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Aiyegbusi OL, Fenton A. The impact of rare kidney diseases on kidney failure. Lancet 2024; 403:1211-1213. [PMID: 38492577 DOI: 10.1016/s0140-6736(24)00198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration West Midlands, Birmingham, UK.
| | - Anthony Fenton
- Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Phillips K, Hazlehurst JM, Sheppard C, Bellary S, Hanif W, Karamat MA, Crowe FL, Stone A, Thomas GN, Peracha J, Fenton A, Sainsbury C, Nirantharakumar K, Dasgupta I. Inequalities in the management of diabetic kidney disease in UK primary care: A cross-sectional analysis of a large primary care database. Diabet Med 2024; 41:e15153. [PMID: 37223892 DOI: 10.1111/dme.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/25/2023]
Abstract
AIMS To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. METHODS A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. RESULTS Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), ACR: aRR 0.94 (0.92-0.96), BP: aRR 0.98 (0.97-0.99), HbA1c : aRR 0.99 (0.98-0.99) and serum cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP: aRR 0.95 (0.94-0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP: aRR 0.91 (0.8-0.95) or HbA1c : aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97). CONCLUSIONS There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan M Hazlehurst
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Srikanth Bellary
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Health and Life Sciences, Aston University, Birmingham, UK
| | - Wasim Hanif
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammad Ali Karamat
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Stone
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - G Neil Thomas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Javeria Peracha
- Renal Unit, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anthony Fenton
- Department of Renal Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Christopher Sainsbury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes, Gartnavel General Hospital, Glasgow, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Canney M, Induruwage D, Tang M, Alencar de Pinho N, Er L, Zhao Y, Djurdjev O, Ahn YH, Behnisch R, Calice-Silva V, Chesnaye NC, de Borst MH, Dember LM, Dionne J, Ebert N, Eder S, Fenton A, Fukagawa M, Furth SL, Hoy WE, Imaizumi T, Jager KJ, Jha V, Kang HG, Kitiyakara C, Mayer G, Oh KH, Onu U, Pecoits-Filho R, Reichel H, Richards A, Schaefer F, Schaeffner E, Scheppach JB, Sola L, Ulasi I, Wang J, Yadav AK, Zhang J, Feldman HI, Taal MW, Stengel B, Levin A. Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts. Kidney Int Rep 2023; 8:2056-2067. [PMID: 37850014 PMCID: PMC10577366 DOI: 10.1016/j.ekir.2023.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. Methods In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. Results A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17-49 ml/min) and 3 pediatric cohorts (median eGFR range of 26-45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7-6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%-44% across cohorts). Conclusion There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.
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Affiliation(s)
- Mark Canney
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Mila Tang
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Canada
| | | | - Lee Er
- Methodology and Analytics, BC Renal, Vancouver, British Columbia, Canada
| | - Yinshan Zhao
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ognjenka Djurdjev
- Methodology and Analytics, BC Renal, Vancouver, British Columbia, Canada
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Rouven Behnisch
- Institute of Medical Biometry, University Hospital Heidelberg, Germany
| | - Viviane Calice-Silva
- Research Department, Pro-rim Foundation, Joinville-SC, Brazil
- School of Medicine, UNIVILLE, Joinville-SC, Brazil
| | - Nicholas C. Chesnaye
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- ERA Registry, Amsterdam UMC Location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura M. Dember
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Canada
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Germany
| | - Susanne Eder
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
| | - Anthony Fenton
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Susan L. Furth
- Division of Nephrology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy E. Hoy
- University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Anatomy and Cell Biology, Monash University, Clayton, Victoria, Australia
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kitty J. Jager
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- ERA Registry, Amsterdam UMC Location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Chagriya Kitiyakara
- Departments of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Ugochi Onu
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- School of Medicine, Pontifica Universidade Catolica do Parana, Curitiba, Brazil
| | | | - Anna Richards
- Value Evidence and Outcomes, GSK, Brentford, Middlesex, UK
| | - Franz Schaefer
- Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Germany
| | | | - Laura Sola
- Hemodialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Ifeoma Ulasi
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Peking University Institute of Nephrology, Peking University Health Science Center, Beijing, China
| | - Ashok K. Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jianzhen Zhang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Harold I. Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Maarten W. Taal
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, University of Nottingham School of Medicine, Nottingham, UK
| | - Bénédicte Stengel
- CESP, University Paris-Saclay, UVSQ, Inserm, Clinical Epidemiology Team, Villejuif, France
| | - Adeera Levin
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Canada
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Fenton A, Smart C, Goldschmidt L, Price V, Scott J. Fat mass, weight and body shape changes at menopause - causes and consequences: a narrative review. Climacteric 2023; 26:381-387. [PMID: 36891919 DOI: 10.1080/13697137.2023.2178892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 03/10/2023]
Abstract
In addition to age-related weight gain, menopause adds additional challenges for women with the occurrence of significant metabolic alterations and central and visceral fat redistribution. The changes in body composition then influence risks of cardiovascular disease, metabolic disruption, cancer, fracture, lung disease, sexual dysfunction, mental health disorders and dementia. They may also heighten the severity of vasomotor symptoms. Treatment of these changes requires a flexible long-term strategy. This narrative review explores the pathogenesis of the metabolic changes at menopause and effective management options.
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Affiliation(s)
- A Fenton
- Oxford Women's Health, Christchurch, New Zealand
| | - C Smart
- Oxford Women's Health, Christchurch, New Zealand
| | | | - V Price
- Oxford Women's Health, Christchurch, New Zealand
| | - J Scott
- Oxford Women's Health, Christchurch, New Zealand
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Lee SI, Cooper J, Fenton A, Subramanian A, Taverner T, Gokhale KM, Phillips K, Patel M, Harper L, Thomas GN, Nirantharakumar K. Decreased renal function is associated with incident dementia: An IMRD-THIN retrospective cohort study in the UK. Alzheimers Dement 2022; 18:1943-1956. [PMID: 34978143 DOI: 10.1002/alz.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Decreased renal function is a potential risk factor for dementia. METHODS This retrospective cohort study of 2.8 million adults aged ≥50 years used the IMRD-THIN database, representative of UK primary care, from January 1, 1995 to February 24, 2020. The associations between estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) with incident all-cause dementia were analyzed using Cox regression. RESULTS In the eGFR cohort (n = 2,797,384), worsening renal dysfunction was associated with increased hazard of all-cause dementia, with greatest hazard at eGFR 15-30 ml/min/1.73min2 (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19-1.33). In the ACR cohort (n = 641,912), the hazard of dementia increased from ACR 3-30 mg/mmol (HR 1.13, 95% CI 1.10-1.15) to ACR > 30 mg/mmol (HR 1.25, 95% CI 1.18-1.33). DISCUSSION Worsening eGFR and albuminuria have graded associations with the risk of dementia, which may have significant implications for the care of patients with kidney disease.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Cooper
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Fenton
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | | | - Tom Taverner
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Mitesh Patel
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Lorraine Harper
- Institute of Clinical Sciences, Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
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6
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Bhachu HK, Fenton A, Cockwell P, Aiyegbusi O, Kyte D, Calvert M. Use of the kidney failure risk equation to inform clinical care of patients with chronic kidney disease: a mixed-methods systematic review. BMJ Open 2022; 12:e055572. [PMID: 35042708 PMCID: PMC8768913 DOI: 10.1136/bmjopen-2021-055572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
RATIONALE AND OBJECTIVE The Kidney Failure Risk Equation (KFRE) predicts the risk of end-stage kidney disease in patients with chronic kidney disease (CKD). This study aimed to evaluate the impact of the utility of KFRE in clinical practice. STUDY DESIGN Systematic review. SETTING AND STUDY POPULATIONS Adult patients with CKD but not receiving renal replacement therapy enrolled in studies where KFRE was used in clinical care pathways. SELECTION CRITERIA FOR STUDIES All studies published from April 2011 to October 2021 identified from Medline, Cumulative Index to Nursing and Allied Health Literature, Embase and reference and citation searches of included studies. DATA EXTRACTION Relevant data were extracted, and two reviewers independently assessed study quality using appropriate appraisal tools. ANALYTICAL APPROACH Findings reported as a narrative synthesis due to heterogeneity of the included studies. RESULTS Of 1635 studies identified, 440 duplicates were removed. The remaining 1195 titles and abstracts were screened. All five studies for full-text review were included in the analysis. Three uses of KFRE were assessed: (1) primary to specialty care interface; (2) general nephrology to multidisciplinary care transition; and (3) treatment planning. Evidence of impact on number of patient referrals into nephrology care was conflicting. However, wait times improved in one study. Although KFRE identified high-risk patients for increased multidisciplinary support, there was concern patients stepped down, no longer meeting eligibility criteria, may lack access to services. CONCLUSIONS This is the first systematic review of studies that have assessed the actual impact of KFRE in clinical practice with five studies of varying quality reported to date. Trials are in progress assessing the impact on clinical outcomes of using KFRE in clinical practice, and KFRE is being incorporated into guidelines for CKD management. Further studies are needed to assess the impact of KFRE on clinical care. TRIAL REGISTRATION NUMBER Protocol registered on PROSPERO before initiation of the study (Ref: CRD42020219926).
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Affiliation(s)
- Harjeet Kaur Bhachu
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Olalekan Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR ARC, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- School of Allied Health and Community, University of Worcester, Worcester, Worcestershire, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR ARC, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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McLeod GFH, Cleland L, Welch J, Spittlehouse JK, Fenton A, Boden JM, Horwood LJ. Menopause status and climacteric symptoms in a birth cohort of mid-life New Zealand women. Climacteric 2021; 25:271-277. [PMID: 34269148 DOI: 10.1080/13697137.2021.1948005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is little current research on the transition to natural menopause among contemporary groups of mid-life women at age 40 years. OBJECTIVE This study reports on female members of the Christchurch Health and Development Study cohort. This research aimed to: document the menopause status, reproductive outcomes and climacteric symptoms of the women at age 40 years; examine the associations between menopause status and concurrent measures of psychosocial and economic well-being; and document the associations between menopause status and potential predictors of menopause reflecting childhood, family and individual factors prior to age 40 years. METHODS The Christchurch Health and Development Study is a longitudinal, representative, prospective cohort of 1265 babies (630 females) born in New Zealand in 1977. At age 40 years, 470 women (who had not experienced surgical menopause) were interviewed on their menopause status, climacteric symptoms and associated factors. RESULTS The majority of women were premenopausal, around 20% were perimenopausal and 2% were postmenopausal. Statistically significant associations were found reflecting higher rates of diagnosed reproductive disorder, climacteric symptoms, low occupational status, non-heterosexual sexuality and exposure to childhood sexual abuse amongst both perimenopausal and postmenopausal women at age 40 years. CONCLUSION These data will inform directions for future data collection and analyses.
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Affiliation(s)
- G F H McLeod
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - L Cleland
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - J Welch
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - J K Spittlehouse
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - A Fenton
- Oxford Women's Health, Christchurch, New Zealand
| | - J M Boden
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - L J Horwood
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Daversa DR, Hechinger RF, Madin E, Fenton A, Dell AI, Ritchie EG, Rohr J, Rudolf VHW, Lafferty KD. Broadening the ecology of fear: non-lethal effects arise from diverse responses to predation and parasitism. Proc Biol Sci 2021; 288:20202966. [PMID: 33622122 DOI: 10.1098/rspb.2020.2966] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Research on the 'ecology of fear' posits that defensive prey responses to avoid predation can cause non-lethal effects across ecological scales. Parasites also elicit defensive responses in hosts with associated non-lethal effects, which raises the longstanding, yet unresolved question of how non-lethal effects of parasites compare with those of predators. We developed a framework for systematically answering this question for all types of predator-prey and host-parasite systems. Our framework reveals likely differences in non-lethal effects not only between predators and parasites, but also between different types of predators and parasites. Trait responses should be strongest towards predators, parasitoids and parasitic castrators, but more numerous and perhaps more frequent for parasites than for predators. In a case study of larval amphibians, whose trait responses to both predators and parasites have been relatively well studied, existing data indicate that individuals generally respond more strongly and proactively to short-term predation risks than to parasitism. Apart from studies using amphibians, there have been few direct comparisons of responses to predation and parasitism, and none have incorporated responses to micropredators, parasitoids or parasitic castrators, or examined their long-term consequences. Addressing these and other data gaps highlighted by our framework can advance the field towards understanding how non-lethal effects impact prey/host population dynamics and shape food webs that contain multiple predator and parasite species.
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Affiliation(s)
- D R Daversa
- La Kretz Center for California Conservation Science, Institute for the Environment and Sustainability, University of California, Los Angeles, CA, USA.,Institute of Integrative Biology, University of Liverpool, Liverpool, UK.,National Great Rivers Research and Education Centre (NGRREC), East Alton, IL 62024, USA
| | - R F Hechinger
- Scripps Institution of Oceanography, University of California, San Diego, San Diego, CA, USA
| | - E Madin
- Hawai'i Institute of Marine Biology, University of Hawai'i, Kane'ohe, HI 96744, USA
| | - A Fenton
- Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - A I Dell
- National Great Rivers Research and Education Centre (NGRREC), East Alton, IL 62024, USA.,Department of Biology, Washington University of St Louis, St Louis, MO 63130, USA.,Department of Biology, Saint Louis University, Saint Louis, MO 63130, USA
| | - E G Ritchie
- School of Life and Environmental Sciences, Centre for Integrative Ecology (Burwood Campus), Deakin University, Geelong, Victoria 3220, Australia
| | - J Rohr
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
| | | | - K D Lafferty
- Western Ecological Research Center, US Geological Survey, at UC Santa Barbara, Santa Barbara, CA, USA
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Sharma P, Fenton A, Dias IHK, Heaton B, Brown CLR, Sidhu A, Rahman M, Griffiths HR, Cockwell P, Ferro CJ, Chapple IL, Dietrich T. Oxidative stress links periodontal inflammation and renal function. J Clin Periodontol 2021; 48:357-367. [PMID: 33368493 PMCID: PMC7986430 DOI: 10.1111/jcpe.13414] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/06/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022]
Abstract
Aims Patients with chronic kidney disease (CKD) are also susceptible to periodontitis. The causal link between periodontitis and CKD may be mediated via systemic inflammation/oxidative stress. Using structural equation modelling (SEM), this cross‐sectional study aimed to explore the causal relationship between periodontal inflammation (PI) and renal function. Materials and methods Baseline data on 770 patients with stage 3–5 (pre‐dialysis) CKD from an ongoing cohort study were used. Detailed, bioclinical data on PI and renal function, as well as potential confounders and mediators of the relationship between the two, were collected. SEMs of increasing complexity were created to test the causal assumption that PI affects renal function and vice versa. Results Structural equation modelling confirmed the assumption that PI and renal function are causally linked, mediated by systemic oxidative stress. The magnitude of this effect was such that a 10% increase in PI resulted in a 3.0% decrease in renal function and a 10% decrease in renal function resulted in a 25% increase in PI. Conclusions Periodontal inflammation represents an occult source of oxidative stress in patients with CKD. Further clinical studies are needed to confirm whether periodontal therapy, as a non‐pharmacological approach to reducing systemic inflammatory/oxidative stress burden, can improve outcomes in CKD.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research Group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare Trust, Birmingham, UK
| | - Anthony Fenton
- Department of Nephrology, University Hospital Birmingham, Birmingham, UK
| | | | - Brenda Heaton
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | | | - Amneet Sidhu
- Periodontal Research Group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare Trust, Birmingham, UK
| | - Mutahir Rahman
- Periodontal Research Group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare Trust, Birmingham, UK
| | | | - Paul Cockwell
- Department of Nephrology, University Hospital Birmingham, Birmingham, UK
| | - Charles J Ferro
- Department of Nephrology, University Hospital Birmingham, Birmingham, UK
| | - Iain L Chapple
- Periodontal Research Group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare Trust, Birmingham, UK
| | - Thomas Dietrich
- Periodontal Research Group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare Trust, Birmingham, UK
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Karangizi AHK, Chanouzas D, Fenton A, Moss P, Cockwell P, Ferro CJ, Harper L. Response to: Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis-dependent chronic kidney disease. QJM 2020; 113:702-703. [PMID: 32531065 DOI: 10.1093/qjmed/hcaa195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A H K Karangizi
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - D Chanouzas
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - A Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - P Moss
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - P Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - C J Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - L Harper
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Karangizi AHK, Chanouzas D, Fenton A, Moss P, Cockwell P, Ferro CJ, Harper L. Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease. QJM 2020; 113:253-257. [PMID: 31613364 DOI: 10.1093/qjmed/hcz258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between Cytomegalovirus (CMV) seropositivity and CVD amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with CVD in non-dialysis dependent CKD has not been established. AIM Investigate whether past CMV infection is associated with prevalent CVD in patients with non-dialysis dependent CKD. DESIGN A retrospective observational study using the Renal Impairment in Secondary Care cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD. METHODS We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent CVD. RESULTS Median estimated glomerular filtration was 24 ml/min/1.73 m2 (IQR 19-32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (P = 0.044), prevalent CVD (P < 0.001), ischaemic heart disease (P < 0.001) and cerebrovascular disease (P = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have CVD compared to seronegative patients [Odds Ratio (OR) = 1.998, CI 1.231-3.242, P = 0.005]. CONCLUSIONS In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of CVD.
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Affiliation(s)
- A H K Karangizi
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - D Chanouzas
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A Fenton
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - P Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - P Cockwell
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - C J Ferro
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - L Harper
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Renal Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
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Fenton A, Chinnadurai R, Gullapudi L, Kampanis P, Dasgupta I, Ritchie J, Harding S, Ferro CJ, Kalra PA, Taal MW, Cockwell P. Association between non-malignant monoclonal gammopathy and adverse outcomes in chronic kidney disease: A cohort study. PLoS Med 2020; 17:e1003050. [PMID: 32109242 PMCID: PMC7048272 DOI: 10.1371/journal.pmed.1003050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In studies including the general population, the presence of non-malignant monoclonal gammopathy (MG) can be causally associated with kidney damage and shorter survival. We assessed whether the presence of an MG is associated with a higher risk of kidney failure or death in individuals with chronic kidney disease (CKD). METHODS AND FINDINGS Data were used from 3 prospective cohorts of individuals with CKD (not on dialysis or with a kidney transplant): (1) Renal Impairment in Secondary Care (RIISC, Queen Elizabeth Hospital and Heartlands Hospital, Birmingham, UK, N = 878), (2) Salford Kidney Study (SKS, Salford Royal Hospital, Salford, UK, N = 861), and (3) Renal Risk in Derby (RRID, Derby, UK, N = 1,739). Participants were excluded if they had multiple myeloma or any other B cell lymphoproliferative disorder with end-organ damage. Median age was 71.0 years, 50.6% were male, median estimated glomerular filtration rate was 42.3 ml/min/1.73 m2, and median urine albumin-to-creatinine ratio was 3.4 mg/mmol. All non-malignant MG was identified in the baseline serum of participants of RIISC. Further, light chain MG (LC-MG) was identified and studied in participants of RIISC, SKS, and RRID. Participants were followed up for kidney failure (defined as the initiation of dialysis or kidney transplantation) and death. Associations with the risk of kidney failure were estimated by competing-risks regression (handling death as a competing risk), and associations with death were estimated by Cox proportional hazards regression. In total, 102 (11.6%) of the 878 RIISC participants had an MG. During a median follow-up time of 74.0 months, there were 327 kidney failure events and 202 deaths. The presence of MG was not associated with risk of kidney failure (univariable subhazard ratio [SHR] 0.97 [95% CI 0.68 to 1.38], P = 0.85; multivariable SHR 1.16 [95% CI 0.80 to 1.69], P = 0.43), and although there was a higher risk of death in univariable analysis (hazard ratio [HR] 2.13 [95% CI 1.49 to 3.02], P < 0.001), this was not significant in multivariable analysis (HR 1.37 [95% CI 0.93 to 2.00], P = 0.11). Fifty-five (1.6%) of the 3,478 participants from all 3 studies had LC-MG. During a median follow-up time of 62.5 months, 564 of the 3,478 participants progressed to kidney failure, and 803 died. LC-MG was not associated with risk of kidney failure (univariable SHR 1.07 [95% CI 0.58 to 1.96], P = 0.82; multivariable SHR 1.42 [95% CI 0.78 to 2.57], P = 0.26). There was a higher risk of death in those with LC-MG in the univariable model (HR 2.51 [95% CI 1.59 to 3.96], P < 0.001), but not in the multivariable model (HR 1.49 [95% CI 0.93 to 2.39], P = 0.10). An important limitation of this work was that only LC-MG, rather than any MG, could be identified in participants from SKS and RRID. CONCLUSIONS The prevalence of MG was higher in this CKD cohort than that reported in the general population. However, the presence of an MG was not independently associated with a significantly higher risk of kidney failure or, unlike in the general population, risk of death.
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Affiliation(s)
- Anthony Fenton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | | | - Latha Gullapudi
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Indranil Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - James Ritchie
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | | | - Charles J. Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Maarten W. Taal
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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Genovese F, Rasmussen DGK, Karsdal MA, Jesky M, Ferro C, Fenton A, Cockwell P. Imbalanced turnover of collagen type III is associated with disease progression and mortality in high-risk chronic kidney disease patients. Clin Kidney J 2020; 14:593-601. [PMID: 33623684 PMCID: PMC7886548 DOI: 10.1093/ckj/sfz174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022] Open
Abstract
Background Tubulointerstitial fibrosis is a major pathological feature in chronic kidney disease (CKD) and collagen type III (COL3) is a major component of the renal fibrotic scar. We hypothesized that a dysregulated turnover of COL3 is an important determinant of CKD progression. We assessed the relationship between fragments reflecting active formation (PRO-C3) and degradation (C3M) of COL3 and CKD disease progression and mortality in a prospective cohort of CKD patients. Methods We measured PRO-C3 and C3M in urine (uPRO-C3 and uC3M) and serum (sPRO-C3 and sC3M) of 500 patients from the Renal Impairment in Secondary Care study. Disease progression was defined as a decline in estimated glomerular filtration rate >30% or the start of renal replacement therapy within 12 and 30 months. Results Levels of uC3M/creatinine decreased, whereas levels of uPRO-C3/creatinine and sPRO-C3 increased with increasing CKD stage. uC3M/creatinine was inversely and independently associated with disease progression by 12 months {odds ratio [OR] 0.39 [95% confidence interval (CI) 0.18-0.83]; P = 0.01 per doubling of uC3M/creatinine} with development of end-stage renal disease [hazard ratio (HR) 0.70 (95% CI 0.50-0.97); P = 0.03 per doubling of uC3M/creatinine]. sPRO-C3 at baseline was independently associated with increased mortality [HR 1.93 (95% CI 1.21-3.1); P = 0.006 per doubling of sPRO-C3] and disease progression by 30 months [OR 2.16 (95% CI 1.21-3.84); P = 0.009 per doubling of sPRO-C3]. Conclusions Dynamic products of COL3 formation and degradation were independently associated with CKD progression and mortality and may represent an opportunity to link pathological processes with targeted treatments against fibrosis.
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Affiliation(s)
| | | | | | - Mark Jesky
- Department of Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Charles Ferro
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Anthony Fenton
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Cockwell
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
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Rasmussen D, Fenton A, Genovese F, Karsdal MA, Jesky M, Ferro CJ, Cockwell P. FP352IDENTIFICATION OF HIGH-RISK PATIENT CLUSTERS BASED ON EXTRACELLULAR MATRIX TURNOVER. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Anthony Fenton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Mark Jesky
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Charles J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Abstract PD8-07: Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Routine resection of cavity shave margins has been shown in single center studies to result in a significant reduction in positive margin and re-excision rates. In this prospective multicenter randomized controlled trial, we sought to validate these findings across practice settings.
METHODS: Nine centers across the United States, varying in practice setting and patient population, participated in this clinical trial of 398 stage 0-III breast cancer patients undergoing partial mastectomy (with or without resection of selective cavity margins). Participants were stratified by clinical stage and randomized 1:1 to either have routine cavity shave margins resected (“shave”) or not (“no shave”). Randomization group was revealed to the surgeon intraoperatively, after they had completed their standard partial mastectomy and were ready to close. Positive margins were defined as “tumor at ink” for invasive cancer or within 2 mm for ductal carcinoma in situ (DCIS). Adverse events were defined as seromas requiring percutaneous drainage, and/or hematomas or abscesses requiring operative intervention.
RESULTS: Median patient age was 65 (range; 29-94). 116 patients had invasive disease, 74 had DCIS, 179 had both, and 29 had no residual cancer at the time of partial mastectomy. The median invasive cancer size was 1.2 cm (range; 0.05-8.00 cm); the median extent of DCIS was 0.9 cm (range; 0.05-6.40 cm). The “shave” and “no shave” groups were well matched at baseline for clinicopathologic and demographic factors.
FactorShave (n=197)No Shave (n=201)p-valueAge (years); median (range)67 (36-94)64 (29-89)0.585Race 0.062-- White173 (87.8%)164 (81.6%) -- Black20 (10.2%)33 (16.4%) -- Asian2 (1.0%)2 (1.0%) -- Native American0 (0%)2 (1.0%) -- Unknown/Declined2 (1.0%)0 (0%) Hispanic ethnicity28 (14.2%)32 (15.9%)0.806Invasive tumor size (cm); median (range)1.30 (0.09-8.00)1.20 (0.05-7.50)0.282DCIS extent (cm); median (range)0.80 (0.10-6.40)1.00 (0.05-5.50)0.906Invasive histology 0.556-- Ductal177 (89.8%)186 (92.5%) -- Lobular16 (8.1%)13 (6.5%) -- Mucinous3 (1.5%)2 (1.0%) -- Other1 (0.5%)0 (0%) Neoadjuvant therapy15 (7.6%)19 (9.5%)0.592Palpable tumor57 (28.9%)56 (27.9%)0.825Node positive*24 (16.3%)16 (10.6%)0.175*Of the 298 patients who had lymph nodes evaluated
Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (38.1% vs. 37.3%, respectively, p=0.918). After randomization, however, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (8.6% vs. 37.3%, respectively, p<0.001). They were also less likely to require re-excision or mastectomy for margin clearance (8.6% vs. 23.9%, p<0.001). There were no significant differences between the two groups in terms of adverse events (p=0.280). Rates of seroma (1.5% vs. 0.5%, p=0.368), hematoma (0.5% vs. 0.5%, p=1.000) and abscess (0.3% vs. 0%, p=0.495) were similar between the “shave” and “no shave” groups, respectively.
CONCLUSION: Resection of cavity shave margins significantly reduces positive margin and re-excision rates in patients with stage 0-III breast cancer undergoing partial mastectomy.
Citation Format: Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-07.
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Affiliation(s)
- AB Chagpar
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - T Tsangaris
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - C Garcia-Cantu
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Howard-McNatt
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Chiba
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - AC Berger
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - E Levine
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - JS Gass
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - K Gallagher
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SS Lum
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - RD Martinez
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - AI Willis
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SV Pandya
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - EA Brown
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Fenton
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Mendiola
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Murray
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - V Haddad
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - NL Solomon
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Senthil
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - H Bansil
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - D Ollila
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SK Snyder
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - D Edmonson
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Lazar
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - JP Namm
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - F Li
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Butler
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - NE McGowan
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - ME Herrera
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - YP Avitan
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - B Yoder
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - E Dupont
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
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Sagmeister MS, Taylor AE, Fenton A, Wall NA, Chanouzas D, Nightingale PG, Ferro CJ, Arlt W, Cockwell P, Hardy RS, Harper L. Glucocorticoid activation by 11β-hydroxysteroid dehydrogenase enzymes in relation to inflammation and glycaemic control in chronic kidney disease: A cross-sectional study. Clin Endocrinol (Oxf) 2019; 90:241-249. [PMID: 30358903 PMCID: PMC6334281 DOI: 10.1111/cen.13889] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) have dysregulated cortisol metabolism secondary to changes in 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes. The determinants of this and its clinical implications are poorly defined. METHODS We performed a cross-sectional study to characterize shifts in cortisol metabolism in relation to renal function, inflammation and glycaemic control. Systemic activation of cortisol by 11β-HSD was measured as the metabolite ratio (tetrahydrocortisol [THF]+5α-tetrahydrocortisol [5αTHF])/tetrahydrocortisone (THE) in urine. RESULTS The cohort included 342 participants with a median age of 63 years, median estimated glomerular filtration rate (eGFR) of 28 mL/min/1.73 m2 and median urine albumin-creatinine ratio of 35.5 mg/mmol. (THF+5αTHF)/THE correlated negatively with eGFR (Spearman's ρ = -0.116, P = 0.032) and positively with C-reactive protein (ρ = 0.208, P < 0.001). In multivariable analysis, C-reactive protein remained a significant independent predictor of (THF+5αTHF)/THE, but eGFR did not. Elevated (THF+5αTHF)/THE was associated with HbA1c (ρ = 0.144, P = 0.008) and diabetes mellitus (odds ratio for high vs low tertile of (THF+5αTHF)/THE 2.57, 95% confidence interval 1.47-4.47). Associations with diabetes mellitus and with HbA1c among the diabetic subgroup were independent of eGFR, C-reactive protein, age, sex and ethnicity. CONCLUSIONS In summary, glucocorticoid activation by 11β-HSD in our cohort comprising a spectrum of renal function was associated with inflammation and impaired glucose control.
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Affiliation(s)
- Michael S. Sagmeister
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Angela E. Taylor
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | - Anthony Fenton
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Nadezhda A. Wall
- Institute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Dimitrios Chanouzas
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Peter G. Nightingale
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Charles J. Ferro
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | - Paul Cockwell
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Rowan S. Hardy
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Institute of Inflammation and Ageing, ARUK Rheumatoid Arthritis Centre of Excellence, and MRC ARUK Centre for Musculoskeletal AgeingUniversity of BirminghamBirminghamUK
| | - Lorraine Harper
- Department of Renal MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Clinical SciencesUniversity of BirminghamBirminghamUK
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17
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Fenton A, Montgomery E, Nightingale P, Peters AM, Sheerin N, Wroe AC, Lipkin GW. Glomerular filtration rate: new age- and gender- specific reference ranges and thresholds for living kidney donation. BMC Nephrol 2018; 19:336. [PMID: 30466393 PMCID: PMC6249883 DOI: 10.1186/s12882-018-1126-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a need for a large, contemporary, multi-centre series of measured glomerular filtration rates (mGFR) from healthy individuals to determine age- and gender-specific reference ranges for GFR. We aimed to address this and to use the ranges to provide age- and gender-specific advisory GFR thresholds considered acceptable for living kidney donation. METHODS Individual-level data including pre-donation mGFR from 2974 prospective living kidney donors from 18 UK renal centres performed between 2003 and 2015 were amalgamated. Age- and gender-specific GFR reference ranges were determined by segmented multiple linear regression and presented as means ± two standard deviations. RESULTS Males had a higher GFR than females (92.0 vs 88.1 mL/min/1.73m2, P < 0.0001). Mean mGFR was 100 mL/min/1.73m2 until 35 years of age, following which there was a linear decline that was faster in females compared to males (7.7 vs 6.6 mL/min/1.73m2/decade, P = 0.013); 10.5% of individuals aged > 60 years had a GFR < 60 mL/min/1.73m2. The GFR ranges were used along with other published evidence to provide advisory age- and gender-specific GFR thresholds for living kidney donation. CONCLUSIONS These data suggest that GFR declines after 35 years of age, and the decline is faster in females. A significant proportion of the healthy population over 60 years of age have a GFR < 60 mL/min/1.73m2 which may have implications for the definition of chronic kidney disease. Age and gender differences in normal GFR can be used to determine advisory GFR thresholds for living kidney donation.
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Affiliation(s)
- Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Montgomery
- Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Nightingale
- Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A. Michael Peters
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Neil Sheerin
- Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - A. Caroline Wroe
- Department of Renal Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Graham W. Lipkin
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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18
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Holm Nielsen S, Guldager Kring Rasmussen D, Brix S, Fenton A, Jesky M, Ferro CJ, Karsdal M, Genovese F, Cockwell P. A novel biomarker of laminin turnover is associated with disease progression and mortality in chronic kidney disease. PLoS One 2018; 13:e0204239. [PMID: 30273365 PMCID: PMC6166934 DOI: 10.1371/journal.pone.0204239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/05/2018] [Indexed: 01/07/2023] Open
Abstract
Background Patients with chronic kidney disease (CKD) have increased risk of development of end-stage renal disease (ESRD) and early mortality. Fibrosis is the central pathogenic process in CKD and is caused by dysregulated extracellular matrix (ECM) remodeling. The laminin γ1 chain (LAMC1) is a core structural protein present in the basement membrane of several organs, including the kidneys. We hypothesized that dysregulation of LAMC1 remodeling could be associated with a higher risk of adverse clinical outcomes in patients with CKD. Methods A novel immunoassay targeting LG1M, a specific MMP-9-generated neo-epitope fragment of LAMC1, was developed and used to measure the levels of the fragment in urine and serum from 492 patients from the Renal Impairment in Secondary Care (RIISC) study, a prospective cohort of patients with high-risk CKD. Patients were monitored for a median follow-up time of 3.5 years. Associations between serum and urine LG1M levels and progression of CKD at 12 months were assessed by a multivariable logistic regression model. The association with ESRD or mortality was assessed by Kaplan-Meier survival curves and Cox proportional hazards regression. Results Forty-six (11%) of the 416 patients who reached 12-month follow-up had progression of CKD; during the study follow-up, 125 patients (25.4%) developed ESRD and 71 patients (14.4%) died. Serum and urine levels of LG1M correlated with baseline eGFR (r = -0.43, p<0.0001 and r = -0.17, p = 0.0002, respectively). Serum levels of LG1M were higher in patients with one-year progression of CKD compared to those who did not progress (p<0.01). Baseline serum levels of LG1M were associated with development of ESRD (HR 3.2, 95% CI 1.99–5.2 for patients in the highest LG1M tertile compared to patient in the lowest tertile). Baseline urinary levels of LG1M (uLG1M) were significantly associated with mortality (HR 5.0, 95% CI 2.8–8.9, p<0.0001 for patients in the highest LG1M tertile compared to patients in the lowest tertile). Urine LG1M was retained in the model for prediction of mortality (HR per standard deviation of uLG1M: 1.01, 95% CI 1.00–1.02, p = 0.001). Conclusions LG1M, a marker of basement membrane remodeling, is increased in serum and urine of patients with CKD and levels are associated with one-year disease progression, development of ESRD, and mortality.
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Affiliation(s)
- Signe Holm Nielsen
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
- * E-mail:
| | - Daniel Guldager Kring Rasmussen
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anthony Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Charles J. Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Morten Karsdal
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | | | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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19
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McCluskey L, Fenton A, Jackson T, Sharma P, Chapple I, Cockwell P. 20THE ASSOCIATION BETWEEN FRAILTY AND PERIODONTITIS IN COMMUNITY DWELLING OLDER ADULTS. Age Ageing 2018. [DOI: 10.1093/ageing/afy113.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L McCluskey
- Institute of Inflammation and Ageing, University of Birmingham
| | - A Fenton
- Institute of Inflammation and Ageing, University of Birmingham
| | - T Jackson
- Institute of Inflammation and Ageing, University of Birmingham
| | - P Sharma
- Institute of Inflammation and Ageing, University of Birmingham
| | - I Chapple
- Institute of Inflammation and Ageing, University of Birmingham
| | - P Cockwell
- Institute of Inflammation and Ageing, University of Birmingham
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20
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Fenton A, Smith SW, Hewins P. Adult minimal-change disease: observational data from a UK centre on patient characteristics, therapies, and outcomes. BMC Nephrol 2018; 19:207. [PMID: 30115013 PMCID: PMC6097194 DOI: 10.1186/s12882-018-0999-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Minimal change disease (MCD) is a common cause of the nephrotic syndrome in adults with limited evidence on its treatment and prognosis. We examined the presenting characteristics, treatments, and outcomes of adult patients with MCD in our centre. Methods This was an observational cohort study using retrospectively-collected data. All patients who had a renal biopsy reported as MCD between 1996 and 2012 were included, and data were collected at baseline and during follow-up. Statistical analysis included Cox-regression analysis to examine which factors were associated with risk of relapse. Results Seventy-eight patients were included, and had a median age of 36 years, and were 60% male and 73% white. Median follow-up time was 72 months. 37% were in AKI at presentation, which was significantly associated with a lower serum albumin and older age. Although 10% were steroid-resistant, 98% achieved remission at a median time of 5 weeks. 61% relapsed, at a median time of 11 months, and patients had a median number of 2 relapses during follow-up. A higher eGFR was associated with an increased risk of relapse (hazard ratio 1.18 [1.03–1.36] per 10 mL/min increase in eGFR), and females were significantly more likely than males to have an early relapse. Nearly half of the cohort required an additional immunosuppressive agent on top of glucocorticoids, the most commonly used being calcineurin inhibitors. Five patients subsequently developed FSGS: these patients had a lower baseline creatinine, a higher serum albumin, a longer time to remission, and were more likely to be steroid-resistant. Follow-up renal function was generally preserved, but follow-up creatinine was higher in those who had presented with AKI, and in those who had been commenced on a RAS inhibitor after biopsy. Infection requiring admission, diabetes mellitus and venous thromboembolism developed in 14%, 12%, and 12% of patients respectively. Conclusions Nearly all adults with MCD achieve remission, but relapses and disease- and therapy-related complications are common. In our cohort, eGFR and gender were associated with risk of relapse, and these previously undescribed associations could be explored further in future work.
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Affiliation(s)
- Anthony Fenton
- Department of Renal Medicine, Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Stuart W Smith
- Department of Renal Medicine, Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Hewins
- Department of Renal Medicine, Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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21
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Daversa DR, Fenton A, Dell AI, Garner TWJ, Manica A. Infections on the move: how transient phases of host movement influence disease spread. Proc Biol Sci 2018; 284:rspb.2017.1807. [PMID: 29263283 PMCID: PMC5745403 DOI: 10.1098/rspb.2017.1807] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022] Open
Abstract
Animal movement impacts the spread of human and wildlife diseases, and there is significant interest in understanding the role of migrations, biological invasions and other wildlife movements in spatial infection dynamics. However, the influence of processes acting on infections during transient phases of host movement is poorly understood. We propose a conceptual framework that explicitly considers infection dynamics during transient phases of host movement to better predict infection spread through spatial host networks. Accounting for host transient movement captures key processes that occur while hosts move between locations, which together determine the rate at which hosts spread infections through networks. We review theoretical and empirical studies of host movement and infection spread, highlighting the multiple factors that impact the infection status of hosts. We then outline characteristics of hosts, parasites and the environment that influence these dynamics. Recent technological advances provide disease ecologists unprecedented ability to track the fine-scale movement of organisms. These, in conjunction with experimental testing of the factors driving infection dynamics during host movement, can inform models of infection spread based on constituent biological processes.
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Affiliation(s)
- D R Daversa
- Institute of Integrative Biology, Biosciences Building, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK .,Institute of Zoology, Zoological Society of London, Regents Park, London NW1 4RY, UK.,Department of Zoology, University of Cambridge, Downing Street, Cambridge CB2 3EJ, UK
| | - A Fenton
- Institute of Integrative Biology, Biosciences Building, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK
| | - A I Dell
- National Great Rivers Research and Education Centre (NGRREC), East Alton, IL 62024, USA.,Department of Biology, Washington University in St Louis, 1 Brookings Dr, St Louis, MO 63130, USA
| | - T W J Garner
- Institute of Zoology, Zoological Society of London, Regents Park, London NW1 4RY, UK
| | - A Manica
- Department of Zoology, University of Cambridge, Downing Street, Cambridge CB2 3EJ, UK
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22
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Fenton A, Jesky MD, Webster R, Stringer SJ, Yadav P, Chapple I, Dasgupta I, Harding SJ, Ferro CJ, Cockwell P. Association between urinary free light chains and progression to end stage renal disease in chronic kidney disease. PLoS One 2018; 13:e0197043. [PMID: 29742142 PMCID: PMC5942781 DOI: 10.1371/journal.pone.0197043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) are at an increased risk of developing end-stage renal disease (ESRD). We assessed for the first time whether urinary free light chains (FLC) are independently associated with risk of ESRD in patients with CKD, and whether they offer incremental value in risk stratification. Materials and methods We measured urinary FLCs in 556 patients with CKD from a prospective cohort study. The association between urinary kappa/creatinine (KCR) and lambda/creatinine (LCR) ratios and development of ESRD was assessed by competing-risks regression (to account for the competing risk of death). The change in C-statistic and integrated discrimination improvement were used to assess the incremental value of adding KCR or LCR to the Kidney Failure Risk Equation (KFRE). Results 136 participants developed ESRD during a median follow-up time of 51 months. Significant associations between KCR and LCR and risk of ESRD became non-significant after adjustment for estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR), although having a KCR or LCR >75th centile remained independently associated with risk of ESRD. Neither KCR nor LCR as continuous or categorical variables provided incremental value when added to the KFRE for estimating risk of ESRD at two years. Conclusions Urinary FLCs have an association with progression to ESRD in patients with CKD which appears to be explained to a degree by their correlation with eGFR and ACR. Levels above the 75th centile do have an independent association with ESRD, but do not improve upon a current model for risk stratification.
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Affiliation(s)
- Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Mark D. Jesky
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rachel Webster
- Department of Biochemistry, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Stephanie J. Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, University of Birmingham and Birmingham Community Healthcare Foundation Trust, Birmingham, United Kingdom
| | - Indranil Dasgupta
- Department of Renal Medicine, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Charles J. Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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Chaya C, Pacoud J, Ng M, Fenton A, Hort J. Measuring the Emotional Response to Beer and the Relative Impact of Sensory and Packaging Cues. Journal of the American Society of Brewing Chemists 2018. [DOI: 10.1094/asbcj-2015-0114-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- C. Chaya
- Department of Statistics and Management Science in Agriculture, Technical University of Madrid, ETSI Agrónomos, 28040, Ciudad Universitaria s/n, Madrid, Spain
| | - J. Pacoud
- Montpellier University Graduate Engineering School, Place Eugene Bataillon, 34095, Montpellier, Cedex 5, France
| | - M. Ng
- Division of Food Sciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leics LE12 5RD, United Kingdom
| | | | - J. Hort
- Division of Food Sciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leics LE12 5RD, United Kingdom
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Rasmussen DGK, Fenton A, Jesky M, Ferro C, Boor P, Tepel M, Karsdal MA, Genovese F, Cockwell P. Urinary endotrophin predicts disease progression in patients with chronic kidney disease. Sci Rep 2017; 7:17328. [PMID: 29229941 PMCID: PMC5725589 DOI: 10.1038/s41598-017-17470-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022] Open
Abstract
Renal fibrosis is the central pathogenic process in progression of chronic kidney disease (CKD). Collagen type VI (COL VI) is upregulated in renal fibrosis. Endotrophin is released from COL VI and promotes pleiotropic pro-fibrotic effects. Kidney disease severity varies considerably and accurate information regarding CKD progression may improve clinical decisions. We tested the hypothesis that urinary endotrophin derived during COL VI deposition in fibrotic human kidneys is a marker for progression of CKD in the Renal Impairment in Secondary Care (RIISC) cohort, a prospective observational study of 499 CKD patients. Endotrophin localised to areas of increased COL VI deposition in fibrotic kidneys but was not present in histologically normal kidneys. The third and fourth quartiles of urinary endotrophin:creatinine ratio (ECR) were independently associated with one-year disease progression after adjustment for traditional risk factors (OR (95%CI) 3.68 (1.06–12.83) and 8.65 (2.46–30.49), respectively). Addition of ECR quartiles to the model for disease progression increased prediction as seen by an increase in category-free net reclassification improvement (0.45, 95% CI 0.16–0.74, p = 0.002) and integrated discrimination improvement (0.04, 95% CI 0.02–0.06, p < 0.001). ECR was associated with development of end-stage renal disease (ESRD). It is concluded that ECR predicts disease progression of CKD patients.
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Affiliation(s)
- Daniel Guldager Kring Rasmussen
- Nordic Bioscience, Herlev, Denmark. .,University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark.
| | - Anthony Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Charles Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Peter Boor
- Division of Nephrology, RWTH University of Aachen, Aachen, Germany.,Institute of Pathology, RWTH University of Aachen, Aachen, Germany
| | - Martin Tepel
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | | | | | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Fraser SDS, Fenton A, Harris S, Shardlow A, Liabeuf S, Massy ZA, Burmeister A, Hutchison CA, Landray M, Emberson J, Kalra PA, Ritchie JP, Cockwell P, Taal MW. The Association of Serum Free Light Chains With Mortality and Progression to End-Stage Renal Disease in Chronic Kidney Disease: Systematic Review and Individual Patient Data Meta-analysis. Mayo Clin Proc 2017; 92:1671-1681. [PMID: 29101935 DOI: 10.1016/j.mayocp.2017.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To clarify the associations between polyclonal serum free light chain (sFLC) levels and adverse outcomes in patients with chronic kidney disease (CKD) by conducting a systematic review and individual patient data meta-analyses. PATIENTS AND METHODS On December 28, 2016, we searched 4 databases (MEDLINE, Embase, CINAHL, and PubMed) and conference proceedings for studies presenting independent analyses of associations between sFLC levels and mortality or progression to end-stage renal disease (ESRD) in patients with CKD. Study quality was assessed in 5 domains: sample selection, measurement, attrition, reporting, and funding. RESULTS Five prospective cohort studies were included, judged moderate to good quality, involving 3912 participants in total. In multivariable meta-analyses, sFLC (kappa+lambda) levels were independently associated with mortality (5 studies, 3680 participants; hazard ratio [HR], 1.04 [95% CI, 1.03-1.06] per 10 mg/L increase in sFLC levels) and progression to ESRD (3 studies, 1848 participants; HR, 1.01 [95% CI, 1.00-1.03] per 10 mg/L increase in sFLC levels). The sFLC values above the upper limit of normal (43.3 mg/L) were independently associated with mortality (HR, 1.45 [95% CI, 1.14-1.85]) and ESRD (HR, 3.25 [95% CI, 1.32-7.99]). CONCLUSION Higher levels of sFLCs are independently associated with higher risk of mortality and ESRD in patients with CKD. Future work is needed to explore the biological role of sFLCs in adverse outcomes in CKD, and their use in risk stratification.
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Affiliation(s)
- Simon D S Fraser
- Academic Unit of Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
| | - Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Scott Harris
- Academic Unit of Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Adam Shardlow
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom
| | - Sophie Liabeuf
- Clinical Research Centre and INSERM U1018, Amiens University Hospital, Amiens, France
| | - Ziad A Massy
- Clinical Research Centre and INSERM U1018, Amiens University Hospital, Amiens, France
| | | | | | - Martin Landray
- Nuffield Department of Population Health, Oxford, United Kingdom
| | | | - Phil A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - James P Ritchie
- Department of Renal Medicine, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom
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Rasmussen D, Genovese F, Fenton A, Boor P, Tepel M, Ferro C, Jesky M, Karsdal M, Cockwell P. SP274URINARY ENDOTROPHIN (PRO-C6), A DYNAMIC PRODUCT OF TYPE VI COLLAGEN FORMATION, PREDICTS DISEASE PROGRESSION AND MORTALITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx145.sp274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Holm Nielsen S, Rasmussen DGK, Fenton A, Jesky M, Ferro C, Karsdal M, Genovese F, Cockwell P. SO015A NOVEL BIOMARKER OF LAMININ TURNOVER IS ASSOCIATED WITH MORTALITY AND DISEASE PROGRESSION IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx102.so015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fenton A, Jesky MD, Ferro CJ, Sørensen J, Karsdal MA, Cockwell P, Genovese F. Serum endotrophin, a type VI collagen cleavage product, is associated with increased mortality in chronic kidney disease. PLoS One 2017; 12:e0175200. [PMID: 28403201 PMCID: PMC5389629 DOI: 10.1371/journal.pone.0175200] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/22/2017] [Indexed: 12/31/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) are at increased risk of end-stage renal disease (ESRD) and early mortality. The underlying pathophysiological processes are not entirely understood but may include dysregulation of extracellular matrix formation with accelerated systemic and renal fibrosis. We assessed the relationship between endotrophin (ETP), a marker of collagen type VI formation, and adverse outcomes in a cohort of patients with CKD. Methods We measured serum ETP levels in 500 patients from the Renal Impairment in Secondary Care (RIISC) study, a prospective observational study of patients with high-risk CKD. Patients were followed up until death or progression to ESRD. Cox regression analysis was used to assess the relationship between ETP and risk of adverse outcomes. Results During a median follow-up time of 37 months, 104 participants progressed to ESRD and 66 died. ETP level was significantly associated with progression to ESRD (HR 1.79 [95% CI 1.59–2.02] per 10 ng/mL increase; HR 11.05 [4.98–24.52] for highest vs lowest quartile; both P<0.0001). ETP level was also significantly associated with mortality (HR 1.60 [1.35–1.89] per 10 ng/mL increase; HR 12.14 [4.26–34.54] for highest vs lowest quartile; both P<0.0001). After adjustment for confounding variables, ETP was no longer significantly associated with progression to ESRD but remained independently associated with mortality (HR 1.51 [1.07–2.12] per 10 ng/mL increase, P = 0.019). Conclusions Serum ETP level is independently associated with mortality in CKD. This study provides the basis for further exploratory work to establish whether collagen type VI formation is mechanistically involved in the increased mortality risk associated with CKD.
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Affiliation(s)
- Anthony Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark D Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charles J Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jacob Sørensen
- Nordic Bioscience A/S, Herlev Hovedgade, Herlev, Denmark
| | | | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Jesky MD, Dutton M, Dasgupta I, Yadav P, Ng KP, Fenton A, Kyte D, Ferro CJ, Calvert M, Cockwell P, Stringer SJ. Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study. PLoS One 2016; 11:e0165675. [PMID: 27832126 PMCID: PMC5104414 DOI: 10.1371/journal.pone.0165675] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/14/2016] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with reduced health-related quality of life (HRQL). However, the relationship between pre-dialysis CKD, HRQL and clinical outcomes, including mortality and progression to end-stage renal disease (ESRD) is unclear. Methods All 745 participants recruited into the Renal Impairment In Secondary Care study to end March 2014 were included. Demographic, clinical and laboratory data were collected at baseline including an assessment of HRQL using the Euroqol EQ-5D-3L. Health states were converted into an EQ-5Dindex score using a set of weighted preferences specific to the UK population. Multivariable Cox proportional hazards regression and competing risk analyses were undertaken to evaluate the association of HRQL with progression to ESRD or all-cause mortality. Regression analyses were then performed to identify variables associated with the significant HRQL components. Results Median eGFR was 25.8 ml/min/1.73 m2 (IQR 19.6–33.7ml/min) and median ACR was 33 mg/mmol (IQR 6.6–130.3 mg/mmol). Five hundred and fifty five participants (75.7%) reported problems with one or more EQ-5D domains. When adjusted for age, gender, comorbidity, eGFR and ACR, both reported problems with self-care [hazard ratio 2.542, 95% confidence interval 1.222–5.286, p = 0.013] and reduced EQ-5Dindex score [hazard ratio 0.283, 95% confidence interval 0.099–0.810, p = 0.019] were significantly associated with an increase in all-cause mortality. Similar findings were observed for competing risk analyses. Reduced HRQL was not a risk factor for progression to ESRD in multivariable analyses. Conclusions Impaired HRQL is common in the pre-dialysis CKD population. Reduced HRQL, as demonstrated by problems with self-care or a lower EQ-5Dindex score, is associated with a higher risk for death but not ESRD. Multiple factors influence these aspects of HRQL but renal function, as measured by eGFR and ACR, are not among them.
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Affiliation(s)
- Mark D. Jesky
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Indranil Dasgupta
- Renal Unit, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Khai Ping Ng
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Derek Kyte
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charles J. Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie J. Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Jesky MD, Stringer SJ, Fenton A, Ng KP, Yadav P, Ndumbo M, McCann K, Plant T, Dasgupta I, Harding SJ, Drayson MT, Redegeld F, Ferro CJ, Cockwell P. Serum tryptase concentration and progression to end-stage renal disease. Eur J Clin Invest 2016; 46:460-74. [PMID: 26999448 DOI: 10.1111/eci.12622] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mast cell activation can lead to nonclassical activation of the Renin-Angiotensin-Aldosterone System. However, the relevance of this to human chronic kidney disease is unknown. We assessed the association between serum tryptase, a product of mast cell activation, and progression to end-stage renal disease or mortality in patients with advanced chronic kidney disease. We stratified patients by use of angiotensin-converting enzyme inhibitors/angiotensin receptor II blockers (ACEi/ARB). MATERIALS AND METHODS This was a prospective cohort study of 446 participants recruited into the Renal Impairment in Secondary Care study. Serum tryptase was measured at recruitment by sandwich immunoassay. Cox regression analysis was undertaken to determine variables associated with progression to end-stage renal disease or death. RESULTS Serum tryptase concentration was independently associated with progression to end-stage renal disease but not with death. In patients treated with ACEi or ARB, there was a strong independent association between higher tryptase concentrations and progression to end-stage renal disease; when compared to the lowest tertile, tryptase concentrations in the middle and highest tertiles had hazard ratios [HR] of 5·78 (95% confidence interval [CI] 1·19-28·03, P = 0·029) and 6·19 (95% CI 1·49-25·69, P = 0·012), respectively. The other independent risk factors for progression to end-stage renal disease were lower age, male gender, lower estimated glomerular filtration rate and higher urinary albumin creatinine ratio. CONCLUSION Elevated serum tryptase concentration is an independent prognostic factor for progression to end-stage renal disease in patients with chronic kidney disease who are receiving treatment with an ACEi or ARB.
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Affiliation(s)
- Mark D Jesky
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stephanie J Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Khai Ping Ng
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Miguel Ndumbo
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Katerina McCann
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tim Plant
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | | | | | - Mark T Drayson
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Frank Redegeld
- Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Griffiths EC, Pedersen AB, Fenton A, Petchey OL. Reported co-infection deaths are more common in early adulthood and among similar infections. BMC Infect Dis 2015; 15:411. [PMID: 26438380 PMCID: PMC4595177 DOI: 10.1186/s12879-015-1118-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 09/10/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Many people have multiple infections at the same time, but the combined contribution of those infections to disease-related mortality is unknown. Registered causes of death offer a unique opportunity to study associations between multiple infections. METHODS We analysed over 900,000 death certificates that reported infectious causes of death. We tested whether reports of multiple infections (i.e., co-infections) differed across individuals' age or sex. We also tested whether each pair of infections were reported together more or less often than expected by chance, and whether this co-reporting was associated with the number of biological characteristics they had in common. RESULTS In England and Wales, and the USA, 10 and 6 % respectively of infection-related deaths involved co-infection. Co-infection was reported reported most often in young adults; 30 % of infection-related deaths among those aged 25-44 from the USA, and 20 % of infection-related deaths among those aged 30-39 from England and Wales, reported multiple infections. The proportion of infection-related deaths involving co-infection declined with age more slowly in males than females, to less than 10 % among those aged >65. Most associated pairs of infections co-occurred more often than expected from their frequency of being reported alone (488/683 [71 %] in the USA, 129/233 [55 %] in England and Wales), and tended to share biological characteristics (taxonomy, transmission mode, tropism or timescale). CONCLUSIONS Age, sex, and biologically similar infections are associated with death from co-infection, and may help indicate patients at risk of severe co-infection.
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Affiliation(s)
- E C Griffiths
- Department of Animal and Plant Sciences, University of Sheffield, Alfred Denny Building, Western Bank, Sheffield, S10 2TN, UK.
- Department of Entomology, North Carolina State University, Campus Box 7613, Gardner Hall, Raleigh, NC, 27695-7613, USA.
| | - A B Pedersen
- Centre for Immunology, Infection and Evolution & Institute of Evolutionary Biology, School of Biological Sciences, Ashworth Labs, University of Edinburgh, Kings Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK.
| | - A Fenton
- Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK.
| | - O L Petchey
- Institute of Evolutionary Biology and Environmental Studies, University of Zürich, Winterthurerstrasse, Zürich, 8057, Switzerland.
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Nel M, Fenton A. Mobilisation of intubated adults on intensive care is safe—challenging current rehabilitation practice. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fenton A, Frank B, Liu Z. Hysteroscopic and Laparoscopic Essure Microinsert Removal 320 Days Post-Essure Placement. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Griffiths E, Pedersen A, Fenton A, Petchey O. P1-459 A within-host network of human coinfection. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976g.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Crespo M, Collado S, Mir M, Hurtado S, Cao H, Barbosa F, Serra C, Hidalgo C, Faura A, Garcia de Lomas J, Montero M, Horcajada JP, Puig JM, Pascual J, Ulusal Okyay G, Uludag K, Sozen H, Arman D, Dalgic A, Guz G, Fraile P, Garcia-Cosmes P, Rosado C, Gonzalez C, Tabernero JM, Costa C, Saldan A, Astegiano S, Terlizzi ME, Messina M, Bergallo M, Segoloni G, Cavallo R, Schwarz A, Grosshennig A, Heim A, Broecker V, Haller H, Linnenweber S, Liborio AB, Mendoza TR, Esmeraldo RM, Oliveira MLMB, Nogueira Paes FJV, Silva Junior GB, Daher EF, Hodgson K, Baharani J, Fenton A, Baharani J, Mjoen G, Hartmann A, Reisaeter A, Midtvedt K, Dahle DO, Holdaas H, Shabir S, Lukacik P, Bevins A, Basnayake K, Bental A, Hughes RG, Cockwell P, Burrows R, Hutchison CA, Varma P, Kumar A, Hooda A, Badwal S, Barrios C, Mir M, Crespo M, Fumado L, Frances A, Puig JM, Horcajada JP, Arango O, Pascual J, Pawlik A, Chudek J, Kolonko A, Wilk J, Jalowiecki P, Wiecek A, Teplan V, Kralova-Lesna I, Mahrova A, Racek J, tollova M, Maggisano V, Caracciolo V, Solazzo A, Montanari M, Della Grotta F, Nakazawa D, Nishio S, Nakagaki T, Ishikawa Y, Ito M, Shibazaki S, Shimoda N, Miura M, Morita K, Nonomura K, Koike T, Locsey L, Seres I, Sztanek F, Harangi M, Padra J, Asztalos L, Paragh G, Rodriguez-Reimundes E, Soler-Pujol G, Diaz CH, Davalos-Michel M, Vilches AR, Laham G, Mjoen G, Stavem K, Midtvedt K, Norby G, Holdaas H, Tutal E, Canver B, Can S, Sezer S, Colak T, Kolonko A, Chudek J, Wiecek A, Paschoalin R, Barros X, Duran C, Torregrosa JV, Crespo M, Mir M, Barrios C, Faura A, Tellez E, Marin M, Puig JM, Pascual J, Smalcelj R, Smalcelj A, Claes K, Petit T, Bammens B, Kuypers D, Naesens M, Vanrenterghem Y, Evenepoel P, Gerhart MK, Colbus S, Seiler S, Grun O, Fliser D, Heine GH, Vincenti F, Grinyo J, Larsen C, Medina Pestana J, Vanrenterghem Y, Dong Y, Thomas D, Charpentier B, Luna E, Martinez R, Cerezo I, Ferreira F, Cubero J, Villa J, Martinez C, Garcia C, Rodrigo E, Santos L, Pinera C, Quintela E, Ruiz JC, Fernandez-Fresnedo G, Palomar R, Gomez-Alamillo C, Martin de Francisco AL, Arias M, Grinyo J, Nainan G, del Carmen Rial M, Steinberg S, Vincenti F, Dong Y, Thomas D, Kamar N, Durrbach A, Grinyo J, Vanrenterghem Y, Becker T, Florman S, Lang P, del Carmen Rial M, Schnitzler M, Duan T, Block A, Medina Pestana J, Sawosz M, Cieciura T, Durlik M, Perkowska A, Sikora P, Beck B, De Mauri A, Brambilla M, Stratta P, Chiarinotti D, De Leo M, Attou S, Arzour H, Boudrifa N, Mekhlouf N, Gaouar A, Merazga S, Kalem K, Haddoum F. Transplantation: clinical studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Al-Saleh M, El-Mowafy O, Tam L, Fenton A. Microleakage of Posterior Composite Restorations Lined with Self-adhesive Resin Cements. Oper Dent 2010; 35:556-63. [DOI: 10.2341/09-189-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinical Relevance
Two self-adhesive resin cements resulted in minimal microleakage scores when used as liners in Class II composite restorations.
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Fenton A, Sayar Z, Dodds A, Dasgupta I. Multidisciplinary Care Improves Outcome of Patients with Stage 5 Chronic Kidney Disease. ACTA ACUST UNITED AC 2010; 115:c283-8. [DOI: 10.1159/000313487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 01/05/2009] [Indexed: 11/19/2022]
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Field D, Draper ES, Fenton A, Papiernik E, Zeitlin J, Blondel B, Cuttini M, Maier RF, Weber T, Carrapato M, Kollée L, Gadzin J, Van Reempts P. Rates of very preterm birth in Europe and neonatal mortality rates. Arch Dis Child Fetal Neonatal Ed 2009; 94:F253-6. [PMID: 19066186 DOI: 10.1136/adc.2008.150433] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the influence of variation in the rate of very preterm delivery on the reported rate of neonatal death in 10 European regions. DESIGN Comparison of 10 separate geographically defined European populations, from nine European countries, over a 1-year period (7 months in one region). PARTICIPANTS All births that occurred between 22(+0) and 31(+6) weeks of gestation in 2003. MAIN OUTCOME MEASURE Neonatal death rate adjusted for rate of delivery at this gestation. RESULTS Rate of delivery of all births at 22(+0)-31(+6) weeks of gestation and live births only were calculated for each region. Two regions had significantly higher rates of very preterm delivery per 1000 births: Trent UK (16.8, 95% CI 15.7 to 17.9) and Northern UK (17.1, 95% CI 15.6 to 18.6); group mean 13.2 (95% CI 12.9 to 13.5). Four regions had rates significantly below the group average: Portugal North (10.7, 95% CI 9.6 to 11.8), Eastern and Central Netherlands (10.6, 95% CI 9.7 to 11.6), Eastern Denmark (11.2, 95% CI 10.1 to 12.4) and Lazio in Italy (11.0, 95% CI 10.1 to 11.9). Similar trends were seen in live birth data. Published rates of neonatal death for each region were then adjusted by applying (a) a standardised rate of very preterm delivery and (b) the existing death rate for babies born at this gestation in the individual region. This produced much greater homogeneity in terms of neonatal mortality. CONCLUSIONS Variation in the rate of very preterm delivery has a major influence on reported neonatal death rates.
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Affiliation(s)
- D Field
- Neonatal Unit, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
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Roche SL, Wren C, Fenton A. Medicine or surgery for patent ductus arteriosus? Arch Dis Child Fetal Neonatal Ed 2008; 93:F394-5. [PMID: 18723780 DOI: 10.1136/adc.2007.136432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Coevolving populations of hosts and parasites are often subdivided into a set of patches connected by dispersal. Higher relative rates of parasite compared with host dispersal are expected to lead to parasite local adaptation. However, we know of no studies that have considered the implications of higher relative rates of parasite dispersal for other aspects of the coevolutionary process, such as the rate of coevolution and extent of evolutionary escalation of resistance and infectivity traits. We investigated the effect of phage dispersal on coevolution in experimental metapopulations of the bacterium Pseudomonas fluorescens SBW25 and its viral parasite, phage SBW25Phi2. Both the rate of coevolution and the breadth of evolved infectivity and resistance ranges peaked at intermediate rates of parasite dispersal. These results suggest that parasite dispersal can enhance the evolutionary potential of parasites through provision of novel genetic variation, but that high rates of parasite dispersal can impede the evolution of parasites by homogenizing genetic variation between patches, thereby constraining coevolution.
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Affiliation(s)
- T Vogwill
- School of Biological Sciences, University of Liverpool, Crown Street, Liverpool L697ZB, UK
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Abstract
OBJECTIVE Malignant transformation in a dermoid cyst of the ovary is a rare complication, occurring in only 1-2% of cases, with squamous cell carcinoma being the most common type. Preoperative diagnosis is difficult because of the lack of specific symptoms and signs to suggest malignancy. Because of the small numbers of women involved, our knowledge of this rare tumour type is limited. This study aims to further characterise the population of women affected, the disease itself and the most appropriate management strategy. DESIGN We identified 14 women with this diagnosis between 1989 and 2006. This is a descriptive study, looking at the patient characteristics, mode of presentation and the role of tumour markers and radiological imaging in diagnosis. We also examined the stage and pathological features of the tumour at presentation and the subsequent course of the disease. We have also described our experiences using surgery, chemotherapy and radiotherapy in the management of these women. RESULTS We found that these tumours present at an age older than that of mature teratomas and that there are no reliable diagnostic tools or prognostic indicators. The behaviour of these tumours is unpredictable, and the role of chemotherapy and radiotherapy remains unclear. We suggest that repeated surgical resection of disease at the time of relapse could give a very durable response in selected women.
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Affiliation(s)
- J L Hurwitz
- Department of Medical Oncology, Northern Ireland Cancer Centre, Belfast, UK.
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Abstract
Parasites are known to directly affect their hosts at both the individual and population level. However, little is known about their more subtle, indirect effects and how these may affect population and community dynamics. In particular, trophically transmitted parasites may manipulate the behavior of intermediate hosts, fundamentally altering the pattern of contact between these individuals and their predators. Here, we develop a suite of population dynamic models to explore the impact of such behavioral modifications on the dynamics and structure of the predator-prey community. We show that, although such manipulations do not directly affect the persistence of the predator and prey populations, they can greatly alter the quantitative dynamics of the community, potentially resulting in high amplitude oscillations in abundance. We show that the precise impact of host manipulation depends greatly on the predator's functional response, which describes the predator's foraging efficiency under changing prey availabilities. Even if the parasite is rarely observed within the prey population, such manipulations extend beyond the direct impact on the intermediate host to affect the foraging success of the predator, with profound implications for the structure and stability of the predator-prey community.
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Affiliation(s)
- A Fenton
- School of Biological Sciences, Crown Street, University of Liverpool, Liverpool L69 7ZB, UK.
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Abstract
Current analytical models of the mammalian immune system typically assume a specialist predator-prey relationship between invading pathogens and the active components of the immune response. However, in reality, the specific immune system is not immediately effective following invasion by a novel pathogen. First, there may be an explicit time delay between infection and immune initiation and, second, there may be a gradual build-up in immune efficacy (for instance, during the period of B-cell affinity maturation) during which the immune response develops, before reaching maximal specificity to the pathogen. Here, we use a novel theoretical approach to show that these processes, together with the presence of long-lived immune memory, decouple the immune response from current pathogen levels, greatly changing the dynamics of the pathogen-immune system interaction and the ability of the immune response to eliminate the pathogen. Furthermore, we use this model to show how distributed primary immune responses combine with immune memory to greatly affect the optimal virulence of the pathogen, potentially resulting in the evolution of highly virulent pathogens.
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Affiliation(s)
- A Fenton
- Institute of Zoology, Zoological Society of London, Regents Park, London NW1 4RY, UK.
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Bull JC, Jepson PD, Ssuna RK, Deaville R, Allchin CR, Law RJ, Fenton A. The relationship between polychlorinated biphenyls in blubber and levels of nematode infestations in harbour porpoises, Phocoena phocoena. Parasitology 2006; 132:565-73. [PMID: 16388689 DOI: 10.1017/s003118200500942x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 08/25/2005] [Accepted: 10/05/2005] [Indexed: 11/07/2022]
Abstract
Post-mortem examinations of harbour porpoises, Phocoena phocoena, regularly reveal heavy parasitic worm burdens. These same post-mortem records show varying levels of polychlorinated biphenyls (PCBs) accumulating in the blubber of porpoises. Although a number of papers have documented geospatial and temporal changes of PCBs and their detrimental effects on marine mammal health, as yet none have examined their role in determining nematode burdens in wild marine mammal populations. Using a data set consisting of harbour porpoises stranded in the UK between 1989 and 2002, we found a significant, positive association between PCB levels and nematode burdens, although the nature of the relationship was confounded with porpoise sex, age and cause of death. It was also apparent that individuals with the heaviest infestations of nematodes did not have the highest PCB level: while PCBs are important, they are clearly not the sole determinants of nematode burdens in wild populations of the harbour porpoise around the UK.
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Affiliation(s)
- J C Bull
- Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK.
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Berrington JE, Fenton A. Interpreting immunogenicity data in UK studies. Arch Dis Child 2005; 90:1205. [PMID: 16243893 PMCID: PMC1720175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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