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Su Y, Feng Y, Lin X, Ma C, Wei J. Genetic association study of TERT gene variants with chronic kidney disease susceptibility in the Chinese population. Ren Fail 2024; 46:2300725. [PMID: 38197421 PMCID: PMC10783823 DOI: 10.1080/0886022x.2023.2300725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
The incidence and mortality of chronic kidney disease (CKD) are increasing globally. Studies have demonstrated the significance of genetic risk factors in the progression of CKD. Telomerase reverse transcriptase (TERT) may be implicated in the development of CKD. This study aimed to investigate the correlation between TERT gene variants and susceptibility to CKD in the Chinese population. A total of 507 patients with CKD and 510 healthy controls were recruited for this case-control study. Four candidate loci were identified using the MassARRAY platform. Logistic regression analysis was employed to assess the association between TERT gene variants and the risk of CKD. The false positive reporting probability (FPRP) method was utilized to evaluate the validity of statistically significant associations. The multifactorial dimensionality reduction (MDR) method was used to evaluate the interaction between SNPs and the risk of CKD. Furthermore, discrepancies in the clinical features of subjects with diverse genotypes were evaluated using one-way analysis of variance (ANOVA). Our findings revealed a correlation between rs2735940 and rs4635969 and an increased risk of CKD. Stratification analysis indicated that rs4635969 was related to an increased risk of CKD in different subgroups (age ≤ 50 years and male). MDR analysis indicated that the two-site model (rs2735940 and rs4635969) was the best prediction model. Furthermore, the rs2735940 GG genotype was found to be linked to an increased level of microalbuminuria (MAU) in patients with CKD. Our study is the first to reveal a connection between TERT gene variants and susceptibility to CKD, providing new insights into the field of nephrology.
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Affiliation(s)
- Yan Su
- Department of Nephrology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, PRChina
| | - Yuan Feng
- Department of Immunology, the Affiliated Children’s Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Xinran Lin
- Department of Nephrology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, PRChina
- Department of Nephrology, the First Affiliated Hospital of Hainan Medical College, Haikou, PR China
| | - Chunyang Ma
- Department of Neurosurgery, the First Affiliated Hospital of Hainan Medical College, Haikou, PR China
| | - Jiali Wei
- Department of Nephrology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, PRChina
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Liu C, Yang J, Li H, Deng Y, He P, Zhang J, Chen S, Chen S, Wang X, Zhang M. Comparative efficacy of exercise modalities for general risk factors, renal function, and physical function in non-dialysis chronic kidney disease patients: a systematic review and network meta-analysis. Ren Fail 2024; 46:2373272. [PMID: 38967189 PMCID: PMC467113 DOI: 10.1080/0886022x.2024.2373272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Exercise therapy can effectively manage chronic kidney disease (CKD) risk factors and improve renal function and physical fitness, but the challenge lies in choosing the right exercise type tailored to patients' condition. METHODS An electronic search of databases including PubMed, The Cochrane Library, EMBASE, Web of Science, VIP, WanFang, and CNKI was performed. The random effects model was used. Mean difference was employed as the effect size for continuous variables, with 95% confidence interval (CI) provided. RESULTS A total of 36 RCTs were included in this study. Compared to conventional therapy (CT), the combination of three exercise therapies with CT resulted in notable benefits in enhancing six minutes walk test (6MWT) capacity, 24-h urinary protein quantity (24hUTP), systolic blood pressure (SBP), diastolic blood pressure (DBP). Resistance exercise therapy (RT) + CT were more effective than CT to reduce serum creatinine (Scr), body mass index (BMI), and hemoglobin A1c (HbA1c) and improve estimated glomerular filtration rate (eGFR). In terms of improving peak oxygen uptake (VO2 peak), only two exercise modalities were involved, aerobic exercise therapy (AT) and combined (Resistance-Aerobic) exercise therapy (CBT), both of which were more efficacious than CT. The efficacy ranking overall demonstrated clear benefits for RT in enhancing eGFR and 6MWT, decreasing Scr, BMI, SBP, DBP, and HbA1c, while AT was more suitable for boosting VO2 peak, and CBT had greater potential for reducing 24hUTP. CONSLUSIONS Exercise therapy combined with CT offers significant advantages over CT in many cases, but no single exercise modality is universally effective for all indicators.
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Affiliation(s)
- Cong Liu
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jiju Yang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Hongdian Li
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuanyuan Deng
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Pengfei He
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jiao Zhang
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shu Chen
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Siyu Chen
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xinli Wang
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Mianzhi Zhang
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
- Tianjin Famous Chinese Medicine Inheritance Workshop of Mianzhi Zhang, Tianjin, China
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Ku E, Inker LA, Tighiouart H, McCulloch CE, Adingwupu OM, Greene T, Estacio RO, Woodward M, de Zeeuw D, Lewis JB, Hannedouche T, Jafar TH, Imai E, Remuzzi G, Heerspink HJL, Hou FF, Toto RD, Li PK, Sarnak MJ. Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease : A Systematic Review and Retrospective Individual Participant-Level Meta-analysis of Clinical Trials. Ann Intern Med 2024; 177:953-963. [PMID: 38950402 DOI: 10.7326/m23-3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In patients with advanced chronic kidney disease (CKD), the effects of initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) on the risk for kidney failure with replacement therapy (KFRT) and death remain unclear. PURPOSE To examine the association of ACEi or ARB treatment initiation, relative to a non-ACEi or ARB comparator, with rates of KFRT and death. DATA SOURCES Ovid Medline and the Chronic Kidney Disease Epidemiology Collaboration Clinical Trials Consortium from 1946 through 31 December 2023. STUDY SELECTION Completed randomized controlled trials testing either an ACEi or an ARB versus a comparator (placebo or antihypertensive drugs other than ACEi or ARB) that included patients with a baseline estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. DATA EXTRACTION The primary outcome was KFRT, and the secondary outcome was death before KFRT. Analyses were done using Cox proportional hazards models according to the intention-to-treat principle. Prespecified subgroup analyses were done according to baseline age (<65 vs. ≥65 years), eGFR (<20 vs. ≥20 mL/min/1.73 m2), albuminuria (urine albumin-creatinine ratio <300 vs. ≥300 mg/g), and history of diabetes. DATA SYNTHESIS A total of 1739 participants from 18 trials were included, with a mean age of 54.9 years and mean eGFR of 22.2 mL/min/1.73 m2, of whom 624 (35.9%) developed KFRT and 133 (7.6%) died during a median follow-up of 34 months (IQR, 19 to 40 months). Overall, ACEi or ARB treatment initiation led to lower risk for KFRT (adjusted hazard ratio, 0.66 [95% CI, 0.55 to 0.79]) but not death (hazard ratio, 0.86 [CI, 0.58 to 1.28]). There was no statistically significant interaction between ACEi or ARB treatment and age, eGFR, albuminuria, or diabetes (P for interaction > 0.05 for all). LIMITATION Individual participant-level data for hyperkalemia or acute kidney injury were not available. CONCLUSION Initiation of ACEi or ARB therapy protects against KFRT, but not death, in people with advanced CKD. PRIMARY FUNDING SOURCE National Institutes of Health. (PROSPERO: CRD42022307589).
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Affiliation(s)
- Elaine Ku
- Departments of Medicine and Pediatrics, Division of Nephrology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (E.K.)
| | - Lesley A Inker
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.)
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts (H.T.)
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (C.E.M.)
| | - Ogechi M Adingwupu
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.)
| | - Tom Greene
- Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah (T.G.)
| | - Raymond O Estacio
- Ambulatory Care Services, Denver Health, and Department of General Internal Medicine, University of Colorado at Denver, Health Sciences Center, Denver, Colorado (R.O.E.)
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia, and The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom (M.W.)
| | - Dick de Zeeuw
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands (D.deZ.)
| | - Julia B Lewis
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee (J.B.L.)
| | | | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (T.H.J.)
| | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Japan (E.I.)
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (G.R.)
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (H.J.L.H.)
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China (F.F.H.)
| | - Robert D Toto
- University of Texas Southwestern Medical Center, Dallas, Texas (R.D.T.)
| | - Philip K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (P.K.L.)
| | - Mark J Sarnak
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.)
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Johnson HN, Prasad-Reddy L. Updates in Chronic Kidney Disease. J Pharm Pract 2024:8971900241262381. [PMID: 38877746 DOI: 10.1177/08971900241262381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Chronic kidney disease (CKD) affects approximately 14% of adults in the United States and is present in at least 10% of the population worldwide. Blood glucose and blood pressure control are imperative to adequately manage CKD as they are the only primary prevention measures for the condition. Recent changes in CKD evaluation and medication therapies that modify disease progression and aid in managing complications such as anemia of CKD have emerged, including a newly approved mineralocorticoid receptor antagonist and hypoxia-inducible factor-prolyl hydroxylase inhibitor, respectively. This focused update on CKD evaluation and management will review the most recent evidence and approved agents to support patients with CKD, including a review of glomerular filtration rate measurement methods such as CKD-EPI 2021 and utilization of cystatin C, Kidney Disease Improving Global Outcomes (KDIGO) guidelines, American Diabetes Association (ADA) guidelines, and primary literature supporting the use of newer agents in CKD. Checklists for managing blood pressure and blood glucose, CKD-mineral bone disorder, and anemia of CKD targeted for pharmacists are also provided. Additionally, a discussion of Centers for Medicare & Medicaid (CMS) coverage of agents approved for managing complications of CKD is included.
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Affiliation(s)
- Haley N Johnson
- Pharmacy Practice, St. Louis College of Pharmacy at University of Health Sciences and Pharmacy, St. Louis, MO, USA
| | - Lalita Prasad-Reddy
- Office of Medical Education, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
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Okuno-Ozeki N, Kohama Y, Taguchi H, Kawate Y, Umehara M, Minamida A, Yamauchi-Sawada H, Sunahara Y, Matoba Y, Nakamura I, Nakai K, Nakata T, Kirita Y, Taniguchi T, Tamagaki K, Hirao T, Matoba S, Kusaba T. Aversion to a High Salt Taste is Disturbed in Patients With CKD. Kidney Int Rep 2024; 9:1254-1264. [PMID: 38707820 PMCID: PMC11069016 DOI: 10.1016/j.ekir.2024.02.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction A reduced salt intake is a vital lifestyle modification in the management of hypertension. Initiatives aimed at decreasing the intake of salt are based on the preference by humans for a salt taste. Salt intake behavior appears to be affected by the balance between attraction to a low salt taste and aversion to a high salt taste. However, aversion to a high salt taste has not yet been quantitively investigated in both healthy individuals and patients with chronic kidney disease (CKD). Methods Assessments of gustatory and aversion thresholds for salt, bitter, sour, and sweet tastes were performed using a stimulant-impregnated test strip in healthy subjects and patients with CKD. Results In a pilot taste test of 125 healthy subjects, the number of participants with an aversive reaction increased at higher salt concentrations. The threshold for normal taste perception was arbitrarily defined as 10% NaCl, with 47.2% of healthy subjects displaying an aversive reaction. In taste tests performed by 70 patients with CKD, 10% were unable to recognize a salt taste, even at the highest concentration (20% NaCl), suggesting a significant impairment in taste perception in patients with CKD. Only 15.7% of patients with CKD exhibited a normal aversion to NaCl, whereas 78.6% showed the complete loss of aversion to salt. Conclusion The present results confirmed the anticipated aversive response to a high salt taste in humans and demonstrated its impairment in patients with CKD, implying that patients with CKD have reduced resistance to a high salt intake.
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Affiliation(s)
- Natsuko Okuno-Ozeki
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Kohama
- Research and Development Headquarters, House Foods Group Inc. Chiba, Japan
| | - Hiromu Taguchi
- Research and Development Headquarters, House Foods Group Inc. Chiba, Japan
| | - Yuka Kawate
- Department of Nutrition, Kyoto Katsura Hospital, Kyoto, Japan
| | - Minato Umehara
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Minamida
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroko Yamauchi-Sawada
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuto Sunahara
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yayoi Matoba
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Itaru Nakamura
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kunihiro Nakai
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiro Nakata
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuhei Kirita
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Taniguchi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Tamagaki
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Hirao
- Research and Development Headquarters, House Foods Group Inc. Chiba, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuro Kusaba
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Jairoun AA, Ping CC, Ibrahim B. Predictors of chronic kidney disease survival in type 2 diabetes: a 12-year retrospective cohort study utilizing estimated glomerular filtration rate. Sci Rep 2024; 14:9014. [PMID: 38641627 PMCID: PMC11031608 DOI: 10.1038/s41598-024-58574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/01/2024] [Indexed: 04/21/2024] Open
Abstract
Predicting the course of kidney disease in individuals with both type 1 and type 2 diabetes mellitus (DM) is a significant clinical and policy challenge. In several regions, DM is now the leading cause of end-stage renal disease. The aim of this study to identify both modifiable and non-modifiable risk factors, along with clinical markers and coexisting conditions, that increase the likelihood of stage 3-5 chronic kidney disease (CKD) development in individuals with type 2 DM in the United Arab Emirates (UAE). This was a single-center retrospective cohort study based on data derived from electronic medical records of UAE patients with DM who were registered at outpatient clinics at Tawam Hospital in Al Ain, UAE, between January 2011 and December 2021. Type 2 DM patients aged ≥ 18 years who had serum HbA1c levels ≥ 6.5% were included in the study. Patients with type 1 DM, who had undergone permanent renal replacement therapy, who had under 1 year of follow-up, or who had missing or incomplete data were excluded from the study. Factors associated with diabetic patients developing stage 3-5 CKD were identified through Cox regression analysis and a fine and gray competing risk model to account for competing events that could potentially hinder the development of CKD. A total of 1003 patients were recruited for the study. The mean age of the study cohort at baseline was 70.6 ± 28.2 years. Several factors were found to increase the risk of developing stage 3-5 CKD: advancing age (HR 1.005, 95% CI 1.002-1.009, p = 0.026), a history of hypertension (HR 1.69, 95% CI 1.032-2.8, p = 0.037), a history of heart disease (HR 1.49, 95% CI 1.16-1.92, p = 0.002), elevated levels of serum creatinine (HR 1.006, 95% CI 1.002-1.010, p = 0.003), decreased levels of estimated glomerular filtration rate (eGFR) (HR 0.943, 95% CI, 0.938-0.947; p < 0.001), and the use of beta-blockers (HR 139, 95% CI 112-173, p = 0.003). Implementing preventative measures, initiating early interventions, and developing personalized care plans tailored to address specific risk factors are imperative for reducing the impact of CKD. Additionally, the unforeseen findings related to eGFR highlight the ongoing need for research to deepen our understanding of the complexities of kidney disease.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Minden, Malaysia.
| | - Chong Chee Ping
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Minden, Malaysia
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Alexander MR, Aday AW, Lewis J, Deyholos CJ, Luther JM. Flow Disturbances: Competing Interests in a Case of Hypertensive Emergency. Hypertension 2024; 81:676-681. [PMID: 38507508 DOI: 10.1161/hypertensionaha.124.22107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Matthew R Alexander
- Department of Medicine, Division of Clinical Pharmacology (M.R.A.), Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center (M.R.A., A.W.A.), Vanderbilt University Medical Center, Nashville, TN
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN (M.R.A.)
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN (M.R.A.)
| | - Aaron W Aday
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center (M.R.A., A.W.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Julia Lewis
- Department of Medicine, Division of Nephrology and Hypertension (J.L., J.M.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Christine J Deyholos
- Department of Vascular Surgery (C.J.D.), Vanderbilt University Medical Center, Nashville, TN
| | - James M Luther
- Department of Medicine, Division of Nephrology and Hypertension (J.L., J.M.L.), Vanderbilt University Medical Center, Nashville, TN
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Liu F, Jin F, Zhang L, Tang Y, Wang J, Zhang H, Gu T. Lactate combined with SOFA score for improving the predictive efficacy of SOFA score in patients with severe heatstroke. Am J Emerg Med 2024; 78:163-169. [PMID: 38295465 DOI: 10.1016/j.ajem.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The relationship between lactate levels and multiple organ dysfunction in patients with severe heatstroke remains unclear. In this study, we aimed to elucidate the clinical significance of lactate in severe heatstroke prognosis and assess whether incorporating lactate in the SOFA score improves its predictive efficacy. METHODS This study was a multicenter retrospective cohort investigation included 275 patients. Logistic regression analysis was performed to examine the relationship between lactate levels and patient outcomes and complications, including acute kidney injury (AKI), disseminated intravascular coagulation (DIC), and myocardial injury. Further, receiver operating characteristic (ROC) curves and clinical decision curve analysis (DCA) were used to evaluate the predictive power of lactate and SOFA scores in severe heatstroke-associated death. Lastly, the Kaplan-Meier survival curve was employed to differentiate the survival rates among the various patient groups. RESULTS After adjusting for confounding factors, lactate was demonstrated as an independent risk factor for death (OR = 1.353, 95% CI [1.170, 1.569]), AKI (OR = 1.158, 95% CI [1.007, 1.332]), DIC (OR = 1.426, 95% CI [1.225, 1.659]), and myocardial injury (OR = 2.039, 95% CI [1.553, 2.679]). The area under the curve (AUC) of lactate for predicting death from severe heatstroke was 0.7540, with a cutoff of 3.35. The Kaplan-Meier survival curve analysis showed that patients with elevated lactate levels had higher mortality rates. Additionally, the ROC curves demonstrated that combining lactate with the SOFA score provided better predictive efficacy than the SOFA score alone in patients with severe heatstroke (AUC: 0.9025 vs. 0.8773, DeLong test, P < 0.001). Finally, the DCA curve revealed a higher net clinical benefit rate for lactate combined with the SOFA score. CONCLUSIONS Lactate is an independent risk factor for severe heatstroke-related death as well as a risk factor for AKI, DIC, and myocardial injury associated with severe heatstroke. Thus, combining lactate with the SOFA score can significantly improve its predictive efficacy in patients with severe heatstroke.
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Affiliation(s)
- Fujing Liu
- Department of Emergency, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Fang Jin
- Department of Critical Care Medicine, The First People's Hospital of Kunshan, Suzhou City, Jiangsu Province, China
| | - Lingling Zhang
- Department of Critical Care Medicine, The First People's Hospital of Nantong, Nantong City, Jiangsu Province, China
| | - Yun Tang
- Department of Emergency and Critical Care Medicine, Jintan First People's Hospital, Changzhou City, Jiangsu Province, China
| | - Jinhai Wang
- Department of Emergency, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - He Zhang
- Department of Emergency, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Tijun Gu
- Department of Emergency, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China.
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Chong HJ, Jang MK, Kim HK. Decision-making experiences regarding kidney transplant among older adults in South Korea: A qualitative descriptive study. PATIENT EDUCATION AND COUNSELING 2024; 119:108044. [PMID: 37976666 DOI: 10.1016/j.pec.2023.108044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/29/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To explore the decision-making experiences of older patients with end-stage renal disease who chose to undergo kidney transplantation. METHODS This was a qualitative descriptive study.Twelve participants aged over 60 years who underwent kidney transplantation were recruited from a kidney transplant clinic in a hospital in South Korea. Individual in-depth interviews were conducted from March to April 2021. The data were analysed using inductive thematic analysis. RESULTS Four main themes were identified: 1) hesitation towards complex and risky kidney transplant, 2) internal suffering due to social prejudice and limits, 3) taking a step back from the decision-making process, and 4) being rushed into a decision on the brink of death. CONCLUSION Older patients with end-stage renal disease experience hesitation and difficulties and are passive in the decision-making process for a kidney transplant. They lacked sufficient relevant information and decided to receive transplant surgery, feeling pressured by the recommendations of family and healthcare providers. PRACTICE IMPLICATIONS Healthcare professionals should help older patients with end-stage renal disease make proactive decisions by providing tailored education programs and improving communication between the patients and their family members. Changing negative social perceptions and implementing supportive policies are necessary to resolve the difficulties experienced by such patients. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the data collection as interview participants in this study.
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Affiliation(s)
- Hye Jin Chong
- Department of Nursing, Sunchon National University, Jeolanam-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
| | - Min Kyeong Jang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Hyun Kyung Kim
- Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea; College of Nursing, Jeonbuk National University, Jeonju, Republic of Korea.
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Sacareau C, Nacher M, Drak Alsibai K, Ntoutoum A, Adenis A, Hounnou M, Liebart M, Cardoso CS, Aurelus JM, Demar M, Casse O, Amokrane S, Carod JF, Hafsi N, Sabbah N. Factors associated with chronic kidney disease in patients with diabetes in French Guiana. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1167852. [PMID: 37953925 PMCID: PMC10634610 DOI: 10.3389/fcdhc.2023.1167852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
Introduction With over half of the population living under the poverty threshold, the social and health context in French Guiana is more difficult than in mainland France. The prevalence of diabetes is twice as great and end-stage renal failure is 45% higher than in mainland France. Objective Our objective was to describe the profile of diabetic patients with chronic kidney disease in French Guiana and search for possible risk factors. Method We conducted a multicenter cross-sectional observational study based on the CODIAM cohort (Cohort of Diabetes in French Amazonia). We analyzed 1,287 patients followed up between May 2019 and June 2021 at Cayenne Hospital, Saint Laurent Hospital, and delocalized health centers. Results In our cohort, chronic kidney disease was present after an average of 12 years of diabetes. Compared with the French population, 41% of diabetic patients had chronic kidney disease (i.e., 12% more), and had an average age of 56 years (i.e., 10 years younger). Forty-eight per cent of these patients were obese (i.e., 7% more). Seventy-four per cent of patients were precarious and 45% were foreigners but neither was associated with chronic kidney disease, contrary to countries where the health system is not universal. Conclusion Screening of patients with chronic kidney disease among diabetics in French Guiana remains a real challenge. Patients were younger and more obese than in other French territories. In this cohort, precariousness and immigration were not associated with the presence of chronic kidney disease. However, particular attention should be paid to hypertensive patients and those over 65 years of age, which are, with diabetes itself, the two most obvious risk factors for developing chronic kidney disease among diabetic patients in our territory.
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Affiliation(s)
- Christopher Sacareau
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
- Department of Pathology and Center of biological Resources (CRB Amazonie), Cayenne Hospital Center, Cayenne, French Guiana
| | - Andre Ntoutoum
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Antoine Adenis
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Marianne Hounnou
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Marion Liebart
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Clara Salasar Cardoso
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Jean-Markens Aurelus
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory of Parasitology-Mycology, Cayenne Hospital Center, Cayenne, French Guiana
- EA3593, Amazon Ecosystems and Tropical Diseases, University of Guiana, Cayenne, French Guiana
| | - Olivier Casse
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Samia Amokrane
- Department of Medicine, Ouest Guyane Hospital Center, Saint-Laurent, French Guiana
| | - Jean-François Carod
- Laboratory of Biology, Ouest Guyane Hospital Center, Saint-Laurent, French Guiana
| | - Nezha Hafsi
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
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11
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Ku E, McCulloch CE, Copeland TP, Inker LA, Tighiouart H, Sarnak MJ. Acute Declines in Estimated GFR in Blood Pressure Target Trials and Risk of Adverse Outcomes. Am J Kidney Dis 2023; 82:454-463. [PMID: 37269972 DOI: 10.1053/j.ajkd.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/10/2023] [Indexed: 06/05/2023]
Abstract
RATIONALE & OBJECTIVE Acute decreases in glomerular filtration rate (GFR) occur commonly during intensive blood pressure (BP) lowering. Our objective was to determine the relationship between acute decreases in estimated GFR and patient outcomes. STUDY DESIGN Retrospective observational study. SETTING & PARTICIPANTS Participants from 4 randomized controlled trials of intensive BP lowering in chronic kidney disease (Modification of Diet in Renal Disease study, African American Study of Kidney Disease and Hypertension, Systolic Blood Pressure Intervention Trial, and Action to Control Cardiovascular Risk in Diabetes trial). EXPOSURE A 4-category exposure defined by the level of acute decrease in estimated GFR (defined as>15% vs≤15% between baseline and month 4) and the randomization to intensive versus usual BP control. OUTCOMES Risk of kidney replacement therapy (primary outcome), defined as the need for dialysis or transplant except in the Action to Control Cardiovascular Risk in Diabetes trial, which defined its kidney outcome as a composite occurrence of serum creatinine concentration>3.3mg/dL, kidney failure, or kidney replacement therapy. ANALYTICAL APPROACH Multivariable Cox models. RESULTS We included 4,473 individuals randomly assigned to intensive versus usual BP control who had a total of 351 kidney outcomes and 304 deaths during median follow-up durations of 22 and 24 months, respectively. Approximately 14% of participants exhibited an acute decrease in eGFR, 11.0% in the usual BP treatment arm and 17.8% in the intensive BP treatment arm. In adjusted models, compared with a≤15% eGFR decrease in the usual BP arm, a≤15% eGFR decrease in the intensive BP control arm was associated with lower risk of the kidney outcome (HR, 0.75; 95% CI, 0.57-0.98). In contrast, a>15% decrease in eGFR was associated with a higher risk of the kidney outcome in the usual (HR, 2.47; 95% CI, 1.80-3.38) and intensive BP treatment arms (HR, 1.99; 95% CI, 1.45-2.73) compared with a≤15% decrease in the usual BP arm. LIMITATIONS Observational study, residual confounding. CONCLUSIONS Decreases in eGFR of>15% in the usual and intensive BP treatment arms were associated with a higher risk of kidney outcomes compared with a≤15% decrease in the usual BP arm and may be a harbinger of adverse outcomes.
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Affiliation(s)
- Elaine Ku
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Timothy P Copeland
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA
| | - Lesley A Inker
- Department of Medicine, Division of Nephrology, Boston, MA
| | - Hocine Tighiouart
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Mark J Sarnak
- Department of Medicine, Division of Nephrology, Boston, MA
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12
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Shi H, Zhao X, Peng Q, Zhou X, Liu S, Sun C, Cao Q, Zhu S, Sun S. Green Tea Polyphenols Alleviate Kidney Injury Induced by Di(2-Ethylhexyl) Phthalate in Mice. Am J Nephrol 2023; 55:86-105. [PMID: 37734331 DOI: 10.1159/000534106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Di(2-ethylhexyl) phthalate (DEHP) is a common plasticizer. Studies have revealed that DEHP exposure can cause kidney damage. Green tea is among the most popular beverages in China. Green tea polyphenols (GTPs) have been proven to have therapeutic effects on organ damage induced by heavy metal exposure. However, few studies have reported on GTP-relieving DEHP-induced kidney damage. METHODS C57BL/6J male mice aged 6-8 weeks were treated with distilled water (control group), 1,500 mg/kg/d DEHP + corn oil (model group), 1,500 mg/kg/d DEHP + corn oil + 70 mg/kg GTP (treatment group), corn oil (oil group), and 70 mg/kg GTP (GTP group) by gavage for 8 weeks, respectively. The renal function of mice and renal tissue histopathology of each group were evaluated. The renal tissues of mice in the model, treatment, and control groups were analyzed using high-throughput sequencing. We calculated the differentially expressed microRNAs (miRNAs) and messenger RNAs (mRNAs) using the limma R package, the CIBERSORT algorithm was used to predict immune infiltration, the starBase database was used to screen the miRNA-mRNA regulatory axis, and immunohistochemical analyses were performed to verify protein expression. RESULTS GTP alleviated the deterioration of renal function, renal inflammation and fibrosis, and mitochondrial and endoplasmic reticulum lesions induced by DEHP in mice. Differential immune infiltrations of plasma, dendritic, T, and B cells were noted between the model and treatment groups. We found that three differentially expressed miRNAs (mmu-miR-383-5p, mmu-miR-152-3p, and mmu-miR-144-3p), three differentially expressed mRNAs (Ddit4, Dusp1, and Snx18), and three differentially expressed proteins (Ddit4, Dusp1, and Snx18) played crucial roles in the miRNA-mRNA-protein regulatory axes when GTPs mitigate DEHP-induced kidney damage in mice. CONCLUSION GTP can alleviate DEHP-induced kidney damage and regulate immune cell infiltration. We screened four important miRNA-mRNA-protein regulatory axes of GTP, mitigating DEHP-induced kidney damage in mice.
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Affiliation(s)
- Heng Shi
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Gastroenterology, The Central Hospital of Shaoyang, Shaoyang, China
| | - Xinhai Zhao
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qin Peng
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xianling Zhou
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sisi Liu
- Department of Pathology, The Central Hospital of Shaoyang, Shaoyang, China
| | - Chuanchuan Sun
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiuyu Cao
- Department of Gynecologic, Jiangmen Hospital Affiliated to Jinan University, Jiangmen, China
| | - Shiping Zhu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shengyun Sun
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Sadiq S, Black E, Oates A. Identifying barriers and utility of obtaining ambulatory blood pressure monitoring in a pediatric chronic kidney disease population. BMC Pediatr 2023; 23:469. [PMID: 37716957 PMCID: PMC10504719 DOI: 10.1186/s12887-023-04304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Hypertension is a prevalent complication of Chronic Kidney Disease (CKD) and Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for diagnosis. The aim of our study was to assess the usefulness of obtaining ABPM and to identify barriers to ABPM in this pediatric patient population. METHOD In this retrospective analysis of patients with CKD stage 3-5 who were seen in one academic medical center's outpatient Pediatric Nephrology clinics between 2018 and 2021, we performed logistic regression to evaluate for associations between demographic factors and odds of having an ABPM. RESULT Among 96 patients included in the study, 48 patients carried a diagnosis of hypertension. 31 patients had ABPM performed with usable data. In those who had ABPM done, 21 had normotension and 10 had undertreated hypertension. Our study also showed 1 had masked hypertension and 5 had white coat hypertension or effect. We did not find a statistically significant difference in those who did or did not undergo ABPM evaluation based on gender, previous diagnosis of hypertension, distance from clinic, language preference, or racial or ethnic identity. CONCLUSION ABPM is a useful tool in our CKD population for the diagnosis and management of hypertension. We did not identify specific barriers to ABPM in our CKD population, and there were no differences in patients who obtained ABPM when looking at specific demographic and disease characteristics. Given these findings, we recommend focusing on areas of future improvement in spheres of patient and provider education as well as better quantification using surveys to further illuminate barriers.
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Affiliation(s)
- Sanober Sadiq
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, 3214, San Francisco, CA, 94143, USA.
| | - Elizabeth Black
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, 3214, San Francisco, CA, 94143, USA
- Department of Pediatrics, University of California, San Francisco - Fresno, Fresno, CA, USA
| | - Aris Oates
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, 3214, San Francisco, CA, 94143, USA
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14
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Ku E, McCulloch CE, Sarnak MJ. Authors' Reply: A Specific Target BP in Chronic Kidney Disease Remains Unclear. J Am Soc Nephrol 2023; 34:1122. [PMID: 37259198 PMCID: PMC10278812 DOI: 10.1681/asn.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Elaine Ku
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Mark J. Sarnak
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
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15
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Takeuchi M, Shinkawa K, Yanagita M, Kawakami K. Hypothetical intervention of targeted systolic blood pressure control of < 120 mmHg on renal prognosis for persons with stage 3-4 chronic kidney disease: an application of parametric g-formula using health checkup data in Japan. Clin Exp Nephrol 2023; 27:542-547. [PMID: 36947305 DOI: 10.1007/s10157-023-02341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The revised KDIGO guidelines recommend maintaining systolic blood pressure (sBP) < 120 mmHg in patients with chronic kidney disease (CKD), based on cardiovascular and survival benefits. However, the renal benefit of this strategy remains less clear. METHODS We used data of routine health checkups in Japan. Persons whose estimated glomerular filtration rate (eGFR) was < 60 mL/min/1.73 m2 in 2015 without end-stage disease were followed until 2020. We estimated the 5-year benefit of hypothetical targeted sBP control using parametric g-formula modeling, accounting for both time-fixed and time-varying confounding variables. Four sensitivity analyses, including analysis using a marginal structural model (MSM) and positive control outcome analysis, were also done. RESULTS We enrolled 28,972 persons with CKD (median age: 54 years, male: 69%, baseline eGFR [median]: 56 mL/min/1.73m2). As compared with the natural course without a targeted intervention, there was no renoprotective effect of targeted sBP control, with a 5-year difference in eGFR of 0.65 mL/min/1.73 m2 (95% confidence interval - 0.42 to 1.65 mL/min/1.73 m2). MSM analysis found a similar result. In contrast, the positive control analysis using the cardiovascular outcome showed that targeted sBP control would reduce the cardiovascular disease incidence by 6.0% over 5 years. CONCLUSIONS A targeted sBP control strategy maintaining < 120 mmHg may not yield a renoprotective effect for patients with stage 3-4 CKD, although it was expected to offer a cardiovascular benefit. Future research may be warranted in higher-risk populations, such as elderly people or those with more advanced kidney disease.
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Affiliation(s)
- Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Kanna Shinkawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
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16
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Ku E, McCulloch CE, Inker LA, Tighiouart H, Schaefer F, Wühl E, Ruggenenti P, Remuzzi G, Grimes BA, Sarnak MJ. Intensive BP Control in Patients with CKD and Risk for Adverse Outcomes. J Am Soc Nephrol 2023; 34:385-393. [PMID: 36735510 PMCID: PMC10103316 DOI: 10.1681/asn.0000000000000072] [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: 06/12/2022] [Accepted: 11/09/2023] [Indexed: 01/22/2023] Open
Abstract
SIGNIFICANCE STATEMENT Although most guidelines recommend tightly controlling BP in patients with CKD, individuals with advanced kidney disease or severe albuminuria were not well-represented in trials examining the effect of this intervention on kidney outcomes. To examine the effect of intensive BP control on the risk of kidney outcomes in patients with CKD, the authors pooled individual-level data from seven trials. They found that overall, intensive BP control was associated with a 13% lower, but not significant, risk of a kidney outcome. However, the intervention's effect on the kidney outcome differed depending on baseline eGFR. Data from this pooled analysis suggested a benefit of intensive BP control in delaying KRT onset in patients with stages 4-5 CKD, but not necessarily in those with stage 3 CKD. BACKGROUND The effect of intensive BP lowering (to systolic BP of <120 mm Hg) on the risk of kidney failure requiring KRT remains unclear in patients with advanced CKD. Such patients were not well represented in trials evaluating intensive BP control. METHODS To examine the effect of intensive BP lowering on KRT risk-or when not possible, trial-defined kidney outcomes-we pooled individual-level data from seven trials that included patients with eGFR<60 ml/min per 1.73 m 2 . We performed prespecified subgroup analyses to evaluate the effect of intensive BP control by baseline albuminuria and eGFR (CKD stages 4-5 versus stage 3). RESULTS Of 5823 trial participants, 526 developed the kidney outcome and 382 died. Overall, intensive (versus usual) BP control was associated with a lower risk of kidney outcome and death in unadjusted analyses but these findings did not achieve statistical significance. However, the intervention's effect on the kidney outcome differed depending on baseline eGFR ( P interaction=0.05). By intention-to-treat analysis, intensive (versus usual) BP control was associated with a 20% lower risk of the primary kidney outcome in those with CKD GFR stages 4-5, but not in CKD GFR stage 3. There was no interaction between intensive BP control and the severity of albuminuria for kidney outcomes. CONCLUSIONS Data from this pooled analysis of seven trials suggest a benefit of intensive BP control in delaying KRT onset in patients with stages 4-5 CKD but not necessarily with stage 3 CKD. These findings suggest no evidence of harm from intensive BP control, but also point to the need for future trials of BP targets focused on populations with advanced kidney disease. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2023_02_27_JASN0000000000000060.mp3.
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Affiliation(s)
- Elaine Ku
- Departments of Medicine and Pediatrics, Divisions of Nephrology, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Lesley A. Inker
- Department of Medicine, Division of Nephrology, Tufts University, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Piero Ruggenenti
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Ranica, Bergamo, Italy
- Unit of Nephrology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Ranica, Bergamo, Italy
| | - Barbara A. Grimes
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Mark J. Sarnak
- Department of Medicine, Division of Nephrology, Tufts University, Boston, Massachusetts
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17
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Briggs JP, Imrey PB. When You SPRINT, It's Good to Know the Goal as Well as the Goal Line. J Am Soc Nephrol 2023; 34:359-360. [PMID: 36857496 PMCID: PMC10103333 DOI: 10.1681/asn.0000000000000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
| | - Peter B Imrey
- Department of Quantitative Health Sciences, Lerner Research Institute and Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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18
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Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
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Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
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Niu M, Zhang L, Zhang H, Chen C, Gao X, Zhang B, Niu X, Zhao Z, Zhang L, Jiang X. Metabolic Syndrome and Its Components are Associated with In-Hospital Complications after Thoracic Endovascular Aortic Repair for Acute Type B Aortic Dissection. Ann Vasc Surg 2023:S0890-5096(23)00024-9. [PMID: 36642165 DOI: 10.1016/j.avsg.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 01/07/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND This study aimed to explore whether and to what extent metabolic syndrome (MetS) and its components are associated with in-hospital complications in patients with acute type B aortic dissection after thoracic endovascular aortic repair (TEVAR). METHODS We retrospectively enrolled 684 patients who had undergone TEVAR. Demographic and clinical data were collected and subgroup analysis, mixed-model regression analysis, scoring systems, and receiver operating characteristic (ROC) curve analyses were performed. RESULTS Overall, 684 inpatients were assigned to the poor outcome (n = 90) or no complications (n = 594) group. Compared to the no complications group, the poor outcome group had a higher incidence of MetS (44 [48.9%] vs. 120 [20.2%], P < 0.05). In the subgroup analysis, in-hospital complications were present in 3.1%, 6.6%, 11.9%, 20.7%, 40.0%, and 62.5% of patients in the 6 groups who met the 0, 1, 2, 3, 4, and 5 MetS diagnostic criteria, respectively. On multivariable logistic regression, hypertension (odds ratio [OR]: 2.680; 95% confidence interval [CI]: 1.571-4.570), type 2 diabetes (OR: 2.135; 95% CI: 1.192-3.824), quartiles of body mass index (OR: 1.801; 95% CI: 1.415-2.291), high-density lipoprotein cholesterol (OR: 0.763; 95% CI: 0.611-0.953), and systolic blood pressure (OR: 1.894; 95% CI: 1.486-2.413) were independent factors for in-hospital complications after adjustment for other risk factors. After adjusting for potential confounding factors, MetS was an independent risk factor for in-hospital complications. We established a scoring system for each component and the area under the ROC curve was 0.664 (95% CI: 0.618-0.710) in all patients, 0.672 (95% CI: 0.595-0.749) in patients with MetS, and 0.610 (95% CI: 0.552-0.667) in patients without MetS, as determined by ROC analysis. CONCLUSIONS MetS, especially the blood pressure component, confers a greater risk of in-hospital complications in patients with acute type B aortic dissection after TEVAR.
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Affiliation(s)
- Mengye Niu
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Like Zhang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Zhang
- Department of Vascular Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Chengyang Chen
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xian Gao
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bingzhou Zhang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xupeng Niu
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zengren Zhao
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Lei Zhang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xia Jiang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Colorectal Cancer Precision, The First Hospital of Hebei Medical University, Shijiazhuang, China.
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20
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Li B, Wang W, Gao Z, Tang X, Yan L, Wan Q, Luo Z, Qin G, Chen L, Ning G, Mu Y. A novel index, Chinese visceral adiposity index is closely associated with urinary albumin-creatinine ratio in Chinese community adults, especially in hypertensive or hyperglycemic population: Results from the REACTION study. J Diabetes 2022; 14:792-805. [PMID: 36446626 PMCID: PMC9789393 DOI: 10.1111/1753-0407.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The association between the Chinese Visceral Adiposity Index (CVAI) and urinary albumin to creatinine ratio (UACR) has not been illustrated. The current study aimed to investigate the association between CVAI and UACR and to compare the discriminative power of CVAI, triglyceride, body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with UACR in the Chinese community population. METHODS This study included 34 732 participants from the REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals) study. Binary logistic regression analyses were performed to detect the association between CVAI, triglyceride, BMI, WC, WHR and UACR. RESULTS Binary logistic regression analysis showed that, after adjusting for potential confounders, in women, CVAI (odds ratio [OR]:1.16, 95% confidence interval [CI]: 1.01-1.34) and triglyceride (OR: 1.18, 95% CI: 1.04-1.33) were associated with UACR, whereas BMI, WC, and WHR were not associated with UACR; in men, CVAI (OR: 1.24, 95% CI: 1.02-1.50), WC (OR: 1.21, 95% CI 1.00-1.48), and triglycerides (OR: 1.18, 95% CI 0.97-1.44) were associated with UACR, whereas BMI and WHR were not associated with UACR. Stratified analysis showed that the correlation between CVAI and UACR was stronger in the population with 5.6 ≤ fasting blood glucose (FBG) <7.0 or 7.8 ≤ post-load blood glucose (PBG) <11.1 mmol/L, FBG ≥7.0 or PBG ≥11.1, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. CONCLUSIONS In the Chinese general population, CVAI and UACR were significantly associated in both genders. At higher CVAI levels, the population with prediabetes, diabetes, and hypertension has a more significant association between CVAI and UACR.
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Affiliation(s)
- Binqi Li
- School of MedicineNankai UniversityTianjinChina
- Department of EndocrinologyFirst Medical Center of PLA General HospitalBeijingChina
| | - Weiqing Wang
- Shanghai National Research Centre for Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | | | - Xulei Tang
- First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Li Yan
- Zhongshan University Sun Yat‐sen Memorial HospitalGuangzhouGuangdongChina
| | - Qin Wan
- Southwest Medical University Affiliated HospitalLuzhouSichuanChina
| | - Zuojie Luo
- First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxiChina
| | - Guijun Qin
- First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Lulu Chen
- Wuhan Union Hospital, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Guang Ning
- Shanghai National Research Centre for Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yiming Mu
- School of MedicineNankai UniversityTianjinChina
- Department of EndocrinologyFirst Medical Center of PLA General HospitalBeijingChina
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21
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Li HB, Xu ML, Xu XD, Tang YY, Jiang HL, Li L, Xia WJ, Cui N, Bai J, Dai ZM, Han B, Li Y, Peng B, Dong YY, Aryal S, Manandhar I, Eladawi MA, Shukla R, Kang YM, Joe B, Yang T. Faecalibacterium prausnitzii Attenuates CKD via Butyrate-Renal GPR43 Axis. Circ Res 2022; 131:e120-e134. [PMID: 36164984 PMCID: PMC9588706 DOI: 10.1161/circresaha.122.320184] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite available clinical management strategies, chronic kidney disease (CKD) is associated with severe morbidity and mortality worldwide, which beckons new solutions. Host-microbial interactions with a depletion of Faecalibacterium prausnitzii in CKD are reported. However, the mechanisms about if and how F prausnitzii can be used as a probiotic to treat CKD remains unknown. METHODS We evaluated the microbial compositions in 2 independent CKD populations for any potential probiotic. Next, we investigated if supplementation of such probiotic in a mouse CKD model can restore gut-renal homeostasis as monitored by its effects on suppression on renal inflammation, improvement in gut permeability and renal function. Last, we investigated the molecular mechanisms underlying the probiotic-induced beneficial outcomes. RESULTS We observed significant depletion of Faecalibacterium in the patients with CKD in both Western (n=283) and Eastern populations (n=75). Supplementation of F prausnitzii to CKD mice reduced renal dysfunction, renal inflammation, and lowered the serum levels of various uremic toxins. These are coupled with improved gut microbial ecology and intestinal integrity. Moreover, we demonstrated that the beneficial effects in kidney induced by F prausnitzii-derived butyrate were through the GPR (G protein-coupled receptor)-43. CONCLUSIONS Using a mouse CKD model, we uncovered a novel beneficial role of F prausnitzii in the restoration of renal function in CKD, which is, at least in part, attributed to the butyrate-mediated GPR-43 signaling in the kidney. Our study provides the necessary foundation to harness the therapeutic potential of F prausnitzii for ameliorating CKD.
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Affiliation(s)
- Hong-Bao Li
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an 710061, China
| | - Meng-Lu Xu
- Department of Nephrology, the First Affiliated Hospital of Xi’an Medical University, Xi’an 710077, China
| | - Xu-Dong Xu
- Department of Nephrology, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Yu-Yan Tang
- Department of Nephrology, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Hong-Li Jiang
- Department of Renal Dialysis, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, China
| | - Lu Li
- Department of Nephrology, the First Affiliated Hospital of Xi’an Medical University, Xi’an 710077, China
| | - Wen-Jie Xia
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an 710061, China
| | - Nan Cui
- Department of Reproductive Medicine, the First Affiliated Hospital of Xi’an Jiaotong University, 710061 Xi’an, China
| | - Juan Bai
- Department of Anesthesiology, Center for Brain Science, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Zhi-Ming Dai
- Department of Anesthesiology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China
| | - Bei Han
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 710061 Xi’an, China
| | - Ying Li
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an 710061, China
| | - Bo Peng
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an 710061, China
| | - Yuan-Yuan Dong
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an 710061, China
| | - Sachin Aryal
- Department of Physiology and Pharmacology and Center for Hypertension and Precision Medicine, College of Medicine and Life Sciences, University of Toledo, OH 43614, USA
| | - Ishan Manandhar
- Department of Physiology and Pharmacology and Center for Hypertension and Precision Medicine, College of Medicine and Life Sciences, University of Toledo, OH 43614, USA
| | - Mahmoud Ali Eladawi
- Department of Neuroscience, College of Medicine and Life Sciences, University of Toledo, OH 43614, USA
| | - Rammohan Shukla
- Department of Neuroscience, College of Medicine and Life Sciences, University of Toledo, OH 43614, USA
| | - Yu-Ming Kang
- Department of Physiology and Pathophysiology, Xi’an Jiaotong University School of Basic Medical Sciences, Xi’an 710061, China
| | - Bina Joe
- Department of Physiology and Pharmacology and Center for Hypertension and Precision Medicine, College of Medicine and Life Sciences, University of Toledo, OH 43614, USA
| | - Tao Yang
- Department of Physiology and Pharmacology and Center for Hypertension and Precision Medicine, College of Medicine and Life Sciences, University of Toledo, OH 43614, USA
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22
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An J, Kurella Tamura M, Odden MC, Ni L, Thomas IC, Montez-Rath ME, Sim JJ. Prevalence of Apparent Treatment-Resistant Hypertension in Chronic Kidney Disease in Two Large US Health Care Systems. Clin J Am Soc Nephrol 2022; 17:1457-1466. [PMID: 36400564 PMCID: PMC9528269 DOI: 10.2215/cjn.04110422] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES More intensive BP goals have been recommended for patients with CKD. We estimated the prevalence of apparent treatment-resistant hypertension among patients with CKD according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA; BP goal <130/80 mm Hg) and 2021 Kidney Disease Improving Global Outcomes (KDIGO; systolic BP <120 mm Hg) guidelines in two US health care systems. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We included adults with CKD (an eGFR <60 ml/min per 1.73 m2) and treated hypertension from Kaiser Permanente Southern California and the Veterans Health Administration. Using electronic health records, we identified apparent treatment-resistant hypertension on the basis of (1) BP above the goal while prescribed three or more classes of antihypertensive medications or (2) prescribed four or more classes of antihypertensive medications regardless of BP. In a sensitivity analysis, we required diuretic use to be classified as apparent treatment-resistant hypertension. We estimated the prevalence of apparent treatment-resistant hypertension per clinical guideline and by CKD stage. RESULTS Among 44,543 Kaiser Permanente Southern California and 241,465 Veterans Health Administration patients with CKD and treated hypertension, the prevalence rates of apparent treatment-resistant hypertension were 39% (Kaiser Permanente Southern California) and 35% (Veterans Health Administration) per the 2017 ACC/AHA guideline and 48% (Kaiser Permanente Southern California) and 55% (Veterans Health Administration) per the 2021 KDIGO guideline. By requiring a diuretic as a criterion for apparent treatment-resistant hypertension, the prevalence rates of apparent treatment-resistant hypertension were lowered to 31% (Kaiser Permanente Southern California) and 23% (Veterans Health Administration) per the 2017 ACC/AHA guideline. The prevalence rates of apparent treatment-resistant hypertension were progressively higher at more advanced stages of CKD (34%/33%, 42%/36%, 52%/41%, and 60%/37% for Kaiser Permanente Southern California/Veterans Health Administration eGFR 45-59, 30-44, 15-29, and <15 ml/min per 1.73 m2, respectively) per the 2017 ACC/AHA guideline. CONCLUSIONS Depending on the CKD stage, up to a half of patients with CKD met apparent treatment-resistant hypertension criteria.
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Affiliation(s)
- Jaejin An
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Michelle C. Odden
- Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Liang Ni
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - I-Chun Thomas
- Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Maria E. Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - John J. Sim
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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23
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Mullen MT, Anderson CS. Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities. Stroke 2022; 53:2142-2151. [PMID: 35657328 DOI: 10.1161/strokeaha.121.036885] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.
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Affiliation(s)
- Michael T Mullen
- Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (M.T.M.)
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.S.A.).,The George Institute China at Peking University Health Sciences Center, Beijing (C.S.A.)
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24
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Umeukeje EM, Washington JT, Nicholas SB. Etiopathogenesis of kidney disease in minority populations and an updated special focus on treatment in diabetes and hypertension. J Natl Med Assoc 2022; 114:S3-S9. [PMID: 35589418 DOI: 10.1016/j.jnma.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diabetes and hypertension are the most common causes of chronic kidney disease (CKD) in the general population as well as in the Black and African American population, who also suffer from high rates of CKD and CKD progression compared to the White population. Progression of CKD can lead to kidney failure, and patients with progressive kidney disease have a high risk of premature mortality, particularly from cardiovascular disease. Screening for early detection of CKD is important as it facilitates the initiation of medications that have been shown to delay the progression of diabetes-related as well as non-diabetes-related CKD, and reduce rates of death from both kidney and cardiovascular disease. The potential adverse effects from use of some of the newer reno- and cardio-protective glucose-lowering medications, such as the sodium glucose cotransporter-2 inhibitors, may be effectively avoided with detailed patient education and monitoring by the healthcare provider. It is important to note that lifestyle modification including regular exercise, diet, and smoking cessation are first-line in the management of diabetes and hypertension. When CKD occurs, co-management by providers using a comprehensive strategy may avert early complications and facilitate appropriate early referral for nephrology specialty care.
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Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Disease, United States
| | | | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, 7-155 Factor Bldg. 10833 LeConte Blvd, Los Angeles, CA 90095, United States.
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25
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Yu G, Cheng J, Jiang Y, Li H, Li X, Chen J. Intensive Systolic Blood Pressure Lowering and Kidney Disease Progression in IgA Nephropathy: A Cohort Study. Front Med (Lausanne) 2022; 9:813603. [PMID: 35252253 PMCID: PMC8890476 DOI: 10.3389/fmed.2022.813603] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hypertension has been shown to be an important risk factor in IgA nephropathy (IgAN). The 2021 the Kidney Disease Improving Global Outcomes (KDIGO) Guideline proposes a target systolic blood pressure (SBP) of less than 120 mmHg in patients with Chronic Kidney Disease (CKD) not receiving dialysis. However, whether lowering SBP from <140– <120 mm Hg is renoprotective is unknown. This study aims to evaluate the association of SBP and the progression of IgAN, then explore whether lowering SBP from <140– <120 mm Hg is renoprotective. Methods Overall, 2,240 patients with IgAN were enrolled in this study. Cox proportional hazards models and restricted cubic splines were used to estimate the associations between SBP and kidney failure events which are defined as 50% estimated glomerular filtration rate (eGFR) decline or kidney failure. Results After a median follow-up of 30.05 months, 217 (9.69%) patients reached composite kidney failure events. The association of SBP and kidney failure events showed a linear relationship. The risk of kidney failure events was greater with higher SBP. Compared with SBP <120 mm Hg, the hazard ratio was 1.85 (1.16–2.97, p = 0.010) for SBP <140 mm Hg after adjustment for traditional risk factors. The renoprotective benefits of therapy targeting SBP <120 mm Hg from SBP <140 mm Hg was detectable within the subgroup with proteinuria >1.0 g/d, CKD 1-3a stage, but not those with proteinuria ≤ 1.0 g/d and CKD 3b-4 stage. Conclusions In patients with IgAN, SBP was independently associated with composite kidney failure events. Lowering SBP from <140– <120 mm Hg was renoprotective.
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Affiliation(s)
- Guizhen Yu
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Preventsion and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jun Cheng
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Preventsion and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Yan Jiang
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Preventsion and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Heng Li
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Preventsion and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Xiayu Li
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Preventsion and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Preventsion and Control Technology, Hangzhou, China.,National Key Clinical Department of Kidney Diseases, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China
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26
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Hypertension and Chronic Kidney Disease – An Unhappy Marriage. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Wei Y, Han S, Zhou R, Xu P, Zhou L, Zhu Z, Kan Y, Yang X, Xiang Y, Cao Y, Jin Y, Yan J, Yu X, Wang X, Shang W. Increased Serum VEGF-B Level Is Associated With Renal Function Impairment in Patients With Type 2 Diabetes. Front Endocrinol (Lausanne) 2022; 13:862545. [PMID: 35399943 PMCID: PMC8988280 DOI: 10.3389/fendo.2022.862545] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
AIMS/INTRODUCTION Renal function impairment related to type 2 diabetes (T2DM) presents serious threat to public health. Previous studies suggest that vascular endothelial growth factor-B (VEGF-B) might contribute to renal injury. Therefore, this study investigated the association of serum VEGF-B level with the risk of renal function impairment in T2DM patients. MATERIALS AND METHODS Serum VEGF-B levels were measured in 213 patients with type 2 diabetes and 31 healthy participants. Participants with type 2 diabetes were further divided into a group of 112 participants with eGFR<90 mL/min/1.73m2 and 101 participants with eGFR≥ 90 mL/min/1.73m2. Clinical data were collected, and a binary logistic regression model was employed to test the association between potential predictors and eGFR. RESULTS Serum VEGF-B levels evaluated in type 2 diabetes patients compared with healthy controls. In patients with type 2 diabetes, serum VEGF-B level was positively correlated with triglyceride, serum creatinine and cystatin C while negatively correlated with HDL-C and eGFR. Binary logistic regression showed that serum VEGF-B level was an independent risk factor of eGFR<90 mL/min/1.73m2. CONCLUSIONS Serum VEGF-B level is associated with renal function impairment in patients with type 2 diabetes and may be a potential drug target for diabetic kidney disease.
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Affiliation(s)
- Yaping Wei
- Department of Endocrinology, Changzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shiyu Han
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruonan Zhou
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Pingyuan Xu
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingyan Zhou
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ziwei Zhu
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Kan
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaoying Yang
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yingying Xiang
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Cao
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Jin
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Yan
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xizhong Yu
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin Wang
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenbin Shang
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Wenbin Shang,
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Hyperuricemia and Associated Factors in Children with Chronic Kidney Disease: A Cross-Sectional Study. CHILDREN 2021; 9:children9010006. [PMID: 35053631 PMCID: PMC8774483 DOI: 10.3390/children9010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
Background: Hyperuricemia is increasingly recognized as a risk factor for chronic kidney disease (CKD) just in adults. The purpose of this study was to investigate the clinical characteristics of hyperuricemia and its associated factors in Chinese children with CKD at a single center. Methods: A cross-sectional study of 170 CKD children collected from the Department of Nephrology, The Zhejiang University Children’s Hospital was conducted. The clinical data, including anthropometric data, blood pressure measurements, and biochemical parameters, were recorded and analyzed retrospectively. The factors associated with hyperuricemia in CKD children were evaluated by Pearson and Spearman correlation analysis and multiple logistic regression analysis. Results: The mean age was 9.79 ± 4.10 years, and 72 (42.35%) were girls. Higher blood urea nitrogen (BUN), serum creatinine, cystatin C, D-dimer, lower hemoglobin, albumin, and estimated glomerular filtration rate (eGFR) were significantly associated with higher serum uric acid (SUA). In multiple logistic regression analysis, anemia and higher BUN were both positively associated factors, whereas eGFR ≥ 90 mL/min/1.73 m2 was a negatively associated factor for subjects with SUA ≥ 390 µmol/L (6.5 mg/dL). Conclusions: SUA was significantly associated with kidney risk factors in CKD children. Monitoring and controlling SUA, Hb, BUN, and Scr levels in CKD children may help to prevent the progression of CKD.
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Schena FP, Tripepi G, Rossini M, Abbrescia DI, Manno C. Randomized clinical study to evaluate the effect of personalized therapy on patients with immunoglobulin a nephropathy. Clin Kidney J 2021; 15:895-902. [PMID: 35498888 PMCID: PMC9050523 DOI: 10.1093/ckj/sfab263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Randomized controlled trials (RCTs) have been conducted, stratifying idiopathic
immunoglobulin A nephropathy (IgAN) patients based on the laboratory findings [serum
creatinine, estimated glomerular filtration rate (eGFR) and daily proteinuria]. In
contrast, data from kidney biopsy have been used only for clinical diagnosis. Therefore,
IgAN patients with active or chronic renal lesions have been receiving the same therapy
in experimental and control arms of randomized clinical trials (RCTs). Methods Our clinical study of IgAN (CLIgAN) is a multicentre, prospective, controlled and
open-label RCT based on patients’ stratification at the time of their kidney biopsy. We
will consider, first, the type of renal lesions, followed by serum creatinine values,
eGFR and proteinuria. Primary and secondary endpoints will be monitored. Then, we will
determine whether personalized therapy can slow the decline of renal function and delay
end-stage kidney disease. Results We will enrol 132 IgAN patients with active renal lesions (66 patients per arm) in the
first RCT (ACIgAN). They will receive corticosteroids combined with renin–angiotensin
system blockers (RASBs) or only RASBs. A total of 294 IgAN patients with chronic or
moderate renal lesions at high or very high risk of chronic kidney disease (147 patients
per arm) will be enrolled in the second RCT (CHRONIgAN), in which they will receive
dapagliflozin, a sodium–glucose cotransporter 2 inhibitor, combined with RASBs, or RASBs
alone. Conclusion Using this approach, we hypothesize that patients could receive personalized therapy
based on renal lesions to ensure that the right drug gets to the right patient at the
right time.
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Affiliation(s)
- Francesco P Schena
- Dept Emergency and Organ Transplant, University of Bari, Bari, Italy
- Fondazione Schena, Policlinic, Bari, Italy
| | - Giovanni Tripepi
- CNR-IFC, Institute of Clinical Physiology, Reggio Calabria, Italy
| | | | | | - Carlo Manno
- Dept Emergency and Organ Transplant, University of Bari, Bari, Italy
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Kaya AH, Tekgunduz E. Management of thrombotic microangiopathy after hematopoietic cell transplantation: A position statement of ThREG (Turkish Hematology Research and Education Group). Transfus Apher Sci 2021; 60:103313. [PMID: 34785151 DOI: 10.1016/j.transci.2021.103313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hematopoietic stem cell transplantation associated-thrombotic microangiopathy (TA-HCT) is one of the early complications of endothelial origin in the course of HCT. Endothelial damage to the microvascular structure and the platelet-rich microthrombi, which are formed as a result of accompanying complement activation, constitute the main pathological conditions resulting TA-TMA. Early diagnosis and management are of utmost importance to prevent multi-organ failure and death. This review summarizes the current understanding of TA-TMA regarding pathogenesis, definition, differential diagnosis, risk factors, surveillance for early diagnosis and management.
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Affiliation(s)
- Ali Hakan Kaya
- Maltepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey.
| | - Emre Tekgunduz
- Maltepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey; Memorial Bahcelievler Hospital, Adult Hematology and BMT Clinic, Istanbul, Turkey
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31
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Weber MA, Lackland DT. Measurement of Blood Pressure in Clinical Practice. Am J Med Sci 2021; 362:533-534. [PMID: 34626571 DOI: 10.1016/j.amjms.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical College, Brooklyn, NY, USA.
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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Chen YC, Lu BZ, Shu YC, Sun YT. Spatiotemporal Dynamics of Cerebral Vascular Permeability in Type 2 Diabetes-Related Cerebral Microangiopathy. Front Endocrinol (Lausanne) 2021; 12:805637. [PMID: 35087478 PMCID: PMC8786705 DOI: 10.3389/fendo.2021.805637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS Diabetes-related cerebral microangiopathy can manifest as cerebral small vessel disease (CSVD) and exhibit cognitive decline. To find the early change of function in advance, this study examined the spatiotemporal dynamics of cerebral vascular permeability (Ktrans) in the progression of type 2 diabetes mellitus (T2DM). METHODS Ktrans was cross-sectionally measured in T2DM and non-diabetes groups with or without CSVD using dynamic contrast-enhanced MRI (DCE-MRI). RESULTS In all patients with T2DM, the Ktrans of white matter (WM) was increased, whereas the Ktrans of gray matter (GM) was increased only in T2DM with CSVD. The involvement of WM was earlier than GM and was before the CSVD features could be visualized on MRI. Among the commonly available four CSVD items of MRI, microbleeds were the most sensitive, indicating the increased permeability in all patients. Increased Ktrans in T2DM was more associated with moderate WM hyperintensity but less with the presence of lacunae or multiple perivascular spaces, in contrast to patients without diabetes. The differential correlation suggested distinct mechanisms underlying diabetes-related CSVD and other CSVDs. CONCLUSIONS This study highlights the early development of cerebral microangiopathy with increased BBB leakage in T2DM, before the CSVD features can be visualized on MRI. The results may increase the proactivity of clinicians in recognizing the subsequent neurological comorbidities.
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Affiliation(s)
- Ying-Chen Chen
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Radiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Bing-Ze Lu
- Department of Mathematics, College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Shu
- Department of Mathematics, College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medical Genomics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Yuan-Ting Sun,
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