were lower (p < 0.001 for all comparisons). Three hundred and forty nine SCD patients had extra-cardiac organ damages (stroke, leg ulcer, priapism, microalbuminuria or osteonecrosis). Increased left ventricular mass index, cardiac dilatation, cardiac output, and decreased systemic vascular resistances were associated with a history of at least one SCD-related organ damage after adjustment for confounders. Conclusions: Cardiac dilatation, cardiac output, left ventricular hypertrophy, and systemic vascular resistance are associated with extracardiac SCD complications in patients from sub-Saharan Africa despite a low prevalence of clinical heart failure. The prognostic value of cardiac subclinical involvement in SCD patients deserves further studies.
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Affiliation(s)
- Aymeric Menet
- Cardiology unit, Groupement des Hôpitaux de L'université Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Brigitte Ranque
- Internal Medicine Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and UMR_S970, Universite Paris Descartes, Inserm, Paris, France
| | | | | | | | - Mamadou Diarra
- Cardiology Unit, Centre Gynéco-obstétrique, Bamako, Mali
| | - Dapa Diallo
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | - Saliou Diop
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Ibrahima Diagne
- Pediatrics Unit, Centre Hospitalier National d'Enfants Albert Royer de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - David Chelo
- Cardiology Unit, Fondation Mère Enfant Chantal Biya, Yaoundé, Cameroon
| | - Guillaume Wamba
- Pediatrics Unit, Centre Hospitalier d'Essos, Yaoundé, Cameroon
| | - Indou Deme-Ly
- Pediatrics Unit, Centre Hospitalier National d'Enfants Albert Royer de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Moussa Seck
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Aissata Tolo
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | - Kouakou Boidy
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | - Gustave Koffi
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | | | | | - Youssouf Traore
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | | | - Ismael Kamara
- Hematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | - Lucile Offredo
- UMR_S970, Université Paris Descartes, Inserm, Paris, France
| | - Sylvestre Marechaux
- Cardiology unit, Groupement des Hôpitaux de L'université Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Mariana Mirabel
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and UMR_S970, Université Paris Descartes, Inserm, Paris, France
| | - Xavier Jouven
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and UMR_S970, Université Paris Descartes, Inserm, Paris, France
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Alexandre-Heymann L, Dubert M, Diallo DA, Diop S, Tolo A, Belinga S, Sanogo I, Diagne I, Wamba G, Boidy K, Ly ID, Kamara I, Traore Y, Offredo L, Jouven X, Ranque B. Prevalence and correlates of growth failure in young African patients with sickle cell disease. Br J Haematol 2018; 184:253-262. [PMID: 30467843 DOI: 10.1111/bjh.15638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022]
Abstract
Growth failure (GF) in children with sickle cell disease (SCD) tends to decline in high-income countries, but data are lacking in sub-Saharan Africa. We performed a cross-sectional study nested in the CADRE (Cœur, Artères et DREpanocytose) cohort in Mali, Senegal, Cameroon, Gabon and the Ivory Coast. SCD patients and healthy controls aged 5-21 years old were recruited (n = 2583). Frequency of GF, defined as a height, weight or body mass index below the 5th percentile on World health Organization growth charts, was calculated. We assessed associations between GF and SCD phenotypic group, clinical and biological characteristics and history of SCD-related complications. GF was diagnosed in 51% of HbSS, 58% of HbSβ0 , 44% of HbSC, 38% of HbSβ+ patients and 32% of controls. GF in patients was positively associated with parents' lower education level, male sex, age 12-14 years, lower blood pressure, HbSS or HbSβ0 phenotypes, icterus, lower haemoglobin level, higher leucocyte count and microalbuminuria. No association was found between GF and clinical SCD-related complications. In sub-Saharan Africa, GF is still frequent in children with SCD, especially in males and during adolescence. GF is associated with haemolysis and microalbuminuria, but not with the history of SCD-related clinical complications.
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Affiliation(s)
- Laure Alexandre-Heymann
- Internal Medicine Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Marie Dubert
- Internal Medicine Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France.,UMR_S970, Université Paris Descartes, Inserm, Paris, France
| | - Dapa A Diallo
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | - Saliou Diop
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Aissata Tolo
- Haematology Unit, CHU de Yopougon, Abidjan, Ivory Coast
| | | | | | | | - Guillaume Wamba
- Pediatrics Unit, Centre Hospitalier d'Essos, Yaoundé, Cameroon
| | - Kouakou Boidy
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | | | - Ismaël Kamara
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | | | - Lucile Offredo
- UMR_S970, Université Paris Descartes, Inserm, Paris, France
| | - Xavier Jouven
- UMR_S970, Université Paris Descartes, Inserm, Paris, France.,Cardiology Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Brigitte Ranque
- Internal Medicine Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France.,UMR_S970, Université Paris Descartes, Inserm, Paris, France
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Aymé S, Bockenhauer D, Day S, Devuyst O, Guay-Woodford LM, Ingelfinger JR, Klein JB, Knoers NVAM, Perrone RD, Roberts J, Schaefer F, Torres VE, Cheung M, Wheeler DC, Winkelmayer WC. Common Elements in Rare Kidney Diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2017; 92:796-808. [PMID: 28938953 PMCID: PMC6685068 DOI: 10.1016/j.kint.2017.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022]
Abstract
Rare kidney diseases encompass at least 150 different conditions, most of which are inherited. Although individual rare kidney diseases raise specific issues, as a group these rare diseases can have overlapping challenges in diagnosis and treatment. These challenges include small numbers of affected patients, unidentified causes of disease, lack of biomarkers for monitoring disease progression, and need for complex care. To address common clinical and patient issues among rare kidney diseases, the KDIGO Controversies Conference entitled, Common Elements in Rare Kidney Diseases, brought together a panel of multidisciplinary clinical providers and patient advocates to address five central issues for rare kidney diseases. These issues encompassed diagnostic challenges, management of kidney functional decline and progression of chronic kidney disease, challenges in clinical study design, translation of advances in research to clinical care, and provision of practical and integrated patient support. Thus, by a process of consensus, guidance for addressing these challenges was developed and is presented here.
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Affiliation(s)
- Ségolène Aymé
- Institut du Cerveau et de la Moelle Épinière, Centre National de la Recherche Scientifique Unite Mixte de Recherche 7225, Institut National de la Santé et de la Recherche Médicale U 1127, Université Pierre et Marie Curie-P6 Unite Mixte de Recherche S 1127, Paris, France
| | - Detlef Bockenhauer
- University College of London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - Simon Day
- Clinical Trials Consulting and Training Limited, Buckingham, UK
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC, USA.
| | - Julie R Ingelfinger
- MassGeneral Hospital for Children at Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jon B Klein
- Division of Nephrology and Hypertension, The University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia Roberts
- Polycystic Kidney Disease Foundation, Kansas City, Missouri, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium
| | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Degree of anemia, indirect markers of hemolysis, and vascular complications of sickle cell disease in Africa. Blood 2017; 130:2215-2223. [PMID: 28931524 DOI: 10.1182/blood-2016-12-755777] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 09/02/2017] [Indexed: 11/20/2022] Open
Abstract
The hyperhemolysis paradigm that describes overlapping "hyperhemolytic-endothelial dysfunction" and "high hemoglobin-hyperviscous" subphenotypes of sickle cell disease (SCD) patients is based on North American studies. We performed a transversal study nested in the CADRE cohort to analyze the association between steady-state hemolysis and vascular complications of SCD among sub-Saharan African patients. In Mali, Cameroon, and Ivory Coast, 2407 SCD patients (1751 SS or sickle β-zero-thalassemia [Sβ0], 495 SC, and 161 sickle β+-thalassemia [Sβ+]), aged 3 years old and over, were included at steady state. Relative hemolytic intensity was estimated from a composite index derived from principal component analysis, which included bilirubin levels or clinical icterus, and lactate dehydrogenase levels. We assessed vascular complications (elevated tricuspid regurgitant jet velocity [TRV], microalbuminuria, leg ulcers, priapism, stroke, and osteonecrosis) by clinical examination, laboratory tests, and echocardiography. After adjustment for age, sex, country, and SCD phenotype, a low hemoglobin level was significantly associated with TRV and microalbuminuria in the whole population and with leg ulcers in SS-Sβ0 adults. A high hemolysis index was associated with microalbuminuria in the whole population and with elevated TRV, microalbuminuria, and leg ulcers in SS-Sβ0 adults, but these associations were no longer significant after adjustment for hemoglobin level. In conclusion, severe anemia at steady state in SCD patients living in West and Central Africa is associated with elevated TRV, microalbuminuria, and leg ulcers, but these vascular complications are not independently associated with indirect markers of increased hemolysis. Other mechanisms leading to anemia, including malnutrition and infectious diseases, may also play a role in the development of SCD vasculopathy.
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Arterial Stiffness Impairment in Sickle Cell Disease Associated With Chronic Vascular Complications. Circulation 2016; 134:923-33. [DOI: 10.1161/circulationaha.115.021015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/27/2016] [Indexed: 11/16/2022]
Abstract
Background:
Although a blood genetic disease, sickle cell disease (SCD) leads to a chronic vasculopathy with multiple organ involvement. We assessed arterial stiffness in SCD patients and looked for associations between arterial stiffness and SCD-related vascular complications.
Methods:
The CADRE (Coeur Artères et Drepanocytose, ie, Heart Arteries and Sickle Cell Disease) study prospectively recruited pediatric and adult SCD patients and healthy controls in Cameroon, Ivory Coast, Gabon, Mali, and Senegal. Patients underwent clinical examination, routine laboratory tests (complete blood count, serum creatinine level), urine albumin/creatinine ratio measure, and a measure of carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AI) at a steady state. The clinical and biological correlates of cf-PWV and AI were investigated by using a multivariable multilevel linear regression analysis with individuals nested in families further nested in countries.
Results:
Included were 3627 patients with SCD and 943 controls. Mean cf-PWV was lower in SCD patients (7.5±2.0 m/s) than in controls (9.1±2.4 m/s,
P
<0.0001), and lower in SS-Sβ
0
than in SC-Sβ
+
phenotypes. AI, corrected for heart rate, increased more rapidly with age in SCD patients and was higher in SCD than in control adults. cf-PWV and AI were independently associated with age, sex, height, heart rate, mean blood pressure, hemoglobin level, country, and hemoglobin phenotype. After adjustment for these correlates, cf-PWV and AI were associated with the glomerular filtration rate and osteonecrosis. AI was also associated with stroke, pulmonary hypertension, and priapism, and cf-PWV was associated with microalbuminuria.
Conclusions:
PWV and AI are deeply modified in SCD patients in comparison with healthy controls. These changes are independently associated with a lower blood pressure and a higher heart rate but also with the hemoglobin phenotype. Moreover, PWV and AI are associated with several SCD clinical complications. Their prognostic value will be assessed at follow-up of the patients.
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Wuttke M, Wong CS, Wühl E, Epting D, Luo L, Hoppmann A, Doyon A, Li Y, Sözeri B, Thurn D, Helmstädter M, Huber TB, Blydt-Hansen TD, Kramer-Zucker A, Mehls O, Melk A, Querfeld U, Furth SL, Warady BA, Schaefer F, Köttgen A. Genetic loci associated with renal function measures and chronic kidney disease in children: the Pediatric Investigation for Genetic Factors Linked with Renal Progression Consortium. Nephrol Dial Transplant 2016; 31:262-9. [PMID: 26420894 PMCID: PMC4829056 DOI: 10.1093/ndt/gfv342] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/26/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) in children is characterized by rapid progression and a high incidence of end-stage renal disease and therefore constitutes an important health problem. While unbiased genetic screens have identified common risk variants influencing renal function and CKD in adults, the presence and identity of such variants in pediatric CKD are unknown. METHODS The international Pediatric Investigation for Genetic Factors Linked with Renal Progression (PediGFR) Consortium comprises three pediatric CKD cohorts: Chronic Kidney Disease in Children (CKiD), Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) and Cardiovascular Comorbidity in Children with CKD (4C). Clean genotype data from > 10 million genotyped or imputed single-nucleotide polymorphisms (SNPs) were available for 1136 patients with measurements of serum creatinine at study enrollment. Genome-wide association studies were conducted to relate the SNPs to creatinine-based estimated glomerular filtration rate (eGFR crea) and proteinuria (urinary albumin- or protein-to-creatinine ratio ≥ 300 and ≥ 500 mg/g, respectively). In addition, European-ancestry PediGFR patients (cases) were compared with 1347 European-ancestry children without kidney disease (controls) to identify genetic variants associated with the presence of CKD. RESULTS SNPs with suggestive association P-values < 1 × 10(-5) were identified in 10 regions for eGFR crea, four regions for proteinuria and six regions for CKD including some plausible biological candidates. No SNP was associated at genome-wide significance (P < 5 × 10(-8)). Investigation of the candidate genes for proteinuria in adults from the general population provided support for a region on chromosome 15 near RSL24D1/UNC13C/RAB27A. Conversely, targeted investigation of genes harboring GFR-associated variants in adults from the general population did not reveal significantly associated SNPs in children with CKD. CONCLUSIONS Our findings suggest that larger collaborative efforts will be needed to draw reliable conclusions about the presence and identity of common variants associated with eGFR, proteinuria and CKD in pediatric populations.
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Affiliation(s)
- Matthias Wuttke
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Craig S. Wong
- Division of Pediatric Nephrology, University of New Mexico Children's Hospital, Albuquerque, NM, USA
| | - Elke Wühl
- Division of Pediatric Nephrology, University Medical Center Heidelberg, Heidelberg, Germany
| | - Daniel Epting
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Li Luo
- Division of Epidemiology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Anselm Hoppmann
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Anke Doyon
- Division of Pediatric Nephrology, University Medical Center Heidelberg, Heidelberg, Germany
| | - Yong Li
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - CKDGen Consortium
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Division of Pediatric Nephrology, University of New Mexico Children's Hospital, Albuquerque, NM, USA
- Division of Pediatric Nephrology, University Medical Center Heidelberg, Heidelberg, Germany
- Division of Epidemiology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Faculty of Medicine, Ege University, Izmir, Turkey
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
- University of Manitoba, Winnipeg, Manitoba, Canada
- Charite Universitätsmedizin Berlin, Berlin, Germany
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Childrens Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Betül Sözeri
- Faculty of Medicine, Ege University, Izmir, Turkey
| | - Daniela Thurn
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Martin Helmstädter
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tobias B. Huber
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Albrecht Kramer-Zucker
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Otto Mehls
- Division of Pediatric Nephrology, University Medical Center Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Uwe Querfeld
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Susan L. Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Childrens Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley A. Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, University Medical Center Heidelberg, Heidelberg, Germany
| | - Anna Köttgen
- Renal Division, Department of Internal Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ranque B, Menet A, Diop IB, Thiam MM, Diallo D, Diop S, Diagne I, Sanogo I, Kingue S, Chelo D, Wamba G, Diarra M, Anzouan JB, N'Guetta R, Diakite CO, Traore Y, Legueun G, Deme-Ly I, Belinga S, Boidy K, Kamara I, Tharaux PL, Jouven X. Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study. LANCET HAEMATOLOGY 2014; 1:e64-73. [PMID: 27030156 DOI: 10.1016/s2352-3026(14)00007-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa. METHODS In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sβ(0); SC and Sβ(+)) with further stratification by age and country. FINDINGS The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sβ(0), 511 SC, and 159 Sβ(+)). 644 patients with the SS and Sβ(0) phenotypes (33·7%, 95% CI 31·6-35·8) and 110 with the SC and Sβ(+) phenotypes (16·4%, 13·6-19·2) had albuminuria. In the SS and Sβ(0) group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged >40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20-1·71; p<0·0001), female sex (1·35, 1·02-1·82; p=0·045), low haemoglobin (0·79, 0·66-0·93; p=0·006), high lactate dehydrogenase concentrations (1·33, 1·14-1·58; p=0·0009), and, using Côte d'Ivoire as the reference, Mali (2·49, 1·64-3·79; p=0·042) and Cameroon (1·59, 1·01-2·51; p=0·0007) in patients with the SS and Sβ(0) phenotypes. The magnitude of the association of albuminuria with haemoglobin and lactate dehydrogenase concentrations increased with age. In the SC and Sβ(+) patients, only low haemoglobin (0·69, 0·48-0·97; p=0·029), high blood pressure (1·63, 1·17-2·27; p=0·0017), and Mali (3·75, 1·75-8·04; p<0·0001) were associated with albuminuria. INTERPRETATION Hyperhaemolysis is associated with albuminuria, with an age-dependent effect, in the SS and Sβ(0) phenotypes only, suggesting a different pathological mechanism for glomerular disease in the patients with SC and Sβ(+) phenotypes. However, both phenotypes are associated with a high prevalence of albuminuria in childhood. Therefore, screening for albuminuria is advised in African children with sickle cell disease to detect early renal damage. FUNDING Paris Cité Sorbonne University (GrEX project) and Cardiology and Development.
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Affiliation(s)
- Brigitte Ranque
- Internal Medicine, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; UMR S970, Université Paris Descartes, Inserm, Paris, France.
| | - Aymeric Menet
- Cardiology Unit, Groupement des Hôpitaux de l'Université Catholique de Lille, Lille, France
| | | | | | - Dapa Diallo
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | - Saliou Diop
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Ibrahima Diagne
- Pediatrics Unit, Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | | | | | - David Chelo
- Cardiology Unit, Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroon
| | - Guillaume Wamba
- Pediatrics Unit, Centre Hospitalier d'Essos, Yaoundé, Cameroon
| | - Mamadou Diarra
- Cardiology Unit, Centre Gynéco-obstétrique, Bamako, Mali
| | | | | | | | - Youssouf Traore
- Centre de Recherche et Lutte contre la Drépanocytose, Bamako, Mali
| | - Gaëlle Legueun
- Cardiology Unit, Centre Hospitalo-Universtaire de Fann, Dakar, Senegal
| | - Indou Deme-Ly
- Pediatrics Unit, Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | | | - Kouakou Boidy
- Hematology Unit, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Ismael Kamara
- Hematology Unit, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Xavier Jouven
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; UMR S970, Université Paris Descartes, Inserm, Paris, France
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Papez KE, Barletta GM, Hsieh S, Joseph M, Morgenstern BZ. Iothalamate versus estimated GFR in a Hispanic-dominant pediatric renal transplant population. Pediatr Nephrol 2013; 28:2369-76. [PMID: 24122293 DOI: 10.1007/s00467-013-2556-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 06/09/2012] [Accepted: 06/27/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Accurate knowledge of glomerular filtration rate (GFR) is essential to the practice of nephrology. Routine surveillance of GFR is most commonly executed using estimated GFR (eGFR) calculations, most often from serum creatinine measurements. However, cystatin C-based equations have demonstrated earlier sensitivity to decline in renal function. The literature regarding eGFR from cystatin C has few references that include transplant recipients. Additionally, for most of the published eGFR equations, patients of Hispanic ethnicity have not been enrolled in sufficient numbers. METHODS The applicability of several eGFR equations to the pediatric kidney transplant population at our center were compared in the context of determining whether Hispanic ethnicity was associated with equation performance. RESULTS Updated Schwartz, CKiD, and Zappitelli eGFR estimation equations demonstrated the highest correlations. CONCLUSIONS The authors recommend further prospective investigations to validate and identify factors contributing to these findings.
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Copelovitch L, Warady BA, Furth SL. Insights from the Chronic Kidney Disease in Children (CKiD) study. Clin J Am Soc Nephrol 2011; 6:2047-53. [PMID: 21784815 PMCID: PMC4898858 DOI: 10.2215/cjn.10751210] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Over the last 5 years, the Chronic Kidney Disease in Children (CKiD) prospective cohort study has enrolled close to 600 children ages 1 to 16 years with mild to moderate chronic kidney disease (CKD). The main purpose of this interim report is to review the initial cross-sectional data and conclusions derived from the clinical studies conducted within CKiD in the context of findings from other pediatric CKD and end-stage renal disease (ESRD) registry and cohort studies. In particular, special emphasis was placed on studying four aspects of chronic kidney disease in children, including the identification of risk factors related to disease progression, the impact of CKD on neurocognition and quality of life (QoL), the cardiovascular morbidity associated with CKD, and identifying the causes and effects of growth failure in the context of mild to moderate kidney failure.
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Abstract
PURPOSE OF REVIEW Estimated glomerular filtration rate (eGFR) is now commonly reported by clinical laboratories. Here, we review the performance of current creatinine and cystatin C-based estimating equations as well as demonstration of their utility in public health and clinical practice. RECENT FINDINGS Lower levels of GFR are associated with multiple adverse outcomes, including acute kidney injury and medical errors. The new Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation improves performance and risk prediction compared with the Modification of Diet in Renal Disease study equation. Current cystatin C-based equations are not accurate in all populations, even in those with reduced muscle mass or chronic illness, in which cystatin C would be expected to outperform creatinine. eGFR reporting has led to a greater number of referrals to nephrologists, but the increased numbers do not appear to be excessive or burdensome. The Modification of Diet in Renal Disease study equation appears to be able to provide drug dosage adjustments similar to the Cockcroft-Gault equation. SUMMARY Estimated GFRs and their reporting can improve and facilitate clinical practice for chronic kidney disease. Understanding strengths and limitations facilitates their optimal use. Endogenous filtration markers, alone or in combination, which are less dependent on non-GFR determinants of the filtration markers, are necessary to lead to more accurate eGFRs.
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Zappitelli M, Zhang X, Foster BJ. Estimating glomerular filtration rate in children at serial follow-up when height is unknown. Clin J Am Soc Nephrol 2010; 5:1763-9. [PMID: 20651157 DOI: 10.2215/cjn.08741209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Estimation of GFR in children from serum creatinine measures in regional databases is limited by a lack of height data. Furthermore, the ability of GFR estimating equations to quantify changes in GFR over time is unknown. Two methods of estimating GFR when height is unknown and the ability of several GFR equations to quantify GFR changes over time were evaluated. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS This retrospective study included 195 children (mean age 11.9 ± 4.6 years, GFR = 78.8 ± 34.5) who underwent iothalamate GFR, serum creatinine, and height measurements; 93 children underwent a second GFR measurement and 47 a third GFR measurement. Four equations were evaluated for bias and precision and for quantifying GFR change over time: (1) Schwartz, using measured height; (2) Schwartz, using estimated height (based on previous height percentile); (3) a locally derived modification of a previously derived height-independent equation. RESULTS The Schwartz (measured height) displayed the least bias (-2 to +7%), followed by the modified height-independent equation and Schwartz (estimated height). All equations were imprecise. All equations performed similarly at capturing change in measured GFR over time, with no significant difference between estimated and measured GFR percentage change over time. The height-estimated Schwartz formula performed similarly to the height-measured Schwartz in all aspects of equation performance. CONCLUSIONS Pediatric GFR follow-up studies may be possible using height-independent equations. Estimating height from prior height measurements enhances GFR estimation when height is unknown. These findings will hopefully help advance future pediatric renal function database studies.
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Affiliation(s)
- Michael Zappitelli
- Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
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Abstract
PURPOSE OF REVIEW The present review provides an overview of the identified risk factors for chronic kidney disease (CKD) progression emphasizing the pediatric population. RECENT FINDINGS Over the past 10 years, there have been significant changes to our understanding and study of preterminal kidney failure. Recent refinements in the measurement of glomerular filtration rate and glomerular filtration rate estimating equations are important tools for identification and association of risk factors for CKD progression in children. In pediatric CKD, lower level of kidney function at presentation, higher levels of proteinuria, and hypertension are known markers for a more rapid decline in glomerular filtration rate. Anemia and other reported risk factors from the pregenomic era require further study and validation. Genome-wide association studies have identified genetic loci that have provided novel genetic risk factors for CKD progression. SUMMARY With cohort studies of children with CKD becoming mature, they have started to yield important refinements to the assessment of CKD progression. Although many of the traditional risk factors for renal progression will certainly be assessed, such cohorts will be important for evaluating novel risk factors identified by genome-wide studies.
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