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Ebert N, Schaeffner E, Seegmiller JC, van Londen M, Bökenkamp A, Cavalier E, Delanaye P, Derain-Dubourg L, Eriksen BO, Indridason OS, Palsson R, Shafi T, Christensson A, Bevc S, Carrara F, Courbebaisse M, Dalton RN, van der Giet M, Melsom T, Methven S, Nordin G, Pottel H, Rule AD, Trillini M, White CA. Iohexol plasma clearance measurement protocol standardization for adults: a consensus paper of the European Kidney Function Consortium. Kidney Int 2024:S0085-2538(24)00537-4. [PMID: 39097002 DOI: 10.1016/j.kint.2024.06.029] [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: 02/20/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 08/05/2024]
Abstract
International consensus supports the development of standardized protocols for measured glomerular filtration rate (mGFR) to facilitate the integration of mGFR testing in both clinical and research settings. To this end, the European Kidney Function Consortium convened an international group of experts with relevant experience in mGFR. The working group performed an extensive literature search to inform the development of recommendations for mGFR determination using 1-compartment plasma clearance models and iohexol as the exogenous filtration marker. Iohexol was selected as it is non-radio labeled, inexpensive, and safe, can be assayed at a central laboratory, and the other commonly used non-radio-labeled tracers have been (inulin) or are soon to be (iothalamate) discontinued. A plasma clearance model was selected over urine clearance as it requires no urine collection. A 1 compartment was preferred to 2 compartments as it requires fewer samples. The recommendations are based on published evidence complemented by expert opinion. The consensus paper covers practical advice for patients and health professionals, preparation, administration, and safety aspects of iohexol, laboratory analysis, blood sample collection and sampling times using both multiple and single-sample protocols, description of the mGFR mathematical calculations, as well as implementation strategies. Supplementary materials include patient and provider information sheets, standard operating procedures, a study protocol template, and support for mGFR calculation.
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Affiliation(s)
- Natalie Ebert
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Elke Schaeffner
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Jesse C Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Arend Bökenkamp
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, Centre Hospitalier Universitaire du Sart-Tilman, Liège, Belgium
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, Centre Hospitalier Universitaire du Sart-Tilman, Liège (ULiege), Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Laurence Derain-Dubourg
- Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Centre de Référence des Maladies Rénales Rares MAREGE, filière maladies rares ORKID, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
| | | | - Runolfur Palsson
- Division of Nephrology, Landspitali University Hospital, Reykavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Tariq Shafi
- Division of Kidney Diseases, Hypertension and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sebastjan Bevc
- Department of Nephrology, Department of Pharmacology, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Fabiola Carrara
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Marie Courbebaisse
- Université Paris Cité; Physiology Department, Hôpital Européen Georges-Pompidou, APHP; INEM, INSERM U1151, Paris, France
| | | | - Markus van der Giet
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Toralf Melsom
- Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Shona Methven
- Department of Renal Medicine, Aberdeen Royal Infirmary, Scotland, UK
| | | | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Matias Trillini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Christine A White
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Li Y, Fujii M, Ohno Y, Ikeda A, Godai K, Nakamura Y, Akagi Y, Yabe D, Tsushita K, Kashihara N, Kamide K, Kabayama M. Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes-Evidence from a large national database in Japan. PLoS One 2023; 18:e0295235. [PMID: 38091297 PMCID: PMC10718407 DOI: 10.1371/journal.pone.0295235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40-74 years with treated and untreated type 2 diabetes. METHODS AND RESULTS This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40-74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR >85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40-59 and 60-74 years) and baseline eGFR levels (60-85, 30-59, and <30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR >30 subgroups (60-85 or 30-59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60-74 age group and non-refreshing sleep in the 40-59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60-74 age group regardless of baseline eGFR levels. In the baseline eGFR <30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. CONCLUSIONS We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.
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Affiliation(s)
- Yaya Li
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuko Ohno
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Asuka Ikeda
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kayo Godai
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuko Nakamura
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuya Akagi
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuyo Tsushita
- Graduate Schools of Nutrition Sciences, Kagawa Nutrition University, Saitama, Sakado, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Kei Kamide
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mai Kabayama
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
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Yamamoto R, Li Q, Otsuki N, Shinzawa M, Yamaguchi M, Wakasugi M, Nagasawa Y, Isaka Y. A Dose-Dependent Association between Alcohol Consumption and Incidence of Proteinuria and Low Glomerular Filtration Rate: A Systematic Review and Meta-Analysis of Cohort Studies. Nutrients 2023; 15:nu15071592. [PMID: 37049433 PMCID: PMC10097279 DOI: 10.3390/nu15071592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular filtration rate (GFR). This systematic review, which included 14,634,940 participants from 11 cohort studies, assessed a dose-dependent association of alcohol consumption and incidence of proteinuria and low estimated GFR (eGFR) of <60 mL/min/1.73 m2. Compared with non-drinkers, the incidence of proteinuria was lower in drinkers with alcohol consumption of ≤12.0 g/day (relative risk 0.87 [95% confidence interval 0.83, 0.92]), but higher in drinkers with alcohol consumption of 36.1–60.0 g/day (1.09 [1.03, 1.15]), suggesting a J-shaped association between alcohol consumption and the incidence of proteinuria. Incidence of low eGFR was lower in drinkers with alcohol consumption of ≤12.0 and 12.1–36.0 than in non-drinkers (≤12.0, 12.1–36.0, and 36.1–60.0 g/day: 0.93 [0.90, 0.95], 0.82 [0.78, 0.86], and 0.89 [0.77, 1.03], respectively), suggesting that drinkers were at lower risk of low eGFR. In conclusion, compared with non-drinkers, mild drinkers were at lower risk of proteinuria and low eGFR, whereas heavy drinkers had a higher risk of proteinuria but a lower risk of low eGFR. The clinical impact of high alcohol consumption should be assessed in well-designed studies.
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Affiliation(s)
- Ryohei Yamamoto
- Health and Counseling Center, Osaka University, Toyonaka 560-0043, Japan
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
- Correspondence:
| | - Qinyan Li
- Health and Counseling Center, Osaka University, Toyonaka 560-0043, Japan
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Naoko Otsuki
- Health and Counseling Center, Osaka University, Toyonaka 560-0043, Japan
| | - Maki Shinzawa
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Minako Wakasugi
- Department of Inter-Organ Communication Research, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yasuyuki Nagasawa
- Department of General Internal Medicine, Hyogo Medical College, Nishinomiya 663-8501, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
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