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Devi S, Sahu S, Behera K, Priyadarshini N, Sahoo D. Assessment of Serum Omentin-1 and Interleukin-6 in the Diagnosis of Early Stages of Diabetic Nephropathy: A Cross-Sectional Observational Study. Cureus 2024; 16:e64239. [PMID: 39131026 PMCID: PMC11313064 DOI: 10.7759/cureus.64239] [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] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction The pathogenesis of diabetic nephropathy highlights the progression of inflammation and fibrosis from tubular to glomerular damage during the early stages of kidney involvement in diabetic individuals. As urine albumin serves as a marker for glomerular function, its detection indicates a stage of diabetic nephropathy where the glomerulus is already compromised. Consequently, relying solely on urine albumin for diagnosis becomes questionable. In our pursuit of identifying innovative biomarkers for the early detection of diabetic nephropathy, this study was crafted to explore the relationship between chemokines, omentin-1, interleukin-6, and microalbuminuria. Materials and methods Our study cohort comprised 116 patients diagnosed with diabetes mellitus. In our study, participants were stratified into two groups based on their urine albumin levels: Group 1, characterized by urine albumin creatinine ratio <30 mg/gm and estimated glomerular filtration rate >90 ml/min, and Group 2, with urine albumin creatinine ratio ≥30 mg/gm and <300 mg/gm, and estimated glomerular filtration rate >60 ml/min and <90 ml/min. Serum creatinine, glycated hemoglobin (HbA1c), fasting blood sugar and post-prandial blood sugar, lipid profile, total protein, albumin, fasting insulin, omentin-1, and interleukin-6 were estimated. Result There was a significant difference in the medians of serum urea, creatinine, omentin-1, interleukin-6, urine albumin creatinine ratio, and estimated glomerular filtration rate levels in the two groups. There was no difference in fasting blood sugar, post-prandial blood sugar, HbA1c, serum lipids, fasting insulin, and homeostatic model assessment for insulin resistance. The receiver operating characteristic curve plotted for the newer biomarkers of diabetic nephropathy showed that there was a significant diagnostic utility in diabetic nephropathy detection of serum omentin (p=0.000), interleukin-6 (p=0.002), and interleukin-6: omentin-1 ratio (p=0.000), which correlated well with the routine test that is urine microalbumin estimation. Risk assessment demonstrated that type 2 diabetes mellitus patients with an interleukin-6: omentin-1 ratio ≥0.26 had significantly higher odds, with an odds ratio of 3.97, for developing diabetic nephropathy, which was statistically significant. Conversely, a ratio of ≤0.26 was associated with kidney protection among patients with type 2 diabetes mellitus. Conclusion Our findings revealed decreased levels of omentin-1 and increased levels of interleukin-6 in the group with diabetic nephropathy compared to those without diabetic nephropathy among patients with type 2 diabetes mellitus. Interleukin-6: omentin-1 ratio of ≤0.26 was associated with kidney protection among patients with type 2 diabetes mellitus. Based on the results obtained from this study, we propose that measuring the serum interleukin-6: omentin-1 ratio in patients with type 2 diabetes mellitus may assist in identifying the early stages of diabetic nephropathy before the onset of microalbuminuria. Timely intervention in these patients predisposed to diabetic nephropathy can aid in better treatment outcomes in type 2 diabetes mellitus.
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Affiliation(s)
- Sujata Devi
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Suchanda Sahu
- Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Kishore Behera
- Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | | | - Debananda Sahoo
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Wu CC, Cao Y, Suen SC, Lin E. Examining chronic kidney disease screening frequency among diabetics: a POMDP approach. Health Care Manag Sci 2024:10.1007/s10729-024-09677-4. [PMID: 38836923 DOI: 10.1007/s10729-024-09677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2024] [Indexed: 06/06/2024]
Abstract
Forty percent of diabetics will develop chronic kidney disease (CKD) in their lifetimes. However, as many as 50% of these CKD cases may go undiagnosed. We developed screening recommendations stratified by age and previous test history for individuals with diagnosed diabetes and unknown proteinuria status by race and gender groups. To do this, we used a Partially Observed Markov Decision Process (POMDP) to identify whether a patient should be screened at every three-month interval from ages 30-85. Model inputs were drawn from nationally-representative datasets, the medical literature, and a microsimulation that integrates this information into group-specific disease progression rates. We implement the POMDP solution policy in the microsimulation to understand how this policy may impact health outcomes and generate an easily-implementable, non-belief-based approximate policy for easier clinical interpretability. We found that the status quo policy, which is to screen annually for all ages and races, is suboptimal for maximizing expected discounted future net monetary benefits (NMB). The POMDP policy suggests more frequent screening after age 40 in all race and gender groups, with screenings 2-4 times a year for ages 61-70. Black individuals are recommended for screening more frequently than their White counterparts. This policy would increase NMB from the status quo policy between $1,000 to $8,000 per diabetic patient at a willingness-to-pay of $150,000 per quality-adjusted life year (QALY).
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Affiliation(s)
- Chou-Chun Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Yiwen Cao
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Eugene Lin
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
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Al Lawati H, Al Zadjali F, Al Salmi I, Al Kindi M. Performance of Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration Equations Versus 99Tc-DTPA-Renogram in Assessing Kidney Function. Oman Med J 2024; 39:e606. [PMID: 38988799 PMCID: PMC11234170 DOI: 10.5001/omj.2024.54] [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: 07/07/2023] [Accepted: 08/27/2023] [Indexed: 07/12/2024] Open
Abstract
Objectives To evaluate the performance of measurement of glomerular filtration rate (GFR) using Modification of Diet in Renal Disease equations (MDRD186, MDRD175) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, in comparison with technetium-99m diethylenetriaminepentaacetic acid (99Tc-DTPA) renogram method, the gold standard. A related aim was to correlate the three equations to estimate GFR and their impact on reclassifying the stages of CKD in adult Omani patients. Methods This cross-sectional study recruited two groups of patients diagnosed with CKD during a 10-month period from January to October 2021. The first group comprised 48 patients who underwent a 99Tc-DTPA renogram procedure for GFR measurement, and the second group comprised 30 348 adult patients who did not undergo the same procedure; estimated GFR was calculated using the three equations. Results The median of the reference GFR was 106.0 mL/min/1.73 m2, whereas the median estimated GFR for the MDRD175, MDRD186, and CKD-EPI equations were 92.5, 98.3, and 102.1, respectively. All three equations correlated moderately with the reference GFR (0.428, 0.428, 0.523, respectively; p < 0.010). The CKD-EPI showed lesser bias (3.7 vs. 12.9 and 7.5 for MDRD175 and MDRD186, respectively) and more accuracy (95.8% vs. 91.7% and 93.8%); however, it was the least precise (25.1 vs. 22.3 and 23.8). The MDRD186 performed similarly to the CKD-EPI equation at CKD stages 3a-5 and differed significantly at stages 1-2. Whereas the MDRD175 differed significantly with both equations at stages 1-3b and was similar to them at stages 4-5. Conclusions The CKD-EPI equation had the highest accuracy and the least bias and precision in the general population. The MDRD186 CKD classification differed significantly from the CKD-EPI equation at CKD-stages 1-2 only. The CKD-EPI equation is preferred to MDRD for the detection and classification of early CKD stages.
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Affiliation(s)
- Hanaa Al Lawati
- Clinical Biochemistry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Fahad Al Zadjali
- Center of Studies and Research, Ministry of Health, Muscat, Oman
| | - Issa Al Salmi
- Renal Medicine Department, Royal Hospital, Muscat, Oman
| | - Manal Al Kindi
- Clinical Biochemistry Department, Royal Hospital, Muscat, Oman
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Kuwatsuru Y, Hirano T, Wakabayashi R, Ishisaki JY, Sokooshi H, Kuwatsuru R. Changes in renal function over time in outpatients with eGFR ≥ 30 mL/min/1.73 m 2: implication for timing of renal function testing before contrast-enhanced CT imaging. Jpn J Radiol 2023; 41:994-1006. [PMID: 37040025 PMCID: PMC10469099 DOI: 10.1007/s11604-023-01425-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the associations between comorbidities and kidney function decline at 6-month and 1-year follow-up in outpatients with initial estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2. MATERIALS AND METHODS Outpatients aged 18 and older with confirmed diagnosis, who had eGFR ≥ 30 mL/min/1.73 m2 measured between April 2017 and March 2019, were included in this retrospective observational study. Of them, 30,595 included outpatients had 6-month eGFR test and 27,698 included outpatients had 1-year eGFR test. The outpatients were further divided into two groups based on initial eGFR: between 30 and 59 and ≥ 60 mL/min/1.73 m2. Impaired renal function was defined as eGFR declined to below 30 mL/min/1.73 m2. The comorbidities with P values less than 0.1 identified in univariable logistic regression models were entered into the multivariable analysis with backward selection, thereby identifying comorbidities that increased the risk of eGFR decline at 6-month and 1-year follow-up. RESULTS Outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2 were 175.94 times more likely to have eGFR decline at 6 months, and were 94.10 times more likely to have eGFR decline at 1 year, compared with their corresponding initial eGFR ≥ 60 counterparts. Multivariable logistic regression analyses disclosed that chronic kidney disease, hypertension, and heart failure were independent risk factors for eGFR decline in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2. CONCLUSIONS Outpatients with initial eGFR ≥ 60 mL/min/1.73 m2 might not need routine eGFR test prior to contrast-enhanced CT scan for 1 year. In addition, chronic kidney disease, hypertension, and heart failure increased the risk of declined renal function, particularly, in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.
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Affiliation(s)
- Yoshiki Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takahiro Hirano
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Clinical Study Support Inc., 2F Daiei Bldg., 1-11-20 Nishiki, Naka-ku, Nagoya, 460-0003, Japan
| | - Ryozo Wakabayashi
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Clinical Study Support Inc., 2F Daiei Bldg., 1-11-20 Nishiki, Naka-ku, Nagoya, 460-0003, Japan
| | - Juliana Yumi Ishisaki
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hideaki Sokooshi
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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Wu CY, Tsai CF, Yang HY. Utilizing a nomogram to predict the one-year postoperative mortality risk for geriatric patients with a hip fracture. Sci Rep 2023; 13:11091. [PMID: 37422577 PMCID: PMC10329653 DOI: 10.1038/s41598-023-38297-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
Despite the abundance of research on the risk factors for mortality following hip fracture surgery, there has been a dearth of studies on prediction models in this population. The objective of this research was to explore the influencing factors and construct a clinical nomogram to predict one-year postoperative mortality in patients with hip fracture surgeries. Using the Ditmanson Research Database (DRD), we included 2333 subjects, aged ≥ 50 years who underwent hip fracture surgery between October, 2008 and August, 2021. The endpoint was all-cause mortality. A least absolute shrinkage and selection operator (LASSO) derived Cox regression was performed to select the independent predictors of one-year postoperative mortality. A nomogram was built for predicting one-year postoperative mortality. The prognostic performance of nomogram was evaluated. On the basis of tertiary points in a nomogram, the patients were divided into low, middle and high risk groups, and compared by the Kaplan-Meier analysis. Within 1 year after hip fracture surgery, 274 patients (11.74%) died. Variables retained in the final model comprised age, sex, length of stay, RBC transfusions, hemoglobin, platelet, and eGFR. The AUC for one-year mortality predictions were 0.717 (95% CI = 0.685-0.749). The Kaplan-Meier curves were significantly different among the three risk groups (p < 0.001). The nomogram showed good calibration. In summary, we explored the one-year postoperative mortality risk in geriatric patients with a hip fracture and developed a prediction model that could help clinicians identify patients at high risk of postoperative mortality.
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Affiliation(s)
- Cheng-Yi Wu
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Osteoporosis Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chiayi City, 60002, Taiwan
| | - Hsin-Yi Yang
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chiayi City, 60002, Taiwan.
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Wu G, Li L, Wu Z. A meta-analysis of randomized controlled trials of tonifying kidney and strengthen bone therapy on nondialysis patients with chronic kidney disease-mineral and bone disorder. Medicine (Baltimore) 2023; 102:e34044. [PMID: 37352066 PMCID: PMC10289535 DOI: 10.1097/md.0000000000034044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Correction of calcium, phosphorus, and parathyroid hormone disorders is the standard of treatment in nondialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD). However, the side effects and adverse reactions are still the main problems. Moreover, the lack of protection of kidney function in the treatment dramatically affects patients' health. Although Traditional Chinese Medicine, specifically tonifying kidney and strengthen bone (TKSB) therapy, is wildly applied to patients with CKD-MBD in China, the evidence of TKSB therapy in the treatment of CKD-MBD is limited. Thus, we conducted this meta-analysis to evaluate the efficacy and safety of TKSB therapy combined with Western medicine (WM) for nondialysis patients with CKD-MBD. METHODS Two investigators conducted systematic research of randomized controlled trials of TKSB therapy for CKD-MBD from 7 electronic databases. Methodological quality evaluations were performed using the Cochrane collaboration tool, and data analysis was conducted by RevMan v5.3 software and STATA v15.0. RESULTS In total, 8 randomized controlled trials involving 310 patients met the criteria of meta-analysis. The complete results showed that compared with WM alone, TKSB treatment could improve the clinical efficacy rate (risk ratio = 4.49, 95% confidence interval [CI]: [2.64, 7.61], P .00001), calcium (weighted mean difference [WMD] = 0.11, 95% CI: [0.08, 0.14], P < .00001), serum creatinine (WMD = 45.58, 95% CI: [32.35, 58.8], P < .00001) phosphorus (WMD = 0.11, 95% CI: [0.08, 0.13], P < .00001), parathyroid hormone (WMD = 16.72, 95% CI: [12.89, 20.55], P < .00001), blood urea nitrogen levels (WMD = 0.95, 95% CI: [0.26, 1.64], P = .007) on nondialysis patients with CKD-MBD, which was beneficial to improve the patients' bone metabolic state and renal function. In addition, evidence shows that, compared with WM alone, TKSB treatment is safe and does not increase side effects. CONCLUSION The systematic review found that TKSB therapy combined with WM has a positive effect on improving renal function and correcting bone metabolism disorder in nondialysis patients with CKD-MBD, which shows that Traditional Chinese Medicine is effective and safe in treating CKD-MBD. However, more high-quality, large-sample, multicenter clinical trials should be conducted to assess the safety and efficacy of TKSB therapy in treating nondialysis patients with CKD-MBD.Systematic review registration: INPLASY2020120086.
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Affiliation(s)
- Guiling Wu
- Wuhan Hospital Of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Liang Li
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Afiliated Hospital ofHubei University of Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Zijian Wu
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Afiliated Hospital ofHubei University of Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
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Gupta N, Yadav DK, Gautam S, Kumar A, Kumar D, Prasad N. Nuclear Magnetic Resonance-Based Metabolomics Approach Revealed the Intervention Effect of Using Complementary and Alternative Medicine (CAM) by CKD Patients. ACS OMEGA 2023; 8:7722-7737. [PMID: 36872986 PMCID: PMC9979328 DOI: 10.1021/acsomega.2c06469] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Chronic kidney disease (CKD) is the end point of a number of systemic chronic diseases. The prevalence of CKD is increasing worldwide and recent epidemiological studies are showing the high prevalence of renal failure in CKD patients using complementary and alternative medicines (CAMs). Clinicians believe that biochemical profiles of CKD patients using CAM (referred here to as CAM-CKD) may be different compared to those on standard clinical treatment and should be managed differently. The present study aims to explore the potential of the NMR-based metabolomics approach to reveal the serum metabolic disparity between CKD and CAM-CKD patients with respect to normal control (NC) subjects and if the differential metabolic patterns can provide rationale for the efficacy and safety of standard and/or alternative therapies. Serum samples were obtained from 30 CKD patients, 43 CAM-CKD patients, and 47 NC subjects. The quantitative serum metabolic profiles were measured using 1D 1H CPMG NMR experiments performed at 800 MHz NMR spectrometer. The serum metabolic profiles were compared using various multivariate statistical analysis tools available on MetaboAnalyst (freely available web-based software) such as partial least-squares discriminant analysis (PLS-DA) and random forest (a machine learning) classification method. The discriminatory metabolites were identified based on variable importance in projection (VIP) statistics and further evaluated for statistical significance (i.e., p < 0.05) using either Student t-test or ANOVA statistics. PLS-DA models were capable of clustering CKD and CAM-CKD with considerably high values of Q 2 and R 2. Compared to CAM-CKD patients, the sera of CKD patients were characterized by (a) elevated levels of urea, creatinine, citrate, glucose, glycerol, and phenylalanine and phenylalanine-to-tyrosine ratio (PTR) and (b) decreased levels of various amino acids (such leucine, isoleucine, valine, and alanine), high-density lipoproteins, lactate, and acetate. These changes suggested that CKD patients manifest severe oxidative stress, hyperglycemia (with dampened glycolysis), increased protein energy wasting, and reduced lipid/membrane metabolism. Statistically significant and strong positive correlation of PTR with serum creatinine levels suggested the role of oxidative stress in the progression of kidney disease. Significant differences in metabolic patterns between CKD and CAM-CKD patients were observed. With respect to NC subjects, the serum metabolic changes were more aberrant in CKD patients compared to CAM-CKD patients. The aberrant metabolic changes in CKD patients with manifestations of higher oxidative stress compared to CAM-CKD patients could explain clinical discrepancies between CKD and CAM-CKD patients and further advocate the use of different treatment strategies for CKD and CAM-CKD patients.
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Affiliation(s)
- Nikhil Gupta
- Centre
of Biomedical Research (CBMR), Lucknow, Uttar Pradesh 226014, India
- Department
of Chemistry, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | | | - Sonam Gautam
- Department
of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh 226014, India
| | - Ashish Kumar
- Department
of Chemistry, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Dinesh Kumar
- Centre
of Biomedical Research (CBMR), Lucknow, Uttar Pradesh 226014, India
| | - Narayan Prasad
- Department
of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh 226014, India
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Fu C, Zhang D, Chen H, Zhang H. Timed-averaged blood pressure showed a J-curve association with stroke in elderly chronic kidney disease patients. Ren Fail 2022; 44:1677-1686. [PMID: 36222093 PMCID: PMC9578479 DOI: 10.1080/0886022x.2022.2131574] [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] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND The risk factors for stroke in elderly patients with chronic kidney disease (CKD) are not well understood. This study aimed to explore the influence of systolic blood pressure (SBP) on the risk of stroke in a large cohort of elderly patients with stage 3-5 CKD. METHODS We retrospectively identified 665 patients hospitalized in Beijing Friendship Hospital from January 2000 to December 2021. Patients were followed up until the occurrence of stroke or death. Multivariate logistic regression analysis and Cox proportional hazard models were used to analyze the risk factors for stroke according to the presence or absence of CKD. The association between CKD and stroke was further evaluated regarding the role of SBP in the hypertensive population. RESULTS In individuals with CKD, a J-shaped relationship was observed between SBP levels and the risk of stroke. Participants with CKD and an SBP less than 125 mmHg had a significantly higher cumulative stroke survival rate than those whose SBP was between 125 and 139 mmHg. The cumulative stroke survival rate increased progressively for those with SBP higher than 140 mmHg. This J-shaped relationship was not found in patients without CKD. CONCLUSION In elderly patients with CKD, those with the lowest BP are at increased risk for incident stroke. This phenomenon could be different from that in the general population.
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Affiliation(s)
- Chen Fu
- Department of Nephrology, Beijing Jishuitan Hospital, Beijing, China
| | - Dongliang Zhang
- Department of Nephrology, Beijing Jishuitan Hospital, Beijing, China
| | - Haiping Chen
- Department of Geriatric Nephrology, Medical and Health Care Center, Beijing Friendship Hospital (affiliated with Capital Medical University), Beijing, China
| | - Hui Zhang
- Department of Nephrology, Tianjin Hospital, Tianjin, China
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Association between serum uric acid level and bone mineral density at multiple skeletal sites in middle-aged and elderly men: a cross-sectional study of a healthy population in Taiwan. Arch Osteoporos 2022; 17:142. [PMID: 36376511 DOI: 10.1007/s11657-022-01186-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
This study revealed that serum uric acid (sUA) levels were not associated with bone mineral density (BMD) at different skeletal sites in middle-aged and elderly men, even adjusting for confounding variables. Nevertheless, a positive association was only found between sUA levels and BMD at all skeletal sites in the normal BMI group. INTRODUCTION Previous studies have reported an association between serum uric acid (sUA) levels and bone mineral density (BMD). However, their findings are controversial and limited to adult men in the general population. This study was aimed at examining the association between sUA levels and BMD at multiple skeletal sites in middle-aged and elderly men. METHODS A cross-sectional analysis of BMD at different skeletal sites and sUA levels was conducted on 918 men (age: 50.83 ± 7.95) using data from the Ditmanson Research Database. The participants were categorized into four groups based on quartiles of the sUA level, and BMD were assessed using dual-energy X-ray absorptiometry. Multivariate linear regression models were utilized to investigate the association between sUA levels and BMD. Further, subgroup analyses were performed. RESULTS After adjusting for potential confounding factors, sUA as a continuous variable was significantly associated with BMD at the femoral neck only (β, 95% confidence interval: 0.007 [0.001-0.013]). However, in the categorical analysis, no significant differences were detected in terms of BMD at different skeletal sites across the different sUA quartile groups. Moreover, if the body mass index (BMI) was < 24 kg/m2 for each unit increase in sUA level, the spine, femoral neck, and total hip BMD increased by 0.014, 0.013, and 0.015 g/cm2, respectively. CONCLUSION The sUA level was not associated with BMD at different skeletal sites in middle-aged and elderly men. Nevertheless, a positive association was only found between sUA levels and BMD at all skeletal sites in the normal weight group.
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Su CT, Chang YP, Ku YT, Lin CM. Machine Learning Models for the Prediction of Renal Failure in Chronic Kidney Disease: A Retrospective Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102454. [PMID: 36292142 PMCID: PMC9600783 DOI: 10.3390/diagnostics12102454] [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: 08/17/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study assessed the feasibility of five separate machine learning (ML) classifiers for predicting disease progression in patients with pre-dialysis chronic kidney disease (CKD). The study enrolled 858 patients with CKD treated at a veteran’s hospital in Taiwan. After classification into early and advanced stages, patient demographics and laboratory data were processed and used to predict progression to renal failure and important features for optimal prediction were identified. The random forest (RF) classifier with synthetic minority over-sampling technique (SMOTE) had the best predictive performances among patients with early-stage CKD who progressed within 3 and 5 years and among patients with advanced-stage CKD who progressed within 1 and 3 years. Important features identified for predicting progression from early- and advanced-stage CKD were urine creatinine and serum creatinine levels, respectively. The RF classifier demonstrated the optimal performance, with an area under the receiver operating characteristic curve values of 0.96 for predicting progression within 5 years in patients with early-stage CKD and 0.97 for predicting progression within 1 year in patients with advanced-stage CKD. The proposed method resulted in the optimal prediction of CKD progression, especially within 1 year of advanced-stage CKD. These results will be useful for predicting prognosis among patients with CKD.
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Affiliation(s)
- Chuan-Tsung Su
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan 333, Taiwan
| | - Yi-Ping Chang
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan 333, Taiwan
- Department of Nephrology, Taoyuan Branch of Taipei Veterans General Hospital, Taoyuan 330, Taiwan
| | - Yuh-Ting Ku
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan 333, Taiwan
| | - Chih-Ming Lin
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-350-7001 (ext. 3530); Fax: +886-3-359-3880
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Eguiguren-Jiménez L, Miles J, Ocampo J, Andrade JM. Prevalence and associated risk factors of chronic kidney disease: A case study within SIME clinics in Quito, Ecuador 2019-2021. Front Med (Lausanne) 2022; 9:908551. [PMID: 36059814 PMCID: PMC9437349 DOI: 10.3389/fmed.2022.908551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background Ecuador has been experiencing an epidemiological transition due to its demographic and lifestyle changes, where non-communicable diseases are the leading cause of death, including chronic kidney disease (CKD). Quito, Ecuador's capital city, is one of the cities burdened by CKD, yet it is unknown the factors that contribute to the rising incidence of this disease. The purpose of this study was to estimate the prevalence of CKD among non-institutionalized adults in Quito between 2019 and 2021, and to examine its associations with various risk factors. Methods For the analysis of prevalence, the Kidney Disease: Improving Global Outcomes guidelines were used, where an estimated glomerular filtration rate (eGFR) of < 60 ml/min/1.73 m2 was counted as a presumed case of CKD. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to calculate eGFR. Multiple linear regression models were used to determined associations between blood pressure, blood glucose, sex, and zone with eGFR. A t-test of independence was used to determine difference in means between sex and zone and eGFR. Results A prevalence of 7.2% was found, in which almost 45% of the participants were classified within stages 2-4 of this disease. The risk factors that were significantly associated with eGFR were systolic blood pressure (β = -0.43, p < 0.001), sex, and zone (p < 0.001). Conclusions Overall a high prevalence of CKD was found among adults who visited SIME clinics in Quito. Associations between main risk factors and eGFR were found, yet further research is needed to explore CKD in Ecuador and its main cities.
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Affiliation(s)
- Lucía Eguiguren-Jiménez
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - Joshua Miles
- Statistics Department, University of Florida, Gainesville, FL, United States
| | - Jaime Ocampo
- School of Public Health, San Francisco de Quito University, Quito, Ecuador
| | - Jeanette Mary Andrade
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
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13
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The Case Against Race-Based GFR. Dela J Public Health 2022. [DOI: 10.32481/djph.2022.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Plasma d-amino acids are associated with markers of immune activation and organ dysfunction in people with HIV. AIDS 2022; 36:911-921. [PMID: 35212669 DOI: 10.1097/qad.0000000000003207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND d-Amino acids (d-AAs) have been associated with age-associated conditions in the general population but their relevance in people with HIV (PWH), who experience accentuated/accelerated aging has not been studied. We compared d-AA levels in HIV-infected and uninfected controls and explored their association with markers of immune activation, gut permeability and organ dysfunction. DESIGN Case-control analysis. METHOD Plasma samples from 60 antiretroviral therapy-treated HIV-infected individuals and 59 uninfected controls were analysed. A three-dimensional HPLC system was used to measure d-and l-asparagine, serine, alanine and proline and presented as %d-AA. Additionally, cell-associated and soluble markers of immune activation and senescence were characterized. Kidney and liver functions were expressed as estimated glomerular filtration rate and fibrosis-4 scores, respectively. Mann-Whitney and Spearman rank correlation coefficients were used for statistical analysis. RESULTS d-Asparagine, d-serine, d-alanine and d-proline were detectable in all plasma samples and correlated with age in HIV-infected and uninfected but not different between groups. Kynurenine/tryptophan ratio was positively correlated with all %d-AAs in PWH and with %d-serine and %d-proline in controls. %d-AAs were not consistently correlated with markers of gut permeability in both groups. All %d-AAs were also correlated with kidney function in both groups whereas age-associated accumulation of %d-asparagine, %d-serine and %d-proline were correlated with liver function and the VACS score in controls. CONCLUSION Plasma d-AAs are associated with chronological age and correlated with markers of immune activation and organ decline, though variably, in PWH and controls. Their role in the biology of aging warrants further investigation.
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TANG CQY, CHIOW SM, LAI SHS, CHIA DSY. The Effect of Hand Dominance, Age, Gender, Fracture Comminution and ASA Status on Time to Fracture Healing Following Surgical Fixation of Distal Radius Fractures. J Hand Surg Asian Pac Vol 2022; 27:459-465. [DOI: 10.1142/s2424835522500461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: There is recent renewed interest in the effect of hand dominance on distal radius fractures. Current studies focus on functional or patient-reported outcomes, with lack of studies pertaining to radiological outcomes. The primary aim of this study is to examine the effect of hand dominance on time to fracture healing following surgical fixation of distal radius fracture. We also looked at the effect of age, gender, fracture comminution and American Society of Anaesthesiologists (ASA) status on time to fracture healing. Methods: Patients who underwent distal radius fracture fixation surgery in our department from 1 January 2015 to 31 December 2015 were included. Time to fracture healing was taken from the day of surgery to when radiographic union was present as evidence by bridging callus or osseous bone. We looked at the effect of hand dominance, age, gender, fracture comminution and ASA status on time to fracture healing. Results: One hundred and forty-five consecutive patients (80 females and 65 males) had a mean period of 56.2 ± 41.8 days to fracture healing post-operatively. Patients with dominant hand injury had a shorter duration to fracture healing than patients with non-dominant hand injury (mean 47.3 ± 31.1 days versus 62.1 ± 46.8 days, p = 0.023). Patients ≥ 65 years and with pre-existing medical conditions (ASA Class II and above) had a longer duration to fracture healing (mean 63.7 ± 53.0 days versus 51.9 ± 33.4 days, p = 0.036 and mean 47.9 ± 30.0 days versus 62.0 ± 47.7 days, p = 0.016, respectively). In addition, patients with comminuted fractures took longer to heal than patients with non-comminuted fractures (mean 57.6 ± 33.4 days versus 48.3 ± 20.8 days, p = 0.038). Conclusion: Time to fracture healing post distal radius fracture fixation surgery was significantly related to hand dominance, as well as age, ASA classification and fracture configuration. Dominant wrist injuries had shorter time to fracture healing. Level of Evidence: Level IV (Therapeutic)
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Affiliation(s)
- Camelia Qian Ying TANG
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Si Min CHIOW
- Department of Radiology, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Sean Han Sheng LAI
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Dawn Sinn Yii CHIA
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
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16
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Renal impairment and time to fracture healing following surgical fixation of distal radius fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1329-1334. [PMID: 35643949 DOI: 10.1007/s00590-022-03300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Despite the prevalence of renal impairments, the existing literature examining fracture healing in the upper limb in patients with renal impairment is sparse. This study hence aims to investigate the effect of renal impairment on time to fracture healing after distal radius fracture fixation surgery. MATERIALS AND METHODS Patients above 50 years old who underwent distal radius fracture fixation via volar plating were included. Time to fracture healing was defined as duration between day of surgery and presence of radiographic union as evidence by bridging of callus or osseous bone. To assess for renal impairment, estimated glomerular filtration rate (eGFR) was calculated based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Pre-existing comorbidities were also collected and analysed. RESULTS Ninety-nine consecutive patients took mean 65.5 ± 8.0 days to fracture healing post-operatively. Patients with renal impairment had longer time to fracture healing than patients without (67.1 ± 50.4 days versus 50.4 ± 31.8 days, p = 0.044). Patients ≥ 65 years also had a longer duration to fracture healing compared to patients < 65 years (mean 63.7 ± 53.0 days versus 50.2 ± 27.2 days, p = 0.033). Similarly, patients with ASA Class I had a shorter mean time to fracture healing than patients with ASA Class II and above (mean 42.5 ± 22.8 days versus 62.8 ± 47.6 days, p = 0.028). CONCLUSIONS Time to fracture healing post-distal radius fracture fixation was significantly related to renal impairment, age and ASA classification.
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17
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Advancements in nanomedicines for the detection and treatment of diabetic kidney disease. BIOMATERIALS AND BIOSYSTEMS 2022; 6:100047. [PMID: 36824160 PMCID: PMC9934479 DOI: 10.1016/j.bbiosy.2022.100047] [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: 12/22/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 12/18/2022] Open
Abstract
In the diabetic kidneys, morbidities such as accelerated ageing, hypertension and hyperglycaemia create a pro-inflammatory microenvironment characterised by extensive fibrogenesis. Radiological techniques are not yet optimised generating inconsistent and non-reproducible data. The gold standard procedure to assess renal fibrosis is kidney biopsy, followed by histopathological assessment. However, this method is risky, invasive, subjective and examines less than 0.01% of kidney tissue resulting in diagnostic errors. As such, less than 10% of patients undergo kidney biopsy, limiting the accuracy of the current diabetic kidney disease (DKD) staging method. Standard treatments suppress the renin-angiotensin system to control hypertension and use of pharmaceuticals aimed at controlling diabetes have shown promise but can cause hypoglycaemia, diuresis and malnutrition as a result of low caloric intake. New approaches to both diagnosis and treatment are required. Nanoparticles (NPs) are an attractive candidate for managing DKD due to their ability to act as theranostic tools that can carry drugs and enhance image contrast. NP-based point-of-care systems can provide physiological information previously considered unattainable and provide control over the rate and location of drug release. Here we discuss the use of nanotechnology in renal disease, its application to both the treatment and diagnosis of DKD. Finally, we propose a new method of NP-based DKD classification that overcomes the current systems limitations.
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18
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Fedotkina O, Sulaieva O, Ozgumus T, Cherviakova L, Khalimon N, Svietleisha T, Buldenko T, Ahlqvist E, Asplund O, Groop L, Nilsson PM, Lyssenko V. Novel Reclassification of Adult Diabetes Is Useful to Distinguish Stages of β-Cell Function Linked to the Risk of Vascular Complications: The DOLCE Study From Northern Ukraine. Front Genet 2021; 12:637945. [PMID: 34276762 PMCID: PMC8283002 DOI: 10.3389/fgene.2021.637945] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Presently, persons with diabetes are classified as having type 1 (T1D) or type 2 diabetes (T2D) based on clinical diagnosis. However, adult patients exhibit diverse clinical representations and this makes treatment approaches challenging to personalize. A recent Scandinavian study proposed a novel classification of adult diabetes into five clusters based on disease pathophysiology and risk of vascular complications. The current study aimed to characterize new subgroups of adult diabetes using this strategy in a defined population from northern Ukraine. Methods We analyzed 2,140 patients with established diabetes from the DOLCE study (n = 887 with new-onset diabetes and n = 1,253 with long duration). We used the k-means approach to perform clustering analyses using BMI, age at onset of diabetes, HbA1c, insulin secretion (HOMA2-B), and insulin resistance (HOMA2-IR) indices and glutamic acid decarboxylase antibodies (GADA) levels. Risks of macro- (myocardial infarction or stroke) and microvascular [retinopathy, chronic kidney disease (CKD) and neuropathy] complications and associations of genetic variants with specific clusters were studied using logistic regression adjusted for age, sex, and diabetes duration. Results Severe autoimmune diabetes (SAID, 11 and 6%) and severe insulin-deficient diabetes (SIDD, 25 and 14%) clusters were twice as prevalent in patients with long-term as compared to those with new-onset diabetes. Patients with long duration in both SAID and SIDD clusters had highest risks of proliferative retinopathy, and elevated risks of CKD. Long-term insulin-resistant obese diabetes 1 (IROD1) subgroup had elevated risks of CKD, while insulin-resistant obese diabetes 2 (IROD2) cluster exhibited the highest HOMA2-B, lowest HbA1c, and lower prevalence of all microvascular complications as compared to all other clusters. Genetic analyses of IROD2 subgroup identified reduced frequency of the risk alleles in the TCF7L2 gene as compared to all other clusters, cumulatively and individually (p = 0.0001). Conclusion The novel reclassification algorithm of patients with adult diabetes was reproducible in this population from northern Ukraine. It may be beneficial for the patients in the SIDD subgroup to initiate earlier insulin treatment or other anti-diabetic modalities to preserve β-cell function. Long-term diabetes cases with preserved β-cell function and lower risk for microvascular complications represent an interesting subgroup of patients for further investigations of protective mechanisms.
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Affiliation(s)
- Olena Fedotkina
- Department of Clinical Science, Center for Diabetes Research, University of Bergen, Bergen, Norway
| | - Oksana Sulaieva
- Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Medical Laboratory CSD, Kyiv, Ukraine
| | - Turkuler Ozgumus
- Department of Clinical Science, Center for Diabetes Research, University of Bergen, Bergen, Norway
| | | | | | | | - Tetiana Buldenko
- Department of Health Care of Chernihiv Regional State Administration, Chernihiv, Ukraine
| | - Emma Ahlqvist
- Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olof Asplund
- Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Leif Groop
- Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Valeriya Lyssenko
- Department of Clinical Science, Center for Diabetes Research, University of Bergen, Bergen, Norway.,Lund University Diabetes Center, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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19
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Jadhav U, Mohanan PP, Almeida AF, Abraham G, Khan MY, Gaurav K, Mane A, Vikas S, Jain M, Meel B. Effectiveness and Effect on Renal Parameters of Amlodipine vs. Other Dihydropyridine Calcium Channel Blockers in Patients with Essential Hypertension: Retrospective Observational Study Based on Real-World Evidence from Electronic Medical Records. Cardiol Ther 2021; 10:465-480. [PMID: 34115326 PMCID: PMC8555025 DOI: 10.1007/s40119-021-00224-8] [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: 03/30/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The renoprotective effects of dihydropyridine calcium channel blockers (CCBs) have been established as non-inferior to other classes of antihypertensive drugs. Studying their effect on renal outcome parameters, specifically for amlodipine as monotherapy, in real-world settings can further help in expanding its usage among Indian patients. This study was performed to assess the effects of amlodipine and other dihydropyridine CCBs (cilnidipine, benidipine and azelnidipine) on renal parameters and effectiveness in blood pressure reduction in Indian patients. Methods The retrospective data of adult patients (> 18 years) with essential hypertensive who were prescribed amlodipine (n = 92), cilnidipine (n = 91), benidipine (n = 70) or azelnidipine (n = 71) as monotherapy were analyzed. The renal outcomes, serum creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), microalbumin, urine albumin-to-creatinine ratio (UACR), sodium and potassium levels, and mean changes in BP were analyzed from baseline to 12 months. Appropriate statistical methods were used to determine the significance (p value < 0.05). Results From baseline to the end of the study, mean serum creatinine changed from 0.98 ± 0.17 to 1.07 ± 0.28 mg/dL with amlodipine, 0.97 ± 0.18 to 1.13 ± 0.50 mg/dL with cilnidipine, 0.98 ± 0.30 to 0.97 ± 0.27 mg/dL wi th benidipine, and 0.99 ± 0.23 to 0.98 ± 0.25 mg/dL with azelnidipine (p = 0.01). The mean microalbumin and UACR were reduced from baseline to the end of the study (p = 0.06 and p > 0.05). No significant changes were observed in BUN, sodium or potassium levels. Overall, for all CCBs, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were reduced from baseline to the end of the study (p = 0.002). At the end of the study, the average dose of amlodipine was 7.25 mg, and the average reduction in SBP and DBP per mg dose was 1.54 and 0.57 mmHg. The corresponding numbers for the other CCBs were as follows: cilnidipine, 14.28 mg, 0.26 and 0.01; benidipine, 5.71 mg, 0.41 and 0.11; azelnidipine, 15.88 mg, 0.13 and 0.06. Conclusion Amlodipine and other CCBs demonstrated good efficacy and similar effects on renal parameters from baseline to end of study. Amlodipine also showed higher potency by demonstrating greater BP reduction at a lower dose. Thus, amlodipine can remain a preferred choice among CCBs, even with the advent of the newer CCBs. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-021-00224-8.
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Affiliation(s)
- Uday Jadhav
- Cardiology Department, MGM New Bombay Hospital, Mumbai, India
| | | | | | - Georgi Abraham
- MGM Healthcare, Nelson Manickam Road, Aminjikarai, Chennai, India
| | | | - Kumar Gaurav
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, India
| | - Amey Mane
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, India
| | - Seema Vikas
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, India
| | - Madhur Jain
- Ujala Cygnus Super Specialty Hospital, Rewari, Haryana, India
| | - Bhavesh Meel
- Heart and General Hospital, Jaipur, Rajasthan, India
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20
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Akkerman-Nijland AM, Möhlmann JE, Akkerman OW, Vd Vaart H, Majoor CJ, Rottier BL, Burgerhof JGM, Hak E, Koppelman GH, Touw DJ. The long-term safety of chronic azithromycin use in adult patients with cystic fibrosis, evaluating biomarkers for renal function, hepatic function and electrical properties of the heart. Expert Opin Drug Saf 2021; 20:959-963. [PMID: 34030570 DOI: 10.1080/14740338.2021.1932814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Azithromycin maintenance therapy is widely used in cystic fibrosis (CF), but little is known about its long-term safety. We investigated whether chronic azithromycin use is safe regarding renal function, hepatic cell toxicity and QTc-interval prolongation.Methods: Adult CF patients (72 patients using azithromycin for a cumulative period of 364.8 years and 19 controls, 108.8 years) from two CF-centers in the Netherlands with azithromycin (non)-use for at least three uninterrupted years were studied retrospectively.Results: There was no difference in mean decline of estimated glomerular filtration rate (eGFR), nor in occurrence of eGFR-events. No drug-induced liver injury could be attributed to azithromycin. Of the 39 azithromycin users of whom an ECG was available, 4/39 (10.3%) had borderline and 4/39 (10.3%) prolonged QTc-intervals, with 7/8 patients using other QTc-prolonging medication. Of the control patients 1/6 (16.7%) had a borderline QTc-interval, without using other QTc-prolonging medication. No cardiac arrhythmias were observed.Conclusion: We observed no renal or hepatic toxicity, nor cardiac arrythmias during azithromycin use in CF patients for a mean study duration of more than 5 years. One should be aware of possible QTc-interval prolongation, in particular in patients using other QTc-interval prolonging medication.
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Affiliation(s)
- A M Akkerman-Nijland
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - J E Möhlmann
- University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
| | - O W Akkerman
- University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, Netherlands
| | - H Vd Vaart
- University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, Netherlands
| | - C J Majoor
- Amsterdam University Medical Centers, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - B L Rottier
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - J G M Burgerhof
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - E Hak
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, The Netherlands.,Department of Pharmacotherapy, -epidemiology and economics, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -epidemiology & -economics, University of Groningen, Groningen, The Netherlands
| | - G H Koppelman
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - D J Touw
- University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
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Fadel FI, Kotb MA, Abdel Mawla MA, Hasanin RM, Salem AM, Fathallah MG, Amr KS, Ahmed HA, Salah DM. Primary hyperoxaluria type 1 in children: Clinical classification, renal replacement therapy, and outcome in a single centre experience. Ther Apher Dial 2021; 26:162-170. [PMID: 33945205 DOI: 10.1111/1744-9987.13666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 12/13/2022]
Abstract
Primary hyperoxaluria type 1 (PH1) is a rare disease that is challenged by the overproduced oxalate and commonly presented with radiopaque renal stones or obstructive uropathy. This study aimed to report clinical presentations, renal replacement therapy (RRT), and outcome of PH1 in end stage kidney disease (ESKD) children. This is an observational cohort study. Data of 22 patients with ESKD due to PH1 were analyzed at Pediatric Nephrology Unit, Faculty of Medicine Cairo University. Infantile onset patients (n = 10) had worst renal outcome (80% with ESRD at presentation, p = 0.019) and worse patient outcome (mortality 40%, p = 0.016) than juvenile (n = 9) and late onset (PH1 n = 3) patients. RRT modalities include peritoneal dialysis (PD) in 7 (31.8%), hemodialysis (HD) in 11 (50%), and combined liver kidney transplantation (CLKT) in 4 (18.2%) patients. Infectious complications were encountered in 42.8% of PD patients. Better HD adequacy was observed with frequent HD (n = 6) and/or HD via arteriovenous fistula (AVF) than with infrequent dialysis (n = 5) and/or via central venous line (CVL) (p = 0.0001 and 0.0047, respectively). Morbidity and mortality (infection related) rates of the whole cohort were 63.6% and 31.8%, respectively. Clinical presentation of PH1 varies according to the age of onset (infantile onset being the most aggressive form). Aggressive HD (better through AVF) is needed to achieve acceptable HD adequacy, PD was challenged by infection. Infection found to be the main cause of mortality even after successful CLKT.
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Affiliation(s)
- Fatina I Fadel
- Department of Pediatrics & Pediatric Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magd A Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Rasha M Hasanin
- Department of Pediatrics, National Research Center, Giza, Egypt
| | - Amr Mohamed Salem
- Department of Pediatrics & Pediatric Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Gamal Fathallah
- Department of Pediatrics & Pediatric Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalda Sayed Amr
- Department of Medical Molecular Genetics, National Research Center, Giza, Egypt
| | - Hoda Abdalla Ahmed
- Department of Medical Molecular Genetics, National Research Center, Giza, Egypt
| | - Doaa M Salah
- Department of Pediatrics & Pediatric Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
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22
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Wu Z, Li L, Wu G, Xie Y, Li J, Peng R. Effects of tonifying kidney and strengthen bone therapy on non-dialysis patients with chronic kidney disease-mineral and bone disorder: A protocol for the systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24445. [PMID: 33578537 PMCID: PMC7886426 DOI: 10.1097/md.0000000000024445] [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] [Received: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Correction of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) disorders is the standard of treatment in non-dialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), but the side effects and adverse reactions brought by western medicine (WM) are still the main problems. More importantly, the lack of protection of kidney function in the treatment greatly affects the health of patients. Although traditional Chinese medicine (TCM), specifically tonifying kidney and strengthen bone (TKSB) therapy is wildly applied for patients with CKD-MBD in China, the evidence of TKSB therapy in the treatment of CKD-MBD is limited. Thus, we pretent to conduct this protocol to evaluate the efficacy and safety of TKSB therapy combined with WM for non-dialysis patients with CKD-MBD. METHODS A system research of randomized controlled trials (RCTs) of TKSB therapy for CKD-MBD will be conducted by 2 investigators from 7 electronic databases. Methodological quality evaluations will be performed by using the Cochrane collaboration tool and data analysis will be conducted by RevMan V5.3 software and STATA v15.0. RESULTS The results of this paper will be submitted to a peer-reviewed journal for publication. CONCLUSION This research will determine the safety and efficacy of TKSB therapy in treating non-dialysis patients with CKD-MBD. INPLASY REGISTRATION NUMBER INPLASY2020120086.
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Affiliation(s)
- Zijian Wu
- College of Acupuncture and Orthopedics
| | - Liang Li
- Clinical College of Chinese Medicine, Hubei University of Chinese Medicine
| | - Guiling Wu
- Wuhan Hospital of Traditional Chinese Medicine
| | | | - Jia Li
- Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
| | - Rui Peng
- College of Acupuncture and Orthopedics
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Tapper M, McGrowder DA, Dilworth L, Soyibo A. Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients. Diseases 2021; 9:diseases9010005. [PMID: 33401560 PMCID: PMC7838907 DOI: 10.3390/diseases9010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. METHODS A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. RESULTS 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. CONCLUSIONS 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Marlene Tapper
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
| | - Donovan A. McGrowder
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
- Correspondence:
| | - Lowell Dilworth
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
| | - Adedamola Soyibo
- Department of Medicine, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica;
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Keshvari-Shad F, Hajebrahimi S, Pilar Laguna Pes M, Mahboub-Ahari A, Nouri M, Seyednejad F, Yousefi M. A Systematic Review of Screening Tests for Chronic Kidney Disease: An Accuracy Analysis. Galen Med J 2020; 9:e1573. [PMID: 34466554 PMCID: PMC8344133 DOI: 10.31661/gmj.v9i0.1573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/25/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
This systematic review was conducted to assess the diagnostic accuracy of chronic kidney disease screening tests in the general population. MEDLINE, EMBASE, Web of Science, Scopus, The Cochrane Library and ProQuest databases were searched for English-language publications up to November 2016. Two reviewers independently screened studies and extracted study data in standardized tables. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity of all available screening methods were identified through included studies. Ten out of 1349 screened records included for final analysis. Sensitivities of the dipstick test with a cutoff value of trace were ranged from 37.1% to 69.4% and specificities from 93.7% to 97.3% for the detection of ACR>30 mg/g. The diagnostic sensitivities of the UAC>10 mg/dL testing was shown to vary from 40% to 87%, and specificities ranged from 75% to 96%. While the sensitivities of ACR were fluctuating between 74% and 90%, likewise the specificities were between 77% and 88%. Sensitivities for C-G, Grubb and Larsson equations were 98.9%, 86.2%, and 70.1% respectively. In the meantime the study showed specificities of 84.8%, 84.2% and 90.5% respectively for these equations. Individual studies were highly heterogeneous in terms of target populations, type of screening tests, thresholds used to detect CKD and variations in design. Results pointed to the superiority of UAC and dipstick over the other tests in terms of all parameters involved. The diversity of methods and thresholds for detection of CKD, necessitate considering the cost parameter along with the effectiveness of tests to scale-up an efficient strategy.
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Affiliation(s)
- Fatemeh Keshvari-Shad
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sceinecs, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Faculty of Medicine, Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Alireza Mahboub-Ahari
- Department of Health Economics, Iranian Evidence-Based Medicine Center of Excellence, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Department of Biochemistry and Clinical Laboratories, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farshad Seyednejad
- Department of Radiation Oncology, Madani Hospital, Tabriz Medical University, Tabriz, Iran
| | - Mahmood Yousefi
- Department of Health Economics, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Correspondence to: Mahmood Yousefi, Department of Health Economics, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Telephone Number: 09121755785 Email Address:
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Husain NRN, Hairon SM, Zain RM, Bakar M, Bee TG, Ismail MS. The Effects of Wet Cupping Therapy on Fasting Blood Sugar, Renal Function Parameters, and Endothelial Function: A Single-arm Intervention Study. Oman Med J 2020; 35:e108. [PMID: 32257417 PMCID: PMC7086389 DOI: 10.5001/omj.2020.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives Despite being recognized worldwide as an alternative therapy in treating various chronic diseases and pain, the mechanism of wet cupping is still not well understood. The purpose of this study was to evaluate fasting blood sugar (FBS), renal function parameters, and endothelial function changes following wet cupping in healthy individuals. Methods We conducted a single-arm intervention study at the Clinical Lab of Community Medicine, Universiti Sains Malaysia, and included 31 healthy individuals aged between 30 and 60 years old. Wet cupping therapy was performed at five treatment points at the beginning of the study and repeated after three months. Health outcomes at baseline, one, three, and four months were assessed for FBS, renal function parameters (urea, creatinine, and uric acid), systolic blood pressure (SBP), and von Willebrand factor (vWF). Results Forty-five percent of participants were female, and the mean age of study participants was 44.9±6.4 years. Wet cupping therapy significantly reduced FBS, serum urea, and serum creatinine at one, three, and four months compared with baseline values. Serum uric acid and SBP showed a significant reduction at one and four months compared with baseline. The vWF (a measure of endothelial function) had a 4.0% reduction at four months compared to baseline, with a mean difference of 5.3 (95% confidence interval (CI): 2.20 = 8.55; p = 0.002). Conclusions This study provides preliminary support that repeated wet cupping therapy enhances body health status; thus, it could be an effective complementary medicine in disease prevention.
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Affiliation(s)
- Nik-Rosmawati Nik Husain
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Rehanah Mohd Zain
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Mujahid Bakar
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Tee Get Bee
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Mohamed Saat Ismail
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
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Joo JH, Lee DW, Choi DW, Park EC. Association between Food Label Unawareness and Loss of Renal Function in Diabetes: A Cross-Sectional Study in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061945. [PMID: 32188140 PMCID: PMC7142459 DOI: 10.3390/ijerph17061945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Abstract
Objectives: To examine sex differences in the association between food label unawareness and loss of renal function among South Korean diabetic patients aged ≥30 year and determine whether reading food labels when choosing which food products to consume plays a potential role in slowing the progression of renal disease. Methods: Data from the 2016–2017 Korea National Health and Nutrition Examination Survey were used for the analysis. Renal function was determined by the Modification of Diet in Renal Disease estimated glomerular filtration rate, and food label unawareness was defined as being unaware of the food label when choosing a food product for consumption. Multiple regression analysis was used to investigate the association between food label unawareness and loss of renal function among South Korean diabetic patients. Results: Four hundred and eighty-seven diabetic patients (men: 274; women: 213) were enrolled. Loss of renal function was associated with food label unawareness in only male diabetic patients (men: β = –10.01, standard error (SE) = 5.08, p = 0.0506; women: β = –0.30, SE = 5.14, p = 0.9528). A strong association was found between loss of renal function and food label unawareness among socially isolated male diabetic patients who lived in a one-generational household, did not have a spouse, and ate alone. Conclusion: Cultivating habits of reading food labels and inducing social facilitation may play a potential role in managing loss of renal function among male diabetic patients.
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Affiliation(s)
- Jae Hong Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea; (J.H.J.); (D.W.L.); (D.-W.C.)
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Doo Woong Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea; (J.H.J.); (D.W.L.); (D.-W.C.)
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Dong-Woo Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea; (J.H.J.); (D.W.L.); (D.-W.C.)
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-1862
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Association of Vegetarian Diet with Chronic Kidney Disease. Nutrients 2019; 11:nu11020279. [PMID: 30691237 PMCID: PMC6412429 DOI: 10.3390/nu11020279] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) and its complications are major global public health issues. Vegetarian diets are associated with a more favorable profile of metabolic risk factors and lower blood pressure, but the protective effect in CKD is still unknown. We aim to assess the association between vegetarian diets and CKD. A cross-sectional study was based on subjects who received physical checkups at the Taipei Tzu Chi Hospital from 5 September 2005, to 31 December 2016. All subjects completed a questionnaire to assess their demographics, medical history, diet pattern, and lifestyles. The diet patterns were categorized into vegan, ovo-lacto vegetarian, or omnivore. CKD was defined as an estimated GFR <60 mL/min/1.73 m2 or the presence of proteinuria. We evaluated the association between vegetarian diets and CKD prevalence by using multivariate analysis. Our study recruited 55,113 subjects. CKD was significantly less common in the vegan group compared with the omnivore group (vegan 14.8%, ovo-lacto vegetarians 20%, and omnivores 16.2%, P < 0.001). The multivariable logistic regression analysis revealed that vegetarian diets including vegan and ovo-lacto vegetarian diets were possible protective factors [odds ratios = 0.87 (0.77–0.99), P = 0.041; 0.84 (0.78–0.90), P < 0.001]. Our study showed a strong negative association between vegetarian diets and prevalence of CKD. If such associations are causal, vegetarian diets could be helpful in reducing the occurrence of CKD.
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New mechanisms of CCR5-Δ32 carriers' advantage - Impact on progenitor cells and renal function. Int J Biochem Cell Biol 2019; 108:92-97. [PMID: 30648621 DOI: 10.1016/j.biocel.2019.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/26/2018] [Accepted: 01/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND CCR5 is a chemokine receptor expressed by various populations including leukocytes, smooth muscle cells and endothelium. Δ32 polymorphism of CCR5 gene has been connected with, inter alia, cardiovascular disease development. The aim of our study was to evaluate impact of CCR5 variant on CD34+ and CD34+VEGFR2+ cells - populations involved in cardiovascular system homeostasis and regeneration. METHODS AND RESULTS We have examined 170 Polish subjects from Pomeranian region. The analysis concerned CCR5 polymorphism and flow cytometry evaluation of whole blood cells. Our results indicate that individuals with at least one CCR5-Δ32 allele are characterized by greater number of CD34+CXCR4+, CD34+VEGFR2+ and CD34+VEGFR2+c-Kit + cells than their wild type counterparts. This group also exhibits more beneficial values of renal function parameters. CONCLUSION Maintaining greater size of CD34+ and CD34+VEGFR2+ populations as well as proper kidney function may constitute mechanisms that connect chemokine receptor polymorphism with cardiovascular system health.
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Elghoroury EA, Fadel FI, Farouk H, Elshamaa MF, Kamel S, Kandil D, Mahmoud E. Association of variable number tandem repeats polymorphism in the IL-4 gene with end-stage renal disease in children. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Klotho G-395A gene polymorphism: impact on progression of end-stage renal disease and development of cardiovascular complications in children on dialysis. Pediatr Nephrol 2018; 33:1019-1027. [PMID: 29313136 DOI: 10.1007/s00467-017-3877-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Klotho G-395-A gene polymorphism may impact children with end-stage renal disease (ESRD). We investigated the relevance of Klotho G-395-A on ESRD development and progression, and its relationship with evolution of cardiovascular complications in pediatric dialysis patients. METHODS Fifty-five children with chronic kidney disease (CKD) and seventy healthy children were genotyped for Klotho G-395A. RESULTS Incidence of GA/AA genotypes and A allele were higher in ESRD patients compared with controls (54.5 vs. 7.1%, P < 0.001; 30.9 vs. 13.6%, P = 0.001, respectively). Also, children with GA/AA genotypes were 15.6 times more likely to develop ESRD than with GG genotype (95% CI 5.4-44.7, P < 0.001). A allele carriers have 2.8 times higher risk of developing ESRD than those with G allele (95% CI 1.5-5.35, P = 0.001). Also, the A allele could be considered a predictor of cardiovascular disease (CVD), as carriers have 161 times higher risk of cardiovascular complications than non-carriers (95% CI 21-1233, P < 0.001). All ESRD patients with CVD presented with left ventricular hypertrophy (LVH) and the frequency of A allele was significantly higher among ESRD children with LVH, whereas G allele frequency was significantly higher among ESRD children without LVH. CONCLUSIONS The A allele of the G-395A Klotho gene polymorphism shows a significantly higher frequency among children with CKD and those with CVD and LVH. This mutant allele could be used as a risk marker for the development of ESRD as well as a predictor of CVD in these children.
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Skrzypkowska M, Słomiński B, Ryba-Stanisławowska M, Gutknecht P, Siebert J. Circulating CD34+ and CD34+VEGFR2+ progenitor cells are associated with KLOTHO KL-VS polymorphism. Microvasc Res 2018; 119:1-6. [PMID: 29604296 DOI: 10.1016/j.mvr.2018.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND KLOTHO is a regulator of endothelial cells activity and integrity. It has been described for the first time because of its anti-aging properties. KLOTHO encoding gene is present in many functional variants in humans, including "KL-VS" variant that has been connected with longevity and cardiovascular disease development. Few mechanisms have been proposed to explain these associations, but none of them focused on cells from CD34+ population. The aim of our study was to investigate influence of KLOTHO KL-VS polymorphism on populations of CD34+ and CD34+VEGFR2+ cells. METHODS AND RESULTS We examined 167 Polish subjects from Pomeranian region. The analysis concerned KL-VS polymorphism, flow cytometry evaluation of whole blood cells and determination of endothelium-associated serum/plasma factors. Our results indicate that individuals possessing at least one KL-VS allele are characterized by greater number of CD34+ and CD34+VEGFR2+ and their various subpopulations (CD34+CD133+, CD34+c-Kit+, CD34+CXCR4+ and CD34+VEGFR2+c-Kit+) than wild-type volunteers. This group also exhibited more favorable lipid profile and statistically insignificant decrease of vWF and angiotensin II in their blood, whereas VEGF levels were elevated. CONCLUSION One of the mechanisms that are responsible for previously described KL-VS heterozygote advantage may be connected with maintaining greater size of hematopoietic and endothelial progenitor cells population.
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Affiliation(s)
- Maria Skrzypkowska
- Department of Immunology, Medical University of Gdańsk, Dębinki 1, 80-211 Gdańsk, Poland.
| | - Bartosz Słomiński
- Department of Immunology, Medical University of Gdańsk, Dębinki 1, 80-211 Gdańsk, Poland
| | | | - Piotr Gutknecht
- University Center for Cardiology Department of Family Medicine, Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland
| | - Janusz Siebert
- University Center for Cardiology Department of Family Medicine, Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland
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Lee CH, Hsieh SY, Chang CC, Wang IK, Huang WH, Weng CH, Hsu CW, Yen TH. Hepatocellular carcinoma in hemodialysis patients. Oncotarget 2017; 8:73154-73161. [PMID: 29069858 PMCID: PMC5641201 DOI: 10.18632/oncotarget.17127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/01/2017] [Indexed: 02/06/2023] Open
Abstract
We investigated the rates and predictors of mortality in hepatocellular carcinoma (HCC) patients who were or were not undergoing long-term hemodialysis. The participants in this retrospective observational study were 1298 HCC patients (60.0 ± 12.1 years old, 72% male), of whom 172 were undergoing hemodialysis and 1126 were not. HCC patients on hemodialysis exhibited a higher hepatitis C virus carrier rate (49.4% versus 39.3%, P = 0.012), lower hepatitis B virus carrier rate (37.2% versus 58.3%, P < 0.001) and lower hepatitis B or C virus carrier rate (77.9% versus 89.3%, P < 0.001) than those not on hemodialysis. Serum alkaline phosphatase levels were higher in the hemodialysis than non-hemodialysis group (162.8 ± 141.1 u/l versus 124.6 ± 102.5 u/l, P < 0.001). By the end of the analysis, 32.0% of HCC patients on hemodialysis and 28.0% of those not on hemodialysis had died. Kaplan-Meier analysis confirmed that cumulative survival was poorer in HCC patients on hemodialysis (P = 0.004). In a multivariate Cox regression model, hemodialysis (P < 0.001), older age (P < 0.001) and advanced tumor stages (P < 0.001) were found to be risk factors for mortality. HCC patients on hemodialysis had a 2.036-fold greater chance of death than HCC patients not on hemodialysis. Prospective studies with longer follow-ups and larger samples are warranted.
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Affiliation(s)
- Chern-Horng Lee
- Department of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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Kalyesubula R, Nankabirwa JI, Ssinabulya I, Siddharthan T, Kayima J, Nakibuuka J, Salata RA, Mondo C, Kamya MR, Hricik D. Kidney disease in Uganda: a community based study. BMC Nephrol 2017; 18:116. [PMID: 28372551 PMCID: PMC5379733 DOI: 10.1186/s12882-017-0521-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/22/2017] [Indexed: 01/09/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Sub-Saharan Africa (SSA). The majority of studies on CKD in SSA have been conducted among HIV-infected populations and mainly from large health facilities. We determined the prevalence of CKD and its predictors among populations in communities in central Uganda. Methods A cross-sectional study was conducted in Wakiso district using multi-stage sampling. Data was collected on age, sex, socio-economic status, history of alcohol intake, diabetes mellitus, hypertension and smoking. Measurement of blood pressure, weight and height to determine body mass index (BMI) and investigations including HIV testing, fasting blood sugar, creatinine and urinalysis were conducted. Logistic regression was used to estimate the strength of the association between variables and the presence of CKD estimated using the Cockcroft Gault formula. Results A total of 955 participants aged 18–87 years were enrolled into the study. The median age was 31 years (Interquartile range 24–42) and majority (67%) were female. Up to 21.4% (204/955) had abnormal renal function with CKD stage 1 in 6.2% (59/955), stage 2 in 12.7% (121/955), stage 3 in 2.4% (23/955), CKD stage 4 in 0% and CKD stage 5 in 0.1% (1/995). Female gender OR 1.8 (95% Confidence Interval [CI] 1.2–2.8), age >30 years OR 2.2(95% CI 1.2–3.8) and high social economic status OR 2.1 (95% CI 1.3–3.6) were associated with increased risk of CKD while BMI > 25Kg/m2 was protective against CKD OR 0.1 (95% CI 0.04–0.2). Traditional risk factors such as HIV-infection, diabetes mellitus, smoking and alcohol intake were not found to be significantly associated with CKD. Conclusion We found a high prevalence of kidney disease in central Uganda. Interestingly the traditional risk factors associated with CKD previously documented, were not associated with CKD.
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Affiliation(s)
- Robert Kalyesubula
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Mulago National Referral Hospital, Kampala, Uganda. .,Departments of Medicine and Physiology, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | | | - Isaac Ssinabulya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Heart Institute, Kampala, Uganda
| | | | - James Kayima
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Heart Institute, Kampala, Uganda
| | | | | | | | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Panjeta M, Tahirović I, Sofić E, Ćorić J, Dervišević A. Interpretation of Erythropoietin and Haemoglobin Levels in Patients with Various Stages of Chronic Kidney Disease. J Med Biochem 2017; 36:145-152. [PMID: 28680358 PMCID: PMC5471647 DOI: 10.1515/jomb-2017-0014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The production of erythrocytes is regulated by the hormone erythropoietin (EPO), which maintains the blood haemoglobin (Hb) levels constant under normal conditions. Human EPO is a glycoprotein hormone and its synthesis is controlled by the hypoxia-inducible transcription factor. The aim of this study was to establish EPO and Hb levels in patients with chronic kidney disease (CKD), as well as in control subjects, and to investigate the relationship between these parameters. METHODS This cross-sectional, observational study included 356 subjects with CKD divided into 4 subgroups according to their glomerular filtration rate (GFR). The control group consisted of 206 age and sex matched healthy subjects with GFR rate ≥90 mL/min/1.73 m2. EPO, Hb and serum creatinine levels were determined by using immunochemical and spectrophotometric methods. GFR was determined using the MDRD formula. RESULTS The CKD patients had significantly lower levels of haemoglobin (p<0.0005) and hematocrit (p<0.0005) compared to control group. Our results showed that Hb levels decreased, whereas serum creatinine increased with the increasing renal failure. The CKD patients in all four groups had significantly lower (p<0.0005) Hb levels, and significantly higher (p<0.0005) creatinine levels compared to the control group. The median EPO in group I and II were significantly higher (p=0.002; p=0.018), while median EPO in group III and IV were significantly lower (p=0.03; p=0.011) compared to the control group. CONCLUSIONS In patients with CKD, GFR positively correlated with Hb and EPO, while the correlation between GFR and serum creatinine was negative.
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Affiliation(s)
- Mirsad Panjeta
- University of Sarajevo, Faculty of Science, Department of Chemistry, Bosnia and Herzegovina
- Clinical Center University of Sarajevo, Institute for Clinical Chemistry and Biochemistry, Bosnia and Herzegovina
| | - Ismet Tahirović
- University of Sarajevo, Faculty of Science, Department of Chemistry, Bosnia and Herzegovina
| | - Emin Sofić
- University of Sarajevo, Faculty of Science, Department of Chemistry, Bosnia and Herzegovina
- Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina
| | - Jozo Ćorić
- Clinical Center University of Sarajevo, Institute for Clinical Chemistry and Biochemistry, Bosnia and Herzegovina
| | - Amela Dervišević
- Department of Human Physiology, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina
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Abdel Hakeem GL, Abdel Naeem EA, Swelam SH, El Morsi Aboul Fotoh L, El Mazary AAM, Abdel Fadil AM, Abdel Hafez AH. Detection of Occult Acute Kidney Injury in Glucose-6-Phosphate Dehydrogenase Deficiency Anemia. Mediterr J Hematol Infect Dis 2016; 8:e2016038. [PMID: 27648201 PMCID: PMC5016010 DOI: 10.4084/mjhid.2016.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia is associated with intravascular hemolysis. The freely filtered hemoglobin can damage the kidney. We aimed to assess any subclinical renal injury in G6PD children. METHODS Sixty children were included. Thirty G6PD deficiency anemia children were enrolled during the acute hemolytic crisis and after the hemolytic episode had elapsed. Another thirty healthy children were included as controls. Serum cystatin C, creatinine levels, and urinary albumin/creatinine (A/C) ratio were measured, and the glomerular filtration rate (GFR) was calculated. RESULTS Significantly higher urinary A/C ratio (p=0.001,0.002 respectively) and lower GFR (p=0.001 for both) were found during hemolysis and after the hemolytic episode compared to the controls. Also, significant higher serum cystatin C (p=0.001), creatinine (p=0.05) and A/C (p= 0.001) ratio and insignificant lower GFR (p=0.3) during acute hemolytic crisis compared to the same children after the hemolytic episode subsided. CONCLUSIONS G6PD deficiency anemia is associated with a variable degree of acute renal injury during acute hemolytic episodes which may persist after elapsing of the hemolytic crises.
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Małkiewicz A, Skrzypkowska M, Słomiński B, Siebert J, Gutknecht P, Myśliwska J. The GG genotype of the -152 G/A vascular endothelial growth factor (VEGF) polymorphism predisposes to hypertension-related chronic kidney disease. Mol Biol Rep 2016; 43:967-75. [PMID: 27382979 DOI: 10.1007/s11033-016-4035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/29/2016] [Indexed: 11/28/2022]
Abstract
Our purpose was to determine whether the VEGF -152 G/A polymorphism could be associated with chronic kidney disease and endothelial dysfunction in hypertensive patients. There were 100 healthy volunteers enrolled into the control group. The group of patients was constituted by 99 consecutively admitted hypertensive patients referred to our Institution by their general practitioner. All patients were treated with anti-hypertensive polytherapy. Presented study revealed that the hypertensive patients bearing the GG genotype were characterized by the highest values of diastolic blood pressure and markers of endothelial damage such as Angiogenin, Endostatin, CRP as well as von Willebrandt factor. In addition, higher number of immature endothelial progenitor cells with CD34(+)CD133(+), CD34(+)CD133(-) markers was observed in GG hypertensive carriers while in normotensive individuals no differences were found. Such phenomenon may indicate an increased mobilization of bone-marrow derived endothelial progenitors. It may testify to the preserved compensatory mechanism in chronic kidney disease (CKD) patients until the G3a stage of the disease. Moreover, patients with higher estimated glomerular filtration rate (eGFR) level had lower of vWf and Endostatin values, and higher level of VEGF. Taken together our findings clearly indicate the -152 GG hypertensive carriers as more prone to develop CKD. We can suspect that the VEGF -152 GG genotype is strongly associated with hypertension-dependent CKD.
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Affiliation(s)
- Anna Małkiewicz
- Department of Immunology, Medical University of Gdańsk, 80-211, Gdańsk, Poland.
| | - Maria Skrzypkowska
- Department of Immunology, Medical University of Gdańsk, 80-211, Gdańsk, Poland
| | - Bartosz Słomiński
- Department of Immunology, Medical University of Gdańsk, 80-211, Gdańsk, Poland
| | - Janusz Siebert
- Department of Family Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland
| | - Piotr Gutknecht
- Department of Family Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland
| | - Jolanta Myśliwska
- Department of Immunology, Medical University of Gdańsk, 80-211, Gdańsk, Poland
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Ryu S, Kim Y, Kim MK, Kwon HS, Baek KH, Song KH, Yun KJ. Effects of Small Dense LDL in Diabetic Nephropathy in Females with Type 2 Diabetes Mellitus. J Lipid Atheroscler 2016. [DOI: 10.12997/jla.2016.5.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Seongyul Ryu
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
| | - Youngwoo Kim
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
| | - Ki-Hyun Baek
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
| | - Kyung-Jin Yun
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea
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Fujimi K, Miura SI, Matsuda T, Fujita M, Ura Y, Kaino K, Sakamoto M, Horita T, Arimura T, Shiga Y, Saku K. Influence of a Cardiac Rehabilitation Program on Renal Function in Patients With Cardiovascular Disease in a One-Year Follow-Up. Cardiol Res 2015; 6:311-315. [PMID: 28197248 PMCID: PMC5295569 DOI: 10.14740/cr440e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/11/2022] Open
Abstract
Background Exercise training may improve renal function in patients with chronic kidney disease (CKD). The effect of cardiac rehabilitation (CR) with exercise training on renal function has not yet been established. We evaluated the effects of CR on renal function in patients with cardiovascular disease (CVD). Methods Twenty-three CVD patients in a 1-year CR program (CR group) who had ischemic heart disease (IHD) and/or heart failure were compared with 26 age- and gender-matched CVD patients without CR (non-CR group, standard pharmacological care alone). At baseline and after 1 year, urea nitrogen (UN), creatinine (Cr), potassium (K), estimated glomerular filtration rate (eGFR) and hematocrit (Hct) in blood were assessed. Results There were no differences in the patient characteristics at baseline between the CR and non-CR groups except for the percentages of heart failure and the use of calcium channel blocker. After 1 year, there were no significant changes in UN, Cr, K, eGFR or Hct in either the CR or non-CR groups. The patients in the CR group were divided into two groups according to the eGFR level at baseline: low (n = 12, eGFR < 51 mL/minute/1.73 m2, indicating mild-to-moderate CKD) and high (n = 11, eGFR ≥ 51 mL/minute/1.73 m2) eGFR groups. Although there were no differences in the patient characteristics at baseline between the low and high eGFR groups, the low eGFR group showed a significant increase in eGFR after the 1-year CR program. Conclusions CR may improve renal function in patients with mild-to-moderate CKD.
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Affiliation(s)
- Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshiyuki Ura
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Bae YH, Lee SM, Jo JI. Aerobic training during hemodialysis improves body composition, muscle function, physical performance, and quality of life in chronic kidney disease patients. J Phys Ther Sci 2015; 27:1445-9. [PMID: 26157237 PMCID: PMC4483415 DOI: 10.1589/jpts.27.1445] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We assessed the influences of individualized aerobic training on body
composition, knee joint muscle function, physical performance, and quality of life in
chronic kidney disease patients. [Subjects] Ten chronic kidney disease patients undergoing
dialysis. [Methods] Overall physical function and quality of life before and after 12
weeks of aerobic training were evaluated by body composition, the six-minute walk test,
cardiopulmonary exercise tests, and Short Form 36-item questionnaire. [Results] The
six-minute walk test distance increased significantly after 12 weeks aerobic training.
Resting metabolic rate, lactate threshold, maximum oxygen uptake, and quality of life
tended to increase after training. Post-training weight, muscle mass, body fat mass, fat
percentage, body mass index, and peak torque of right and left knee extension and flexion
did not change significantly. [Conclusion] Intra-dialytic training can a safe approach to
maintain or improve physical performance and quality of life of chronic kidney disease
patients undergoing hemodialysis without adverse events or negative cardiovascular
responses. Aerobic training may prevent a decline in body composition and knee joint
muscle function due to inactivity in chronic kidney disease patients. Clinically, aerobic
training may initially be adapted to maintain overall physical function or improve quality
of life in chronic kidney disease patients undergoing hemodialysis.
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Affiliation(s)
- Young-Hyeon Bae
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Republic of Korea ; Department of Physical Therapy, Angelo State University, USA
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Jong Il Jo
- Department of Physical Therapy, New York University, USA
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Cheng MH, Zeng FW, Xie LJ, Li JF, Zhang F, Jiang H. A new quantitative method for estimating glomerular filtration rate and its clinical value. Clin Physiol Funct Imaging 2014; 36:118-25. [PMID: 25412856 DOI: 10.1111/cpf.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The estimation of the glomerular filtration rate (GFR) is essential for the renal function. However, all estimation methods for GFR have advantages and disadvantages. The aim of this study was to develop a new quantitative method for estimating GFR and evaluate its clinical value. METHODS The new GFR was estimated by quantifying the accumulation of Tc-99m DTPA in the dual kidneys and bladder during a gamma camera renogram study in 116 patients with chronic kidney disease. GFR was determined by this new method (nGFR), Gates' gamma camera technique (gGFR), a two-plasma sampling method (tGFR) and creatinine-based clearance as estimated by Cockcroft-Gault (cGFR) and abbreviated MDRD (aGFR) formulae. The correlation analysis, Bland-Altman analysis and receiver-operating characteristic (ROC) plots were carried out among above methods. RESULTS The nGFR value has significant correlation with tGRF (r = 0·827, P<0·01). The nGFR had the best overall performances with a lowest bias deviation (3·1 ml min(-1) /1·73 m(2) ), better precision (53·0 ml min(-1) /1·73 m(2) ), narrowest interquartile range (13·5 ml min(-1) /1·73 m(2) ) and best accuracy (68·1%) within 30% of the tGFR, compared with those of gGFR, cGFR and aGFR. The new method had the similar maximum accuracy with the Gates' method and creatinine clearance as estimated by Cockcroft-Gault and abbreviated modification of diet in renal disease (MDRD) method. The new method had better repeatability characteristic compared with the Gates' method. CONCLUSIONS The new method for estimating GFR had the better performances compared with the Gates' method and creatinine clearance as estimated by Cockcroft-Gault and MDRD method.
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Affiliation(s)
- Mu-Hua Cheng
- Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, GuangZhou, Guangdong, China
| | - Feng-Wei Zeng
- Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, GuangZhou, Guangdong, China
| | - Liang-Jun Xie
- Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, GuangZhou, Guangdong, China
| | - Jian-Fang Li
- Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, GuangZhou, Guangdong, China
| | - Feng Zhang
- Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, GuangZhou, Guangdong, China
| | - Hang Jiang
- Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, GuangZhou, Guangdong, China
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Skrzypkowska M, Myśliwska J, Słomiński B, Siebert J, Gutknecht P, Ryba-Stanisławowska M. Quantitative and functional characteristics of endothelial progenitor cells in newly diagnosed hypertensive patients. J Hum Hypertens 2014; 29:324-30. [PMID: 25296717 DOI: 10.1038/jhh.2014.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Abstract
Populations of peripheral blood CD34(+) cells comprise precursors of endothelial cells. These precursors are crucial to cardiovascular homeostasis. Hypertension, as one of the main risk factors for cardiovascular disease, is associated with the loss of endothelium structural integrity and its functional impairment. The aim of our study was to evaluate the subsets of endothelial precursor cells in patients with newly diagnosed arterial hypertension. Twenty-four newly diagnosed, previously untreated hypertensive patients aged 59.5 ± 12.5 years, were enrolled into the study group, whereas the control group comprised 45 healthy subjects, 55.5±10.0 years old. Endothelial progenitor cells (EPCs) were analysed by flow cytometry. The results showed that hypertensive patients were characterized by a significantly higher percentage and number of the CD34(+) cells and simultaneously less differentiated CD34(+)CD45(dim/neg)CD133(+) progenitors. The percentage and number of CD34(+)CD45(neg)VEGFR2(+) and CD34(+)CD45(neg)CD133(+)VEGFR2(+) cells were not different from the control group. Moreover, patients had a significantly lower percentage and number of the CD34(+)CD45(neg)VEGFR2(+)CXCR4(+) and CD34(+)CD45(neg)VEGFR2(+)ICAM-1(+) cells than healthy individuals. These changes were paralleled by early symptoms of nephropathy, that is, lower glomerular filtration rate (GFR) values and borderline micro albuminuria. Our results indicate that an elevation in the number of less differentiated progenitors may be a mechanism compensating for defects of migration and adhesion, present in a more differentiated subset.
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Affiliation(s)
- M Skrzypkowska
- Department of Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Myśliwska
- Department of Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - B Słomiński
- Department of Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Siebert
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - P Gutknecht
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - M Ryba-Stanisławowska
- Department of Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Pastore A, Noce A, Di Giovamberardino G, De Stefano A, Callà C, Zenobi R, Dessì M, Di Daniele N. Homocysteine, cysteine, folate and vitamin B₁₂ status in type 2 diabetic patients with chronic kidney disease. J Nephrol 2014; 28:571-6. [PMID: 25095762 DOI: 10.1007/s40620-014-0126-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyperhomocysteinemia (hHcy) is a risk factor in the progression of chronic kidney disease (CKD). In type 2 diabetes (T2D), hHcy is strongly associated with increased risk of cardiovascular disease. Vitamin B12 and folic acid supplementation have been reported to lower homocysteine (tHcy) levels, but no data on plasma tHcy, cysteine (Cys), folate and vitamin B12 levels in T2D-CKD patients are reported. PROCEDURES tHcy and Cys levels were analyzed in 178 T2D-CKD patients by high performance liquid chromatography (HPLC) with fluorescence detection. In addition, we determined folate and vitamin B12 levels using a chemiluminescence method. RESULTS tHcy and Cys levels were increased in T2D patients, and this rise positively correlated with the CKD stage (P < 0.001). Folate levels were comparable to controls at various CKD stages, whereas vitamin B12 levels were lower, except at stage IV. We did not find any correlation between B-vitamins and levels of tHcy and Cys, regardless of the CKD stage. CONCLUSIONS This is the first study reporting tHcy, Cys and B-vitamins status in T2D-CKD patients. Although limited to our cohort of 178 patients, our findings could be helpful in clarifying the conflicting literature regarding B-vitamins supplementation. Further studies are necessary before any Hcy-lowering therapy can be safely established in T2D-CKD subjects.
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Affiliation(s)
- Anna Pastore
- Metabolomic and Proteomic Unit, Children's Hospital "Bambino Gesù", IRCCS, P.zza S. Onofrio, 4, 00165, Rome, Italy.
| | - Annalisa Noce
- Department of Internal Medicine, Nephrology and Hypertension Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Gianna Di Giovamberardino
- Metabolomic and Proteomic Unit, Children's Hospital "Bambino Gesù", IRCCS, P.zza S. Onofrio, 4, 00165, Rome, Italy
| | | | - Cinzia Callà
- Department of Laboratory Medicine, "Policlinico Gemelli" University Hospital, Rome, Italy
| | - Rossella Zenobi
- Department of Laboratory Medicine, "Tor Vergata" University Hospital, Rome, Italy
| | - Mariarita Dessì
- Department of Laboratory Medicine, "Tor Vergata" University Hospital, Rome, Italy
| | - Nicola Di Daniele
- Department of Internal Medicine, Nephrology and Hypertension Unit, "Tor Vergata" University Hospital, Rome, Italy
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Al-Maqbali SRS, Mula-Abed WAS. Comparison between Three Different Equations for the Estimation of Glomerular Filtration Rate in Omani Patients with Type 2 Diabetes Mellitus. Sultan Qaboos Univ Med J 2014; 14:e197-e203. [PMID: 24790742 PMCID: PMC3997536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 11/11/2013] [Accepted: 01/16/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES Estimated glomerular filtration rate (eGFR) is an important component of a patient's renal function profile. The Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation are both commonly used. The aim of this study was to compare the performance of the original MDRD186, revised MDRD175 and CKD-EPI equations in calculating eGFR in type 2 diabetes mellitus (T2DM) patients in Oman. METHODS The study included 607 T2DM patients (275 males and 332 females, mean age ± standard deviation 56 ± 12 years) who visited primary health centres in Muscat, Oman, during 2011 and whose renal function was assessed based on serum creatinine measurements. The eGFR was calculated using the three equations and the patients were classified based on chronic kidney disease (CKD) stages according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. A performance comparison was undertaken using the weighted kappa test. RESULTS The median eGFR (mL/min/1.73 m(2)) was 92.9 for MDRD186, 87.4 for MDRD175 and 93.7 for CKD-EPI. The prevalence of CKD stage 1 was 55.4%, 44.7% and 57% while for stages 2 and 3 it was 43.2%, 54% and 41.8%, based on MDRD186, MDRD175 and CKD-EPI, respectively. The agreement between MDRD186 and CKD-EPI (к 0.868) was stronger than MDRD186 and MDRD175 (к 0.753) and MDRD175 and CKD-EPI (к 0.730). CONCLUSION The performances of MDRD186 and CKD-EPI were comparable. Considering that CKD-EPI-based eGFR is known to be close to isotopically measured GFR, the use of MDRD186 rather than MDRD175 may be recommended.
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Noce A, Fabrini R, Dessì M, Bocedi A, Santini S, Rovella V, Pastore A, Tesauro M, Bernardini S, Di Daniele N, Ricci G. Erythrocyte glutathione transferase activity: a possible early biomarker for blood toxicity in uremic diabetic patients. Acta Diabetol 2014; 51:219-24. [PMID: 23818012 DOI: 10.1007/s00592-013-0497-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
Erythrocyte glutathione transferase (e-GST) displays increased activity in patients with renal damage and positive correlation with homocysteine (Hcy) in patients under maintenance hemodialysis. Here, we determined e-GST, Hcy, and erythrocyte catalase (e-CAT) in 328 patients affected by type 2 diabetes mellitus (T2DM), 61 diabetic non-nephropathic patients and 267 affected by diabetes and by chronic kidney disease (CKD) under conservative therapy subdivided into four stages according to K-DOQI lines. e-GST activity was significantly higher in all T2DM patients compared to the control group (7.90 ± 0.26 vs. 5.6 ± 0.4 U/g(Hb)), and we observed an enhanced activity in all subgroups of CKD diabetic patients. No significant correlation or increase has been found for e-CAT in all patients tested. Mean Hcy in diabetic patients is higher than that in healthy subjects (33.42 ± 1.23 vs. 13.6 ± 0.8 μM), and Hcy increases in relation to the CKD stage. As expected, a significant correlation was found between e-GST and Hcy levels. These findings suggest that e-GST hyperactivity is not caused directly by diabetes but by its consequent renal damage. e-GST, as well as Hcy, may represent an early biomarker of renal failure.
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Affiliation(s)
- Annalisa Noce
- Nephrology and Hypertension Unit, Department of System Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial. BMC Nephrol 2013; 14:215. [PMID: 24103561 PMCID: PMC3851595 DOI: 10.1186/1471-2369-14-215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/03/2013] [Indexed: 11/16/2022] Open
Abstract
Background Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life. Methods/Design A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height2; circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life. Discussion CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients. Trial registration The protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).
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Mohseni R, Emami Zeydi A, Ilali E, Adib-Hajbaghery M, Makhlough A. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial. Oman Med J 2013; 28:345-9. [PMID: 24044062 DOI: 10.5001/omj.2013.99] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/18/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study was conducted to determine the impact of an 8-week intradialytic exercise program (consisting of 15 minutes low-intensity exercise during the first 2 hours of dialysis) on dialysis efficacy. METHODS In an open randomized controlled trial, a total of 50 clinically stable hemodialysis patients were enrolled into the study and randomly allocated into two groups: the aerobic exercise group (n=25) and the control group (n=25). Aerobic exercises were done in the intervention group for 15 min/day, three times a week for 2 months. The dialysis efficacy was assessed prior to and at the end of each month of the program. RESULTS The efficacy of dialysis increased at the end of the first month and remained elevated for the duration of the program in the exercise group (p<0.05). CONCLUSION A simplified aerobic exercise program has increased the efficacy of dialysis and may be considered as a safe, complementary and effective modality for hemodialysis patients.
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Affiliation(s)
- Raheleh Mohseni
- MSc in Critical Care Nursing, Department of Medical Surgical Nursing, Nursing and Midwifery faculty, Kashan University of Medical Sciences, Kashan, Iran
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Lee CH, Hsieh SY, Lin JL, Liu MS, Yen TH. Hepatocellular carcinoma in patients with chronic kidney disease. World J Gastroenterol 2013; 19:2466-2472. [PMID: 23674847 PMCID: PMC3646136 DOI: 10.3748/wjg.v19.i16.2466] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/25/2012] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate outcomes of hepatocellular carcinomas (HCCs) in patients with chronic kidney disease (CKD).
METHODS: Four hundred and forty patients referred between 2000 and 2002 for management of HCCs were categorized according to their CKD stage, i.e., estimated glomerular filtration rate (eGFR) > 90 (stage 1), 60-90 (stage 2), 30-60 (stage 3), 15-30 (stage 4), and < 15 (stage 5) mL/min per 1.73 m2, respectively. Demographic, clinical and laboratory data were collected and mortality rates and cause of mortality were analyzed. The mortality data were examined with Kaplan-meier method and the significance was tested using a log-rank test. An initial univariate Cox regression analysis was performed to compare the frequency of possible risk factors associated with mortality. To control for possible confounding factors, a multivariate Cox regression analysis (stepwise backward approach) was performed to analyze those factors that were significant in univariate models (P < 0.05) and met the assumptions of a proportional hazard model.
RESULTS: Most HCC patients with CKD were elderly, with mean age of diagnosis of 60.6 ± 11.9 years, and mostly male (74.8%). Hepatitis B, C and B and C co-infection virus were positive in 61.6%, 45.7% and 14.1% of the patients, respectively. It was found that patients with stages 4 and 5 CKD were not only older (P = 0.001), but also had higher hepatitis C virus carrier rate (P = 0.001), lower serum albumin level (P = 0.001), lower platelet count (P = 0.037), longer prothrombin time (P = 0.001) as well as higher proportions of advanced cirrhosis (P = 0.002) and HCCs (P = 0.001) than patients with stages 1 and 2 CKD. At the end of analysis, 162 (36.9%) patients had died. Kaplan-Meier analysis revealed that patients with stages 4 and 5 CKD suffered lower cumulative survival than stages 1 and 2 CKD (log-rank test, χ2 = 11.764, P = 0.003). In a multivariate Cox-regression model, it was confirmed that CKD stage [odds ratio (OR) = 1.988, 95%CI: 1.012-3.906, P = 0.046)], liver cirrhosis stage (OR = 3.571, 95%CI: 1.590-8.000, P = 0.002) and serum albumin level (OR = 0.657, 95%CI: 0.491-0.878, P = 0.005) were significant predictors for mortality in this population.
CONCLUSION: HCC patients with stages 4 and 5 CKD had inferior survival than stages 1 and 2 CKD. This warrants further studies.
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Mula-Abed WAS. Estimated Glomerular Filtration rate (eGFR): A Serum Creatinine-based Test for the Detection of Chronic Kidney Disease and its Impact on Clinical Practice. Oman Med J 2012; 27:339-40. [PMID: 23071895 DOI: 10.5001/omj.2012.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 07/10/2012] [Indexed: 11/03/2022] Open
Affiliation(s)
- Waad-Allah S Mula-Abed
- Department of Chemical Pathology, Directorate of Laboratory Medicine and Pathology, Royal Hospital, Muscat, Sultanate of Oman
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Mikhailidis DP, Jain A, Nair DR. Estimated Glomerular Filtration rate (eGFR): A Serum Creatinine-Based Test for the Detection of Chronic Kidney Disease and its Impact on Clinical Practice. Oman Med J 2012; 27:260. [PMID: 22811784 DOI: 10.5001/omj.2012.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 04/22/2012] [Indexed: 01/26/2023] Open
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