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Lemlijn-Slenter AHWM, Wijnands KAP, van der Hamsvoort G, van Iperen LP, Wolter N, de Rijk AE, Masclee AAM. Positive health: An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders. World J Gastroenterol 2024; 30:3418-3427. [PMID: 39091714 PMCID: PMC11290394 DOI: 10.3748/wjg.v30.i28.3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/05/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The concept of positive health (PH) supports an integrated approach for patients by taking into account six dimensions of health. This approach is especially relevant for patients with chronic disorders. Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disorders are among the top-6 of the most prevalent chronically affected organ systems. The impact of chronic GI-HPB disorders on individuals may be disproportionally high because: (1) The affected organ system frequently contributes to a malnourished state; and (2) persons with chronic GI-HPB disorders are often younger than persons with chronic diseases in other organ systems. AIM To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders. METHODS Prospective, observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GI-HPB disorder attending the Outpatient Department of the Maastricht University Medical Center. Validated questionnaires and data from patient files were used to quantify the six dimensions of PH. Internal consistency was tested with McDonald's Omega. Zero-order Pearson correlations and t-tests were used to assess associations and differences. A P value < 0.05 was considered significant. RESULTS The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population. Regarding quality of life, participation and daily functioning, GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems, but depressive symptoms (in 35%) and malnutrition (in 45%) were more frequent in patients with chronic GI-HPB disorders. Intercorrelation scores between the six dimensions were only very weak to weak, forcing us to quantify each domain separately. CONCLUSION All six dimensions of PH are impaired in the GI-HPB patients. Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.
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Affiliation(s)
- Anja H W M Lemlijn-Slenter
- Department of Social Medicine, Faculty of Health, Medicine and Life sciences, Care and Public Health Research Institute Maastricht University, Maastricht 6200 MD, Limburg, Netherlands
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism, Maastricht 6200 MD, Limburg, Netherlands
- Social Medical Affairs, Employee Insurance Agency (UWV), Heerlen 6400 AC, Limburg, Netherlands
- Department of Research, Academic Knowledge Center Work and Health South-East Netherlands (AKAG-ZON), Heerlen 6400 AC, Limburg, Netherlands
| | - Karolina A P Wijnands
- Department of Social Medicine, Faculty of Health, Medicine and Life sciences, Care and Public Health Research Institute Maastricht University, Maastricht 6200 MD, Limburg, Netherlands
- Social Medical Affairs, Employee Insurance Agency (UWV), Heerlen 6400 AC, Limburg, Netherlands
- Department of Research, Academic Knowledge Center Work and Health South-East Netherlands (AKAG-ZON), Heerlen 6400 AC, Limburg, Netherlands
| | - Gijs van der Hamsvoort
- Social Medical Affairs, Employee Insurance Agency (UWV), Heerlen 6400 AC, Limburg, Netherlands
| | - Luuk P van Iperen
- Department of Social Medicine, Faculty of Health, Medicine and Life sciences, Care and Public Health Research Institute Maastricht University, Maastricht 6200 MD, Limburg, Netherlands
| | - Nico Wolter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism, Maastricht 6200 MD, Limburg, Netherlands
| | - Angelique E de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life sciences, Care and Public Health Research Institute Maastricht University, Maastricht 6200 MD, Limburg, Netherlands
- Department of Research, Academic Knowledge Center Work and Health South-East Netherlands (AKAG-ZON), Heerlen 6400 AC, Limburg, Netherlands
| | - Ad A M Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism, Maastricht 6200 MD, Limburg, Netherlands
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Alshahrani M, Almalki LZ, Hasoosah NA, Alahmari AH, Alqahtani AM, Alqahtani AA, AL Muarfaj AM, Al Ghaseb LS, Alkahtani FS, Alsharif RY. Prevalence and assessment of risk factors of chronic kidney disease in the ASIR region of Saudi Arabia. Ann Med Surg (Lond) 2024; 86:3909-3916. [PMID: 38989199 PMCID: PMC11230802 DOI: 10.1097/ms9.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Chronic kidney disease (CKD) is a major health concern in Saudi Arabia. The prevalence of CKD and associated risk factors in Saudi Arabia's general population are not efficiently studied. The goal of this research is to determine the prevalence rate of CKD in the ASIR region and its associated epidemiological risk factors. Methodology This is a cross-sectional study that used a comprehensive direct questionnaire to collect data on CKD prevalence and risk factors in the ASIR region of Saudi Arabia. The study was carried out in different age groups. Demographic characteristics, presence of CKD, and associated factors such as a history of acute kidney disease, obstructive sleep apnoea, family history, history of non-steroid anti-inflammatory drugs (NSAID), smoking status, comorbidities, and history of periodontal diseases were asked. The survey tool was validated through a pilot study, and a statistical p value of 0.05 was considered significant. Results A total of 967 participants were included in the study, with a CKD prevalence rate of 1.9%. Sex, history of acute kidney disease, obstructive sleep apnoea, family history of kidney disease, smoking, diabetes, peptic ulcer disease, hypertension and hyperlipidemia were commonly found to be associated with CKD. A binary logistic regression model was carried out to assess the risk factors for CKD. Sex, history of acute kidney disease, family history of kidney disease, obstructive sleep apnoea, smoking status, peptic ulcer, diabetes, hypertension, hyperlipidemia, hypertension and diabetes, two or more comorbidities and NSAID use had an increased risk of CKD. Conclusion Sex, history of acute kidney disease, obstructive sleep apnoea, family history, smoking, diabetes, hypertension, peptic ulcer, hyperlipidemia, multi-comorbidity, and use of NSAIDs are all associated with an increased risk of CKD. The prevalence of CKD in this study is comparatively lower when compared to other regions in Saudi Arabia.
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Mourchid R, Yassine A, Bellahcen M, Cherrah Y, Serragui S. Chronic kidney disease in America, Africa, and Asia: Overview of treatment cost and options. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:392-400. [PMID: 38218427 DOI: 10.1016/j.pharma.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
Chronic kidney disease (CKD) is one of the non-infectious diseases that threaten patients' lives on a daily basis. Its prevalence is high, but under-reported by patients and those living with the disease, as it is silent and asymptomatic in the early stages. Kidney disease increases the risk of heart and vascular disease. These problems can manifest themselves slowly, over a long period of time. Early detection and treatment can often prevent chronic kidney disease from worsening. As kidney disease progresses, it can lead to kidney failure, requiring dialysis or a kidney transplant to stay alive. In this narrative review, we will mainly discuss different treatment option costs in different countries and how much they cost healthcare systems in countries in three different continents.
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Affiliation(s)
- Rania Mourchid
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Amal Yassine
- National health Insurance agency, 10100 Rabat, Morocco.
| | - Mohammed Bellahcen
- Hemodialysis Center Fondation Amal Hay Nahda Rabat, 10210 Rabat, Morocco.
| | - Yahia Cherrah
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Samira Serragui
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
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Farah R, Alhajahjeh A, Al-Farahid O, Abuzaid H, Hyassat D, Al-Khuraisat G, Al-Shimi R, Athamnah F, Aldurgham A, Aljabiry H, Ajlouni K. Risk factors for chronic kidney disease in middle eastern patients with type 2 diabetes mellitus: A cross-sectional study using the KDIGO classification. J Diabetes Complications 2024; 38:108740. [PMID: 38581843 DOI: 10.1016/j.jdiacomp.2024.108740] [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: 08/30/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
AIMS Chronic kidney disease (CKD) is prevalent in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate risk factors for CKD progression across the kidney disease-Improving Global Outcomes (KDIGO)categories in a Middle Eastern population beyond hyperglycemia as emphasized by KDIGO guidelines which classifying CKD by cause and severity. METHODS This cross-sectional study targeted 1603 patients with T2DM. Risk factors for CKD progression were determined using odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS Overall, 35.5 %, 31.7 %, and 32.8 % of patients were classified as low-risk, moderate-risk, and high-/very high-/highest-risk, respectively. Several factors were associated with high/very high/highest risk categorization, including being aged >45 years (OR: 1.85, 95 % CI: 1.36-2.49; P < 0.001), male gender (OR: 1.87, 95 % CI: 1.38-2.54; P < 0.001), hypertension (OR: 3.66, 95 % CI: 2.32-5.78; P < 0.001), and T2DM duration of ≥15 years (OR: 3.2, 95 % CI: 2.27-4.5; P < 0.001). Patients with more concurrent risk factors were notably represented in the high/very high/highest risk category. CONCLUSIONS Male patients, older patients, and those with comorbid hypertension, longstanding T2DM, and additional concurrent risk factors have a significantly higher risk of advanced CKD. Such findings should be considered when planning management approaches for patients with CKD.
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Affiliation(s)
- Randa Farah
- Nephrology Division, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan.
| | | | - Oraib Al-Farahid
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Hana Abuzaid
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Dana Hyassat
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Ghaith Al-Khuraisat
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Rana Al-Shimi
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Faisal Athamnah
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Ahmad Aldurgham
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Husam Aljabiry
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG), The University of Jordan, Amman, Jordan
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Kim K, Crook J, Lu CC, Nyman H, Abdelaziz A, LaFleur J. Epidemiology of Diabetic Kidney Disease among US Veterans. Diabetes Metab Syndr Obes 2024; 17:1585-1596. [PMID: 38616990 PMCID: PMC11011711 DOI: 10.2147/dmso.s450370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/15/2024] [Indexed: 04/16/2024] Open
Abstract
Rationale With a large number of patients and high mortality, diabetic kidney disease (DKD) imposes a significant burden on US health care. Although diabetes is the leading cause of chronic kidney disease and complications, the epidemiology of DKD in the contemporary US veteran population is generally unknown. Objective We aimed to estimate the rate of DKD progression and to measure the general epidemiology of DKD in the United States veteran population. Study Design We performed a retrospective observational research using electronic health-care records and administrative databases. Setting The DKD patient cohort was abstracted from the Veterans Health Administration health-record data from January 2016 to March 2022. Participants We defined DKD patients using the laboratory test data based on Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines. Analytic Approach Summary statistics include the five-year cumulative incidence of progression to an advanced stage from the DKD stage at the cohort entry date and prevalence at a series of single time points. Results A total of 685,288 patients (male [96%], mean age 62 years, Caucasian [64%], non-Hispanic [87%]) met our eligibility criteria. The 5-year cumulative incidence of progression to an advanced DKD stage or all-cause death from DKD stages G1 A2/A3, G2 A2/A3, G3a, and G3b were 52.0%, 47.4%, 50.5%, and 60.9%, respectively. In sum, 594,082 patients were classified as moderate or high risk as per KDIGO guidelines in 2021, and stages G3a and G3b accounted for 51.2% and 25.3%, respectively, of cases. Conclusion More than half of DKD patients underwent a stage progression or death within 5 years. A substantial number of DKD patients at an earlier stage might be left undetermined. The study findings warrant a revision of DKD patient identification and management in US veterans.
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Affiliation(s)
- Kibum Kim
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jacob Crook
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Chao-Chin Lu
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Heather Nyman
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Abdullah Abdelaziz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Joanne LaFleur
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Stojadinovic M, Lausevic M, Milosevic IA, Zaric RZ, Jemcov TK, Komadina L, Petrovic DS, Djuric P, Bulatovic A, Jakovljevic S, Jankovic S. Risk Factors for Potential Drug-Drug Interactions in Patients on Chronic Peritoneal Dialysis. Pharmacology 2024; 109:147-155. [PMID: 38432197 DOI: 10.1159/000537968] [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: 12/19/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The prevalence of potential drug-drug interactions (pDDIs) is becoming a major safety concern, as it has been previously linked to a significant number of adverse drug events and could have serious consequences for patients, including death. This is especially relevant for patients with chronic renal failure, as they are particularly vulnerable to drug-drug interactions. The aim of this study was to evaluate the prevalence and associated factors of pDDIs in patients receiving chronic peritoneal dialysis. METHODS An observational, cross-sectional study was conducted on consecutive peritoneal dialysis patients attending four tertiary care hospitals for regular monthly examination. The primary outcome was the number of pDDIs identified using Lexicomp. Potential predictors were determined using multiple linear regression. RESULTS Total number of patients included in the study was 140. The results showed that pDDIs were highly prevalent, especially in patients who use antiarrhythmics (p = 0.001), have diabetes mellitus (p = 0.001), recently started peritoneal dialysis (p = 0.003), or have higher number of prescribed drugs (p < 0.001). Number of prescribed drugs (p < 0.001) remained a significant predictor of high-risk pDDIs in addition to the female gender (p = 0.043). CONCLUSION Clinicians should be particularly cautious when prescribing multiple medications to high-risk patients, such as peritoneal dialysis patients, to mitigate the risk of drug-drug interactions and associated adverse health outcomes.
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Affiliation(s)
- Milorad Stojadinovic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mirjana Lausevic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Iman Assi Milosevic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Tamara Kosta Jemcov
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Ljiljana Komadina
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Dejan Slavko Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Nephrology, University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Petar Djuric
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Ana Bulatovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Stefan Jakovljevic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Surgery, University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Clinical Pharmacology, University Clinical Center of Kragujevac, Kragujevac, Serbia
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Arici M, Assaad-Khalil SH, Bertoluci MC, Choo J, Lee YJ, Madero M, Rosa Diez GJ, Sánchez Polo V, Chung S, Thanachayanont T, Pollock C. Results from a cross-specialty consensus on optimal management of patients with chronic kidney disease (CKD): from screening to complications. BMJ Open 2024; 14:e080891. [PMID: 38453198 PMCID: PMC10921537 DOI: 10.1136/bmjopen-2023-080891] [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: 10/13/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects around 10% of the global population and has been estimated to affect around 50% of individuals with type 2 diabetes and 50% of those with heart failure. The guideline-recommended approach is to manage with disease-modifying therapies, but real-world data suggest that prescribing rates do not reflect this in practice. OBJECTIVE To develop a cross-specialty consensus on optimal management of the patient with CKD using a modified Delphi method. DESIGN An international steering group of experts specialising in internal medicine, endocrinology/diabetology, nephrology and primary care medicine developed 42 statements on aspects of CKD management including identification and screening, risk factors, holistic management, guidelines, cross-specialty alignment and education. Consensus was determined by agreement using an online survey. PARTICIPANTS The survey was distributed to cardiologists, nephrologists, endocrinologists and primary care physicians across 11 countries. MAIN OUTCOMES AND MEASURES The threshold for consensus agreement was established a priori by the steering group at 75%. Stopping criteria were defined as a target of 25 responses from each country (N=275), and a 4-week survey period. RESULTS 274 responses were received in December 2022, 25 responses from Argentina, Australia, Brazil, Guatemala, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey and 24 responses from Egypt. 53 responses were received from cardiologists, 52 from nephrologists, 55 from endocrinologists and 114 from primary care physicians. 37 statements attained very high agreement (≥90%) and 5 attained high agreement (≥75% and <90%). Strong alignment between roles was seen across the statements, and different levels of experience (2-5 years or 5+ years), some variation was observed between countries. CONCLUSIONS There is a high degree of consensus regarding aspects of CKD management among healthcare professionals from 11 countries. Based on these strong levels of agreement, the steering group derived 12 key recommendations focused on diagnosis and management of CKD.
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Affiliation(s)
- Mustafa Arici
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Hacettepe Universitesi, Ankara, Türkiye
| | - Samir Helmy Assaad-Khalil
- Unit of Diabetes, Lipidology & Metabolism, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Marcello Casaccia Bertoluci
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul Instituto de Biociencias, Porto Alegre, Brazil
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute of Mexico, Mexico City, Mexico
| | | | - Vicente Sánchez Polo
- Servicio de Nefrología y Trasplante Renal, Instituto Guatemalteco de Seguridad Social, Guatemala City, Guatemala
| | - Sungjin Chung
- Division of Nephrology, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
| | | | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Canki E, Kho E, Hoenderop JGJ. Urinary biomarkers in kidney disease. Clin Chim Acta 2024; 555:117798. [PMID: 38280489 DOI: 10.1016/j.cca.2024.117798] [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: 11/24/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) affects many people worldwide and early diagnosis is essential for successful treatment and improved outcome. Unfortunately, current methods are insufficient especially for early disease detection. However, advances in the analytical methods for urinary biomarkers may provide a unique opportunity for diagnosis and management of CKD. This review explores evolving technology and highlights the importance of early marker detection in these patients. APPROACH A search strategy was set up using the terms CKD, biomarkers, and urine. The search included 53 studies comprising 37 biomarkers. The value of these biomarkers for CKD are based on their ability to diagnose CKD, monitor progression, assess mortality and nephrotoxicity. RESULTS KIM-1 was the best marker for diagnosis as it increased with the development of incident CKD. DKK3 increased in patients with declining eGFR, whereas UMOD decreased in those with declining kidney function. Unfortunately, none fulfilled all criteria to adequately assess mortality and nephrotoxicity. CONCLUSION New developments in the field of urinalysis using smart toilets may open several possibilities for urinary biomarkers. This review explored which biomarkers could be used for CKD disease detection and management.
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Affiliation(s)
- Esra Canki
- Department of Medical BioSciences, Radboudumc, Nijmegen, The Netherlands
| | - Esther Kho
- imec within OnePlanet Research Center, Wageningen, The Netherlands
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Bover J, Gómez-Alonso C, Casado E, Rodríguez-García M, Lloret MJ, Castro-Alonso C, Gifre L, Henríquez-Palop F, Prior-Español Á, López de la Manzanara V, Láiz AM, Martínez-Ferrer À, Torregrosa JV, Cigarrán S, Górriz JL, Montomoli M, Panizo N, Costa E, Martínez-Laguna D, Rodríguez M, Navarro-González JF. Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care. Nefrologia 2024; 44:241-250. [PMID: 38531765 DOI: 10.1016/j.nefroe.2024.03.005] [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: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 03/28/2024] Open
Abstract
Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.
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Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, REMAR-IGTP Group, Can Ruti Campus, Badalona, Barcelona, Spain.
| | - Carlos Gómez-Alonso
- Unidad de Gestión Clínica de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Enrique Casado
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Minerva Rodríguez-García
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Cristina Castro-Alonso
- Servicio de Nefrología, Hospital Universitario Doctor Peset, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Gifre
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Águeda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Ana María Láiz
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Marco Montomoli
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Nayara Panizo
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ester Costa
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Mariano Rodríguez
- Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan F Navarro-González
- Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Islas Canarias, Spain
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Chen HF, Xiao BJ, Chen LY, OuYang WW, Zhang XL, He ZR, Fu LZ, Tang F, Tang XN, Liu XS, Wu YF. Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients. Lipids Health Dis 2024; 23:5. [PMID: 38185630 PMCID: PMC10773091 DOI: 10.1186/s12944-024-02004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Lipid management in clinic is critical to the prevention and treatment of Chronic kidney disease (CKD), while the manifestations of lipid indicators vary in types and have flexible association with CKD prognosis. PURPOSE Explore the associations between the widely used indicators of lipid metabolism and their distribution in clinic and CKD prognosis; provide a reference for lipid management and inform treatment decisions for patients with non-dialysis CKD stage 3-5. METHODS This is a retrospective cohort study utilizing the Self-Management Program for Patients with Chronic Kidney Disease Cohort (SMP-CKD) database of 794 individuals with CKD stages 3-5. It covers demographic data, clinical diagnosis and medical history collection, laboratory results, circulating lipid profiles and lipid distribution assessments. Primary endpoint was defined as a composite outcome(the initiation of chronic dialysis or renal transplantation, sustained decline of 40% or more in estimated glomerular filtration rate (eGFR), doubled of serum creatinine (SCr) from the baseline, eGFR less than 5 mL/min/1.73m2, or all-cause mortality). Exposure variables were circulating lipid profiles and lipid distribution measurements. Association were assessed using Relative risks (RRs) (95% confidence intervals (CIs)) computed by multivariate Poisson models combined with least absolute shrinkage and selection operator (LASSO) regression according to categories of lipid manifestations. The best model was selected via akaike information criterion (AIC), area under curve (AUC), receiver operating characteristic curve (ROC) and net reclassification index (NRI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness.. RESULTS 255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.8 [48.7, 67.2] years with a median eGFR of 33.7 [17.6, 47.8] ml/min/1.73 m2. Five dataset were built after multiple imputation and five category-based Possion models were constructed for each dataset. Model 5 across five datasets had the best fitness with smallest AIC and largest AUC. The pooled results of Model 5 showed that total cholesterol (TC) (RR (95%CI) (per mmol/L) :1.143[1.023,1.278], P = 0.018) and percentage of body fat (PBF) (RR (95%CI) (per percentage):0.976[0.961,0.992], P = 0.003) were significant factors of composite outcome. The results indicated that comprehensive consideration of lipid metabolism and fat distribution is more critical in the prediction of CKD prognosis.. CONCLUSION Comprehensive consideration of lipid manifestations is optimal in predicting the prognosis of individuals with non-dialysis CKD stages 3-5.
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Affiliation(s)
- Hui-Fen Chen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bing-Jie Xiao
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lin-Yi Chen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wen-Wei OuYang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Global Health - Health Systems and Policy, Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Xian-Long Zhang
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
| | - Zhi-Ren He
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
| | - Li-Zhe Fu
- Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Xiao-Na Tang
- Bao'an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xu-Sheng Liu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China.
| | - Yi-Fan Wu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China.
- Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
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11
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Gatlin B, Miller J, Chang S. Optimizing Collaborative Care of Patients with Chronic Kidney Disease Associated with Type 2 Diabetes: An Example Practice Model at a Health Care Practice in Kentucky, United States. Diabetes Ther 2024; 15:1-11. [PMID: 37914833 PMCID: PMC10786800 DOI: 10.1007/s13300-023-01500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
Suboptimal multidisciplinary team collaboration is a barrier to effective health care provision for patients with chronic kidney disease (CKD) associated with type 2 diabetes mellitus (T2DM). We describe an example practice model of a clinical practice called Baptist Health Deaconess, based in Madisonville, Kentucky, USA, where a small multidisciplinary team consisting of an endocrinologist, nurse practitioner, and pharmacist (authors of this article) work collaboratively in an ambulatory care setting to provide health care to the patients they serve. Many of the patients who receive care at Baptist Health Deaconess are on a low income, have poor health literacy, and do not have a primary care physician. The presence of a pharmacist in the team allows for insurance/access investigations to assess drug choice and affordability; such aspects can be performed quickly with a pharmacist in the office.
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Affiliation(s)
- Benjamin Gatlin
- Baptist Health Deaconess Madisonville, Madisonville, KY, USA.
| | - Jamie Miller
- Baptist Health Deaconess Madisonville, Madisonville, KY, USA
| | - Sergio Chang
- Baptist Health Deaconess Madisonville, Madisonville, KY, USA
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12
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Heo GY, Koh HB, Kim HJ, Kim KW, Jung CY, Kim HW, Chang TI, Park JT, Yoo TH, Kang SW, Han SH. Association of Plant Protein Intake With Risk of Incident CKD: A UK Biobank Study. Am J Kidney Dis 2023; 82:687-697.e1. [PMID: 37517545 DOI: 10.1053/j.ajkd.2023.05.007] [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: 12/11/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 08/01/2023]
Abstract
RATIONALE & OBJECTIVE Data suggest that various dietary interventions slow kidney disease progression and improve clinical outcomes for those with chronic kidney disease (CKD). However, the association between plant protein intake and incident CKD has been uncertain. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 117,809 participants who completed at least 1 dietary questionnaire and had an estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m2, a urinary albumin-creatinine ratio (UACR)<30mg/g, and no history of CKD. EXPOSURE Daily plant protein intake in g/kg/day. OUTCOME Incident CKD based on the International Classification of Diseases, 10th Revision (ICD-10) or the Office of Population Censuses and Surveys Classification of Interventions and Procedures, version 4 (OPCS-4) codes. ANALYTICAL APPROACH A cause-specific proportional hazards analysis incorporating competing risks that treated death occurring before incident CKD as a competing event. RESULTS During a median follow-up period of 9.9 years, incident CKD occurred in 3,745 participants (3.2%; incidence rate, 3.2 per 1,000 person-years). In a multivariable model, the adjusted hazard ratio (AHR) for the second, third, and highest quartiles of plant protein intake was 0.90 (95% CI, 0.82-0.99), 0.83 (95% CI, 0.75-0.92), and 0.82 (95% CI, 0.73-0.93), respectively, compared with the lowest quartile. Modeled as a continuous variable, the AHR per 0.1g/kg/day plant protein intake increase was 0.96 (95% CI, 0.93-0.99). This beneficial association was also consistent in secondary analyses for which CKD was defined based on codes or 2 consecutive measures of eGFR<60mL/min/1.73m2 or UACR>30mg/g. Various sensitivity analyses demonstrated consistent findings. LIMITATIONS Potential incomplete dietary assessments; limited generalizability due to the characteristics of participants in the UK Biobank Study. CONCLUSIONS In this large, prospective cohort study, greater dietary plant protein intake was associated with a lower risk of incident CKD. Further interventional studies demonstrating the kidney-protective benefits of plant protein intake are warranted. PLAIN-LANGUAGE SUMMARY Plant-based diets confer various health benefits, including lowering the risk of cardiovascular disease and certain cancers. However, the relationship between plant protein intake and the risk of chronic kidney disease (CKD) remains unclear. Our study investigated the association between plant protein intake and the development of CKD. Using the UK Biobank Study data, we found that participants with a higher plant protein intake had a lower risk of developing CKD. Our finding suggests that a higher dietary intake of plant-based protein may be beneficial for kidney health and provides insight into dietary interventions to prevent CKD in primary care settings.
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Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Hee Byung Koh
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Hyo Jeong Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Kyung Won Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Chan Young Jung
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, South Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul.
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13
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Manewell SM, Rao P, Haneman K, Zheng M, Charaf H, Menz HB, Sherrington C, Paul SS. Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review. J Foot Ankle Res 2023; 16:81. [PMID: 37986004 PMCID: PMC10659051 DOI: 10.1186/s13047-023-00679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Foot and lower limb health complications are common among patients undergoing dialysis; but a summary of prevention and management evidence is not available. The aim of this scoping review was to summarise study characteristics and the nature of results regarding strategies to prevent and manage peripheral arterial disease (PAD), foot ulceration, amputation, associated infection and associated hospital admission in adults undergoing dialysis. METHODS MEDLINE, Embase, CINAHL and AMED databases were searched for longitudinal experimental and observational studies. Eligible studies included adults undergoing dialysis (≥10 dialysis patients, with separate results or ≥ 75% of the cohort). Any interventions relating to PAD, foot ulceration, amputation, associated infection, and associated hospital admission were included. RESULTS The review included 212 studies, of which 199 were observational (94%) and 13 were experimental (6%). Sixteen studies (8%) addressed the prevention of foot and lower limb health complications, 43 (20%) addressed management, and 153 (72%) addressed both. The main intervention type in each study was surgery (n = 159, 75%), care from one or more health professionals (n = 13, 6%), screening by a health professional (n = 10, 5%), medication (n = 9, 4%) and rehabilitation (n = 5, 2%). No studies were identified where exercise, offloading or education were the main intervention. Results for PAD were reported in 137 (65%) studies, foot ulceration in 54 (25%), amputation in 171 (81%), infection in 7 (3%), and admission in 26 studies (12%). Results for more than one foot or lower limb outcome were reported in 141 studies (67%), with each study reporting on average two outcomes. Results varied and spanned positive, negative, and neutral outcomes following intervention. CONCLUSIONS Identified studies frequently aimed to both prevent and manage foot and lower limb health complications. A variety of interventions were identified and studies often reported results for more than one foot or lower limb health outcome. Findings from this review can be used to guide future research, with a goal to support improved patient outcomes.
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Affiliation(s)
- Sarah M Manewell
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia.
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia.
| | - Purnima Rao
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Keren Haneman
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Minjia Zheng
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia
| | - Hady Charaf
- Faculty of Podiatric Medicine, School of Health Sciences, Western Sydney University, NSW, Campbelltown, Australia
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney/Sydney Local Health District, NSW, Camperdown, Australia
| | - Serene S Paul
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia
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14
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Heo GY, Koh HB, Kim HW, Park JT, Yoo TH, Kang SW, Kim J, Kim SW, Kim YH, Sung SA, Oh KH, Han SH. Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD. Diabetes Metab J 2023; 47:535-546. [PMID: 37096377 PMCID: PMC10404520 DOI: 10.4093/dmj.2022.0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 04/26/2023] Open
Abstract
BACKGRUOUND The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). METHODS We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease. RESULTS During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%-7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups. CONCLUSION This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM.
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Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Byung Koh
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Su Ah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
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15
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Cotta A, Kristiansen M. Enacting person-centred care: a multi-perspective study of practices in clinical encounters for people living with chronic kidney disease. BMC Nephrol 2023; 24:185. [PMID: 37349691 PMCID: PMC10288716 DOI: 10.1186/s12882-023-03245-8] [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: 02/24/2022] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND There is growing emphasis on the need for ensuring person-centred care for patients living with chronic kidney disease as this will benefit patients, providers, and healthcare systems alike. Nevertheless, less emphasis is given to how this complex concept is practiced in clinical encounters and how it is experienced by patients. This qualitative multi-perspective study investigates how person-centred care for people living with chronic kidney disease is practiced and experienced by patients in clinical encounters at a nephrological ward at a hospital in the capital region of Denmark. METHODS The study builds upon qualitative methodologies, including field notes from observations of clinical encounters between clinicians and patients in an out-patient clinic (n = ~ 80) and in-person interviews with patients in peritoneal dialysis (n = 4). Key themes from field notes and interview transcripts were identified through thematic analysis. Analyses were informed by practice theory. RESULTS Findings illustrate that person-centred care is practiced in a relational and situational encounter between patients and clinicians as dialogues about choice of treatment modality, which is shaped by the individual's life circumstances, preferences, and values. The practice of person-centred care appeared to be complex and interlinked with a range of factors, individual to each patient. We identified three themes of relevance for practices and experiences related to person-centred care: (1) Patients' perceptions of living with chronic kidney disease. Perceptions differed according to medical history, life situation and prior experiences with treatment in the healthcare system. These patient-related factors were perceived to be important for person-centred care to unfold; (2) Relations between patients and healthcare professionals were important for patients' experiences of trust and appeared fundamental for the practice and experiences of person-centred care; and (3) Decision-making on treatment modality that is the best fit for each patient's everyday life, appear to be shaped by the patient's need for knowledge about treatment modalities and level of self-determination in the decision-making. CONCLUSIONS The context of clinical encounters influences the practices and experiences of person-centred care, where health policies and lack of embodiment are identified as barriers for providing and experiencing person-centred care.
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Affiliation(s)
- Amie Cotta
- Center for IT and Medical technology, Capital Region, Borgervaenget 5, 2100 Copenhagen Ø, Denmark
| | - Maria Kristiansen
- Department of Public Health, Center for Healthy Aging, University of Copenhagen, Øster Farimagsgade 5, DK 1353 Copenhagen K, Denmark
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16
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Liu Z, Nan P, Gong Y, Tian L, Zheng Y, Wu Z. Endoplasmic reticulum stress-triggered ferroptosis via the XBP1-Hrd1-Nrf2 pathway induces EMT progression in diabetic nephropathy. Biomed Pharmacother 2023; 164:114897. [PMID: 37224754 DOI: 10.1016/j.biopha.2023.114897] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
Diabetic nephropathy (DN) is characterized by tubulointerstitial fibrosis caused by epithelial-mesenchymal transition (EMT) of renal tubular epithelial cells. Although ferroptosis promotes DN development, the specific pathological process that is affected by ferroptosis in DN remains unclear. Herein, EMT-related changes, including increased α-smooth muscle actin (α-SMA) and Vimentin expression and decreased E-cadherin expression, were observed in the renal tissues of streptozotocin-induced DN mice and high glucose-cultured human renal proximal tubular (HK-2) cells. Treatment with ferrostatin-1 (Fer-1) ameliorated these changes and rescued renal pathological injury in diabetic mice. Interestingly, endoplasmic reticulum stress (ERS) was activated during EMT progression in DN. Inhibiting ERS improved the expression of EMT-associated indicators and further rescued the characteristic changes in ferroptosis caused by high glucose, including reactive oxygen species (ROS) accumulation, iron overload, increased lipid peroxidation product generation, and reduced mitochondrial cristae. Moreover, overexpression of XBP1 increased Hrd1 expression and inhibited NFE2-related factor 2 (Nrf2) expression, which could enhance cell susceptibility to ferroptosis. Co-immunoprecipitation (Co-IP) and ubiquitylation assays indicated that Hrd1 interacted with and ubiquitinated Nrf2 under high-glucose conditions. Collectively, our results demonstrated that ERS triggers ferroptosis-related EMT progression through the XBP1-Hrd1-Nrf2 pathway, which provides new insights into potential mechanisms for delaying EMT progression in DN.
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Affiliation(s)
- Zijun Liu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China.
| | - Ping Nan
- Department of Obster & Gynecol, Shengli Oilfield Center Hospital, Dongying, Shandong 257000, China.
| | - Yihui Gong
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China.
| | - Ling Tian
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China.
| | - Yin Zheng
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
| | - Zhongming Wu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
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17
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Little DJ, Arnold M, Hedman K, Sun P, Haque SA, James G. Rates of adverse clinical events in patients with chronic kidney disease: analysis of electronic health records from the UK clinical practice research datalink linked to hospital data. BMC Nephrol 2023; 24:91. [PMID: 37020294 PMCID: PMC10077632 DOI: 10.1186/s12882-023-03119-z] [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: 09/12/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Further understanding of adverse clinical event rates in patients with chronic kidney disease (CKD) is required for improved quality of care. This study described baseline characteristics, adverse clinical event rates, and mortality risk in patients with CKD, accounting for CKD stage and dialysis status. METHODS This retrospective, noninterventional cohort study included data from adults (aged ≥ 18 years) with two consecutive estimated glomerular filtration rates of < 60 ml/min/1.73 m2, recorded ≥ 3 months apart, from the UK Clinical Practice Research Datalink of electronic health records obtained between January 1, 2004, and December 31, 2017. Select adverse clinical events, associated with CKD and difficult to quantify in randomized trials, were assessed; defined by Read codes and International Classification of Diseases, Tenth Revision codes. Clinical event rates were assessed by dialysis status (dialysis-dependent [DD], incident dialysis-dependent [IDD], or non-dialysis-dependent [NDD]), dialysis modality (hemodialysis [HD] or peritoneal dialysis [PD]), baseline NDD-CKD stage (3a-5), and observation period. RESULTS Overall, 310,953 patients with CKD were included. Comorbidities were more common in patients receiving dialysis than in NDD-CKD, and increased with advancing CKD stage. Rates of adverse clinical events, particularly hyperkalemia and infection/sepsis, also increased with advancing CKD stage and were higher in patients on HD versus PD. Mortality risk during follow-up (1-5-year range) was lowest in patients with stage 3a NDD-CKD (2.0-18.5%) and highest in patients with IDD-CKD (26.3-58.4%). CONCLUSIONS These findings highlight the need to monitor patients with CKD for comorbidities and complications, as well as signs or symptoms of clinical adverse events.
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Affiliation(s)
- Dustin J Little
- Late Cardiovascular, Renal, Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, 20876, USA.
| | - Matthew Arnold
- Real World Data Science, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Katarina Hedman
- Biometrics CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ping Sun
- Real World Data Science, Oncology Business Unit, AstraZeneca, Cambridge, UK
| | - Syed Asif Haque
- Global Patient Safety BioPharma, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Glen James
- Cardiovascular, Renal, Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
- Present Address: Integrated Evidence Generation & Business Innovation, Bayer PLC, Reading, UK
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18
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Roushani J, Thomas D, Oliver MJ, Ip J, Yeung A, Tang Y, Brimble KS, Levin A, Hladunewich MA, Cooper R, Blake PG. Clinical Outcomes and Vaccine Effectiveness for SARS-CoV-2 Infection in People Attending Advanced CKD Clinics: A Retrospective Provincial Cohort Study. Clin J Am Soc Nephrol 2023; 18:465-474. [PMID: 36795940 PMCID: PMC10103334 DOI: 10.2215/cjn.0000000000000087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with advanced CKD are at high risk of mortality and morbidity from coronavirus disease 2019 (COVID-19). We measured rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe outcomes in a large population attending advanced CKD clinics during the first 21 months of the pandemic. We examined risk factors for infection and case fatality, and we assessed vaccine effectiveness in this population. METHODS In this retrospective cohort study, we analyzed data on demographics, diagnosed SARS-CoV-2 infection rates, outcomes, and associated risk factors, including vaccine effectiveness, for people attending a province-wide network of advanced CKD clinics during the first four waves of the pandemic in Ontario, Canada. RESULTS In a population of 20,235 patients with advanced CKD, 607 were diagnosed with SARS-CoV-2 infection over 21 months. The case fatality rate at 30 days was 19% overall but declined from 29% in the first wave to 14% in the fourth. Hospitalization and intensive care unit (ICU) admission rates were 41% and 12%, respectively, and 4% started long-term dialysis within 90 days. Significant risk factors for diagnosed infection on multivariable analysis included lower eGFR, higher Charlson Comorbidity Index, attending advanced CKD clinics for more than 2 years, non-White ethnicity, lower income, living in the Greater Toronto Area, and long-term care home residency. Being doubly vaccinated was associated with lower 30-day case fatality rate (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.03 to 0.52). Older age (OR, 1.06 per year; 95% CI, 1.04 to 1.08) and higher Charlson Comorbidity Index (OR, 1.11 per unit; 95% CI, 1.01 to 1.23) were associated with higher 30-day case fatality rate. CONCLUSIONS People attending advanced CKD clinics and diagnosed with SARS-CoV-2 infection in the first 21 months of the pandemic had high case fatality and hospitalization rates. Fatality rates were significantly lower in those who were doubly vaccinated. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_04_10_CJN10560922.mp3.
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Affiliation(s)
- Jian Roushani
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Doneal Thomas
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Matthew J. Oliver
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Ip
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Angie Yeung
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Yiwen Tang
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Kenneth Scott Brimble
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Adeera Levin
- British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michelle A. Hladunewich
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Cooper
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Peter G. Blake
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Bollenbecker S, Heitman K, Czaya B, Easter M, Hirsch MJ, Vang S, Harris E, Helton ES, Barnes JW, Faul C, Krick S. Phosphate induces inflammation and exacerbates injury from cigarette smoke in the bronchial epithelium. Sci Rep 2023; 13:4898. [PMID: 36966182 PMCID: PMC10039898 DOI: 10.1038/s41598-023-32053-1] [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: 01/13/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
An elevation in serum phosphate-also called hyperphosphatemia-is associated with reduced kidney function in chronic kidney disease (CKD). Reports show CKD patients are more likely to develop lung disease and have poorer kidney function that positively correlates with pulmonary obstruction. However, the underlying mechanisms are not well understood. Here, we report that two murine models of CKD, which both exhibit increased serum levels of phosphate and fibroblast growth factor (FGF) 23, a regulator of phosphate homeostasis, develop concomitant airway inflammation. Our in vitro studies point towards a similar increase of phosphate-induced inflammatory markers in human bronchial epithelial cells. FGF23 stimulation alone does not induce a proinflammatory response in the non-COPD bronchial epithelium and phosphate does not cause endogenous FGF23 release. Upregulation of the phosphate-induced proinflammatory cytokines is accompanied by activation of the extracellular-signal regulated kinase (ERK) pathway. Moreover, the addition of cigarette smoke extract (CSE) during phosphate treatments exacerbates inflammation as well as ERK activation, whereas co-treatment with FGF23 attenuates both the phosphate as well as the combined phosphate- and CS-induced inflammatory response, independent of ERK activation. Together, these data demonstrate a novel pathway that potentially explains pathological kidney-lung crosstalk with phosphate as a key mediator.
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Affiliation(s)
- Seth Bollenbecker
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - Kylie Heitman
- Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian Czaya
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Molly Easter
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - Meghan June Hirsch
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - Shia Vang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - Elex Harris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - E Scott Helton
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - Jarrod W Barnes
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA
| | - Christian Faul
- Section of Mineral Metabolism, Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, 1918 University Blvd, MCLM 718, Birmingham, AL, 35294, USA.
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Multimorbidity prevalence and patterns in chronic kidney disease: findings from an observational multicentre UK cohort study. Int Urol Nephrol 2023:10.1007/s11255-023-03516-1. [PMID: 36806100 DOI: 10.1007/s11255-023-03516-1] [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: 05/17/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Multimorbidity [defined as two or more long-term conditions (LTCs)] contributes to increased treatment and medication burden, poor health-related quality of life, and worse outcomes. Management strategies need to be patient centred and tailored depending on existing comorbidities; however, little is known about the prevalence and patterns of comorbidities in people with chronic kidney disease (CKD). We investigated the prevalence of multimorbidity and comorbidity patterns across all CKD stages. METHODS Multimorbidity was assessed, using a composite of self-report and clinical data, across four CKD groups stratified by eGFR [stage 1-2, stage 3a&b, stage 4-5, and kidney transplant (KTx)]. Principal component analysis using varimax rotation was used to identify comorbidity clusters across each group. RESULTS Of the 978 participants (mean 66.3 ± 14 years, 60% male), 96.0% had multimorbidity. In addition to CKD, the mean number of comorbidities was 3.0 ± 1.7. Complex multimorbidity (i.e. ≥ 4 multiple LTCs) was identified in 560 (57.3%) participants. When stratified by CKD stage, the two most prevalent comorbidities across all stages were hypertension (> 55%) and musculoskeletal disorders (> 40%). The next most prevalent comorbidity for CKD stages 1-2 was lung conditions and for CKD stages 3 and 4-5 it was heart problems. CKD stages 1-2 showed different comorbidity patterns and clustering compared to other CKD stages. CONCLUSION Most people across the spectrum of CKD have multimorbidity. Different patterns of multimorbidity exist at different stages of CKD, and as such, clinicians should consider patient comorbidities to integrate care and provide effective treatment strategies.
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Denosumab Is Superior to Raloxifene in Lowering Risks of Mortality and Ischemic Stroke in Osteoporotic Women. Pharmaceuticals (Basel) 2023. [DOI: 10.3390/ph16020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Both osteoporosis and cardiovascular disease (CVD) share similar pathways in pathophysiology and are intercorrelated with increased morbidity and mortality in elderly women. Although denosumab and raloxifene are the current guideline-based pharmacological treatments, their impacts on cardiovascular protection are yet to be examined. This study aimed to compare mortality rate and cardiovascular events between denosumab and raloxifene in osteoporotic women. Risks of CVD development and all-cause mortality were estimated using Cox proportional hazard regression. A total of 7972 (3986 in each group) women were recruited between January 2003 and December 2018. No significant difference between denosumab and raloxifene was observed in composite CVDs, myocardial infarction, or congestive heart failure. However, comparison of the propensity score matched cohorts revealed that patients with proportion of days covered (PDC) ≥60% had lower incidence of ischemic stroke in the denosumab group than that in the raloxifene group (aHR 0.68; 95% CI 0.47–0.98; p = 0.0399). In addition, all-cause mortality was lower in the denosumab group than in the raloxifene group (aHR 0.59; 95% CI 0.48–0.72; p = 0.001), except in patients aged <65 y/o in this cohort study. We concluded that denosumab is superior to raloxifene in lowering risks of all-cause mortality and certain ischemic strokes in osteoporotic women.
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Screening Cases of Suspected Early Stage Chronic Kidney Disease from Clinical Laboratory Data: The Comparison between Urine Conductivity and Urine Protein. Biomedicines 2023; 11:biomedicines11020379. [PMID: 36830916 PMCID: PMC9953103 DOI: 10.3390/biomedicines11020379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: Chronic kidney disease (CKD) affects more than 800 million global population. Early detection followed by clinical management is among the best approaches for the affected individuals. However, a sensitive screening tool is not yet available. (2) Methods: We retrospectively reviewed 600 patients aged >20 years with a full range of estimated glomerular filtration rate (eGFR) for clinical assessment of kidney function between 1 January 2020, to 30 April 2021, at the Taichung Veterans General Hospital, Taichung, Taiwan. With stratified sampling based on the level of eGFR, participants were evenly grouped into training and validation sets for predictive modeling. Concurrent records of laboratory data from urine samples were used as inputs to the model. (3) Results: The predictive model proposed two formulae based on urine conductivity for detecting suspected early-stage CKD. One formula, P_male45, was for used male subjects aged ≥45 years, and it had a prediction accuracy of 76.3% and a sensitivity of 97.3%. The other formula, P_female55, was used for female subjects aged ≥55 years. It had a prediction accuracy of 81.9% and a sensitivity of 98.4%. Urine conductivity, however, had low associations with urine glucose and urine protein levels. (4) Conclusion: The two predictive models were low-cost and provided rapid detection. Compared to urine protein, these models had a better screening performance for suspected early-stage CKD. It may also be applied for monitoring CKD in patients with progressing diabetes mellitus.
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23
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Kampmann JD, Heaf JG, Mogensen CB, Mickley H, Wolff DL, Brandt F. Prevalence and incidence of chronic kidney disease stage 3-5 - results from KidDiCo. BMC Nephrol 2023; 24:17. [PMID: 36658506 PMCID: PMC9849831 DOI: 10.1186/s12882-023-03056-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global challenge. CKD prevalence estimation is central to management strategies and prevention. It is necessary to predict end stage kidney disease (ESKD) and, subsequently, the burden for healthcare systems. In this study we characterize CKD stage 3-5 prevalence and incidence in a cohort covering the majority of the Region of Southern Denmark and investigate individuals' demographic, socioeconomic, and comorbidity status. METHODS We used data from the Kidney Disease Cohort (KidDiCo) combining laboratory data from Southern Denmark with Danish national databases. Chronic kidney disease was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS The prevalence varied between 4.83 and 4.98% and incidence rate of CKD was 0.49%/year. The median age was 76.4 years. The proportion of individuals with CKD stage 3-5 in the entire population increased consistently with age. The percentage of women in the CKD 3-5 group was higher than in the background population. Diabetes mellitus, hypertension and cardiovascular disease were more prominent in patients with CKD. CKD stage 5 and ESKD were more frequent as incident CKD stages in the 18-49 year olds when compared to older individuals. CKD patients tended to have a lower socioeconomic status. CONCLUSION Chronic kidney disease stage 3-5 is common, especially in the elderly. Patients with CKD stage 3-5 are predominantly female. The KidDiCo data suggests an association between lower socioeconomic status and prevalence of CKD.
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Affiliation(s)
- Jan Dominik Kampmann
- grid.7143.10000 0004 0512 5013Department of Internal Medicine, University Hospital of Southern Denmark, Sydvang 1, Sonderborg, 6400 Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark
| | - James Goya Heaf
- grid.476266.7Department of Medicine, Zealand University Hospital, Roskilde, Sygehusvej 10, Roskilde, 4000 Denmark
| | - Christian Backer Mogensen
- grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark ,grid.7143.10000 0004 0512 5013Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, Aabenraa, 6200 Denmark
| | - Hans Mickley
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense, 5000 Denmark
| | - Donna Lykke Wolff
- grid.7143.10000 0004 0512 5013Department of Internal Medicine, University Hospital of Southern Denmark, Sydvang 1, Sonderborg, 6400 Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark
| | - Frans Brandt
- grid.7143.10000 0004 0512 5013Department of Internal Medicine, University Hospital of Southern Denmark, Sydvang 1, Sonderborg, 6400 Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, Odense, 5230 Denmark
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Heo GY, Kim HJ, Kalantar D, Jung CY, Kim HW, Park JT, Chang TI, Yoo TH, Kang SW, Rhee CM, Kalantar-Zadeh K, Han SH. Association between Fiber Intake and Risk of Incident Chronic Kidney Disease: The UK Biobank Study. J Nutr Health Aging 2023; 27:1018-1027. [PMID: 37997724 DOI: 10.1007/s12603-023-1998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Dietary fiber intake is associated with a lower risk of diabetes, cardiovascular disease, and cancer. However, it is unknown whether dietary fiber has a beneficial effect on preventing the development of chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Using the UK Biobank prospective cohort, 110,412 participants who completed at least one dietary questionnaire and had an estimated glomerular filtration rate ≥60 mL/min/1.73 m2, urinary albumin-to-creatinine ratio <30 mg/g, and no history of CKD were included. The primary exposure was total dietary fiber density, calculated by dividing the absolute amount of daily total fiber intake by total energy intake (g/1,000 kcal). We separately examined soluble and insoluble fiber densities as additional predictors. The primary outcome was incident CKD based on diagnosis codes. RESULTS A total of 3,507 (3.2%) participants developed incident CKD during a median follow-up of 9.9 years. In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for incident CKD were 0.85 (0.77-0.94), 0.78 (0.70-0.86), and 0.76 (0.68-0.86), respectively, for the second, third, and highest quartiles of dietary fiber density (reference: lowest quartile). In a continuous model, the aHR for each +∆1.0g/1,000 kcal increase in dietary fiber density was 0.97 (95% CI, 0.95-0.99). This pattern of associations was similar for both soluble and insoluble fiber densities and did not differ across subgroups of sex, age, body mass index, hypertension, diabetes, smoking, and inflammation. CONCLUSION Increased fiber intake was associated with a lower risk of CKD in this large well-characterized cohort.
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Affiliation(s)
- G Y Heo
- Seung Hyeok Han, MD, Ph.D. Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, Phone: 82-2-2228-1984; Fax: 82-2-393-6884; E-mail: , (https://orcid.org/0000-0001-7923-5635)
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25
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Milne B, Gilbey T, Kunst G. Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury. J Cardiothorac Vasc Anesth 2022; 36:4460-4482. [PMID: 36241503 DOI: 10.1053/j.jvca.2022.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is one of the most common major complications of cardiac surgery, and is associated with increased morbidity and mortality. Cardiac surgery-associated AKI has a complex, multifactorial etiology, including numerous factors such as primary cardiac dysfunction, hemodynamic derangements of cardiac surgery and cardiopulmonary bypass, and the possibility of a large volume of blood transfusion. There are no truly effective pharmacologic therapies for the management of AKI, and, therefore, anesthesiologists, intensivists, and cardiac surgeons must remain vigilant and attempt to minimize the risk of developing renal dysfunction. This narrative review describes the current state of the scientific literature concerning the specific aspects of cardiac surgery-associated AKI, and presents it in a chronological fashion to aid the perioperative clinician in their approach to this high-risk patient group. The evidence was considered for risk prediction models, preoperative optimization, and the intraoperative and postoperative management of cardiac surgery patients to improve renal outcomes.
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Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Academic Clinical Fellow, King's College London, London, United Kingdom
| | - Tom Gilbey
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Academic Clinical Fellow, King's College London, London, United Kingdom
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Excellence, Faculty of Life Sciences and Medicine, London, United Kingdom.
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26
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Eldehni MT. Frailty, multimorbidity and sarcopaenia in haemodialysis patients. Curr Opin Nephrol Hypertens 2022; 31:560-565. [PMID: 36172855 DOI: 10.1097/mnh.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It is well recognised that haemodialysis patients have higher levels of multimorbidity, frailty and sarcopaenia. This review examines the current understanding of the three concepts in relation to the general population and haemodialysis patients, and the methods used to quantify them. It also looks at the interaction between multimorbidity, frailty and sarcopaenia in this patient group and proposes a new model that utilises muscle mass index and fat mass index as a surrogate representation of the three concepts. RECENT FINDINGS Multimorbidity in on the rise in the general population and this is one of the contributing factors to higher rates of chronic kidney disease, progression to end-stage renal disease and multimorbidity in haemodialysis patients. Malnutrition and haemodialysis induced end organ damage further contributes to muscle loss and frailty in this patient group. There is a significant overlap and interaction between multimorbidity, frailty and sarcopaenia in haemodialysis and their presence carries a significant impact on quality of life and survival. There are multiple scores for measuring multimorbidity, frailty and sarcopenia and there is no consensus on their utilisation in haemodialysis patients. We propose the use of fat mass index and muscle mass index model as a surrogate method for clinically quantifying multimorbidity, frailty and sarcopaenia. SUMMARY Effective public health policies are likely to have an impact on reducing the prevalence of multimorbidity and the development of end stage renal disease. Future research is required to develop interventions that are targeted at maintaining muscle mass and function in haemodialysis patients.
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Affiliation(s)
- Mohamed Tarek Eldehni
- Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences School of Medicine, University of Nottingham, Nottingham, UK
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Mineralocorticoid Receptor Pathway Is a Key Mediator of Carfilzomib-induced Nephrotoxicity: Preventive Role of Eplerenone. Hemasphere 2022; 6:e791. [PMID: 36285072 PMCID: PMC9584194 DOI: 10.1097/hs9.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Carfilzomib is an irreversible proteasome inhibitor indicated for relapsed/refractory multiple myeloma. Carfilzomib toxicity includes renal adverse effects (RAEs) of obscure pathobiology. Therefore, we investigated the mechanisms of nephrotoxicity developed by Carfilzomib. In a first experimental series, we used our previously established in vivo mouse models of Carfilzomib cardiotoxicity, that incorporated 2 and 4 doses of Carfilzomib, to identify whether Carfilzomib affects renal pathways. Hematology and biochemical analyses were performed, while kidneys underwent histological and molecular analyses. In a second and third experimental series, the 4 doses protocol was repeated for 24 hours urine collection and proteomic/metabolomic analyses. To test an experimental intervention, primary murine collecting duct tubular epithelial cells were treated with Carfilzomib and/or Eplerenone and Metformin. Finally, Eplerenone was orally co-administered with Carfilzomib daily (165 mg/kg) in the 4 doses protocol. We additionally used material from 7 patients to validate our findings and patients underwent biochemical analysis and assessment of renal mineralocorticoid receptor (MR) axis activation. In vivo screening showed that Carfilzomib-induced renal histological deficits and increased serum creatinine, urea, NGAL levels, and proteinuria only in the 4 doses protocol. Carfilzomib decreased diuresis, altered renal metabolism, and activated MR axis. This was consistent with the cytotoxicity found in primary murine collecting duct tubular epithelial cells, whereas Carfilzomib + Eplerenone co-administration abrogated Carfilzomib-related nephrotoxic effects in vitro and in vivo. Renal SGK-1, a marker of MR activation, increased in patients with Carfilzomib-related RAEs. Conclusively, Carfilzomib-induced renal MR/SGK-1 activation orchestrates RAEs and water retention both in vivo and in the clinical setting. MR blockade emerges as a potential therapeutic approach against Carfilzomib-related nephrotoxicity.
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Strenth CR, Pagels P, SoRelle JA, Gonzalez L, Day PG, Gimpel NE, Levy Kamugisha EI, Moore RM, Arnold EM. Predictors of mood or anxiety problems among transgender individuals seeking hormone therapy. Fam Pract 2022; 40:273-281. [PMID: 36250448 DOI: 10.1093/fampra/cmac111] [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] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mental health needs of transgender individuals can be complex with individual, social, and medical factors impacting symptoms. This study examines predictors of mood or anxiety problems among transgender individuals seeking hormone therapy (HT). METHODS A retrospective chart review was conducted at 2 clinics providing gender-affirming HT. Cross-sectional data from initial patient encounters (N = 311) were used in this study. Bivariate correlations and multiple logistic regression analyses were carried out. RESULTS Transgender women (TW) were 2.2 times more likely to have mood or anxiety problems while transgender men (TM) were 2.6 times more likely as the number of medical comorbidities increased. For both TW and TM, White race significantly increased the likelihood of mood or anxiety problems. Neither previous nor current HT were associated with mood or anxiety problems for TW and TM. However, receiving multiple gender-affirming procedures decreased the likelihood of mood or anxiety problems for TM. CONCLUSIONS Gender-affirming care and addressing comorbidities can be important aspects of mental health needs for transgender individuals.
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Affiliation(s)
- Chance R Strenth
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Patti Pagels
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey A SoRelle
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Leo Gonzalez
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Philip G Day
- Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nora E Gimpel
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Emily I Levy Kamugisha
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Rachel M Moore
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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Burrows NR, Koyama AK, Choudhury D, Yu W, Pavkov ME, Nee R, Cheung AK, Norris KC, Yan G. Age-Related Association between Multimorbidity and Mortality in US Veterans with Incident Chronic Kidney Disease. Am J Nephrol 2022; 53:652-662. [PMID: 36209732 PMCID: PMC10880036 DOI: 10.1159/000526254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/05/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Mortality is an important long-term indicator of the public health impact of chronic kidney disease (CKD). We investigated the role of individual comorbidities and multimorbidity on age-specific mortality risk among US veterans with new-onset CKD. METHODS The cohort included 892,005 veterans aged ≥18 years with incident CKD stage 3 between January 2004 and April 2018 in the US Veterans Health Administration (VHA) system and followed until death, December 2018, or up to 10 years. Incident CKD was defined as the first-time estimated glomerular filtration rate (eGFR) was <60 mL/min/1.73 m2 for >3 months. Comorbidities were ascertained using inpatient and outpatient clinical records in the VHA system and Medicare claims. We estimated death rates for any cardiovascular disease (CVD, a composite of 6 CVD conditions) and 15 non-CVD comorbidities, and adjusted risks of death (hazard ratio [HR], 95% confidence interval [CI]) overall and by age group at CKD incidence. RESULTS At CKD incidence, the mean age was 72 years, and 97% were male; the mean eGFR was 52 mL/min/1.73 m2, and 95% had ≥2 comorbidities (median, 4) in addition to CKD. During a median follow-up of 4.5 years, among the 16 comorbidities, CVD was associated with the highest relative risk of death in younger veterans (HR 1.96 [95% CI: 1.61-2.37] in ages 18-44 years and HR 1.66 [1.63-1.70] in ages 45-64 years). Dementia was associated with the highest relative risk of death among older veterans (HR 1.71 [1.68-1.74] in ages 65-84 years and HR 1.69 [1.65-1.73] in ages 85-100 years). The additive effect of multimorbidity on risk of death was stronger in younger than older veterans. Compared to having 1 or no comorbidity at CKD onset, the risk of death with ≥5 comorbidities was >7-fold higher among veterans aged 18-44 years and >2-fold higher among veterans aged 85-100 years. CONCLUSION The large burden of comorbidities in US veterans with newly identified CKD places them at the risk of premature death. Compared with older veterans, younger veterans with multiple comorbidities, particularly with CVD, at CKD onset are at an even higher relative risk of death.
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Affiliation(s)
- Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alain K. Koyama
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Devasmita Choudhury
- VA Salem Medical Center, Salem, VA, USA
- University of Virginia School of Medicine, Charlottesville, VA, USA
- Virginia-Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Wei Yu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Meda E. Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center; Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Alfred K. Cheung
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Jawa NA, Vanderlinden JA, Scott SH, Jacobson JA, Silver SA, Holden R, Boyd JG. Visuospatial and Executive Dysfunction in Patients With Acute Kidney Injury, Chronic Kidney Disease, and Kidney Failure: A Multilevel Modeling Analysis. Can J Kidney Health Dis 2022; 9:20543581221103100. [PMID: 35721396 PMCID: PMC9201347 DOI: 10.1177/20543581221103100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Neurocognitive impairment is a common finding across the spectrum of kidney
disease and carries important consequences for quality of life. We
previously demonstrated that robotic technology can identify neurocognitive
impairments not readily detectable by traditional testing in patients with
acute kidney injury (AKI) and chronic kidney disease (CKD). Objective: The present study aimed to assess whether these quantifiable deficits in
neurocognition differ based on a diagnosis of AKI, CKD, or kidney
failure. Design: This was a cross-sectional analysis of participants previously enrolled in an
observational study. Setting: Patients were enrolled at a tertiary academic hospital, Kingston Health
Sciences Centre, Kingston, ON, Canada. Patients: Adults with AKI, CKD, or kidney failure. Measurements: Each participant underwent robotic neurocognitive assessment using the
Kinarm: an interactive robotic device that uses a series of behavioral tasks
involving movement of the upper limbs to precisely quantify neurocognitive
impairment across a variety of neurocognitive domains. Methods: Multilevel modeling was used to determine the effect of Kinarm task type,
kidney diagnostic group (AKI vs CKD vs kidney failure), and the interaction
between the two, on neurocognitive performance. Results: A total of 104 participants within 1 year of an AKI event or with CKD
category G3-5 were enrolled. We found that across all of the kidney
diagnostic groups, participants performed worst on the Kinarm tasks of
Reverse Visually Guided Reaching (b = 0.64 [95% confidence
interval = 0.42, 0.85]), Visually Guided Reaching (b = 0.28
[0.07, 0.49]), and Trail Making (b = 0.50 [0.28, 0.72]),
relative to all other tasks. There were no significant differences in
average performance across tasks based on kidney diagnostic group. However,
diagnostic group and neurocognitive task type interacted to determine
performance, such that patients with AKI performed worse than those with
either CKD or kidney failure on the Reverse Visually Guided Reaching
task. Limitations: Kinarm assessment was performed at a single time point, and the sample size
itself was small, which may lead to the risk of a false-positive association
despite the use of multilevel modeling. Our sample size also did not permit
inclusion of the underlying etiology of kidney impairment as a covariate in
our analyses, which may have also influenced neurocognitive function. Conclusions: In this study that utilized the Kinarm to assess neurocognitive function,
patients with AKI demonstrated significantly worse neurocognitive
functioning than patients with CKD or kidney failure on a task measuring
executive function and visuomotor control.
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Affiliation(s)
- Natasha A Jawa
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jessica A Vanderlinden
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jill A Jacobson
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Samuel A Silver
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Rachel Holden
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J Gordon Boyd
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.,Departments of Medicine (Neurology) and Critical Care, Kingston General Hospital, ON, Canada
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Predictors of Acute Kidney Disease Severity in Hospitalized Patients with Acute Kidney Injury. Biomedicines 2022; 10:biomedicines10051081. [PMID: 35625818 PMCID: PMC9138458 DOI: 10.3390/biomedicines10051081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
Acute kidney disease (AKD) forms part of the continuum of acute kidney injury (AKI) and worsens clinical outcomes. Currently, the predictors of AKD severity have yet to be established. We conducted a retrospective investigation involving 310 hospitalized patients with AKI and stratified them based on the AKD stages defined by the Acute Dialysis Quality Initiative criteria. Demographic, clinical, hematologic, and biochemical profiles, as well as 30-day outcomes, were compared between subgroups. In the analysis, the use of offending drugs (odds ratio, OR (95% confidence interval, CI), AKD stage 3 vs. non-AKD, 3.132 (1.304−7.526), p = 0.011, AKD stage 2 vs. non-AKD, 2.314 (1.049−5.107), p = 0.038), high AKI severity (OR (95% CI), AKD stage 3 vs. non-AKD, 6.214 (2.658−14.526), p < 0.001), and early dialysis requirement (OR (95% CI), AKD stage 3 vs. non-AKD, 3.366 (1.008−11.242), p = 0.049) were identified as independent predictors of AKD severity. Moreover, a higher AKD severity was associated with higher 30-day mortality and lower dialysis-independent survival rates. In conclusion, our study demonstrated that offending drug use, AKI severity, and early dialysis requirement were independent predictors of AKD severity, and high AKD severity had negative impact on post-AKI outcomes.
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32
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Bollenbecker S, Czaya B, Gutiérrez OM, Krick S. Lung-kidney interactions and their role in chronic kidney disease-associated pulmonary diseases. Am J Physiol Lung Cell Mol Physiol 2022; 322:L625-L640. [PMID: 35272496 DOI: 10.1152/ajplung.00152.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Chronic illnesses rarely present in a vacuum, devoid of other complications, and chronic kidney disease is hardly an exception. Comorbidities associated with chronic kidney disease lead to faster disease progression, expedited dialysis dependency, and a higher mortality rate. Although chronic kidney disease is most commonly accompanied by cardiovascular diseases and diabetes, there is clear cross talk between the lungs and kidneys pH balance, phosphate metabolism, and immune system regulation. Our present understanding of the exact underlying mechanisms that contribute to chronic kidney disease-related pulmonary disease is poor. This review summarizes the current research on kidney-pulmonary interorgan cross talk in the context of chronic kidney disease, highlighting various acute and chronic pulmonary diseases that lead to further complications in patient care. Treatment options for patients presenting with chronic kidney disease and lung disease are explored by assessing activated molecular pathways and the body's compensatory response mechanisms following homeostatic imbalance. Understanding the link between the lungs and kidneys will potentially improve health outcomes for patients and guide healthcare professionals to better understand how and when to treat each of the pulmonary comorbidities that can present with chronic kidney disease.
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Affiliation(s)
- Seth Bollenbecker
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian Czaya
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Stefanie Krick
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, Alabama
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33
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Lee WC, Chiu CH, Chu TH, Chien YS. WT1: The Hinge Between Anemia Correction and Cancer Development in Chronic Kidney Disease. Front Cell Dev Biol 2022; 10:876723. [PMID: 35465313 PMCID: PMC9019781 DOI: 10.3389/fcell.2022.876723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) emerge as promising agents to treat anemia in chronic kidney disease (CKD) but the major concern is their correlated risk of cancer development and progression. The Wilms’ tumor gene, WT1, is transcriptionally regulated by HIF and is known to play a crucial role in tumorigenesis and invasiveness of certain types of cancers. From the mechanism of action of HIF–PHIs, to cancer hypoxia and the biological significance of WT1, this review will discuss the link between HIF, WT1, anemia correction, and cancer. We aimed to reveal the research gaps and offer a focused strategy to monitor the development and progression of specific types of cancer when using HIF–PHIs to treat anemia in CKD patients. In addition, to facilitate the long-term use of HIF–PHIs in anemic CKD patients, we will discuss the strategy of WT1 inhibition to reduce the development and progression of cancer.
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Affiliation(s)
- Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hua Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tian-Huei Chu
- Medical Laboratory, Medical Education and Research Center, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Yu-Shu Chien
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- *Correspondence: Yu-Shu Chien,
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34
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Pollock C, James G, Garcia Sanchez JJ, Arnold M, Carrero JJ, Lam CSP, Chen H, Nolan S, Pecoits-Filho R. Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort. Adv Ther 2022; 39:1432-1445. [PMID: 35112306 PMCID: PMC8810284 DOI: 10.1007/s12325-021-02010-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
Introduction Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease (CKD) are limited. We examined length of hospitalisation and costs associated with end-of-life inpatient encounters using retrospective data from DISCOVER CKD. Methods Data on inpatient encounters for patients with CKD aged ≥ 18 years between January 2016 and March 2020 were extracted from the US Premier Hospital Database. Encounters ending in death were identified and grouped by reason for the encounter, using the International Classification of Diseases, Tenth Revision, and by their insurance coverage. Encounters were evaluated overall and stratified according to cardiovascular (CV), kidney failure and infection-related reasons, and by their coverage by commercial, Medicaid, Medicare or other insurers. Length of hospitalisation and total costs were calculated for encounters. Results Among 237,734 encounters ending in death, the mean [standard deviation (SD)] age was 74.2 (12.4) years, and 45.3% of patients were female. In total, 25,118, 4210 and 76,307 encounters were classified as relating to CV reasons, kidney failure and infection, respectively. Among all encounters, the mean (SD) length of hospitalisation ranged from 9.1 (11.2) (Medicare) to 12.8 (18.4) (Medicaid) days. Across insurers, encounters related to kidney failure were associated with the longest hospitalisations compared with CV and infection [mean range (days): 10.7–15.9 vs. 7.5–10.5 and 8.7–12.7, respectively]. The median [interquartile range (IQR)] total cost of any inpatient encounter was $17,057 ($8040–35,873). Kidney failure-related encounters had higher costs compared with CV and infection [median (IQR), $18,469 ($8673–38,315) vs. $17,503 ($7766–39,693) and $16,403 ($7762–34,910), respectively]. Medicaid-covered encounters had the highest costs of all insurers [median (IQR), $16,189 ($7725–33,443)]. Conclusions Among patients with CKD, end-of-life encounters were most frequently related to infection. Encounters relating to kidney failure incurred the highest costs. Trial registration ClinicalTrials.gov identifier: NCT04034992. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02010-3.
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35
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Acceptability of Plant-Based Diets for People with Chronic Kidney Disease: Perspectives of Renal Dietitians. Nutrients 2022; 14:nu14010216. [PMID: 35011091 PMCID: PMC8747619 DOI: 10.3390/nu14010216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/24/2021] [Accepted: 01/01/2022] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians participated in either an online survey (n = 35) or an in-depth interview (n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription included shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation; while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary approaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multidisciplinary team was also considered imperative.
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36
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Chronic Kidney Disease and SGLT2 Inhibitors: A Review of the Evolving Treatment Landscape. Adv Ther 2022; 39:148-164. [PMID: 34846711 PMCID: PMC8799531 DOI: 10.1007/s12325-021-01994-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/10/2021] [Indexed: 12/31/2022]
Abstract
There is currently an unmet need for effective treatment of chronic kidney disease (CKD) that slows disease progression, prevents development of end-stage kidney disease and cardiovascular disease, and prolongs survival of patients with CKD. In the last 20 years, the only agents to show a reduction in the risk of CKD progression in patients with and without type 2 diabetes (T2D) were angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, but neither drug class has provided a decreased risk of all-cause mortality in patients with CKD and evidence for their use in patients with CKD without T2D is relatively limited. This review discusses the mechanisms underlying the progression of CKD, its associated risk factors, and summarizes the potential therapeutic approaches for managing CKD. There is increasing evidence to support the role of sodium–glucose cotransporter 2 (SGLT2) inhibitor therapy in patients with CKD, including data from the designated kidney outcome trials in patients with T2D (CREDENCE) and in patients with or without T2D (DAPA-CKD). These studies showed a significant reduction in the risk of CKD progression with canagliflozin (in patients with T2D) or dapagliflozin (in patients with or without T2D), respectively, with DAPA-CKD being the first trial to show a reduced risk of all-cause mortality. On the basis of these data, individualized treatment with SGLT2 inhibitors represents a promising therapeutic option for patients with diabetic and nondiabetic CKD to slow disease progression. Chronic kidney disease is a common condition in which the ability of the kidneys to work correctly gradually decreases over time. It is a major risk factor for a number of other serious conditions, including cardiovascular disease and end-stage kidney disease, and for early death. Several treatments have been shown to reduce the risk of chronic kidney disease progressing (particularly in patients with type 2 diabetes), but there have been no treatments that slow chronic kidney disease progression, prevent the development of end-stage kidney disease and cardiovascular disease, and prolong survival. However, evidence is now accumulating to suggest that some drugs initially developed to treat other diseases may be potential treatments for chronic kidney disease. The sodium–glucose cotransporter 2 inhibitors, which are commonly used to lower blood sugar levels in people with type 2 diabetes, are examples of such drugs. Data from two studies of sodium–glucose cotransporter 2 inhibitors—the CREDENCE study of canagliflozin in patients with chronic kidney disease and type 2 diabetes and the DAPA-CKD study of dapagliflozin in patients with chronic kidney disease with or without type 2 diabetes—have shown that these drugs reduce the risk of chronic kidney disease progression in these patients. More importantly, the DAPA-CKD study showed that patients with chronic kidney disease who were taking dapagliflozin had a reduced risk of death compared with placebo. These results show that sodium–glucose cotransporter 2 inhibitors are slowing the progression of chronic kidney disease and improve overall outcomes for properly selected patients.
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37
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Ibrahim ZM, Bean D, Searle T, Qian L, Wu H, Shek A, Kraljevic Z, Galloway J, Norton S, Teo JT, Dobson RJ. A Knowledge Distillation Ensemble Framework for Predicting Short- and Long-Term Hospitalization Outcomes From Electronic Health Records Data. IEEE J Biomed Health Inform 2022; 26:423-435. [PMID: 34129509 DOI: 10.1109/jbhi.2021.3089287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The ability to perform accurate prognosis is crucial for proactive clinical decision making, informed resource management and personalised care. Existing outcome prediction models suffer from a low recall of infrequent positive outcomes. We present a highly-scalable and robust machine learning framework to automatically predict adversity represented by mortality and ICU admission and readmission from time-series of vital signs and laboratory results obtained within the first 24 hours of hospital admission. The stacked ensemble platform comprises two components: a) an unsupervised LSTM Autoencoder that learns an optimal representation of the time-series, using it to differentiate the less frequent patterns which conclude with an adverse event from the majority patterns that do not, and b) a gradient boosting model, which relies on the constructed representation to refine prediction by incorporating static features. The model is used to assess a patient's risk of adversity and provides visual justifications of its prediction. Results of three case studies show that the model outperforms existing platforms in ICU and general ward settings, achieving average Precision-Recall Areas Under the Curve (PR-AUCs) of 0.891 (95% CI: 0.878-0.939) for mortality and 0.908 (95% CI: 0.870-0.935) in predicting ICU admission and readmission.
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38
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Fan G, Gong T, Lin Y, Wang J, Sun L, Wei H, Yang X, Liu Z, Li X, Zhao L, Song L, He J, Liu H, Li X, Liu L, Li A, Lu Q, Zou D, Wen J, Xia Y, Wu L, Huang H, Zhang Y, Xie W, Huang J, Luo L, Wu L, He L, Liang Q, Chen Q, Chen G, Bai M, Qin J, Ni X, Tang X, Wang Y. Urine proteomics identifies biomarkers for diabetic kidney disease at different stages. Clin Proteomics 2021; 18:32. [PMID: 34963468 PMCID: PMC8903606 DOI: 10.1186/s12014-021-09338-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetic kidney disease is the most common cause of chronic kidney diseases (CKD) and end-stage renal diseases (ESRD). Although kidney biopsy is considered as the 'gold standard' for diabetic kidney disease (DKD) diagnosis, it is an invasive procedure, and the diagnosis can be influenced by sampling bias and personal judgement. It is desirable to establish a non-invasive procedure that can complement kidney biopsy in diagnosis and tracking the DKD progress. METHODS In this cross-sectional study, we collected 252 urine samples, including 134 uncomplicated diabetes, 65 DKD, 40 CKD without diabetes and 13 follow-up diabetic samples, and analyzed the urine proteomes with liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). We built logistic regression models to distinguish uncomplicated diabetes, DKD and other CKDs. RESULTS We quantified 559 ± 202 gene products (GPs) (Mean ± SD) on a single sample and 2946 GPs in total. Based on logistic regression models, DKD patients could be differentiated from the uncomplicated diabetic patients with 2 urinary proteins (AUC = 0.928), and the stage 3 (DKD3) and stage 4 (DKD4) DKD patients with 3 urinary proteins (AUC = 0.949). These results were validated in an independent dataset. Finally, a 4-protein classifier identified putative pre-DKD3 patients, who showed DKD3 proteomic features but were not diagnosed by clinical standards. Follow-up studies on 11 patients indicated that 2 putative pre-DKD patients have progressed to DKD3. CONCLUSIONS Our study demonstrated the potential for urinary proteomics as a noninvasive method for DKD diagnosis and identifying high-risk patients for progression monitoring.
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Affiliation(s)
- Guanjie Fan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China. .,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China. .,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China. .,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China.
| | - Tongqing Gong
- Beijing Pineal Health Management Co., Ltd, Beijing, 102206, China
| | - Yuping Lin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jianping Wang
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Institute of Lifeomics, Beijing, 102206, China.,Chongqing Key Laboratory of Big Data for Bio Intelligence, School of Bioinformation, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China
| | - Lu Sun
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Hua Wei
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Xing Yang
- Beijing Pineal Health Management Co., Ltd, Beijing, 102206, China
| | - Zhenjie Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Xinliang Li
- Beijing Pineal Health Management Co., Ltd, Beijing, 102206, China
| | - Ling Zhao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lan Song
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Institute of Lifeomics, Beijing, 102206, China
| | - Jiali He
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Haibo Liu
- Beijing Pineal Health Management Co., Ltd, Beijing, 102206, China
| | - Xiuming Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lifeng Liu
- Beijing Pineal Health Management Co., Ltd, Beijing, 102206, China
| | - Anxiang Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qiyun Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Dongyin Zou
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jianxuan Wen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yaqing Xia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Liyan Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Haoyue Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yuan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wenwen Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jinzhu Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lulu Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lulu Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Liu He
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qingshun Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qubo Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Guowei Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Mingze Bai
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Institute of Lifeomics, Beijing, 102206, China.,Chongqing Key Laboratory of Big Data for Bio Intelligence, School of Bioinformation, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China
| | - Jun Qin
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Institute of Lifeomics, Beijing, 102206, China
| | - Xiaotian Ni
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Institute of Lifeomics, Beijing, 102206, China.
| | - Xianyu Tang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China. .,The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China. .,Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China. .,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China.
| | - Yi Wang
- State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Proteome Research Center, Institute of Lifeomics, Beijing, 102206, China.
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39
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Wood S, Magliano DJ, Bell JS, Shaw JE, Ilomäki J. Treatment Dynamics in People Who Initiate Metformin or Sulfonylureas for Type 2 Diabetes: A National Cohort Study. Front Pharmacol 2021; 12:794273. [PMID: 34970149 PMCID: PMC8712936 DOI: 10.3389/fphar.2021.794273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: To investigate the incidence of, and factors associated with addition and switching of glucose-lowering medications within 12-months of initiating metformin or a sulfonylurea for type 2 diabetes (T2D). Methods: We identified 109,573 individuals aged 18-99 years who initiated metformin or a sulfonylurea between July 2013 and April 2015 using Australian National Diabetes Service Scheme (NDSS) data linked with national dispensing data. Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CI) for factors associated with time to addition to or switch from metformin or sulfonylurea over a 12-months follow-up. Results: Treatment addition or switching occurred in 18% and 4% of individuals who initiated metformin and in 28% and 13% of individuals who initiated sulfonylureas. Median time to addition was 104 days for metformin and 82 days for sulfonylureas. Median time to switching was 63 days for metformin and 52 days for sulfonylureas. Congestive heart failure, nicotine dependence, end stage renal disease and dispensing of systemic corticosteroids were associated with higher likelihood of treatment additions and switching in individuals initiating metformin. Antipsychotic dispensing was associated with a higher likelihood of treatment addition in individuals initiating sulfonylureas. Women initiating metformin were less likely to receive treatment additions but more likely to switch treatment than men. Conclusion: Nearly one quarter of Australians who initiate treatment for T2D with metformin or sulfonylureas switch or receive additional treatment within 12-months, with those who initiate sulfonylureas more likely to switch or receive additional treatment than those who initiate metformin.
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Affiliation(s)
- Stephen Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Dianna J. Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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40
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Lin YK, Zafirah Y, Ke MT, Andhikaputra G, Wang YC. The effects of extreme temperatures on emergency room visits-a population-based analysis by age, sex, and comorbidity. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:2087-2098. [PMID: 34173056 DOI: 10.1007/s00484-021-02166-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/02/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan's metropolitan city from 2000 to 2014. The distributed lag non-linear model was adopted to examine the association between ambient temperature and area-age-sex-disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area-age-sex-disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40-64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40-64 years. All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40-64 years.
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Affiliation(s)
- Yu-Kai Lin
- Department of Health and Welfare, University of Taipei, 101 Zhongcheng Road Sec. 2, Taipei, 111, Taiwan
| | - Yasmin Zafirah
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan
| | - Meng-Ting Ke
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan
| | - Gerry Andhikaputra
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan
| | - Yu-Chun Wang
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan.
- Research Center for Environmental Changes, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 11529, Taiwan.
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41
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Sullivan MK, Jani BD, Lees JS, Welsh CE, McConnachie A, Stanley B, Welsh P, Nicholl BI, Lyall DM, Carrero JJ, Nitsch D, Sattar N, Mair FS, Mark PB. Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort. Clin Kidney J 2021; 14:2409-2419. [PMID: 34754437 PMCID: PMC8573008 DOI: 10.1093/ckj/sfab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 01/28/2023] Open
Abstract
Background Multimorbidity [the presence of two or more long-term conditions (LTCs)] is associated with a heightened risk of mortality, but little is known about its relationship with the risk of kidney events. Methods Associations between multimorbidity and major adverse kidney events [MAKE: the need for long-term kidney replacement therapy, doubling of serum creatinine, fall of estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73 m2 or 30% decline in eGFR] were studied in 68 505 participants from the UK Biobank cohort. Participants were enrolled in the study between 2006 and 2010. Associations between LTC counts and MAKE were tested using survival analyses accounting for the competing risk of death. Results Over a median follow-up period of 12.0 years, 2963 participants had MAKE. There were associations between LTC count categories and the risk of MAKE [one LTC adjusted subhazard ratio (sHR) = 1.29, 95% confidence interval (CI) 1.15–1.45; two LTCs sHR = 1.74 (95% CI 1.55–1.96); and three or more LTCs sHR = 2.41 (95% CI 2.14–2.71)]. This finding was more pronounced when only cardiometabolic LTCs were considered [one LTC sHR = 1.58 (95% CI 1.45–1.73); two LTCs sHR = 3.17 (95% CI 2.80–3.59); and three or more LTCs sHR = 5.24 (95% CI 4.34–6.33)]. Combinations of LTCs associated with MAKE were identified. Diabetes, hypertension and coronary heart disease featured most commonly in high-risk combinations. Conclusions Multimorbidity, and in particular cardiometabolic multimorbidity, is a risk factor for MAKE. Future research should study groups of patients who are at high risk of progressive kidney disease based on the number and type of LTCs.
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Affiliation(s)
- Michael K Sullivan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Claire E Welsh
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Swedenand
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Arcoraci V, Barbieri MA, Rottura M, Nobili A, Natoli G, Argano C, Squadrito G, Squadrito F, Corrao S. Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients. Front Pharmacol 2021; 12:749711. [PMID: 34690782 PMCID: PMC8531549 DOI: 10.3389/fphar.2021.749711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010-2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16-1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38-25.12, p < 0.001; G5: 19.38, 11.51-32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.
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Affiliation(s)
- Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giuseppe Natoli
- Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, University of Palermo, Palermo, Italy
| | - Christiano Argano
- Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, University of Palermo, Palermo, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,SunNutraPharma, Academic Spin-Off Company of the University of Messina, Messina, Italy
| | - Salvatore Corrao
- Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, University of Palermo, Palermo, Italy.,Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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43
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Lim R, How P, Lee C, Yong XN, Wong WK, Lo E. Phosphorus Content of Commonly Prescribed Medications Among Patients With Chronic Kidney Disease. J Ren Nutr 2021; 32:22-29. [PMID: 34625333 DOI: 10.1053/j.jrn.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/03/2021] [Accepted: 08/19/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study aimed to build a brand-specific library of phosphorus content in medications and to determine the median daily phosphorus intake from medications among chronic kidney disease (CKD) patients in Singapore. METHODS This is a single-center, cross-sectional study conducted in 200 patients with CKD Stages 3-5D. Package inserts of medications commonly used by the CKD patients were reviewed to identify brands containing phosphorus. Drug manufacturers were contacted to obtain phosphorus content of products. The median daily phosphorus intake from medications of the 200 patients was then calculated using the information. RESULTS A total of 399 formulations of 204 medications and supplements were reviewed (March 2020). Fifty-eight (15%) formulations were found to contain phosphorus. Forty-three (11%) formulations had missing information regarding the phosphorus content. Based on available information, the median daily phosphorus intake from medications was 1.28 mg (interquartile range = 0.006-16.08) across the CKD stages. Patients with CKD Stage 5D had a higher median intake of 4.09 mg (P = .009). A dose-independent variation in phosphorus content of excipients between generic and branded formulations was noted in this study. We have developed a library of phosphorus content in medications. CONCLUSIONS The inorganic phosphorous content in frequently prescribed medications for CKD patients is generally low, with excipients (as opposed to the active ingredient or counterions) being the main source of phosphorus. Although this may seem almost negligible in comparison to the recommended dietary intake, prescribers should still exercise care, given the wide range of phosphorus content possible between different brands of the same medication, and the unpredictable absorption of inorganic phosphate in CKD patients.
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Affiliation(s)
- Rowena Lim
- Department of Pharmacy, National University of Singapore, Singapore.
| | - Priscilla How
- Department of Pharmacy, National University of Singapore, Singapore; Division of Nephrology, Department of Medicine, National University Hospital, Singapore
| | - Clara Lee
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore
| | - Xin Nee Yong
- Department of Dietetics, National University Hospital, Singapore
| | - Weng Kin Wong
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore
| | - Elaine Lo
- Department of Pharmacy, National University Hospital, Singapore
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44
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COVID-19 impact on the renal system: Pathophysiology and clinical outcomes. Best Pract Res Clin Anaesthesiol 2021; 35:449-459. [PMID: 34511232 PMCID: PMC7920815 DOI: 10.1016/j.bpa.2021.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease (COVID-19) causes many deleterious effects throughout the body. Prior studies show that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this literature analysis, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.
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45
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Sowa PM, Venuthurupalli SK, Hoy WE, Zhang J, Cameron A, Healy HG, Connelly LB. Identification of factors associated with high-cost use of inpatient care in chronic kidney disease: a registry study. BMJ Open 2021; 11:e049755. [PMID: 34413105 PMCID: PMC8378349 DOI: 10.1136/bmjopen-2021-049755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To explore factors behind inpatient admissions by high-cost users (HCUs) in pre-end-stage chronic kidney disease (CKD). DESIGN Retrospective analysis of CKD.QLD Registry and hospital admissions of the Queensland Government Department of Health recorded between 1 July 2011 and 30 June 2016. SETTING Queensland public and private hospitals. PARTICIPANTS 5096 individuals with CKD who consented to the CKD.QLD Registry via 1 of 11 participating sites. MAIN OUTCOMES Associations of HCU status with patient characteristics, pathways and diagnoses behind hospital admissions at 12 months. RESULTS Age, advanced CKD, primary renal diagnosis, cardiovascular disease and hypertension were predictors of the high-cost outcome. HCUs were more likely than non-HCUs to be admitted by means of episode change (relative risk: 5.21; 95% CI 5.02 to 5.39), 30-day readmission (2.19; 2.13 to 2.25), scheduled readmission (1.29; 1.11 to 1.46) and emergency (1.07; 1.02 to 1.13), for diagnoses of the nervous (1.94; 1.74 to 2.15), circulatory (1.24; 1.14 to 1.34) and respiratory (1.2; 1.03 to 1.37) systems and other factors influencing health status (1.92; 1.74 to 2.09). CONCLUSIONS The high relevance of episode change and other factors influencing health status revealed that a substantial part of excess demand for inpatient care was associated with discordant conditions often linked to frailty, decline in psychological health and social vulnerability. This suggests that multidisciplinary models of care that aim to manage discordant comorbidities and address psychosocial determinants of health, such as renal supportive care, may play an important role in reducing inpatient admissions in this population.
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Affiliation(s)
- P Marcin Sowa
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Sree K Venuthurupalli
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Wendy E Hoy
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jianzhen Zhang
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Anne Cameron
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Helen G Healy
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Luke B Connelly
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
- Department of Sociology and Business Law, The University of Bologna, Bologna, Italy
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46
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Mohamed NE, Benn EKT, Astha V, Okhawere KE, Korn TG, Nkemdirim W, Rambhia A, Ige OA, Funchess H, Mihalopoulos M, Meilika KN, Kyprianou N, Badani KK. Association between chronic kidney disease and COVID-19-related mortality in New York. World J Urol 2021; 39:2987-2993. [PMID: 33481113 PMCID: PMC7821175 DOI: 10.1007/s00345-020-03567-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate mortality risk of CKD patients infected with COVID-19, and assess shared characteristics associated with health disparities in CKD outcome. METHODS We extracted the data from a case series of 7624 patients presented at Mount Sinai Health System, in New York for testing between 3/28/2020 and 4/16/2020. De-identified patient data set is being produced by the Scientific Computing department and made available to the Mount Sinai research community at the following website: https://msdw.mountsinai.org/ . RESULTS Of 7624 COVID-19 patients, 7.8% (n = 597) had CKD on hospital admission, and 11.2% (n = 856) died of COVID-19 infection. CKD patients were older, more likely to have diabetes, hypertension, and chronic obstructive pulmonary disease (COPD), were current or former smokers, had a longer time to discharge, and had worse survival compared to non-CKD patients (p < 0.05). COVID-19 mortality rate was significantly higher in CKD patients (23.1% vs 10.2%) with a 1.51 greater odds of dying (95% CI: 1.19-1.90). Controlling for demographic, behavioral, and clinical covariates, the logistic regression analysis showed significant and consistent effects of CKD, older age, male gender, and hypertension with mortality (p < 0.05). CONCLUSION CKD was a significant independent predictor of COVID-19 mortality, along with older age, male gender, and hypertension. Future research will investigate the effects of COVID-19 on long-term renal function.
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Affiliation(s)
- Nihal E Mohamed
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Emma K T Benn
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Varuna Astha
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - William Nkemdirim
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Ami Rambhia
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Olajumoke A Ige
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Hassan Funchess
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Meredith Mihalopoulos
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA
- Tisch Cancer Institute at Mount Sinai, New York, NY, 10029, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 6th Floor, 1425, Madison Ave, New York, NY, 10029, USA.
- Tisch Cancer Institute at Mount Sinai, New York, NY, 10029, USA.
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Dizon K, Ng PCK, Battistella M. A retrospective study of antithrombotic therapy use in an outpatient haemodialysis unit. J Clin Pharm Ther 2021; 46:1387-1394. [PMID: 34129239 DOI: 10.1111/jcpt.13467] [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: 04/29/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Patients on haemodialysis (HD) are at increased risk of both bleeding and thrombotic events, due to comorbidities and nature of dialysis treatment. However, there is a lack of research on evidence-based treatment strategies and prescribing patterns for antithrombotic therapies (ATT) in this population. To characterize ATT use and its main indications in an outpatient HD unit. METHODS A single-centre retrospective chart review was conducted in a Toronto outpatient HD unit (n = 329). Medical histories, number of ATTs and corresponding indications were collected from adult patients prescribed at least one ATT from 1 October 2019 to 31 December 2019, inclusive. RESULTS AND DISCUSSION Of 329 patients in the unit, a total of 135 (41%) patients were on at least one ATT. Of these 135 patients, 80% were on monotherapy (55% antiplatelet, 25.1% anticoagulant), 12.6% were on dual antiplatelet therapy (DAPT), and 7.4% were on a antiplatelet and anticoagulant combination. Primary indications for ATT in our cohort were coronary artery disease (CAD; 55%), atrial fibrillation (18.5%) and venous thromboembolism (VTE; 17%). Described ATT use was in-line with current clinical guidelines. Monotherapy was primarily used in our HD cohort, whereas few patients were on dual therapy. Low-dose aspirin was the most common antiplatelet prescribed for secondary prevention of cardiovascular events. Warfarin monotherapy was primarily indicated for VTE, and DAPT aspirin/clopidogrel was the most commonly prescribed for CAD. WHAT IS NEW AND CONCLUSION Our characterization of ATT use in this HD cohort demonstrates that ATT is often prescribed for a number of different CVD reasons. Overlapping and confounding indications for prescribing ATTs, lack of randomized controlled trials and unclear clinical guidelines mean that individualized risk-benefit assessments for ATT use are still needed to provide care for these high-risk patients. More research to address the safety and efficacy of ATTs is warranted to develop more robust evidence-based treatment guidelines for the HD population.
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Affiliation(s)
- Kaye Dizon
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Patrick C K Ng
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Marisa Battistella
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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A Mediterranean lifestyle is associated with favourable cardiometabolic markers in people with non-dialysis dependent chronic kidney disease. J Nutr Sci 2021; 10:e42. [PMID: 34164121 PMCID: PMC8190716 DOI: 10.1017/jns.2021.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 01/22/2023] Open
Abstract
Adherence to a Mediterranean lifestyle may be a useful primary and secondary prevention strategy for chronic kidney disease (CKD). This cross-sectional study aimed to explore adherence to a Mediterranean lifestyle and its association with cardiometabolic markers and kidney function in 99 people aged 73⋅2 ± 10⋅5 years with non-dialysis dependant CKD (stages 3-5) at a single Australian centre. Adherence was assessed using an a priori index, the Mediterranean Lifestyle (MEDLIFE) index. Cardiometabolic markers (total cholesterol, LDL-cholesterol, HbA1c and random blood glucose) and kidney function (estimated GFR) were sourced from medical records and blood pressure measured upon recruitment. Overall, adherence to a Mediterranean lifestyle was moderate to low with an average MEDLIFE index score of 11⋅33 ± 3⋅31. Adherence to a Mediterranean lifestyle was associated with employment (r 0⋅30, P = 0⋅004). Mediterranean dietary habits were associated with cardiometabolic markers, such as limiting sugar in beverages was associated with lower diastolic blood pressure (r 0⋅32, P = 0⋅002), eating in moderation with favourable random blood glucose (r 0⋅21, P = 0⋅043), having more than two snack foods per week with HbA1c (r 0⋅29, P = 0⋅037) and LDL-cholesterol (r 0⋅41, P = 0⋅002). Interestingly, eating in company was associated with a lower frequency of depression (χ 2 5⋅975, P = 0⋅015). To conclude, Mediterranean dietary habits were favourably associated with cardiometabolic markers and management of some comorbidities in this group of people with non-dialysis dependent CKD.
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49
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Sultan AA, James G, Wang X, Kuranz S, Hedman K, Houser M, Haque SA, Little D. Incidence of Uncommon Clinical Events in USA Patients with Dialysis-Dependent and Nondialysis-Dependent Chronic Kidney Disease: Analysis of Electronic Health Records from TriNetX. Nephron Clin Pract 2021; 145:462-473. [PMID: 34082426 DOI: 10.1159/000516280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Further understanding of adverse clinical events in patients with chronic kidney disease (CKD) is needed. This study aimed to describe characteristics of patients with nondialysis-dependent (NDD) and dialysis-dependent (DD) CKD and to assess incidence rates of uncommon adverse clinical events of interest in these patients. METHODS This retrospective study used electronic medical record data from USA CKD patients (≥18 years) with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 between January 1, 2010, and December 31, 2018, obtained from the USA-based TriNetX database. NDD-CKD and DD-CKD were diagnosed and staged from ≥2 consecutive eGFR readings, recorded ≥90 days apart. Dialysis was identified using procedure codes for renal replacement therapy. Outcomes assessed were select uncommon adverse clinical events, defined by International Classification of Disease, 9th and 10th Revision codes. RESULTS Incidence rates of adverse clinical events per 100 person-years (95% confidence interval) were generally higher in patients with DD-CKD versus NDD-CKD. Differences were particularly pronounced for hyperkalemia (26.9 [26.2-27.6] vs. 4.5 [4.5-4.6]), acidosis (15.1 [14.7-15.6] vs. 3.4 [3.4-3.4]), and sepsis (14.6 [14.2-15.1] vs. 3.3 [3.3-3.4]). Among DD-CKD patients, incidence rates of adverse events were particularly high during the first 3 months following dialysis initiation. Incidence of adverse clinical events generally increased with decreasing eGFR among patients with NDD-CKD and with hemoglobin <10 g/dL in both NDD- and DD-CKD patients. CONCLUSIONS Our results help establish baseline rates of uncommon adverse clinical events and provide additional evidence of increased morbidity for patients with DD-CKD versus NDD-CKD.
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Affiliation(s)
| | | | - Xia Wang
- AstraZeneca, Gaithersburg, Maryland, USA
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HCV Infection and Chronic Renal Disease. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Chronic Hepatitis C virus (HCV) infection is defined as persistence of HCV RNA in the blood for more than six months. HCV is a major cause of chronic liver disease and cirrhosis. It’s serious public health problem, affects about 71 million people worldwide. HCV doesn’t destroy hepatocytes directly. It activates the host's innate and acquired immune system and causes liver injury indirectly. Behind hepatic, HCV can cause extra-hepatic manifestations. One of them is renal disease which can lead to end-stage renal disease, ESRD. The prevalence of HCV infection in patients on hemodialysis is high, ranging from 5% to 60%. HCV infection is a significant cause of morbidity and mortality in patients with ESRD on hemodialysis. In this review, we discuss HCV infection and chronic renal disease as comorbidities, their severity and outcome.
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