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Santhakumaran S, Fisher L, Zheng B, Mahalingasivam V, Plumb L, Parker EPK, Steenkamp R, Morton C, Mehrkar A, Bacon S, Lyon S, Konstant-Hambling R, Goldacre B, MacKenna B, Tomlinson LA, Nitsch D. Identification of patients undergoing chronic kidney replacement therapy in primary and secondary care data: validation study based on OpenSAFELY and UK Renal Registry. BMJ Med 2024; 3:e000807. [PMID: 38645891 PMCID: PMC11029353 DOI: 10.1136/bmjmed-2023-000807] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Abstract
Objective To validate primary and secondary care codes in electronic health records to identify people receiving chronic kidney replacement therapy based on gold standard registry data. Design Validation study using data from OpenSAFELY and the UK Renal Registry, with the approval of NHS England. Setting Primary and secondary care electronic health records from people registered at 45% of general practices in England on 1 January 2020, linked to data from the UK Renal Registry (UKRR) within the OpenSAFELY-TPP platform, part of the NHS England OpenSAFELY covid-19 service. Participants 38 745 prevalent patients (recorded as receiving kidney replacement therapy on 1 January 2020 in UKRR data, or primary or secondary care data) and 10 730 incident patients (starting kidney replacement therapy during 2020), from a population of 19 million people alive and registered with a general practice in England on 1 January 2020. Main outcome measures Sensitivity and positive predictive values of primary and secondary care code lists for identifying prevalent and incident kidney replacement therapy cohorts compared with the gold standard UKRR data on chronic kidney replacement therapy. Agreement across the data sources overall, and by treatment modality (transplantation or dialysis) and personal characteristics. Results Primary and secondary care code lists were sensitive for identifying the UKRR prevalent cohort (91.2% (95% confidence interval (CI) 90.8% to 91.6%) and 92.0% (91.6% to 92.4%), respectively), but not the incident cohort (52.3% (50.3% to 54.3%) and 67.9% (66.1% to 69.7%)). Positive predictive values were low (77.7% (77.2% to 78.2%) for primary care data and 64.7% (64.1% to 65.3%) for secondary care data), particularly for chronic dialysis (53.7% (52.9% to 54.5%) for primary care data and 49.1% (48.0% to 50.2%) for secondary care data). Sensitivity decreased with age and index of multiple deprivation in primary care data, but the opposite was true in secondary care data. Agreement was lower in children, with 30% (295/980) featuring in all three datasets. Half (1165/2315) of the incident patients receiving dialysis in UKRR data had a kidney replacement therapy code in the primary care data within three months of the start date of the kidney replacement therapy. No codes existed whose exclusion would substantially improve the positive predictive value without a decrease in sensitivity. Conclusions Codes used in primary and secondary care data failed to identify a small proportion of prevalent patients receiving kidney replacement therapy. Codes also identified many patients who were not recipients of chronic kidney replacement therapy in UKRR data, particularly dialysis codes. Linkage with UKRR kidney replacement therapy data facilitated more accurate identification of incident and prevalent kidney replacement therapy cohorts for research into this vulnerable population. Poor coding has implications for any patient care (including eligibility for vaccination, resourcing, and health policy responses in future pandemics) that relies on accurate reporting of kidney replacement therapy in primary and secondary care data.
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Affiliation(s)
| | - Louis Fisher
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Bang Zheng
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lucy Plumb
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Population Health Science Institute, University of Bristol, Bristol, UK
| | | | | | - Caroline Morton
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Sebastian Bacon
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Sue Lyon
- UKKA Patient Council, UK Kidney Association, Bristol, UK
| | | | - Ben Goldacre
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | | | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Grant CH, Caskey FJ, Davids MR, Sahay M, Bello AK, Nitsch D, Bell S. The global landscape of kidney registries: immense challenges and unique opportunities. Nat Rev Nephrol 2024:10.1038/s41581-024-00833-1. [PMID: 38565773 DOI: 10.1038/s41581-024-00833-1] [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: 04/04/2024]
Affiliation(s)
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - M Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital & Osmania Medical College, Hyderabad, India
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dorothea Nitsch
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Bell
- Division of Population Health & Genomics, University of Dundee, Dundee, UK.
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Brown JP, Hunnicutt JN, Ali MS, Bhaskaran K, Cole A, Langan SM, Nitsch D, Rentsch CT, Galwey NW, Wing K, Douglas IJ. Quantifying possible bias in clinical and epidemiological studies with quantitative bias analysis: common approaches and limitations. BMJ 2024; 385:e076365. [PMID: 38565248 DOI: 10.1136/bmj-2023-076365] [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] [Accepted: 02/12/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Jeremy P Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacob N Hunnicutt
- Epidemiology, Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA
| | - M Sanni Ali
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ashley Cole
- Real World Analytics, Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA
| | - Sinead M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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4
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Currin S, George JA, Hansen CH, Naicker S, Tomlinson L, Crampin A, Kalyesubula R, Newton R, Nakanga WP, Nitsch D, Fabian J. Single-sample measured glomerular filtration rate in Malawi, South Africa, and Uganda. Kidney Int 2024; 105:882-885. [PMID: 38307202 DOI: 10.1016/j.kint.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Sean Currin
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, South Africa.
| | - Jaya A George
- National Health Laboratory Service, South Africa; Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christian Holm Hansen
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurie Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Kalyesubula
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Wisdom P Nakanga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Zhang Z, Heerspink HJL, Chertow GM, Correa-Rotter R, Gasparrini A, Jongs N, Langkilde AM, McMurray JJV, Mistry MN, Rossing P, Toto RD, Vart P, Nitsch D, Wheeler DC, Caplin B. Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial. Lancet Planet Health 2024; 8:e225-e233. [PMID: 38580424 DOI: 10.1016/s2542-5196(24)00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Higher temperatures are associated with higher rates of hospital admissions for nephrolithiasis and acute kidney injury. Occupational heat stress is also a risk factor for kidney dysfunction in resource-poor settings. It is unclear whether ambient heat exposure is associated with loss of kidney function in patients with established chronic kidney disease. We assessed the association between heat index and change in estimated glomerular filtration rate (eGFR) in participants from the DAPA-CKD trial in a post-hoc analysis. METHODS DAPA-CKD was a randomised controlled trial of oral dapagliflozin 10 mg once daily or placebo that enrolled participants aged 18 years or older, with or without type 2 diabetes, with a urinary albumin-to-creatinine ratio of 200-5000 mg/g, and an eGFR of 25-75 mL/min per 1·73 m2. In this post-hoc analysis, we explored the association between time-varying daily centre-level heat index (ERA5 dataset) and individual-level change in eGFR in trial participants using linear mixed effect models and case-time series. The DAPA-CKD trial is registered with ClinicalTrials.gov, NCT03036150. FINDINGS Climate and eGFR data were available for 4017 (93·3%) of 4304 participants in 21 countries (mean age: 61·9 years; mean eGFR: 43·3 mL per 1·73 m2; median 28 months follow-up). Across centres, a heat index of more than 30°C occurred on a median of 0·6% of days. In adjusted linear mixed effect models, within each 120-day window, each 30 days' heat index of more than 30°C was associated with a -0·6% (95% CI -0·9% to -0·3%) change in eGFR. Similar estimates were obtained using case-time series. Additional analyses over longer time-windows showed associations consistent with haemodynamic or seasonal variability, or both, but overall estimates corresponded to an additional 3·7 mL per 1·73 m2 (95% CI 0·1 to 7·0) loss of eGFR per year in a patient with an eGFR of 45 mL per 1·73 m2 located in a very hot versus a temperate environment. INTERPRETATION Higher ambient heat exposure is associated with more rapid eGFR decline in those with established chronic kidney disease. Efforts to mitigate heat exposure should be tested as part of strategies to attenuate chronic kidney disease progression. FUNDING None.
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Affiliation(s)
- Zhiyan Zhang
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands; The George Institute for Global Health, Sydney, NSW, Australia
| | - Glenn M Chertow
- Department of Medicine, Department of Epidemiology and Population Health, and Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Gasparrini
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands
| | | | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Malcolm N Mistry
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert D Toto
- Department of Internal Medicine, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK.
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6
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Wong K, Pitcher D, Braddon F, Downward L, Steenkamp R, Annear N, Barratt J, Bingham C, Chrysochou C, Coward RJ, Game D, Griffin S, Hall M, Johnson S, Kanigicherla D, Karet Frankl F, Kavanagh D, Kerecuk L, Maher ER, Moochhala S, Pinney J, Sayer JA, Simms R, Sinha S, Srivastava S, Tam FWK, Turner AN, Walsh SB, Waters A, Wilson P, Wong E, Taylor CM, Nitsch D, Saleem M, Bockenhauer D, Bramham K, Gale DP. Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort. Lancet 2024; 403:1279-1289. [PMID: 38492578 DOI: 10.1016/s0140-6736(23)02843-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Individuals with rare kidney diseases account for 5-10% of people with chronic kidney disease, but constitute more than 25% of patients receiving kidney replacement therapy. The National Registry of Rare Kidney Diseases (RaDaR) gathers longitudinal data from patients with these conditions, which we used to study disease progression and outcomes of death and kidney failure. METHODS People aged 0-96 years living with 28 types of rare kidney diseases were recruited from 108 UK renal care facilities. The primary outcomes were cumulative incidence of mortality and kidney failure in individuals with rare kidney diseases, which were calculated and compared with that of unselected patients with chronic kidney disease. Cumulative incidence and Kaplan-Meier survival estimates were calculated for the following outcomes: median age at kidney failure; median age at death; time from start of dialysis to death; and time from diagnosis to estimated glomerular filtration rate (eGFR) thresholds, allowing calculation of time from last eGFR of 75 mL/min per 1·73 m2 or more to first eGFR of less than 30 mL/min per 1·73 m2 (the therapeutic trial window). FINDINGS Between Jan 18, 2010, and July 25, 2022, 27 285 participants were recruited to RaDaR. Median follow-up time from diagnosis was 9·6 years (IQR 5·9-16·7). RaDaR participants had significantly higher 5-year cumulative incidence of kidney failure than 2·81 million UK patients with all-cause chronic kidney disease (28% vs 1%; p<0·0001), but better survival rates (standardised mortality ratio 0·42 [95% CI 0·32-0·52]; p<0·0001). Median age at kidney failure, median age at death, time from start of dialysis to death, time from diagnosis to eGFR thresholds, and therapeutic trial window all varied substantially between rare diseases. INTERPRETATION Patients with rare kidney diseases differ from the general population of individuals with chronic kidney disease: they have higher 5-year rates of kidney failure but higher survival than other patients with chronic kidney disease stages 3-5, and so are over-represented in the cohort of patients requiring kidney replacement therapy. Addressing unmet therapeutic need for patients with rare kidney diseases could have a large beneficial effect on long-term kidney replacement therapy demand. FUNDING RaDaR is funded by the Medical Research Council, Kidney Research UK, Kidney Care UK, and the Polycystic Kidney Disease Charity.
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Affiliation(s)
- Katie Wong
- National Registry of Rare Kidney Diseases, Bristol, UK; Department of Renal Medicine, University College London, London, UK
| | - David Pitcher
- National Registry of Rare Kidney Diseases, Bristol, UK
| | - Fiona Braddon
- National Registry of Rare Kidney Diseases, Bristol, UK
| | | | | | - Nicholas Annear
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Coralie Bingham
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Richard J Coward
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - David Game
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sian Griffin
- Department of Nephrology, University Hospital Wales, Cardiff, UK
| | - Matt Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Sally Johnson
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Durga Kanigicherla
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Fiona Karet Frankl
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - David Kavanagh
- National Renal Complement Therapeutics Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Complement Therapeutics Research Group, Newcastle University, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Larissa Kerecuk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Shabbir Moochhala
- Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Jenny Pinney
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John A Sayer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Roslyn Simms
- Academic Unit of Nephrology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smeeta Sinha
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Shalabh Srivastava
- Department of Renal Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Frederick W K Tam
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Andrew Neil Turner
- Medical Research Council Centre for Inflammation, Edinburgh University, Edinburgh, UK
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK; Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Aoife Waters
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Patricia Wilson
- Department of Renal Medicine, University College London, London, UK
| | - Edwin Wong
- National Renal Complement Therapeutics Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Dorothea Nitsch
- UK Renal Registry, Bristol, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Moin Saleem
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Bramham
- National Registry of Rare Kidney Diseases, Bristol, UK; King's Health Partners, King's College London, London, UK
| | - Daniel P Gale
- National Registry of Rare Kidney Diseases, Bristol, UK; Department of Renal Medicine, University College London, London, UK; Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.
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7
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Megersa BS, Andersen GS, Abera M, Abdissa A, Zinab B, Ali R, Admassu B, Kedir E, Nitsch D, Filteau S, Girma T, Yilma D, Wells JC, Friis H, Wibaek R. Associations of early childhood body mass index trajectories with body composition and cardiometabolic markers at age 10 years: the Ethiopian infant anthropometry and body composition (iABC) birth cohort study. Am J Clin Nutr 2024:S0002-9165(24)00339-3. [PMID: 38458400 DOI: 10.1016/j.ajcnut.2024.03.004] [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] [Received: 10/11/2023] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Variability in body mass index (BMI) (kg/m2) trajectories is associated with body composition and cardiometabolic markers in early childhood, but it is unknown how these associations track to later childhood. OBJECTIVES We aimed to assess associations of BMI trajectories from 0 to 5 y with body composition and cardiometabolic markers at 10 y. METHODS In the Ethiopian infant anthropometry and body composition (iABC) birth cohort, we previously identified 4 distinct BMI trajectories from 0 to 5 y: stable low BMI (19.2%), normal BMI (48.8%), rapid growth to high BMI (17.9%), and slow growth to high BMI (14.1%). At 10 y, we obtained data from 320 children on anthropometry, body composition, abdominal subcutaneous and visceral fat, and cardiometabolic markers. Associations of BMI trajectories and 10-y outcomes were analyzed using multiple linear regression. RESULTS Compared with children with the normal BMI trajectory, those with rapid growth to high BMI had 1.7 cm (95% CI: 0.1, 3.3) larger waist circumference and those with slow growth to high had 0.63 kg/m2 (95% CI: 0.09, 1.17) greater fat mass index and 0.19 cm (95% CI: 0.02, 0.37) greater abdominal subcutaneous fat, whereas those with stable low BMI had -0.28 kg/m2 (95% CI: -0.59, 0.03) lower fat-free mass at 10 y. Although the confidence bands were wide and included the null value, children with rapid growth to high BMI trajectory had 48.6% (95% CI: -1.4, 123.8) higher C-peptide concentration and those with slow growth to high BMI had 29.8% (95% CI: -0.8, 69.8) higher insulin and 30.3% (95% CI: -1.1, 71.6) higher homeostasis model assessment of insulin resistance, whereas those with rapid growth to high BMI had -0.23 mmol/L (95% CI: -0.47, 0.02) lower total cholesterol concentration. The trajectories were not associated with abdominal visceral fat, blood pressure, glucose, and other lipids at 10 y. CONCLUSIONS Children with rapid and slow growth to high BMI trajectories before 5 y tend to show higher measures of adiposity and higher concentrations of markers related to glucose metabolism at 10 y. CLINICAL TRIAL REGISTRY ISRCTN46718296 (https://www.isrctn.com/ISRCTN46718296).
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Affiliation(s)
- Bikila S Megersa
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
| | | | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Beakal Zinab
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Rahma Ali
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jonathan Ck Wells
- Childhood Nutrition Research Center, Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Rasmus Wibaek
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
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8
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Stel VS, Boenink R, Astley ME, Boerstra BA, Radunovic D, Skrunes R, Ruiz San Millán JC, Slon Roblero MF, Bell S, Ucio Mingo P, Ten Dam MAGJ, Ambühl PM, Resic H, Rodríguez Arévalo OL, Aresté-Fosalba N, Tort I Bardolet J, Lassalle M, Trujillo-Alemán S, Indridason OS, Artamendi M, Finne P, Rodríguez Camblor M, Nitsch D, Hommel K, Moustakas G, Kerschbaum J, Lausevic M, Jager KJ, Ortiz A, Kramer A. A comparison of the epidemiology of kidney replacement therapy between Europe and the United States: 2021 data of the ERA Registry and the USRDS. Nephrol Dial Transplant 2024:gfae040. [PMID: 38439701 DOI: 10.1093/ndt/gfae040] [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: 03/06/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS This paper compares the most recent data on the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT from Europe to those from the United States (US), including comparisons of treatment modalities (haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx)). METHODS Data were derived from the annual reports of the European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). The European data include information from national and regional renal registries providing the ERA Registry with individual patient data. Additional analyses were performed to present results for all participating European countries together. RESULTS In 2021, the KRT incidence in the US (409.7 per million population (pmp)) was almost 3-fold higher than in Europe (144.4 pmp). Despite the substantial difference in KRT incidence, approximately the same proportion of patients initiated HD (Europe: 82%, US: 84%), PD (14%; 13% respectively), or underwent pre-emptive KTx (4%; 3% respectively). The KRT prevalence in the US (2436.1 pmp) was 2-fold higher than in Europe (1187.8 pmp). Within Europe, approximately half of all prevalent patients were living with a functioning graft (47%), while in the US, this was one third (32%). The number of kidney transplantations performed was almost twice as high in the US (77.0 pmp) compared to Europe (41.6 pmp). The mortality of patients receiving KRT was 1.6-fold higher in the US (157.3 per 1000 patient years) compared to Europe (98.7 per 1000 patient years). CONCLUSIONS The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft.
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Affiliation(s)
- Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Rianne Boenink
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Megan E Astley
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Brittany A Boerstra
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Danilo Radunovic
- Clinical Center of Montenegro, Clinic for Nephrology, Podgorica, Montenegro
| | - Rannveig Skrunes
- Department of Medicine, Haukeland university Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Juan C Ruiz San Millán
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Cantabria, Spain
| | | | - Samira Bell
- Scottish Renal Registry, Public Health Scotland, Meridian Court, Glasgow, UK
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Pablo Ucio Mingo
- Coordinación Autonómica de Trasplantes de Castilla y León, Dirección General de Asistencia Sanitaria y Humanización, Gerencia Regional de Salud de Castilla y León, Valladolid, Castilla y León, Spain
| | | | | | - Halima Resic
- Society for Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Olga Lucia Rodríguez Arévalo
- Registry of Kidney Patients of the Valencian Community, General Directorate of Public Health, Ministry of Health, Valencia, Spain
- Health and Well-being Technologies Program, Polytechnic University of Valencia, Valencia, Spain
| | - Nuria Aresté-Fosalba
- Nephrology Department, Virgen Macarena Hospital, Seville, Andalusia, Spain
- Information System of Andalusian Transplant Coordination (SICATA), Seville, Andalusia, Spain
| | - Jaume Tort I Bardolet
- Catalan Transplant Organization (OCATT), Catalan Health Service, Department of Health Barcelona, Spain
| | - Mathilde Lassalle
- REIN registry (Renal Epidemiology and Information Network), Paris, France
| | - Sara Trujillo-Alemán
- Health Quality Assessment and Information System Service, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
| | - Olafur S Indridason
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Marta Artamendi
- Nephrology Department, Hospital San Pedro, Logroño, La Rioja, Spain
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine. Renal Unit, Royal Free London NHS Foundation Trust. UK Kidney Association, Bristol, UK
| | | | - George Moustakas
- Nephrology department, General hospital of Athens "G.Gennimatas", Athens, Greece
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Mirjana Lausevic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Nephrology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
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9
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Sam R, Rankin L, Ulasi I, Frantzen L, Nitsch D, Henner D, Molony D, Wagner J, Chen J, Agarwal SK, Howard A, Atkinson R, Landry D, Pastan SO, Kalantar-Zadeh K. Vaccination for Patients Receiving Dialysis. Kidney Med 2024; 6:100775. [PMID: 38435066 PMCID: PMC10906410 DOI: 10.1016/j.xkme.2023.100775] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Vaccinating patients receiving dialysis may prevent morbidity and mortality in this vulnerable population. The National Forum of End-Stage Renal Disease Networks (the Forum) published a revised vaccination toolkit in 2021 to update evidence and recommendations on vaccination for patients receiving dialysis. Significant changes in the last 10 years include more data supporting the use of a high-dose influenza vaccine, the introduction of the Heplisav-B vaccine for hepatitis B, and changes in pneumococcal vaccines, including the approval of the PCV15 and PCV20 to replace the PCV13 and PPSV23 vaccines. Additional key items include the introduction of vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), and a new vaccine to prevent respiratory syncytial virus disease. Historically, influenza and pneumococcal vaccinations were routinely administered by dialysis facilities, and because of possible risks of hematogenous spread of hepatitis B, dialysis providers often have detailed hepatitis B vaccine protocols. In March 2021, COVID-19 vaccines were made available for dialysis facilities to administer, although with the end of the public health emergency, vaccine policies by dialysis facilities against COVID-19 remains uncertain. The respiratory syncytial virus vaccine was authorized in 2023, and how dialysis facilities will approach this vaccine also remains uncertain. This review summarizes the Forum's vaccination toolkit and discusses the role of the dialysis facility in vaccinating patients to reduce the risk of severe infections.
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Affiliation(s)
- Ramin Sam
- Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Laura Rankin
- Kidney Specialists of Central Oklahoma, Oklahoma City, Oklahoma
| | - Ifeoma Ulasi
- Division of Nephrology, University of Nigeria, Enugu, Nigeria
- College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Luc Frantzen
- Service de Nephrologie, Hopital Saint Joseph, Marseilles, France
| | - Dorothea Nitsch
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Henner
- Division of Nephrology, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Donald Molony
- Division of Nephrology, University of Texas McGovern Medical School, Houston, Texas
- Division of Renal Diseases and Hypertension, McGovern Medical School, University of Texas Health, Houston, Texas
| | - John Wagner
- Division of Nephrology, New York City Health + Hospitals/Kings County, Brooklyn, New York
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Sanjay Kumar Agarwal
- Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India
- Nephrology and Renal Transplant Medicine, Marengo Asia Hospital, Gurugram and Faridabad, Haryana, India
| | - Andrew Howard
- Metropolitan Nephrology Associates PC, Clinton, Maryland
| | | | - Daniel Landry
- Division of Nephrology, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Stephen O. Pastan
- Division of Nephrology, Emory University School of Medicine, Atlanta, Georgia
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California, School of Medicine, Los Angeles, California
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Hajat S, Casula A, Murage P, Omoyeni D, Gray T, Plummer Z, Steenkamp R, Nitsch D. Ambient heat and acute kidney injury: case-crossover analysis of 1 354 675 automated e-alert episodes linked to high-resolution climate data. Lancet Planet Health 2024; 8:e156-e162. [PMID: 38453381 DOI: 10.1016/s2542-5196(24)00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/26/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND As global temperatures continue to rise, the effects of ambient heat on acute kidney injury (AKI) are of growing concern. We used a novel nationwide electronic alert (e-alert) system to detect increases in AKI risk associated with high temperatures. METHODS We used a case-crossover design to link 1 354 675 AKI episodes occurring in England between April and September in years 2017-2021 to daily maximum temperature data at postcode sector level. AKI episode data were obtained from the UK Renal Registry. There were no further inclusion or exclusion criteria. Conditional logistic regression employing distributed lag non-linear models was used to assess odds of AKI episode on case days compared with day-of-week matched control days. Effects during heatwaves were also assessed using heat-episode analysis. FINDINGS There were strongly increased odds of AKI episode associated with high temperatures, with odds ratio (OR) 1·623 (95% CI 1·319-1·997) on a day of temperature 32°C compared with one of 17°C, the effects being strongest on a lag of 1 day. There was an OR of 1·020 (1·019-1·020) per 1°C increase in temperature above 17°C. The odds of a heat-related AKI episode were similar between AKI stages 1 and 2, but considerably lower for stage 3 events. A 7-day heatwave in July 2021 was associated with a 28·6% increase in AKI counts (95% CI 26·5-30·7). INTERPRETATION Heat-related AKI is a growing public health challenge. As even small changes in renal function can affect patient outcomes, susceptible individuals should be advised to take preventive measures whenever hot weather is forecast. Use of an e-alert system allows effects in milder cases that do not require secondary care to also be detected. FUNDING National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Shakoor Hajat
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Peninah Murage
- London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Omoyeni
- London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Gray
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Zoe Plummer
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | | | - Dorothea Nitsch
- London School of Hygiene & Tropical Medicine, London, UK; UK Renal Registry, UK Kidney Association, Bristol, UK
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11
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ElHafeez SA, Kramer A, Arici M, Arnol M, Åsberg A, Bell S, Belliere J, Corte CD, Fresnedo GF, Hemmelder M, Heylen L, Hommel K, Kerschbaum J, Naumović R, Nitsch D, Santamaria R, Finne P, Palsson R, Pippias M, Resic H, Rosenberg M, de Pablos CS, Segelmark M, Sørensen SS, Soler MJ, Vidal E, Jager KJ, Ortiz A, Stel VS. Incidence and outcomes of kidney replacement therapy for end-stage kidney disease due to primary glomerular disease in Europe: findings from the ERA Registry. Nephrol Dial Transplant 2024:gfae034. [PMID: 38327216 DOI: 10.1093/ndt/gfae034] [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: 02/09/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS Primary glomerular disease (PGD) is a major cause of end-stage kidney disease (ESKD) leading to kidney replacement therapy (KRT). We aimed to describe incidence (trends) in individuals starting KRT for ESKD due to PGD and to examine their survival and causes of death. METHODS We used data from the European Renal Association (ERA) Registry on 69 854 patients who started KRT for ESKD due to PGD between 2000 and 2019. ERA primary renal disease codes were used to define six PGD subgroups. We examined age and sex standardized incidence, trend of the incidence, and survival. RESULTS The standardized incidence of KRT for ESKD due to PGD was 16.6 per million population (pmp), ranging from 8.6 pmp in Serbia to 20.0 pmp in France. IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) had the highest incidence of 4.6 pmp and 2.6 pmp, respectively. Histologically non-examined PGDs represented over 50% of cases in Serbia, Bosnia and Herzegovina, and Romania and were also common in Greece, Estonia, Belgium, and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, after which it stabilized. All PGD subgroups had five-year survival probabilities above 50%, with crescentic glomerulonephritis having the highest risk of death (adjusted hazard ratio: 1.8 [95% confidence interval: 1.6-1.9]) compared with IgAN. Cardiovascular disease was the most common cause of death (33.9%). CONCLUSION The incidence of KRT for ESKD due to PGD showed large differences between countries and was highest and increasing for IgAN and FSGS. Lack of kidney biopsy facilities in some countries may have affected accurate assignment of the cause of ESKD. The recognition of the incidence and outcomes of KRT among different PGD subgroups may contribute to a more individualized patient care approach.
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Affiliation(s)
- Samar Abd ElHafeez
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Anders Åsberg
- The Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, UK
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, University Hospital of Toulouse, Toulouse, France
| | - Carmen Díaz Corte
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo University, Oviedo, Spain
| | | | - Marc Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
| | - Line Heylen
- Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
- Dienst Nefrologie, Ziekenhuis Oost-Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | | | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | | | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK Renal Registry, Bristol, UK
| | - Rafael Santamaria
- Andalusian Autonomous Transplant Coordination Information System, Seville, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Patrik Finne
- Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Maria Pippias
- University of Bristol, Department of Health Care Evaluation, Population Health Sciences, Bristol, UK
- Bright Renal Unit, North Bristol NHS Trust, Bristol, UK
| | - Halima Resic
- Renal Registry of Society of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina, Clinic for Hemodialysis Sarajevo, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Mai Rosenberg
- Competence Centre for Rare Diseases, Tartu University Hospital, Tartu, Estonia
| | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Søren Schwartz Sørensen
- Department of Nephrology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Enrico Vidal
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Pediatric Nephrology Unit, University-Hospital of Padova, Padova, Italy
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
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12
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Gonzalez-Quiroz M, Heggeseth B, Camacho A, Oomatia A, Al-Rashed AM, Zhang Y, McCreight A, Jewell N, Aragon A, Nitsch D, Pearce N, Caplin B. Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy. Int J Epidemiol 2024; 53:dyad151. [PMID: 37930052 PMCID: PMC10859140 DOI: 10.1093/ije/dyad151] [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] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. METHODS Two community-based cohorts (adults aged 18-30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. RESULTS CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. CONCLUSIONS CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Department of Renal Medicine, University College London, London, UK
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Brianna Heggeseth
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Armando Camacho
- Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua, León (UNAN-Leon), León, Nicaragua
| | - Amin Oomatia
- Department of Renal Medicine, University College London, London, UK
| | - Ali M Al-Rashed
- Department of Renal Medicine, University College London, London, UK
| | - Yixuan Zhang
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Alexander McCreight
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Nicholas Jewell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurora Aragon
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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13
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Silva S, Fatumo S, Nitsch D. Mendelian randomization studies on coronary artery disease: a systematic review and meta-analysis. Syst Rev 2024; 13:29. [PMID: 38225600 PMCID: PMC10790478 DOI: 10.1186/s13643-023-02442-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide. We aimed to summarize what is currently known with regard to causal modifiable risk factors associated with CAD in populations of diverse ancestries through conducting a systematic review and meta-analysis of Mendelian randomization (MR) studies on CAD. METHODS The databases Embase, Medline, Cochrane Library and Web of Science were searched on the 19th and 20th of December 2022 for MR studies with CAD as a primary outcome; keywords of the search strategy included "coronary artery disease" and "mendelian randomization". Studies were included if they were published in the English language, included only human participants, employed Mendelian randomization as the primary methodology and studied CAD as the outcome of interest. The exclusion criteria resulted in the removal of studies that did not align with the predefined inclusion criteria, as well as studies which were systematic reviews themselves, and used the same exposure and outcome source as another study. An ancestry-specific meta-analysis was subsequently conducted on studies which investigated either body mass index, lipid traits, blood pressure or type 2 diabetes as an exposure variable. Assessment of publication bias and sensitivity analyses was conducted for risk of bias assessment in the included studies. RESULTS A total of 1781 studies were identified through the database searches after de-duplication was performed, with 47 studies included in the quantitative synthesis after eligibility screening. Approximately 80% of all included study participants for MR studies on CAD were of European descent irrespective of the exposure of interest, while no study included individuals of African ancestry. We found no evidence of differences in terms of direction of causation between ancestry groups; however, the strength of the respective relationships between each exposure and CAD were different, with this finding most evident when blood pressure was the exposure of interest. CONCLUSIONS Findings from this review suggest that patterns regarding the causational relationship between modifiable risk factors and CAD do not differ in terms of direction when compared across diverse ancestry populations. Differences in the observed strengths of the respective relationships however are indicative of the value of increasing representation in non-European populations, as novel genetic pathways or functional SNPs relating to CAD may be uncovered through a more global analysis. SYSTEMATIC REVIEW REGISTRATION The protocol for this systematic review was registered to the International Prospective Register of Systematic Reviews (PROSPERO) and is publicly available online (CRD42021272726).
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Affiliation(s)
- Sarah Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
- The African Computational Genomics (TACG) Research Group, MRC/UVRI, and LSHTM, Entebbe, Uganda.
| | - Segun Fatumo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
- The African Computational Genomics (TACG) Research Group, MRC/UVRI, and LSHTM, Entebbe, Uganda.
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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14
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Shan Y, Zhang J, Lu Y, Liao J, Liu Y, Dai L, Li J, Song C, Su G, Hägg S, Xiong Z, Nitsch D, Carrero JJ, Huang X. Kidney Function Measures and Mortality: A Mendelian Randomization Study. Am J Kidney Dis 2023:S0272-6386(23)00994-0. [PMID: 38151225 DOI: 10.1053/j.ajkd.2023.10.014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE & OBJECTIVE Individuals with a low estimated glomerular filtration rate (eGFR) are at a high risk of death. However, the causes underpinning this association are largely uncertain. This study aimed to assess the causal relationship of low eGFR with all-cause and cause-specific mortality. STUDY DESIGN Retrospective cohort study incorporating Mendelian randomization (MR). SETTING & PARTICIPANTS Individual-level data from 436,214 White participants (54.3% female; aged 56.8±8.0 years) included in the UK Biobank. EXPOSURES eGFR estimated using cystatin C (eGFRcyst). OUTCOMES The outcomes of interest included all-cause mortality, cardiovascular mortality, cancer mortality, infection mortality, and other-cause mortality. ANALYTICAL APPROACH Cox proportional hazards analysis for the conventional observational analyses; linear and nonlinear MR analyses implemented using genetic allele scores as instrumental variables representing kidney function to estimate the effect of kidney function on the survival outcomes. RESULTS During a median follow-up of 12.1 years, there were 30,489 deaths, 6,098 of which were attributed to cardiovascular events, 15,538 to cancer, 1,516 to infection, and 7,227 to other events. In the conventional observational analysis, eGFRcyst exhibited a nonlinear association with all the outcomes. MR analysis suggested that a genetically predicted lower eGFRcyst was linearly associated with a higher rate of cardiovascular mortality (HR, 1.43; 95% CI, 1.18-1.75) across the entire measurement range (every 10-mL/min/1.73m2 decrement). Nonetheless, no causal associations between eGFRcyst and all-cause mortality (HR, 1.07; 95% CI, 0.98-1.17) or any types of noncardiovascular mortality were detected. LIMITATIONS Potential misclassification of the actual cause of death, a nonrepresentative sample, and potential error in the interpretation of the magnitude of associations generated in MR analyses. CONCLUSIONS These findings suggest a potential causal association between low eGFR and cardiovascular mortality in the general population, but no causal relationship with all-cause mortality or noncardiovascular mortality was observed. Further studies in other populations are warranted to confirm these findings. PLAIN-LANGUAGE SUMMARY This study investigated the existence of a causal relationship between lower kidney function and death of different causes. Using data from 436,214 people in the United Kingdom, we applied conventional statistical analyses and those incorporating genetic data to implement Mendelian randomization, an approach that estimates causal associations. The observational analysis showed a nonlinear association between kidney function and various types of mortality outcomes. However, Mendelian randomization analysis suggested a linear increase in the risk of cardiovascular mortality with lower kidney function, but no causal link between the level of kidney function and all-cause or noncardiovascular mortality was identified. Managing kidney health may help reduce cardiovascular mortality, but caution is needed in interpreting the magnitudes of these results. Further validation in other populations and in those with advanced kidney failure is needed.
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Affiliation(s)
- Ying Shan
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Jingwen Zhang
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | | | - Jinlan Liao
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | | | - Liang Dai
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Jing Li
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Congying Song
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Guobin Su
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Sara Hägg
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, China
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Xiaoyan Huang
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, China; Renal Division, Peking University Shenzhen Hospital, Peking University, Shenzhen, China.
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Chen TK, Hoenig MP, Nitsch D, Grams ME. Advances in the management of chronic kidney disease. BMJ 2023; 383:e074216. [PMID: 38052474 DOI: 10.1136/bmj-2022-074216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Chronic kidney disease (CKD) represents a global public health crisis, but awareness by patients and providers is poor. Defined as persistent abnormalities in kidney structure or function for more than three months, manifested as either low glomerular filtration rate or presence of a marker of kidney damage such as albuminuria, CKD can be identified through readily available blood and urine tests. Early recognition of CKD is crucial for harnessing major advances in staging, prognosis, and treatment. This review discusses the evidence behind the general principles of CKD management, such as blood pressure and glucose control, renin-angiotensin-aldosterone system blockade, statin therapy, and dietary management. It additionally describes individualized approaches to treatment based on risk of kidney failure and cause of CKD. Finally, it reviews novel classes of kidney protective agents including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, non-steroidal selective mineralocorticoid receptor antagonists, and endothelin receptor antagonists. Appropriate, widespread implementation of these highly effective therapies should improve the lives of people with CKD and decrease the worldwide incidence of kidney failure.
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Affiliation(s)
- Teresa K Chen
- Kidney Health Research Collaborative and Division of Nephrology, Department of Medicine, University of California San Francisco; and San Francisco VA Health Care System, San Francisco, CA, USA
| | - Melanie P Hoenig
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Morgan E Grams
- Department of Medicine, New York University Langone School of Medicine, New York, NY, USA
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16
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Zinab B, Ali R, Megersa BS, Belachew T, Kedir E, Girma T, Abdisa A, Berhane M, Admasu B, Friis H, Abera M, Olsen MF, Andersen GS, Wells JCK, Filteau S, Wibaek R, Nitsch D, Yilma D. Association of linear growth velocities between 0 and 6 years with kidney function and size at 10 years: A birth cohort study in Ethiopia. Am J Clin Nutr 2023; 118:1145-1152. [PMID: 37758061 DOI: 10.1016/j.ajcnut.2023.09.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Risk of noncommunicable diseases accrues from fetal life, with early childhood growth having an important role in adult disease risk. There is a need to understand how early-life growth relates to kidney function and size. OBJECTIVES This study aimed to assess the association of linear growth velocities among children between 0 and 6 y with kidney function and size among children aged 10 y. METHODS The Ethiopian Anthropometric and Body Composition birth cohort recruited infants born at term to mothers living in Jimma with a birth weight of ≥1500 g and without congenital malformations. Participants were followed up with 13 measurements between birth and 6 y of age. The latest follow-up was at ages 7-12 y with measurement of serum cystatin C as a marker of kidney function and ultrasound assessment of kidney dimensions. Kidney volume was computed using an ellipsoid formula. Linear-spline multilevel modeling was used to compute linear growth velocities between 0 and 6 y. Multiple linear regression modeling was used to examine the associations of linear growth velocities in selected age periods with cystatin C and kidney size. RESULTS Data were captured from 355 children, at a mean age of 10 (range 7-12) y. The linear growth velocity was high between 0 and 3 mo and then decreased with age. There was no evidence of an association of growth velocity ≤24 mo with cystatin C at 10 y. Between 24 and 48 and 48 and 76 mo, serum cystatin C was higher by 2.3% [95% confidence interval (CI): 0.6, 4.2] and 2.1% (95% CI: 0.3, 4.0) for 1 SD higher linear growth velocity, respectively. We found a positive association between linear growth velocities at all intervals between 0 and 6 y and kidney volume. CONCLUSIONS Greater linear growth between 0 and 6 y of development was positively associated with kidney size, and greater growth velocity after 2 y was associated with higher serum cystatin C concentrations.
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Affiliation(s)
- Beakal Zinab
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.
| | - Rahma Ali
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Bikila S Megersa
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Melkamu Berhane
- Department of Pediatrics and Child Health Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bitiya Admasu
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Jonathan C K Wells
- Childhood Nutrition Research Center, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Yilma
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
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17
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Hafez G, Malyszko J, Golenia A, Klimkowicz-Mrowiec A, Ferreira AC, Arıcı M, Bruchfeld A, Nitsch D, Massy ZA, Pépin M, Capasso G, Mani LY, Liabeuf S. Drugs with a negative impact on cognitive functions (Part 2): drug classes to consider while prescribing in CKD patients. Clin Kidney J 2023; 16:2378-2392. [PMID: 38046029 PMCID: PMC10689198 DOI: 10.1093/ckj/sfad239] [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: 06/07/2023] [Indexed: 12/05/2023] Open
Abstract
There is growing evidence that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment, especially due to vascular damage, blood-brain barrier disruption and uremic toxins. Given the presence of multiple comorbidities, the medication regimen of CKD patients often becomes very complex. Several medications such as psychotropic agents, drugs with anticholinergic properties, GABAergic drugs, opioids, corticosteroids, antibiotics and others have been linked to negative effects on cognition. These drugs are frequently included in the treatment regimen of CKD patients. The first review of this series described how CKD could represent a risk factor for adverse drug reactions affecting the central nervous system. This second review will describe some of the most common medications associated with cognitive impairment (in the general population and in CKD) and describe their effects.
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Affiliation(s)
- Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Ana Carina Ferreira
- Nephrology Department, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
- Universidade Nova de Lisboa-Faculdade de Ciências Médicas-Nephology, Lisbon, Portugal
| | - Mustafa Arıcı
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ziad A Massy
- Paris-Saclay University, UVSQ, Inserm, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Villejuif, France
- Department of Nephrology, Ambroise Paré University Medical Center, APHP, Paris, France
| | - Marion Pépin
- Department of Nephrology, Ambroise Paré University Medical Center, APHP, Paris, France
- Department of Geriatrics, Ambroise Paré University Medical Center, APHP, Boulogne-Billancourt, France
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Laila-Yasmin Mani
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
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18
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Silva S, Nitsch D, Fatumo S. Genome-wide association studies on coronary artery disease: A systematic review and implications for populations of different ancestries. PLoS One 2023; 18:e0294341. [PMID: 38019802 PMCID: PMC10686512 DOI: 10.1371/journal.pone.0294341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are some of the leading causes of death worldwide, with coronary artery disease leading as one of the primary causes of mortality in both the developing and developed worlds. Despite its prevalence, there is a disproportionately small number of studies conducted in populations of non-European ancestry, with the limited sample sizes of such studies further restricting the power and generalizability of respective findings. This research aimed at understanding the differences in the genetic architecture of coronary artery disease (CAD) in populations of diverse ancestries in order to contribute towards the understanding of the pathophysiology of coronary artery disease. METHODS We performed a systematic review on the 6th of October, 2022 summarizing genome-wide association studies on coronary artery disease, while employing the GWAS Catalog as an independent database to support the search. We developed a framework to assess the methodological quality of each study. We extracted and grouped associated single nucleotide polymorphisms and genes according to ancestry groups of participants. RESULTS We identified 3100 studies, of which, 36 relevant studies were included in this research. Three of the studies that were included were not listed in the GWAS Catalog, highlighting the value of conducting an independent search alongside established databases in order to ensure the full research landscape has been captured. 743,919 CAD case participants from 25 different countries were analysed, with 61% of the studies identified in this research conducted in populations of European ancestry. No studies investigated populations of Africans living in continental Africa or admixed American ancestry groups besides African-Americans, while limited sample sizes were included of population groups besides Europeans and East Asians. This observed disproportionate population representation highlights the gaps in the literature, which limits our ability to understand coronary artery disease as a global disease. 71 genetic loci were identified to be associated with coronary artery disease in more than one article, with ancestry-specific genetic loci identified in each respective population group which were not detected in studies of other ancestries. CONCLUSIONS Although the replication and validation of these variants are still warranted, these finding are indicative of the value of including diverse ancestry populations in GWAS reference panels, as a more comprehensive understanding of the genetic architecture and pathophysiology of CAD can be achieved.
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Affiliation(s)
- Sarah Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The African Computational Genomics (TACG) Research Group, MRC/UVRI, and LSHTM, Entebbe, Uganda
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Segun Fatumo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The African Computational Genomics (TACG) Research Group, MRC/UVRI, and LSHTM, Entebbe, Uganda
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19
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Scott J, Bidulka P, Taylor DM, Udayaraj U, Caskey FJ, Birnie K, Deanfield J, de Belder M, Denaxas S, Weston C, Adlam D, Nitsch D. Management and outcomes of myocardial infarction in people with impaired kidney function in England. BMC Nephrol 2023; 24:325. [PMID: 37919679 PMCID: PMC10623815 DOI: 10.1186/s12882-023-03377-x] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK. METHODS Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015-2017. RESULTS In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people. CONCLUSIONS In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI.
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Affiliation(s)
- Jemima Scott
- Population Health Sciences, University of Bristol, Bristol, England.
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, England.
| | - Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, England
| | - Dominic M Taylor
- Population Health Sciences, University of Bristol, Bristol, England
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, England
| | - Udaya Udayaraj
- Oxford Kidney Unit, Churchill Hospital, Oxford, England
- Nuffield Department of Medicine, University of Oxford, Oxford, England
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, England
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, England
| | - Kate Birnie
- Population Health Sciences, University of Bristol, Bristol, England
| | - John Deanfield
- National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & Greater East Midlands Commissioning Support Unit, Leicester, England
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & Greater East Midlands Commissioning Support Unit, Leicester, England
| | - Spiros Denaxas
- British Heart Foundation, Data Science Centre, London, UK
- University College London Hospitals Biomedical Research Centre, London, UK
| | - Clive Weston
- Glangwili General Hospital, Dolgwili Road, Carmarthen, Wales, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, England
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20
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Zheng B, Campbell J, Carr EJ, Tazare J, Nab L, Mahalingasivam V, Mehrkar A, Santhakumaran S, Steenkamp R, Loud F, Lyon S, Scanlon M, Hulme WJ, Green ACA, Curtis HJ, Fisher L, Parker E, Goldacre B, Douglas I, Evans S, MacKenna B, Bell S, Tomlinson LA, Nitsch D. Comparative effectiveness of sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in patients on kidney replacement therapy: observational study using the OpenSAFELY-UKRR and SRR databases. Clin Kidney J 2023; 16:2048-2058. [PMID: 37915915 PMCID: PMC10616487 DOI: 10.1093/ckj/sfad184] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Due to limited inclusion of patients on kidney replacement therapy (KRT) in clinical trials, the effectiveness of coronavirus disease 2019 (COVID-19) therapies in this population remains unclear. We sought to address this by comparing the effectiveness of sotrovimab against molnupiravir, two commonly used treatments for non-hospitalised KRT patients with COVID-19 in the UK. Methods With the approval of National Health Service England, we used routine clinical data from 24 million patients in England within the OpenSAFELY-TPP platform linked to the UK Renal Registry (UKRR) to identify patients on KRT. A Cox proportional hazards model was used to estimate hazard ratios (HRs) of sotrovimab versus molnupiravir with regards to COVID-19-related hospitalisations or deaths in the subsequent 28 days. We also conducted a complementary analysis using data from the Scottish Renal Registry (SRR). Results Among the 2367 kidney patients treated with sotrovimab (n = 1852) or molnupiravir (n = 515) between 16 December 2021 and 1 August 2022 in England, 38 cases (1.6%) of COVID-19-related hospitalisations/deaths were observed. Sotrovimab was associated with substantially lower outcome risk than molnupiravir {adjusted HR 0.35 [95% confidence interval (CI) 0.17-0.71]; P = .004}, with results remaining robust in multiple sensitivity analyses. In the SRR cohort, sotrovimab showed a trend toward lower outcome risk than molnupiravir [HR 0.39 (95% CI 0.13-1.21); P = .106]. In both datasets, sotrovimab had no evidence of an association with other hospitalisation/death compared with molnupiravir (HRs ranged from 0.73 to 1.29; P > .05). Conclusions In routine care of non-hospitalised patients with COVID-19 on KRT, sotrovimab was associated with a lower risk of severe COVID-19 outcomes compared with molnupiravir during Omicron waves.
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Affiliation(s)
- Bang Zheng
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Jacqueline Campbell
- Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
| | | | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Linda Nab
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Susan Lyon
- Patient Council, UK Kidney Association, Bristol, UK
| | | | - William J Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amelia C A Green
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen J Curtis
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Edward Parker
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ian Douglas
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Stephen Evans
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Samira Bell
- Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- UK Renal Registry, Bristol, UK
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21
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Birnie K, Tomson C, Caskey FJ, Ben-Shlomo Y, Nitsch D, Casula A, Murray EJ, Sterne JAC. Comparative Effectiveness of Dynamic Treatment Strategies for Medication Use and Dosage: Emulating a Target Trial Using Observational Data. Epidemiology 2023; 34:879-887. [PMID: 37757876 PMCID: PMC7615288 DOI: 10.1097/ede.0000000000001649] [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] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Availability of detailed data from electronic health records (EHRs) has increased the potential to examine the comparative effectiveness of dynamic treatment strategies using observational data. Inverse probability (IP) weighting of dynamic marginal structural models can control for time-varying confounders. However, IP weights for continuous treatments may be sensitive to model choice. METHODS We describe a target trial comparing strategies for treating anemia with darbepoetin in hemodialysis patients using EHR data from the UK Renal Registry 2004 to 2016. Patients received a specified dose (microgram/week) or did not receive darbepoetin. We compared 4 methods for modeling time-varying treatment: (A) logistic regression for zero dose, standard linear regression for log dose; (B) logistic regression for zero dose, heteroscedastic linear regression for log dose; (C) logistic regression for zero dose, heteroscedastic linear regression for log dose, multinomial regression for patients who recently received very low or high doses; and (D) ordinal logistic regression. RESULTS For this dataset, method (C) was the only approach that provided a robust estimate of the mortality hazard ratio (HR), with less-extreme weights in a fully weighted analysis and no substantial change of the HR point estimate after weight truncation. After truncating IP weights at the 95th percentile, estimates were similar across the methods. CONCLUSIONS EHR data can be used to emulate target trials estimating the comparative effectiveness of dynamic strategies adjusting treatment to evolving patient characteristics. However, model checking, monitoring of large weights, and adaptation of model strategies to account for these is essential if an aspect of treatment is continuous.
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Affiliation(s)
- Kate Birnie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Eleanor J Murray
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Jonathan AC Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Health Data Research UK South-West
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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22
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Grams ME, Coresh J, Matsushita K, Ballew SH, Sang Y, Surapaneni A, Alencar de Pinho N, Anderson A, Appel LJ, Ärnlöv J, Azizi F, Bansal N, Bell S, Bilo HJG, Brunskill NJ, Carrero JJ, Chadban S, Chalmers J, Chen J, Ciemins E, Cirillo M, Ebert N, Evans M, Ferreiro A, Fu EL, Fukagawa M, Green JA, Gutierrez OM, Herrington WG, Hwang SJ, Inker LA, Iseki K, Jafar T, Jassal SK, Jha V, Kadota A, Katz R, Köttgen A, Konta T, Kronenberg F, Lee BJ, Lees J, Levin A, Looker HC, Major R, Melzer Cohen C, Mieno M, Miyazaki M, Moranne O, Muraki I, Naimark D, Nitsch D, Oh W, Pena M, Purnell TS, Sabanayagam C, Satoh M, Sawhney S, Schaeffner E, Schöttker B, Shen JI, Shlipak MG, Sinha S, Stengel B, Sumida K, Tonelli M, Valdivielso JM, van Zuilen AD, Visseren FLJ, Wang AYM, Wen CP, Wheeler DC, Yatsuya H, Yamagata K, Yang JW, Young A, Zhang H, Zhang L, Levey AS, Gansevoort RT. Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis. JAMA 2023; 330:1266-1277. [PMID: 37787795 PMCID: PMC10548311 DOI: 10.1001/jama.2023.17002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/15/2023] [Indexed: 10/04/2023]
Abstract
Importance Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. Objective To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. Design, Setting, and Participants Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. Exposures The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). Main Outcomes and Measures The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. Results Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). Conclusions and Relevance In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.
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Affiliation(s)
- Morgan E Grams
- Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shoshana H Ballew
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Yingying Sang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Aditya Surapaneni
- Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Amanda Anderson
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Lawrence J Appel
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences, and Society, Family Medicine and Primary Care Unit, Karolinska Institutet, Huddinge, Sweden
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland
| | - Henk J G Bilo
- Diabetes Centre and Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, University of Leicester, and John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden
| | - Steve Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - John Chalmers
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College, London, England
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jing Chen
- Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Massimo Cirillo
- Department Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie Evans
- Department of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Alejandro Ferreiro
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, School of Medicine, Tokai University, Isehara, Japan
| | - Jamie A Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
- Center for Kidney Health Research, Geisinger, Danville, Pennsylvania
| | | | - William G Herrington
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, England
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, England
| | - Shih-Jen Hwang
- Framingham Heart Study, Framingham, Massachusetts
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | | | - Tazeen Jafar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Simerjot K Jassal
- University of California-San Diego, La Jolla
- San Diego VA Health Care System, San Diego, California
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- George Institute for Global Health, School of Public Health, Imperial College, London, England
| | - Aya Kadota
- Department of Public Health, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Brian J Lee
- Kaiser Permanente, Hawaii Region, and Moanalua Medical Center, Honolulu, Hawai'i
| | - Jennifer Lees
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Helen C Looker
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Rupert Major
- Department of Cardiovascular Sciences, University of Leicester, and John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Cheli Melzer Cohen
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Mariko Miyazaki
- Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Olivier Moranne
- Service de Néphrologie Dialyse Aphérèse, Nîmes Hôpital Universitaire, Nîmes, France
- IDESP, UMR-INSERM, Universite de Montpellier, Montpellier, France
| | - Isao Muraki
- Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| | - David Naimark
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, England
| | - Wonsuk Oh
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle Pena
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tanjala S Purnell
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Division of Transplantation, Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Michihiro Satoh
- Division of Public Health, Hygiene, and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, Scotland
- NHS Grampian, Aberdeen, Scotland
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Jenny I Shen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco
- General Internal Medicine Division, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Smeeta Sinha
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, England
| | - Benedicte Stengel
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, Biomedical Research Institute of Lleida, IRBLleida and University of Lleida, Lleida, Spain
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Chi-Pang Wen
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan/China Medical University Hospital, Taichung, Taiwan
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, England
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Jae Won Yang
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Ann Young
- Division of Nephrology, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- ICES Western, London, Ontario, Canada
| | - Haitao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Luxia Zhang
- Peking University First Hospital, Beijing, China
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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23
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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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24
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Andresen K, Carreira H, Strongman H, McDonald HI, Benitez-Majano S, Mansfield KE, Nitsch D, Tomlinson LA, Bhaskaran K. The risk of acute kidney injury in colorectal cancer survivors: an english population-based matched cohort study. BMC Cancer 2023; 23:839. [PMID: 37679679 PMCID: PMC10483792 DOI: 10.1186/s12885-023-11329-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Colorectal cancer survival has improved in recent decades but there are concerns that survivors may develop kidney problems due to adverse effects of cancer treatment or complications of the cancer itself. We quantified the risk of acute kidney injury (AKI) in colorectal cancer survivors compared to people with no prior cancer. METHODS Retrospective matched cohort study using electronic health record primary care data from the Clinical Practice Research Datalink GOLD linked to hospital data in England (HES-APC). Individuals with colorectal cancer between 1997-2018 were individually matched on age, sex, and GP practice to people with no prior cancer. We used Cox models to estimate hazard ratios for an incident hospital diagnosis of AKI in colorectal cancer survivors compared to individuals without cancer, overall and stratified by time since diagnosis adjusted for other individual-level factors (adj-HR). RESULTS Twenty thousand three hundred forty colorectal cancer survivors were matched to 100,058 cancer-free individuals. Colorectal cancer survivors were at increased risk of developing AKI compared to people without cancer (adj-HR = 2.16; 95%CI 2.05-2.27). The HR was highest in the year after diagnosis (adj-HR 7.47, 6.66-8.37), and attenuated over time, but there was still increased AKI risk > 5 years after diagnosis (adj-HR = 1.26, 1.17-1.37). The association between colorectal cancer and AKI was greater for younger people, men, and those with pre-existing chronic kidney disease. CONCLUSIONS Colorectal cancer survivors were at increased risk of AKI for several years after cancer diagnosis, suggesting a need to prioritise monitoring, prevention, and management of kidney problems in this group of cancer survivors.
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Affiliation(s)
- Kirsty Andresen
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Helen Strongman
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Helen I McDonald
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sara Benitez-Majano
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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25
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Mayanja R, Machipisa T, Soremekun O, Kamiza AB, Kintu C, Kalungi A, Kalyesubula R, Sande OJ, Jjingo D, Fabian J, Robinson-Cohen C, Franceschini N, Nitsch D, Nyirenda M, Zeggini E, Morris AP, Chikowore T, Fatumo S. Genome-wide association analysis of cystatin-C kidney function in continental Africa. EBioMedicine 2023; 95:104775. [PMID: 37639939 PMCID: PMC10474146 DOI: 10.1016/j.ebiom.2023.104775] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Chronic kidney disease is becoming more prevalent in Africa, and its genetic determinants are poorly understood. Creatinine-based estimated glomerular filtration rate (eGFR) is commonly used to estimate kidney function, modelling the excretion of the endogenous biomarker (creatinine). However, eGFR based on creatinine has been shown to inadequately detect individuals with low kidney function in Sub-Saharan Africa, with eGFR based on cystatin-C (eGFRcys) exhibiting significantly superior performance. Therefore, we opted to conduct a GWAS for eGFRcys. METHODS Using the Uganda Genomic Resource, we performed a genome-wide association study (GWAS) of eGFRcys in 5877 Ugandans and evaluated replication in independent studies. Subsequently, putative causal variants were screened through Bayesian fine-mapping. Functional annotation of the GWAS loci was performed using Functional Mapping and Annotation (FUMA). FINDINGS Three independent lead single nucleotide polymorphisms (SNPs) (P-value <5 × 10-8 (based on likelihood ratio test (LRT))) were identified; rs59288815 (ANK3), rs4277141 (OR51B5) and rs911119 (CST3). From fine-mapping, rs59288815 and rs911119 each had a posterior probability of causality of >99%. The rs911119 SNP maps to the cystatin C gene and has been previously associated with eGFRcys among Europeans. With gene-set enrichment analyses of the olfactory receptor family 51 overlapping genes, we identified an association with the G-alpha-S signalling events. INTERPRETATION Our study found two previously unreported associated SNPs for eGFRcys in continental Africans (rs59288815 and rs4277141) and validated a previously well-established SNP (rs911119) for eGFRcys. The identified gene-set enrichment for the G-protein signalling pathways relates to the capacity of the kidney to readily adapt to an ever-changing environment. Additional GWASs are required to represent the diverse regions in Africa. FUNDING Wellcome (220740/Z/20/Z).
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Affiliation(s)
- Richard Mayanja
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Tafadzwa Machipisa
- Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa; Clinical Research Laboratory-Genetic and Molecular Epidemiology Laboratory (CRLB-GMEL), Population Health Research Institute (PHRI) & McMaster University, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada
| | - Opeyemi Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Abram B Kamiza
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Christopher Kintu
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Allan Kalungi
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Robert Kalyesubula
- Medical Research Council/ Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Obondo J Sande
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics (ACE-B), Makerere University, Kampala, Uganda
| | - June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cassianne Robinson-Cohen
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nora Franceschini
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Moffat Nyirenda
- Clinical Research Laboratory-Genetic and Molecular Epidemiology Laboratory (CRLB-GMEL), Population Health Research Institute (PHRI) & McMaster University, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada; London School of Hygiene and Tropical Medicine London, UK
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; TUM School of Medicine, Translational Genomics, Technical University of Munich and Klinikum Rechts der Isar, Munich, Germany
| | - Andrew P Morris
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Tinashe Chikowore
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Medical Research Council/ Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine London, UK; Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
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26
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Ponce D, Nitsch D, Ikizler TA. Strategies to Prevent Infections in Dialysis Patients. Semin Nephrol 2023; 43:151467. [PMID: 38199826 DOI: 10.1016/j.semnephrol.2023.151467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. Vascular access is a major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. Catheter-related bacteremia is the most severe central venous catheter (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. Peritoneal dialysis chronic treatment without the occurence of peritonitis is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal dialysis catheter. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.
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Affiliation(s)
- Daniela Ponce
- Division of Internal Medicine, Botucatu School of Medicine, University of São Paulo State (UNESP). Botucatu, Sao paulo, Brazil.
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
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27
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Megersa BS, Zinab B, Ali R, Kedir E, Girma T, Berhane M, Admassu B, Friis H, Abera M, Olsen MF, Filteau S, Nitsch D, Yilma D, Wells JC, Andersen GS, Wibaek R. Associations of weight and body composition at birth with body composition and cardiometabolic markers in children aged 10 y: the Ethiopian infant anthropometry and body composition birth cohort study. Am J Clin Nutr 2023; 118:412-421. [PMID: 37328067 DOI: 10.1016/j.ajcnut.2023.06.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Although birth weight (BW) has been associated with later cardiovascular disease and type 2 diabetes, the role of birth fat mass (BFM) and birth fat-free mass (BFFM) on cardiometabolic health is unclear. OBJECTIVES To examine associations of BW, BFM, and BFFM with later anthropometry, body composition, abdominal fat, and cardiometabolic markers. METHODS Birth cohort data on standardized exposure variables (BW, BFM, and BFFM) and follow-up information at age 10 y on anthropometry, body composition, abdominal fat, and cardiometabolic markers were included. A linear regression analysis was used to assess associations of exposures with outcome variables, adjusting for maternal and child characteristics at birth and current body size in separate models. RESULTS Among 353 children, mean (SD) age was 9.8 (1.0) y, and 51.5% were boys. In the fully adjusted model, 1-SD higher BW and BFFM were associated with 0.81 cm (95% CI: 0.21, 1.41 cm) and 1.25 cm (95% CI: 0.64, 1.85 cm) greater height at 10 y, respectively. The 1-SD higher BW and BFM were associated with 0.32 kg/m2 (95% CI: 0.14, 0.51 kg/m2) and 0.42 kg/m2 (95% CI: 0.25, 0.59 kg/m2) greater fat mass index at 10 y, respectively. In addition, 1-SD higher BW and BFFM were associated with 0.22 kg/m2 (95% CI: 0.09, 0.34 kg/m2) greater FFM index, whereas a 1-SD greater BFM was associated with a 0.05 cm greater subcutaneous adipose tissue (95% CI: 0.01, 0.11 cm). Furthermore, 1-SD higher BW and BFFM were associated with 10.3% (95% CI: 1.4%, 20.0%) and 8.3% (95% CI: -0.5%, 17.9%) greater insulin, respectively. Similarly, 1-SD higher BW and BFFM were associated with 10.0% (95% CI: 0.9%, 20.0%) and 8.5% (95% CI: -0.6%, 18.5%) greater homeostasis model assessment of insulin resistance, respectively. CONCLUSIONS BW and BFFM rather than BFM are predictors of height and FFM index at 10 y. Children with higher BW and BFFM showed higher insulin concentrations and homeostasis model assessment of insulin resistance at 10 y of age. This trial was registered at ISRCTN as ISRCTN46718296.
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Affiliation(s)
- Bikila S Megersa
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Beakal Zinab
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Rahma Ali
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Yilma
- Department of Internal Medicine; Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jonathan Ck Wells
- Childhood Nutrition Research Center, Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Rasmus Wibaek
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
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28
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Plumb L, Casula A, Sinha MD, Inward CD, Marks SD, Medcalf J, Nitsch D. Epidemiology of childhood acute kidney injury in England using e-alerts. Clin Kidney J 2023; 16:1288-1297. [PMID: 37529656 PMCID: PMC10387403 DOI: 10.1093/ckj/sfad070] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 08/03/2023] Open
Abstract
Background Few studies describe the epidemiology of childhood acute kidney injury (AKI) nationally. Laboratories in England are required to issue electronic (e-)alerts for AKI based on serum creatinine changes. This study describes a national cohort of children who received an AKI alert and their clinical course. Methods A cross-section of AKI episodes from 2017 are described. Hospital record linkage enabled description of AKI-associated hospitalizations including length of stay (LOS) and critical care requirement. Risk associations with critical care (hospitalized cohort) and 30-day mortality (total cohort) were examined using multivariable logistic regression. Results In 2017, 7788 children (52% male, median age 4.4 years, interquartile range 0.9-11.5 years) experienced 8927 AKI episodes; 8% occurred during birth admissions. Of 5582 children with hospitalized AKI, 25% required critical care. In children experiencing an AKI episode unrelated to their birth admission, Asian ethnicity, young (<1 year) or old (16-<18 years) age (reference 1-<5 years), and high peak AKI stage had higher odds of critical care. LOS was higher with peak AKI stage, irrespective of critical care admission. Overall, 30-day mortality rate was 3% (n = 251); youngest and oldest age groups, hospital-acquired AKI, higher peak stage and critical care requirement had higher odds of death. For children experiencing AKI alerts during their birth admission, no association was seen between higher peak AKI stage and critical care admission. Conclusions Risk associations for adverse AKI outcomes differed among children according to AKI type and whether hospitalization was related to birth. Understanding the factors driving AKI development and progression may help inform interventions to minimize morbidity.
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Affiliation(s)
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Manish D Sinha
- Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK
- British Heart Foundation Centre, Kings College London, London, UK
| | - Carol D Inward
- Department of Paediatric Nephrology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - James Medcalf
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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29
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Graham S, Tessier E, Stowe J, Bernal JL, Parker EPK, Nitsch D, Miller E, Andrews N, Walker JL, McDonald HI. Bias assessment of a test-negative design study of COVID-19 vaccine effectiveness used in national policymaking. Nat Commun 2023; 14:3984. [PMID: 37414791 PMCID: PMC10325974 DOI: 10.1038/s41467-023-39674-0] [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] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
National test-negative-case-control (TNCC) studies are used to monitor COVID-19 vaccine effectiveness in the UK. A questionnaire was sent to participants from the first published TNCC COVID-19 vaccine effectiveness study conducted by the UK Health Security Agency, to assess for potential biases and changes in behaviour related to vaccination. The original study included symptomatic adults aged ≥70 years testing for COVID-19 between 08/12/2020 and 21/02/2021. A questionnaire was sent to cases and controls tested from 1-21 February 2021. In this study, 8648 individuals responded to the questionnaire (36.5% response). Using information from the questionnaire to produce a combined estimate that accounted for all potential biases decreased the original vaccine effectiveness estimate after two doses of BNT162b2 from 88% (95% CI: 79-94%) to 85% (95% CI: 68-94%). Self-reported behaviour demonstrated minimal evidence of riskier behaviour after vaccination. These findings offer reassurance to policy makers and clinicians making decisions based on COVID-19 vaccine effectiveness TNCC studies.
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Affiliation(s)
- Sophie Graham
- London School of Hygiene and Tropical Medicine, London, UK.
- UK Health Security Agency, London, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK.
| | | | | | | | | | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, UK
- UK Renal Registry, Bristol, UK
- Renal Unit, Royal Free London NHS Foundation Trust, Hertfordshire, UK
| | - Elizabeth Miller
- London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Nick Andrews
- UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Jemma L Walker
- London School of Hygiene and Tropical Medicine, London, UK
- UK Health Security Agency, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Helen I McDonald
- London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London, UK
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30
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Soremekun O, Musanabaganwa C, Uwineza A, Ardissino M, Rajasundaram S, Wani AH, Jansen S, Mutabaruka J, Rutembesa E, Soremekun C, Cheickna C, Wele M, Mugisha J, Nash O, Kinyanda E, Nitsch D, Fornage M, Chikowore T, Gill D, Wildman DE, Mutesa L, Uddin M, Fatumo S. A Mendelian randomization study of genetic liability to post-traumatic stress disorder and risk of ischemic stroke. Transl Psychiatry 2023; 13:237. [PMID: 37391434 PMCID: PMC10313806 DOI: 10.1038/s41398-023-02542-y] [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: 03/08/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
Observational studies have shown an association between post-traumatic stress disorder (PTSD) and ischemic stroke (IS) but given the susceptibility to confounding it is unclear if these associations represent causal effects. Mendelian randomization (MR) facilitates causal inference that is robust to the influence of confounding. Using two sample MR, we investigated the causal effect of genetic liability to PTSD on IS risk. Ancestry-specific genetic instruments of PTSD and four quantitative sub-phenotypes of PTSD, including hyperarousal, avoidance, re-experiencing, and total symptom severity score (PCL-Total) were obtained from the Million Veteran Programme (MVP) using a threshold P value (P) of <5 × 10-7, clumping distance of 1000 kilobase (Mb) and r2 < 0.01. Genetic association estimates for IS were obtained from the MEGASTROKE consortium (Ncases = 34,217, Ncontrols = 406,111) for European ancestry individuals and from the Consortium of Minority Population Genome-Wide Association Studies of Stroke (COMPASS) (Ncases = 3734, Ncontrols = 18,317) for African ancestry individuals. We used the inverse-variance weighted (IVW) approach as the main analysis and performed MR-Egger and the weighted median methods as pleiotropy-robust sensitivity analyses. In European ancestry individuals, we found evidence of an association between genetic liability to PTSD avoidance, and PCL-Total and increased IS risk (odds ratio (OR)1.04, 95% Confidence Interval (CI) 1.007-1.077, P = 0.017 for avoidance and (OR 1.02, 95% CI 1.010-1.040, P = 7.6 × 10-4 for PCL total). In African ancestry individuals, we found evidence of an association between genetically liability to PCL-Total and reduced IS risk (OR 0.95 (95% CI 0.923-0.991, P = 0.01) and hyperarousal (OR 0.83 (95% CI 0.691-0.991, P = 0.039) but no association was observed for PTSD case-control, avoidance, or re-experiencing. Similar estimates were obtained with MR sensitivity analyses. Our findings suggest that specific sub-phenotypes of PTSD, such as hyperarousal, avoidance, PCL total, may have a causal effect on people of European and African ancestry's risk of IS. This shows that the molecular mechanisms behind the relationship between IS and PTSD may be connected to symptoms of hyperarousal and avoidance. To clarify the precise biological mechanisms involved and how they may vary between populations, more research is required.
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Affiliation(s)
- Opeyemi Soremekun
- The African Computational Genomics (TACG) Research group, MRC/UVRI and LSHTM, Entebbe, Uganda
- Discipline of Pharmaceutical Chemistry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Annette Uwineza
- Department of Biochemistry, Molecular Biology and Genetics, CMHS, University of Rwanda, Kigali, Rwanda
- Center for Human Genetics at the College of Medicine and Health Sciences-University of Rwanda, Kigali, Rwanda
| | - Maddalena Ardissino
- Department of Epidemiology and Biostatistics, Medical School Building, St Mary's Hospital, Imperial College London, London, UK
| | - Skanda Rajasundaram
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Agaz H Wani
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Stefan Jansen
- Directorate of Research and Innovation, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, University of Rwanda, Kigali, Rwanda
| | - Eugene Rutembesa
- Department of Clinical Psychology, University of Rwanda, Kigali, Rwanda
| | - Chisom Soremekun
- The African Computational Genomics (TACG) Research group, MRC/UVRI and LSHTM, Entebbe, Uganda
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria
| | - Cisse Cheickna
- The African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mamadou Wele
- The African Center of Excellence in Bioinformatics, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | | | - Oyekanmi Nash
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria
| | | | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology (NCDE), London School of Hygiene and Tropical Medicine, London, UK
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Austin, USA
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Austin, USA
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, Medical School Building, St Mary's Hospital, Imperial College London, London, UK
| | - Derek E Wildman
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Leon Mutesa
- Center for Human Genetics at the College of Medicine and Health Sciences-University of Rwanda, Kigali, Rwanda
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research group, MRC/UVRI and LSHTM, Entebbe, Uganda.
- H3Africa Bioinformatics Network (H3ABioNet) Node, Centre for Genomics Research and Innovation, NABDA/FMST, Abuja, Nigeria.
- MRC/UVRI and LSHTM, Entebbe, Uganda.
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31
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Magadi W, Peracha J, McKane WS, Savino M, Braddon F, Steenkamp R, Nitsch D. Do outcomes for patients with hospital-acquired Acute Kidney Injury (H-AKI) vary across specialties in England? BMC Nephrol 2023; 24:193. [PMID: 37386432 PMCID: PMC10308766 DOI: 10.1186/s12882-023-03197-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/13/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Acute Kidney Injury (AKI) is a common and serious clinical syndrome. There is increasing recognition of heterogeneity in observed AKI across different clinical settings. In this analysis we have utilised a large national dataset to outline, for the first time, differences in burden of hospital acquired AKI (H-AKI) and mortality risk across different treatment specialities in the English National Health Service (NHS). METHODS A retrospective observational study was conducted using a large national dataset of patients who triggered a biochemical AKI alert in England during 2019. This dataset was enriched through linkage with NHS hospitals administrative and mortality data. Episodes of H-AKI were identified and attributed to the speciality of the supervising consultant during the hospitalisation episode in which the H-AKI alert was generated. Associations between speciality and death in hospital or within 30 days of discharge (30-day mortality) was modelled using logistic regression, adjusting for patient age, sex, ethnicity, socioeconomic status, AKI severity, season and method of admission. RESULTS In total, 93,196 episodes of H-AKI were studied. The largest number of patients with H-AKI were observed under general medicine (21.9%), care of the elderly (18.9%) and general surgery (11.2%). Despite adjusting for differences in patient case-mix, 30-day mortality risk was consistently lower for patients in surgical specialities compared to general medicine, including general surgery (OR 0.65, 95% CI 0.61 to 0.7) and trauma and orthopaedics (OR 0.52, 95% CI 0.48 to 0.56). Mortality risk was highest in critical care (OR 1.78, 95% CI 1.56 to 2.03) and oncology (OR 1.74, CI 1.54 to 1.96). CONCLUSIONS Significant differences were identified in the burden of H-AKI and associated mortality risk for patients across different specialities in the English NHS. This work can help inform future service delivery and quality improvement activity for patients with AKI across the NHS.
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Affiliation(s)
- Winnie Magadi
- UK Renal Registry, UK Kidney Association, Bristol, UK.
- UK Renal Registry, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK.
| | - Javeria Peracha
- Department of Nephrology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - William S McKane
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHSFT, Sheffield, UK
| | - Manuela Savino
- Acute Internal Medicine, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Fiona Braddon
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | | | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
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Wong E, Peracha J, Pitcher D, Casula A, Steenkamp R, Medcalf JF, Nitsch D. Seasonal mortality trends for hospitalised patients with acute kidney injury across England. BMC Nephrol 2023; 24:144. [PMID: 37226118 DOI: 10.1186/s12882-023-03094-5] [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] [Received: 09/14/2022] [Accepted: 02/22/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Incidence of acute kidney injury (AKI) is known to peak in winter months. This is likely influenced by seasonality of commonly associated acute illnesses. We set out to assess seasonal mortality trends for patients who develop AKI across the English National Health Service (NHS) and to better understand associations with patient 'case-mix'. METHODS The study cohort included all hospitalised adult patients in England who triggered a biochemical AKI alert in 2017. We modelled the impact of season on 30-day mortality using multivariable logistic regression; adjusting for age, sex, ethnicity, index of multiple deprivation (IMD), primary diagnosis, comorbidity (RCCI), elective/emergency admission, peak AKI stage and community/hospital acquired AKI. Seasonal odds ratios for AKI mortality were then calculated and compared across individual NHS hospital trusts. RESULTS The crude 30-day mortality for hospitalised AKI patients was 33% higher in winter compared to summer. Case-mix adjustment for a wide range of clinical and demographic factors did not fully explain excess winter mortality. The adjusted odds ratio of patients dying in winter vs. summer was 1.25 (1.22-1.29), this was higher than for Autumn and Spring vs. Summer, 1.09 (1.06-1.12) and 1.07 (1.04-1.11) respectively and varied across different NHS trusts (9 out of 90 centres outliers). CONCLUSION We have demonstrated an excess winter mortality risk for hospitalised patients with AKI across the English NHS, which could not be fully explained by seasonal variation in patient case-mix. Whilst the explanation for worse winter outcomes is not clear, unaccounted differences including 'winter-pressures' merit further investigation.
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Affiliation(s)
- Esther Wong
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Javeria Peracha
- Department of Renal Medicine, Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - David Pitcher
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Renal Medicine, University College London, London, UK
| | - Anna Casula
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - Retha Steenkamp
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - James F Medcalf
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Dorothea Nitsch
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Nephrology, Royal Free London NHS Foundation trust, London, NW3 2QG, UK
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Santhakumaran S, Savino M, Benoy-Deeney F, Steenkamp R, Medcalf J, Nitsch D. What data collection methods work best for COVID19 outbreak surveillance for people with end stage kidney disease? An observational cohort study using the UK Renal Registry. BMC Nephrol 2023; 24:130. [PMID: 37158816 PMCID: PMC10166021 DOI: 10.1186/s12882-023-03148-8] [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] [Received: 07/06/2022] [Accepted: 03/31/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Patients on kidney replacement therapy (KRT) are vulnerable to severe illness from COVID-19. Timely, accurate surveillance is essential for planning and implementing infection control at local, regional and national levels. Our aim was to compare two methods of data collection for COVID-19 infections amongst KRT patients in England. METHODS Adults receiving KRT in England were linked to two sources of data on positive COVID-19 tests recorded March-August 2020: (1) submissions from renal centres to the UK Renal Registry (UKRR) and (2) Public Health England (PHE) laboratory data. Patient characteristics, cumulative incidence by modality (in-centre haemodialysis (ICHD), home HD, peritoneal dialysis (PD) and transplant), and 28-day survival were compared between the two sources. RESULTS 2,783/54,795 patients (5.1%) had a positive test in the combined UKRR-PHE dataset. Of these 2,783, 87% had positive tests in both datasets. Capture was consistently high for PHE (> 95% across modalities) but varied for UKRR (ranging from ICHD 95% to transplant 78%, p < 0.0001). Patients captured only by PHE were more likely to be on transplant or home therapies (OR 3.5 95% CI [2.3-5.2] vs. ICHD) and to be infected in later months (OR 3.3 95%CI [2.4-4.6] for May-June, OR 6.5 95%CI [3.8-11.3] for July-August, vs. March-April), compared to patients in both datasets. Stratified by modality, patient characteristics and 28-day survival were similar between datasets. CONCLUSIONS For patients undergoing ICHD treatment the collection of data submitted directly by renal centres allows constant monitoring in real time. For other KRT modalities, using a national swab test dataset through frequent linkage may be the most effective method. Optimising central surveillance can improve patient care by informing interventions and assisting planning at local, regional and national levels.
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Affiliation(s)
- Shalini Santhakumaran
- UK Renal Registry, Brandon House Building 20A1 Southmead Road Filton, Bristol, BS34 7RR, UK.
| | - Manuela Savino
- UK Renal Registry, Brandon House Building 20A1 Southmead Road Filton, Bristol, BS34 7RR, UK
- Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Fran Benoy-Deeney
- UK Renal Registry, Brandon House Building 20A1 Southmead Road Filton, Bristol, BS34 7RR, UK
| | - Retha Steenkamp
- UK Renal Registry, Brandon House Building 20A1 Southmead Road Filton, Bristol, BS34 7RR, UK
| | - James Medcalf
- UK Renal Registry, Brandon House Building 20A1 Southmead Road Filton, Bristol, BS34 7RR, UK
- University of Leicester, Leicester, UK
- Leicester General Hospital, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, Brandon House Building 20A1 Southmead Road Filton, Bristol, BS34 7RR, UK
- London School of Hygiene and Tropical Medicine, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Parker EP, Horne EM, Hulme WJ, Tazare J, Zheng B, Carr EJ, Loud F, Lyon S, Mahalingasivam V, MacKenna B, Mehrkar A, Scanlon M, Santhakumaran S, Steenkamp R, Goldacre B, Sterne JA, Nitsch D, Tomlinson LA. Comparative effectiveness of two- and three-dose COVID-19 vaccination schedules involving AZD1222 and BNT162b2 in people with kidney disease: a linked OpenSAFELY and UK Renal Registry cohort study. Lancet Reg Health Eur 2023; 30:100636. [PMID: 37363796 PMCID: PMC10155829 DOI: 10.1016/j.lanepe.2023.100636] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 06/28/2023]
Abstract
Background Kidney disease is a key risk factor for COVID-19-related mortality and suboptimal vaccine response. Optimising vaccination strategies is essential to reduce the disease burden in this vulnerable population. We therefore compared the effectiveness of two- and three-dose schedules involving AZD1222 (AZ; ChAdOx1-S) and BNT162b2 (BNT) among people with kidney disease in England. Methods With the approval of NHS England, we performed a retrospective cohort study among people with moderate-to-severe kidney disease. Using linked primary care and UK Renal Registry records in the OpenSAFELY-TPP platform, we identified adults with stage 3-5 chronic kidney disease, dialysis recipients, and kidney transplant recipients. We used Cox proportional hazards models to compare COVID-19-related outcomes and non-COVID-19 death after two-dose (AZ-AZ vs BNT-BNT) and three-dose (AZ-AZ-BNT vs BNT-BNT-BNT) schedules. Findings After two doses, incidence during the Delta wave was higher in AZ-AZ (n = 257,580) than BNT-BNT recipients (n = 169,205; adjusted hazard ratios [95% CIs] 1.43 [1.37-1.50], 1.59 [1.43-1.77], 1.44 [1.12-1.85], and 1.09 [1.02-1.17] for SARS-CoV-2 infection, COVID-19-related hospitalisation, COVID-19-related death, and non-COVID-19 death, respectively). Findings were consistent across disease subgroups, including dialysis and transplant recipients. After three doses, there was little evidence of differences between AZ-AZ-BNT (n = 220,330) and BNT-BNT-BNT recipients (n = 157,065) for any outcome during a period of Omicron dominance. Interpretation Among individuals with moderate-to-severe kidney disease, two doses of BNT conferred stronger protection than AZ against SARS-CoV-2 infection and severe disease. A subsequent BNT dose levelled the playing field, emphasising the value of heterologous RNA doses in vulnerable populations. Funding National Core Studies, Wellcome Trust, MRC, and Health Data Research UK.
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Affiliation(s)
- The OpenSAFELY Collaborative
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- The Francis Crick Institute, London, NW1 1AT, UK
- Kidney Care UK, Alton, UK
- Patient Council, UK Kidney Association, Bristol, UK
- Kidney Research UK, Peterborough, UK
- UK Renal Registry, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Edward P.K. Parker
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Elsie M.F. Horne
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - William J. Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bang Zheng
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | - Susan Lyon
- Patient Council, UK Kidney Association, Bristol, UK
| | | | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | | | | | | | - Ben Goldacre
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jonathan A.C. Sterne
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- UK Renal Registry, Bristol, UK
| | - Laurie A. Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - The LH&W NCS (or CONVALESCENCE) Collaborative
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- The Francis Crick Institute, London, NW1 1AT, UK
- Kidney Care UK, Alton, UK
- Patient Council, UK Kidney Association, Bristol, UK
- Kidney Research UK, Peterborough, UK
- UK Renal Registry, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
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Vestergaard SV, Birn H, Jensen SK, Sørensen HT, Nitsch D, Christiansen CF. Twenty-four-Year Trends in Incidence and Mortality of Nephrotic Syndrome: A Population-Based Cohort Study. Epidemiology 2023; 34:411-420. [PMID: 36730008 DOI: 10.1097/ede.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND With the increasing prevalence of risk factors for nephrotic syndrome, updated epidemiologic data on the syndrome are needed. We examined its age- and sex-specific incidence, histopathology, and mortality over 24 years. METHODS This nationwide cohort study included all adults with first-time-recorded nephrotic syndrome in Denmark during 1995-2018 using the Danish National Patient Registry. We obtained data on age, sex, hospital-diagnosed comorbidities, and histopathologic findings. We computed overall, and age- and sex-specific, incidence rates of nephrotic syndrome, 1- and 5-year mortality by calendar period, and 1-year hazard ratios (HRs) of death using Cox models. RESULTS We identified 3,970 adults with first-time nephrotic syndrome diagnosis. Incidence was highest in men and increased with age to 11.77 per 100,000 person-years (95% confidence interval [CI]: 10.21-13.32) in men aged 80+ years, and 6.56 per 100,000 person-years (95% CI: 5.71-7.41) in women aged 80+ years. Incidence of nephrotic syndrome increased from 3.35 per 100,000 person-years (95% CI: 3.12-3.58) in 1995-2000 to 4.30 per 100,000 person-years (95% CI: 4.05-4.54) in 2013-2018. Over time, 1-year mortality of nephrotic syndrome was stable at 13%-16%, but HR of death was 0.54 (95% CI: 0.42-0.69), adjusted for age, sex, and comorbidities, in 2013-2018 compared with 1995-2000. Subdistribution of glomerulopathies was stable over time with membranous nephropathy and minimal change disease being the most common. CONCLUSION During 1995-2018, the incidence of recorded adult nephrotic syndrome increased slightly, and the adjusted mortality of nephrotic syndrome decreased markedly. Whether these findings reflect changes in epidemiology or awareness and coding of nephrotic syndrome, remains to be clarified.
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Affiliation(s)
- Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Birn
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Renal medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Kintu C, Soremekun O, Kamiza AB, Kalungi A, Mayanja R, Kalyesubula R, Bagaya S B, Jjingo D, Fabian J, Gill D, Nyirenda M, Nitsch D, Chikowore T, Fatumo S. The causal effects of lipid traits on kidney function in Africans: bidirectional and multivariable Mendelian-randomization study. EBioMedicine 2023; 90:104537. [PMID: 37001235 PMCID: PMC10070509 DOI: 10.1016/j.ebiom.2023.104537] [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] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Observational studies have investigated the effect of serum lipids on kidney function, but these findings are limited by confounding, reverse causation and have reported conflicting results. Mendelian randomization (MR) studies address this confounding problem. However, they have been conducted mostly in European ancestry individuals. We, therefore, set out to investigate the effect of lipid traits on the estimated glomerular filtration rate (eGFR) based on serum creatinine in individuals of African ancestry. METHODS We used the two-sample and multivariable Mendelian randomization (MVMR) approaches; in which instrument variables (IV's) for the predictor (lipid traits) were derived from summary-level data of a meta-analyzed African lipid GWAS (MALG, n = 24,215) from the African Partnership for Chronic Disease Research (APCDR) (n = 13,612) & the Africa Wits-IN-DEPTH partnership for Genomics studies (AWI-Gen) dataset (n = 10,603). The outcome IV's were computed from the eGFR summary-level data of African-ancestry individuals within the Million Veteran Program (n = 57,336). A random-effects inverse variance method was used in our primary analysis, and pleiotropy was adjusted for using robust and penalized sensitivity testing. The lipid predictors for the MVMR were high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TG). FINDINGS We found a significant causal association between genetically predicted low-density lipoprotein (LDL) cholesterol and eGFR in African ancestry individuals β = 1.1 (95% CI [0.411-1.788]; p = 0.002). Similarly, total cholesterol (TC) showed a significant causal effect on eGFR β = 1.619 (95% CI [0.412-2.826]; p = 0.009). However, the IVW estimate showed that genetically predicted HDL-C β = -0.164, (95% CI = [-1.329 to 1.00]; p = 0.782), and TG β = -0.934 (CI = [-2.815 to 0.947]; p = 0.33) were not significantly causally associated with the risk of eGFR. In the multivariable analysis inverse-variance weighted (MVIVW) method, there was evidence for a causal association between LDL and eGFR β = 1.228 (CI = [0.477-1.979]; p = 0.001). A significant causal effect of Triglycerides (TG) on eGFR in the MVIVW analysis β = -1.3 ([-2.533 to -0.067]; p = 0.039) was observed as well. All the causal estimates reported reflect a unit change in the outcome per a 1 SD increase in the exposure. HDL showed no evidence of a significant causal association with eGFR in the MVIVW method (β = -0.117 (95% CI [-1.252 to 0.018]; p = 0.840)). We found no evidence of a reverse causal impact of eGFR on serum lipids. All our sensitivity analyses indicated no strong evidence of pleiotropy or heterogeneity between our instrumental variables for both the forward and reverse MR analysis. INTERPRETATION In this African ancestry population, genetically predicted higher LDL-C and TC are causally associated with higher eGFR levels, which may suggest that the relationship between LDL, TC and kidney function may be U-shaped. And as such, lowering LDL_C does not necessarily improve risk of kidney disease. This may also imply the reason why LDL_C is seen to be a poorer predictor of kidney function compared to HDL. In addition, this further supports that more work is warranted to confirm the potential association between lipid traits and risk of kidney disease in individuals of African Ancestry. FUNDING Wellcome (220740/Z/20/Z).
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Affiliation(s)
- Christopher Kintu
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Opeyemi Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Abram B Kamiza
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Allan Kalungi
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Richard Mayanja
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Robert Kalyesubula
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Bernard Bagaya S
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics (ACE-B), Makerere University, Kampala 10101, Uganda
| | - June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Chief Scientific Advisor Office, Research and Early Development, Novo Nordisk, Copenhagen, Denmark
| | - Moffat Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Fabian J, Kalyesubula R, Mkandawire J, Nakanga W, Prynn J, Snyman T, Ssebunnya B, Musenge E, Dreyer G, George J, Hansen C, Newton R, Crampin A, Nitsch D, Tomlinson L. WCN23-0503 Measurement of kidney function in Malawi, South Africa, and Uganda - a multi-centre population cohort study. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.269] [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: 03/22/2023] Open
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Sullivan MK, Jani BD, Rutherford E, Welsh P, McConnachie A, Major RW, McAllister D, Nitsch D, Mair FS, Mark PB, Lees JS. Potential impact of NICE guidelines on referrals from primary care to nephrology: a primary care database and prospective research study. Br J Gen Pract 2023; 73:e141-e147. [PMID: 36376072 PMCID: PMC9678375 DOI: 10.3399/bjgp.2022.0145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/11/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND National Institute for Health and Care Excellence 2021 guidelines on chronic kidney disease (CKD) recommend the use of the Kidney Failure Risk Equation (KFRE), which includes measurement of albuminuria. The equation to calculate estimated glomerular filtration rate (eGFR) has also been updated. AIM To investigate the impact of the use of KFRE and the updated eGFR equation on CKD diagnosis (eGFR <60 mL/min/1.73 m2) in primary care and potential referrals to nephrology. DESIGN AND SETTING Primary care database (Secure Anonymised Information Linkage Databank [SAIL]) and prospective cohort study (UK Biobank) using data available between 2013 and 2020. METHOD CKD diagnosis rates were assessed when using the updated eGFR equation. Among people with eGFR 30-59 mL/min/1.73 m2 the following groups were identified: those with annual albuminuria testing and those who met nephrology referral criteria because of: a) accelerated eGFR decline or significant albuminuria; b) eGFR decline <30 mL/ min/1.73 m2 only; and c) KFRE >5% only. Analyses were stratified by ethnicity in UK Biobank. RESULTS Using the updated eGFR equation resulted in a 1.2-fold fall in new CKD diagnoses in the predominantly White population in SAIL, whereas CKD prevalence rose by 1.9-fold among Black participants in UK Biobank. Rates of albuminuria testing have been consistently below 30% since 2015. In 2019, using KFRE >5% identified 182/61 721 (0.3%) patients at high risk of CKD progression before their eGFR declined and 361/61 721 (0.6%) low-risk patients who were no longer eligible for referral. Ethnic groups 'Asian' and 'other' had disproportionately raised KFREs. CONCLUSION Application of KFRE criteria in primary care will lead to referral of more patients at elevated risk of kidney failure (particularly among minority ethnic groups) and fewer low-risk patients. Albuminuria testing needs to be expanded to enable wider KFRE implementation.
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Affiliation(s)
- Michael K Sullivan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow; consultant in renal medicine, Renal Unit, Mountainhall Treatment Centre, NHS Dumfries and Galloway, Dumfries
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow
| | - Rupert W Major
- Department of Cardiovascular Sciences, University of Leicester, Leicester; consultant nephrologist, John Walls Renal Unit, University Hospitals of Leicester, Leicester
| | - David McAllister
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
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Parker EP, Tazare J, Hulme WJ, Bates C, Carr EJ, Cockburn J, Curtis HJ, Fisher L, Green AC, Harper S, Hester F, Horne EM, Loud F, Lyon S, Mahalingasivam V, Mehrkar A, Nab L, Parry J, Santhakumaran S, Steenkamp R, Sterne JA, Walker AJ, Williamson EJ, Willicombe M, Zheng B, Goldacre B, Nitsch D, Tomlinson LA. Factors associated with COVID-19 vaccine uptake in people with kidney disease: an OpenSAFELY cohort study. BMJ Open 2023; 13:e066164. [PMID: 36720568 PMCID: PMC9890277 DOI: 10.1136/bmjopen-2022-066164] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/06/2023] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To characterise factors associated with COVID-19 vaccine uptake among people with kidney disease in England. DESIGN Retrospective cohort study using the OpenSAFELY-TPP platform, performed with the approval of NHS England. SETTING Individual-level routine clinical data from 24 million people across GPs in England using TPP software. Primary care data were linked directly with COVID-19 vaccine records up to 31 August 2022 and with renal replacement therapy (RRT) status via the UK Renal Registry (UKRR). PARTICIPANTS A cohort of adults with stage 3-5 chronic kidney disease (CKD) or receiving RRT at the start of the COVID-19 vaccine roll-out was identified based on evidence of reduced estimated glomerular filtration rate (eGFR) or inclusion in the UKRR. MAIN OUTCOME MEASURES Dose-specific vaccine coverage over time was determined from 1 December 2020 to 31 August 2022. Individual-level factors associated with receipt of a 3-dose or 4-dose vaccine series were explored via Cox proportional hazards models. RESULTS 992 205 people with stage 3-5 CKD or receiving RRT were included. Cumulative vaccine coverage as of 31 August 2022 was 97.5%, 97.0% and 93.9% for doses 1, 2 and 3, respectively, and 81.9% for dose 4 among individuals with one or more indications for eligibility. Delayed 3-dose vaccine uptake was associated with younger age, minority ethnicity, social deprivation and severe mental illness-associations that were consistent across CKD severity subgroups, dialysis patients and kidney transplant recipients. Similar associations were observed for 4-dose uptake. CONCLUSION Although high primary vaccine and booster dose coverage has been achieved among people with kidney disease in England, key disparities in vaccine uptake remain across clinical and demographic groups and 4-dose coverage is suboptimal. Targeted interventions are needed to identify barriers to vaccine uptake among under-vaccinated subgroups identified in the present study.
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Affiliation(s)
| | - John Tazare
- London School of Hygiene & Tropical Medicine, London, UK
| | - William J Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | | | | | - Helen J Curtis
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Amelia Ca Green
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | | | - Elsie Mf Horne
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | | | | | | | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Linda Nab
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | | | | | - Jonathan Ac Sterne
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Bang Zheng
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Dorothea Nitsch
- London School of Hygiene & Tropical Medicine, London, UK
- UK Renal Registry, Bristol, UK
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Carrero JJ, Fu EL, Vestergaard SV, Jensen SK, Gasparini A, Mahalingasivam V, Bell S, Birn H, Heide-Jørgensen U, Clase CM, Cleary F, Coresh J, Dekker FW, Gansevoort RT, Hemmelgarn BR, Jager KJ, Jafar TH, Kovesdy CP, Sood MM, Stengel B, Christiansen CF, Iwagami M, Nitsch D. Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations. Kidney Int 2023; 103:53-69. [PMID: 36280224 DOI: 10.1016/j.kint.2022.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
The availability of electronic health records and access to a large number of routine measurements of serum creatinine and urinary albumin enhance the possibilities for epidemiologic research in kidney disease. However, the frequency of health care use and laboratory testing is determined by health status and indication, imposing certain challenges when identifying patients with kidney injury or disease, when using markers of kidney function as covariates, or when evaluating kidney outcomes. Depending on the specific research question, this may influence the interpretation, generalizability, and/or validity of study results. This review illustrates the heterogeneity of working definitions of kidney disease in the scientific literature and discusses advantages and limitations of the most commonly used approaches using 3 examples. We summarize ways to identify and overcome possible biases and conclude by proposing a framework for reporting definitions of exposures and outcomes in studies of kidney disease using routinely collected health care data.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Søren V Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alessandro Gasparini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Viyaasan Mahalingasivam
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research and Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Faye Cleary
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Manish M Sood
- Department of Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bénédicte Stengel
- CESP (Center for Research in Epidemiology and Population Health), Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Inserm U1018, Villejuif, France
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Masao Iwagami
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; UK Renal Registry, UK Kidney Association, Bristol, UK.
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Kuan V, Denaxas S, Patalay P, Nitsch D, Mathur R, Gonzalez-Izquierdo A, Sofat R, Partridge L, Roberts A, Wong ICK, Hingorani M, Chaturvedi N, Hemingway H, Hingorani AD. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health 2023; 5:e16-e27. [PMID: 36460578 DOI: 10.1016/s2589-7500(22)00187-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Globally, there is a paucity of multimorbidity and comorbidity data, especially for minority ethnic groups and younger people. We estimated the frequency of common disease combinations and identified non-random disease associations for all ages in a multiethnic population. METHODS In this population-based study, we examined multimorbidity and comorbidity patterns stratified by ethnicity or race, sex, and age for 308 health conditions using electronic health records from individuals included on the Clinical Practice Research Datalink linked with the Hospital Episode Statistics admitted patient care dataset in England. We included individuals who were older than 1 year and who had been registered for at least 1 year in a participating general practice during the study period (between April 1, 2010, and March 31, 2015). We identified the most common combinations of conditions and comorbidities for index conditions. We defined comorbidity as the accumulation of additional conditions to an index condition over an individual's lifetime. We used network analysis to identify conditions that co-occurred more often than expected by chance. We developed online interactive tools to explore multimorbidity and comorbidity patterns overall and by subgroup based on ethnicity, sex, and age. FINDINGS We collected data for 3 872 451 eligible patients, of whom 1 955 700 (50·5%) were women and girls, 1 916 751 (49·5%) were men and boys, 2 666 234 (68·9%) were White, 155 435 (4·0%) were south Asian, and 98 815 (2·6%) were Black. We found that a higher proportion of boys aged 1-9 years (132 506 [47·8%] of 277 158) had two or more diagnosed conditions than did girls in the same age group (106 982 [40·3%] of 265 179), but more women and girls were diagnosed with multimorbidity than were boys aged 10 years and older and men (1 361 232 [80·5%] of 1 690 521 vs 1 161 308 [70·8%] of 1 639 593). White individuals (2 097 536 [78·7%] of 2 666 234) were more likely to be diagnosed with two or more conditions than were Black (59 339 [60·1%] of 98 815) or south Asian individuals (93 617 [60·2%] of 155 435). Depression commonly co-occurred with anxiety, migraine, obesity, atopic conditions, deafness, soft-tissue disorders, and gastrointestinal disorders across all subgroups. Heart failure often co-occurred with hypertension, atrial fibrillation, osteoarthritis, stable angina, myocardial infarction, chronic kidney disease, type 2 diabetes, and chronic obstructive pulmonary disease. Spinal fractures were most strongly non-randomly associated with malignancy in Black individuals, but with osteoporosis in White individuals. Hypertension was most strongly associated with kidney disorders in those aged 20-29 years, but with dyslipidaemia, obesity, and type 2 diabetes in individuals aged 40 years and older. Breast cancer was associated with different comorbidities in individuals from different ethnic groups. Asthma was associated with different comorbidities between males and females. Bipolar disorder was associated with different comorbidities in younger age groups compared with older age groups. INTERPRETATION Our findings and interactive online tools are a resource for: patients and their clinicians, to prevent and detect comorbid conditions; research funders and policy makers, to redesign service provision, training priorities, and guideline development; and biomedical researchers and manufacturers of medicines, to provide leads for research into common or sequential pathways of disease and inform the design of clinical trials. FUNDING UK Research and Innovation, Medical Research Council, National Institute for Health and Care Research, Department of Health and Social Care, Wellcome Trust, British Heart Foundation, and The Alan Turing Institute.
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Affiliation(s)
- Valerie Kuan
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK.
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; UCL BHF Research Accelerator, University College London, London, UK; Alan Turing Institute, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, University College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Primary Care, Wolfson Institute of Primary Care, Queen Mary University of London, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK
| | - Linda Partridge
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London, London, UK; Max Planck Institute for Biology of Ageing, Cologne, Germany
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Ian C K Wong
- School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | | | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | - Aroon D Hingorani
- UCL BHF Research Accelerator, University College London, London, UK; Institute of Cardiovascular Science, University College London, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK
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Mulick AR, Henderson AD, Prieto-Merino D, Mansfield KE, Matthewman J, Quint JK, Lyons RA, Sheikh A, McAllister DA, Nitsch D, Langan SM. Novel multimorbidity clusters in people with eczema and asthma: a population-based cluster analysis. Sci Rep 2022; 12:21866. [PMID: 36529816 PMCID: PMC9760185 DOI: 10.1038/s41598-022-26357-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Eczema and asthma are allergic diseases and two of the commonest chronic conditions in high-income countries. Their co-existence with other allergic conditions is common, but little research exists on wider multimorbidity with these conditions. We set out to identify and compare clusters of multimorbidity in people with eczema or asthma and people without. Using routinely-collected primary care data from the U.K. Clinical Research Practice Datalink GOLD, we identified adults ever having eczema (or asthma), and comparison groups never having eczema (or asthma). We derived clusters of multimorbidity from hierarchical cluster analysis of Jaccard distances between pairs of diagnostic categories estimated from mixed-effects logistic regressions. We analysed 434,422 individuals with eczema (58% female, median age 47 years) and 1,333,281 individuals without (55% female, 47 years), and 517,712 individuals with asthma (53% female, 44 years) and 1,601,210 individuals without (53% female, 45 years). Age at first morbidity, sex and having eczema/asthma affected the scope of multimorbidity, with women, older age and eczema/asthma being associated with larger morbidity clusters. Injuries, digestive, nervous system and mental health disorders were more commonly seen in eczema and asthma than control clusters. People with eczema and asthma of all ages and both sexes may experience greater multimorbidity than people without eczema and asthma, including conditions not previously recognised as contributing to their disease burden. This work highlights areas where there is a critical need for research addressing the burden and drivers of multimorbidity in order to inform strategies to reduce poor health outcomes.
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Affiliation(s)
- Amy R. Mulick
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Alasdair D. Henderson
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - David Prieto-Merino
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Kathryn E. Mansfield
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Julian Matthewman
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jennifer K. Quint
- grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College London, London, UK
| | - Ronan A. Lyons
- grid.4827.90000 0001 0658 8800National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK ,grid.4827.90000 0001 0658 8800Administrative Data Research UK, Swansea University Medical School, Swansea, UK
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX UK
| | - David A. McAllister
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dorothea Nitsch
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Sinéad M. Langan
- grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK ,grid.507332.00000 0004 9548 940XHealth Data Research UK, Gibbs Building, 215 Euston Road, London, NW1 2BE UK
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Jensen SK, Heide-Jørgensen U, Vestergaard SV, Gammelager H, Birn H, Nitsch D, Christiansen CF. Kidney function before and after acute kidney injury: a nationwide population-based cohort study. Clin Kidney J 2022; 16:484-493. [PMID: 36865015 PMCID: PMC9972836 DOI: 10.1093/ckj/sfac247] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common and serious condition defined by a rapid decline in kidney function. Data on changes in long-term kidney function following AKI are sparse and conflicting. Therefore, we examined the changes in estimated glomerular filtration rate (eGFR) from before to after AKI in a nationwide population-based setting. Methods Using Danish laboratory databases, we identified individuals with first-time AKI defined by an acute increase in plasma creatinine (pCr) during 2010 to 2017. Individuals with three or more outpatient pCr measurements before and after AKI were included and cohorts were stratified by baseline eGFR (≥/<60 mL/min/1.73 m2). Linear regression models were used to estimate and compare individual eGFR slopes and eGFR levels before and after AKI. Results Among individuals with a baseline eGFR ≥60 mL/min/1.73 m2 (n = 64 805), first-time AKI was associated with a median difference in eGFR level of -5.6 mL/min/1.73 m2 [interquartile range (IQR) -16.1 to 1.8] and a median difference in eGFR slope of -0.4 mL/min/1.73 m2/year (IQR -5.5 to 4.4). Correspondingly, among individuals with a baseline eGFR <60 mL/min/1.73 m2 (n = 33 267), first-time AKI was associated with a median difference in eGFR level of -2.2 mL/min/1.73 m2 (IQR -9.2 to 4.3) and a median difference in eGFR slope of 1.5 mL/min/1.73 m2/year (IQR -2.9 to 6.5). Conclusion Among individuals with first-time AKI surviving to have repeated outpatient pCr measurements, AKI was associated with changes in eGFR level and eGFR slope for which the magnitude and direction depended on baseline eGFR.
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Affiliation(s)
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Gammelager
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Birn
- Department of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark,Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Gaziano L, Sun L, Arnold M, Bell S, Cho K, Kaptoge SK, Song RJ, Burgess S, Posner DC, Mosconi K, Robinson-Cohen C, Mason AM, Bolton TR, Tao R, Allara E, Schubert P, Chen L, Staley JR, Staplin N, Altay S, Amiano P, Arndt V, Ärnlöv J, Barr EL, Björkelund C, Boer JM, Brenner H, Casiglia E, Chiodini P, Cooper JA, Coresh J, Cushman M, Dankner R, Davidson KW, de Jongh RT, Donfrancesco C, Engström G, Freisling H, de la Cámara AG, Gudnason V, Hankey GJ, Hansson PO, Heath AK, Hoorn EJ, Imano H, Jassal SK, Kaaks R, Katzke V, Kauhanen J, Kiechl S, Koenig W, Kronmal RA, Kyrø C, Lawlor DA, Ljungberg B, MacDonald C, Masala G, Meisinger C, Melander O, Moreno Iribas C, Ninomiya T, Nitsch D, Nordestgaard BG, Onland-Moret C, Palmieri L, Petrova D, Garcia JRQ, Rosengren A, Sacerdote C, Sakurai M, Santiuste C, Schulze MB, Sieri S, Sundström J, Tikhonoff V, Tjønneland A, Tong T, Tumino R, Tzoulaki I, van der Schouw YT, Monique Verschuren W, Völzke H, Wallace RB, Wannamethee SG, Weiderpass E, Willeit P, Woodward M, Yamagishi K, Zamora-Ros R, Akwo EA, Pyarajan S, Gagnon DR, Tsao PS, Muralidhar S, Edwards TL, Damrauer SM, Joseph J, Pennells L, Wilson PW, Harrison S, Gaziano TA, Inouye M, Baigent C, Casas JP, Langenberg C, Wareham N, Riboli E, Gaziano J, Danesh J, Hung AM, Butterworth AS, Wood AM, Di Angelantonio E. Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses. Circulation 2022; 146:1507-1517. [PMID: 36314129 PMCID: PMC9662821 DOI: 10.1161/circulationaha.122.060700] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/18/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. METHODS Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. RESULTS There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values <60 or >105 mL·min-1·1.73 m-2, compared with those with eGFR between 60 and 105 mL·min-1·1.73 m-2. Mendelian randomization analyses for CHD showed an association among participants with eGFR <60 mL·min-1·1.73 m-2, with a 14% (95% CI, 3%-27%) higher CHD risk per 5 mL·min-1·1.73 m-2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min-1·1.73 m-2. Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. CONCLUSIONS In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.
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Affiliation(s)
- Liam Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Luanluan Sun
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | | | - Steven Bell
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Stroke Research Group, Department of Clinical Neurosciences (S. Bell), University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
| | - Kelly Cho
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Stephen K. Kaptoge
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, MA (R.J.S.)
| | - Stephen Burgess
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
| | - Daniel C. Posner
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
| | - Katja Mosconi
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Amy M. Mason
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
| | - Thomas R. Bolton
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
| | - Ran Tao
- Department of Biostatistics (R. Tao), Vanderbilt University Medical Center, Nashville, TN
| | - Elias Allara
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
| | - Petra Schubert
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
| | - Lingyan Chen
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - James R. Staley
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Natalie Staplin
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
| | - Servet Altay
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey (S.A.)
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain (P.A.)
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain (P.A.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research (V.A.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johan Ärnlöv
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
- Stroke Research Group, Department of Clinical Neurosciences (S. Bell), University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, MA (R.J.S.)
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics (R. Tao), Vanderbilt University Medical Center, Nashville, TN
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
- Cancer Epidemiology Unit (T.T.), Nuffield Department of Population Health, University of Oxford, UK
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey (S.A.)
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain (P.A.)
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain (P.A.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Division of Clinical Epidemiology and Aging Research (V.A.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (J.A., H.B.)
- School of Health and Social Studies, Dalarna University, Falun, Sweden (J.A.)
- Wellbeing & Preventable Chronic Diseases (WPCD) Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (E.L.M.B.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
- Institute of Medicine, School of Public Health and Community Medicine (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
- Network Aging Research (NAR), Heidelberg University, Germany (H.B.)
- Studium Patavinum (E.C.), University of Padua, Italy
- Department of Medicine (V.T.), University of Padua, Italy
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Caserta, Italy (P.C.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, UK (J.A.C.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
- Larner College of Medicine, The University of Vermont, Burlington (M.C.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel (R.D.)
- School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel (R.D.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
- Amsterdam University Medical Centers, VUMC, the Netherlands (R.T.d.J.)
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy (C.D., L. Palmer)
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
- 12 Octubre Hospital Research Institute, Madrid, Spain (A.G.d,l,C.)
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Icelandic Heart Association, Kopavogur, Iceland (V.G.)
- Medical School Faculty of Health & Medical Sciences, The University of Western Australia, Perth, WA, Australia (G.J.H.)
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
- The George Institute for Global Health (M.W.), Imperial College London, UK
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, the Netherlands (E.J.H.)
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan (H.I.)
- University of Eastern Finland (UEF), Kuopio, Finland (J.K.)
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (S.K.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
- Deutsches Herzzentrum München, Technische Universität München, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (W.K.)
- School of Public Health, University of Washington, Seattle (R.A.K.)
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (D.A.L.)
- Population Health Science, Bristol Medical School, UK (D.A.L.)
- Department of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Sweden (B.L.)
- University Paris-Saclay, UVSQ, Inserm, Villejuif, France (C. MacDonald)
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy (G.M.)
- Helmholtz Zentrum München, Munich, Germany (C. Meisinger)
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain (C.M.I.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (C.M.I.)
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (T.N.)
- London School of Hygiene & Tropical Medicine, UK (D.N.)
- Herlev and Gentofte Hospital (B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Frederiksberg Hospital B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (B.G.N.), University of Copenhagen, Denmark
- Department of Public Health (A.T.), University of Copenhagen, Denmark
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain (D.P.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain (D.P.)
- Consejería de Sanidad del Principado de Asturias Oviedo, Asturias, Spain (J.R.Q.G.)
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy (C. Sacerdote)
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Japan (M.S.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Spain (C. Santiuste)
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.)
- German Center for Diabetes Research (DZD), Neuherberg, Germany (M.B.S.)
- Institute of Nutritional Science, University of Potsdam, Germany (M.B.S.)
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy (S.S.)
- Department of Medical Sciences, Uppsala University, Sweden (J.S.)
- Hyblean Association for Epidemiological Reserach AIRE - ONLUS, Ragusa, Italy (R.T.)
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung SHIP/ Klinisch-Epidemiologische Forschung, Germany (H.V.)
- College of Public Health, University of Iowa (R.B.W.)
- University College London, UK (S.G.W.)
- The George Institute for Global Health, Camperdown, NSW, Australia (M.W.)
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan (K.Y.)
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona), Spain (R.Z.-R.)
- Center for Data and Computational Sciences, VA Boston Healthcare System, Boston, MA (S.P.)
- Department of Biostatistics, Boston University School of Public Health, MA (D.R.G.)
- VA Pal Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, CA (P.S.T.)
- Medicine (Cardiovascular Medicine), Stanford University of School of Medicine, CA (P.S.T.)
- Office of Research and Development, Veterans Health Administration, Washington, DC (S.M.)
- Department of Veterans Affairs, Tennessee Valley Health Care System, Vanderbilt University, Nashville (T.L.E.)
- Medicine/Epidemiology, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (T.L.E.)
- Department of Surgery, Corporal Michael Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
- Internal Medicine, VA Atlanta Healthcare System, Decatur, GA (P.W.F.W.)
- Emory University School of Medicine (Cardiology), Emory University, Atlanta, GA (P.W.F.W.)
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (T.A.G.)
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- The Alan Turing Institute, London, UK (M.I.)
- Computational Medicine, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (C.L.)
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK (J.D.)
- Division of Nephrology & Hypertension, Department of Medicine, Tennessee Valley Health Care System and Vanderbilt University Medical Center, Nashville (A.M.H.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
- Health Data Science Centre, Human Technopole, Milan, Italy (E.D.A.)
| | - Elizabeth L.M. Barr
- Wellbeing & Preventable Chronic Diseases (WPCD) Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (E.L.M.B.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
| | - Cecilia Björkelund
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
| | - Jolanda M.A. Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
| | - Hermann Brenner
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (J.A., H.B.)
- Network Aging Research (NAR), Heidelberg University, Germany (H.B.)
| | | | - Paolo Chiodini
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Caserta, Italy (P.C.)
| | - Jackie A. Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, UK (J.A.C.)
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Mary Cushman
- Larner College of Medicine, The University of Vermont, Burlington (M.C.)
| | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel (R.D.)
- School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel (R.D.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
| | - Karina W. Davidson
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
| | | | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy (C.D., L. Palmer)
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
| | - Agustín Gómez de la Cámara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- 12 Octubre Hospital Research Institute, Madrid, Spain (A.G.d,l,C.)
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Icelandic Heart Association, Kopavogur, Iceland (V.G.)
| | - Graeme J. Hankey
- Medical School Faculty of Health & Medical Sciences, The University of Western Australia, Perth, WA, Australia (G.J.H.)
| | - Per-Olof Hansson
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
| | - Alicia K. Heath
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
| | - Ewout J. Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, the Netherlands (E.J.H.)
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan (H.I.)
| | - Simerjot K. Jassal
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jussi Kauhanen
- University of Eastern Finland (UEF), Kuopio, Finland (J.K.)
| | - Stefan Kiechl
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (S.K.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
- Deutsches Herzzentrum München, Technische Universität München, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (W.K.)
| | | | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (D.A.L.)
- Population Health Science, Bristol Medical School, UK (D.A.L.)
| | - Börje Ljungberg
- Department of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Sweden (B.L.)
| | - Conor MacDonald
- University Paris-Saclay, UVSQ, Inserm, Villejuif, France (C. MacDonald)
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy (G.M.)
| | | | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
| | - Conchi Moreno Iribas
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain (C.M.I.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (C.M.I.)
| | - Toshiharu Ninomiya
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (T.N.)
| | | | - Børge G. Nordestgaard
- Herlev and Gentofte Hospital (B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Frederiksberg Hospital B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (B.G.N.), University of Copenhagen, Denmark
| | - Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
| | - Luigi Palmieri
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
- Stroke Research Group, Department of Clinical Neurosciences (S. Bell), University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, MA (R.J.S.)
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics (R. Tao), Vanderbilt University Medical Center, Nashville, TN
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
- Cancer Epidemiology Unit (T.T.), Nuffield Department of Population Health, University of Oxford, UK
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey (S.A.)
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain (P.A.)
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain (P.A.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Division of Clinical Epidemiology and Aging Research (V.A.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (J.A., H.B.)
- School of Health and Social Studies, Dalarna University, Falun, Sweden (J.A.)
- Wellbeing & Preventable Chronic Diseases (WPCD) Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (E.L.M.B.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
- Institute of Medicine, School of Public Health and Community Medicine (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
- Network Aging Research (NAR), Heidelberg University, Germany (H.B.)
- Studium Patavinum (E.C.), University of Padua, Italy
- Department of Medicine (V.T.), University of Padua, Italy
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Caserta, Italy (P.C.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, UK (J.A.C.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
- Larner College of Medicine, The University of Vermont, Burlington (M.C.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel (R.D.)
- School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel (R.D.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
- Amsterdam University Medical Centers, VUMC, the Netherlands (R.T.d.J.)
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy (C.D., L. Palmer)
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
- 12 Octubre Hospital Research Institute, Madrid, Spain (A.G.d,l,C.)
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Icelandic Heart Association, Kopavogur, Iceland (V.G.)
- Medical School Faculty of Health & Medical Sciences, The University of Western Australia, Perth, WA, Australia (G.J.H.)
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
- The George Institute for Global Health (M.W.), Imperial College London, UK
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, the Netherlands (E.J.H.)
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan (H.I.)
- University of Eastern Finland (UEF), Kuopio, Finland (J.K.)
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (S.K.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
- Deutsches Herzzentrum München, Technische Universität München, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (W.K.)
- School of Public Health, University of Washington, Seattle (R.A.K.)
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (D.A.L.)
- Population Health Science, Bristol Medical School, UK (D.A.L.)
- Department of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Sweden (B.L.)
- University Paris-Saclay, UVSQ, Inserm, Villejuif, France (C. MacDonald)
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy (G.M.)
- Helmholtz Zentrum München, Munich, Germany (C. Meisinger)
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain (C.M.I.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (C.M.I.)
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (T.N.)
- London School of Hygiene & Tropical Medicine, UK (D.N.)
- Herlev and Gentofte Hospital (B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Frederiksberg Hospital B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (B.G.N.), University of Copenhagen, Denmark
- Department of Public Health (A.T.), University of Copenhagen, Denmark
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain (D.P.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain (D.P.)
- Consejería de Sanidad del Principado de Asturias Oviedo, Asturias, Spain (J.R.Q.G.)
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy (C. Sacerdote)
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Japan (M.S.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Spain (C. Santiuste)
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.)
- German Center for Diabetes Research (DZD), Neuherberg, Germany (M.B.S.)
- Institute of Nutritional Science, University of Potsdam, Germany (M.B.S.)
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy (S.S.)
- Department of Medical Sciences, Uppsala University, Sweden (J.S.)
- Hyblean Association for Epidemiological Reserach AIRE - ONLUS, Ragusa, Italy (R.T.)
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung SHIP/ Klinisch-Epidemiologische Forschung, Germany (H.V.)
- College of Public Health, University of Iowa (R.B.W.)
- University College London, UK (S.G.W.)
- The George Institute for Global Health, Camperdown, NSW, Australia (M.W.)
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan (K.Y.)
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona), Spain (R.Z.-R.)
- Center for Data and Computational Sciences, VA Boston Healthcare System, Boston, MA (S.P.)
- Department of Biostatistics, Boston University School of Public Health, MA (D.R.G.)
- VA Pal Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, CA (P.S.T.)
- Medicine (Cardiovascular Medicine), Stanford University of School of Medicine, CA (P.S.T.)
- Office of Research and Development, Veterans Health Administration, Washington, DC (S.M.)
- Department of Veterans Affairs, Tennessee Valley Health Care System, Vanderbilt University, Nashville (T.L.E.)
- Medicine/Epidemiology, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (T.L.E.)
- Department of Surgery, Corporal Michael Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
- Internal Medicine, VA Atlanta Healthcare System, Decatur, GA (P.W.F.W.)
- Emory University School of Medicine (Cardiology), Emory University, Atlanta, GA (P.W.F.W.)
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (T.A.G.)
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- The Alan Turing Institute, London, UK (M.I.)
- Computational Medicine, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (C.L.)
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK (J.D.)
- Division of Nephrology & Hypertension, Department of Medicine, Tennessee Valley Health Care System and Vanderbilt University Medical Center, Nashville (A.M.H.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
- Health Data Science Centre, Human Technopole, Milan, Italy (E.D.A.)
| | - Dafina Petrova
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain (D.P.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain (D.P.)
| | | | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy (C. Sacerdote)
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Japan (M.S.)
| | - Carmen Santiuste
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Spain (C. Santiuste)
| | - Matthias B. Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.)
- German Center for Diabetes Research (DZD), Neuherberg, Germany (M.B.S.)
- Institute of Nutritional Science, University of Potsdam, Germany (M.B.S.)
| | - Sabina Sieri
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy (S.S.)
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Sweden (J.S.)
| | | | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
- Department of Public Health (A.T.), University of Copenhagen, Denmark
| | - Tammy Tong
- Cancer Epidemiology Unit (T.T.), Nuffield Department of Population Health, University of Oxford, UK
| | - Rosario Tumino
- Hyblean Association for Epidemiological Reserach AIRE - ONLUS, Ragusa, Italy (R.T.)
| | - Ioanna Tzoulaki
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
| | - W.M. Monique Verschuren
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
| | - Henry Völzke
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung SHIP/ Klinisch-Epidemiologische Forschung, Germany (H.V.)
| | | | | | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
| | - Peter Willeit
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
| | - Mark Woodward
- The George Institute for Global Health, Camperdown, NSW, Australia (M.W.)
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan (K.Y.)
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona), Spain (R.Z.-R.)
| | - Elvis A. Akwo
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Saiju Pyarajan
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Data and Computational Sciences, VA Boston Healthcare System, Boston, MA (S.P.)
| | - David R. Gagnon
- Department of Biostatistics, Boston University School of Public Health, MA (D.R.G.)
| | - Philip S. Tsao
- VA Pal Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, CA (P.S.T.)
- Medicine (Cardiovascular Medicine), Stanford University of School of Medicine, CA (P.S.T.)
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC (S.M.)
| | - Todd L. Edwards
- Department of Veterans Affairs, Tennessee Valley Health Care System, Vanderbilt University, Nashville (T.L.E.)
- Medicine/Epidemiology, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (T.L.E.)
| | - Scott M. Damrauer
- Department of Surgery, Corporal Michael Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Lisa Pennells
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Peter W.F. Wilson
- Internal Medicine, VA Atlanta Healthcare System, Decatur, GA (P.W.F.W.)
- Emory University School of Medicine (Cardiology), Emory University, Atlanta, GA (P.W.F.W.)
| | - Seamus Harrison
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Thomas A. Gaziano
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (T.A.G.)
| | - Michael Inouye
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- The Alan Turing Institute, London, UK (M.I.)
| | - Colin Baigent
- Institute of Medicine, School of Public Health and Community Medicine (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Claudia Langenberg
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
- Computational Medicine, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (C.L.)
| | - Nick Wareham
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
| | - Elio Riboli
- The George Institute for Global Health (M.W.), Imperial College London, UK
| | - J.Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK (J.D.)
| | - Adriana M. Hung
- Division of Nephrology & Hypertension, Department of Medicine, Tennessee Valley Health Care System and Vanderbilt University Medical Center, Nashville (A.M.H.)
| | - Adam S. Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Angela M. Wood
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
| | - Emanuele Di Angelantonio
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Health Data Science Centre, Human Technopole, Milan, Italy (E.D.A.)
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Habte-Asres HH, Murrells T, Nitsch D, Wheeler DC, Forbes A. Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: Retrospective cohort study. Diabetes Res Clin Pract 2022; 193:110117. [PMID: 36243232 DOI: 10.1016/j.diabres.2022.110117] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/15/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022]
Abstract
AIM To investigate the association between glycaemic variability and the development of End-Stage-Kidney-Disease (ESKD) among individuals with diabetes and chronic kidney disease. METHODS A cohort study using UK electronic primary care health records from the Clinical Practice Research Datalink. Glycaemic variability was assessed using a variability score and intra-individual coefficient of variation (CV) of HbA1c. We calculated sub-distribution hazard ratios (sHR) for developing ESKD using competing risk regression analysis. RESULTS There were 37,222 eligible participants (45.5 % male), with a mean age of 76.4 years (SD ± 9.2), and a mean baseline eGFR 40.7 (±10.7) ml/min/1.73 m2. There were 5,086 incidents of ESKD in the follow-up period. The adjusted sHR (95 %CI) for each variability score group, were as follows: 21-40, 1.38 (1.27-1.50); 41-60, 1.54 (1.41-1.68); 61-80, 1.61 (1.45-1.79); and 81-100, 1.42 (1.19-1.68), compared with the group (score 0-20) with least variability. The adjusted sHR for CV were as follows: 6.7-9.9, 1.29 (1.15-1.45); 10.0-13.9, 1.55 (1.39-1.74); 14.0-20.1, 1.79 (1.60-2.01) and ≥20.2, 2.10 (1.88-2.34) compared to reference group 0-6.6. CONCLUSIONS Glycaemic variability was strongly associated with the development of ESKD in people with diabetes and CKD.
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Affiliation(s)
- Hellena Hailu Habte-Asres
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine Keppel Street, London, UK
| | - David C Wheeler
- Department of Renal Medicine, Royal Free Campus, University College London, Rowland Hill Street, London, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Sullivan MK, Carrero JJ, Jani BD, Anderson C, McConnachie A, Hanlon P, Nitsch D, McAllister DA, Mair FS, Mark PB, Gasparini A. The presence and impact of multimorbidity clusters on adverse outcomes across the spectrum of kidney function. BMC Med 2022; 20:420. [PMID: 36320059 PMCID: PMC9623942 DOI: 10.1186/s12916-022-02628-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity (the presence of two or more chronic conditions) is common amongst people with chronic kidney disease, but it is unclear which conditions cluster together and if this changes as kidney function declines. We explored which clusters of conditions are associated with different estimated glomerular filtration rates (eGFRs) and studied associations between these clusters and adverse outcomes. METHODS Two population-based cohort studies were used: the Stockholm Creatinine Measurements project (SCREAM, Sweden, 2006-2018) and the Secure Anonymised Information Linkage Databank (SAIL, Wales, 2006-2021). We studied participants in SCREAM (404,681 adults) and SAIL (533,362) whose eGFR declined lower than thresholds (90, 75, 60, 45, 30 and 15 mL/min/1.73m2). Clusters based on 27 chronic conditions were identified. We described the most common chronic condition(s) in each cluster and studied their association with adverse outcomes using Cox proportional hazards models (all-cause mortality (ACM) and major adverse cardiovascular events (MACE)). RESULTS Chronic conditions became more common and clustered differently across lower eGFR categories. At eGFR 90, 75, and 60 mL/min/1.73m2, most participants were in large clusters with no prominent conditions. At eGFR 15 and 30 mL/min/1.73m2, clusters involving cardiovascular conditions were larger and were at the highest risk of adverse outcomes. At eGFR 30 mL/min/1.73m2, in the heart failure, peripheral vascular disease and diabetes cluster in SCREAM, ACM hazard ratio (HR) is 2.66 (95% confidence interval (CI) 2.31-3.07) and MACE HR is 4.18 (CI 3.65-4.78); in the heart failure and atrial fibrillation cluster in SAIL, ACM HR is 2.23 (CI 2.04 to 2.44) and MACE HR is 3.43 (CI 3.22-3.64). Chronic pain and depression were common and associated with adverse outcomes when combined with physical conditions. At eGFR 30 mL/min/1.73m2, in the chronic pain, heart failure and myocardial infarction cluster in SCREAM, ACM HR is 2.00 (CI 1.62-2.46) and MACE HR is 4.09 (CI 3.39-4.93); in the depression, chronic pain and stroke cluster in SAIL, ACM HR is 1.38 (CI 1.18-1.61) and MACE HR is 1.58 (CI 1.42-1.76). CONCLUSIONS Patterns of multimorbidity and corresponding risk of adverse outcomes varied with declining eGFR. While diabetes and cardiovascular disease are known high-risk conditions, chronic pain and depression emerged as important conditions and associated with adverse outcomes when combined with physical conditions.
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Affiliation(s)
- Michael K Sullivan
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Anderson
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David A McAllister
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Alessandro Gasparini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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47
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Cleary F, Kim L, Prieto-Merino D, Wheeler D, Steenkamp R, Fluck R, Adlam D, Denaxas S, Griffith K, Loud F, Hull S, Caplin B, Nitsch D. Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data. BMJ Open 2022; 12:e064513. [PMID: 36220323 PMCID: PMC9558803 DOI: 10.1136/bmjopen-2022-064513] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine the association between practice percentage coding of chronic kidney disease (CKD) in primary care with risk of subsequent hospitalisations and death. DESIGN Retrospective cohort study using linked electronic healthcare records. SETTING 637 general practitioner (GP) practices in England. PARTICIPANTS 167 208 patients with CKD stages 3-5 identified by 2 measures of estimated glomerular filtration rate <60 mL/min/1.73 m2, separated by at least 90 days, excluding those with coded initiation of renal replacement therapy. MAIN OUTCOME MEASURES Hospitalisations with cardiovascular (CV) events, heart failure (HF), acute kidney injury (AKI) and all-cause mortality RESULTS: Participants were followed for (median) 3.8 years for hospital outcomes and 4.3 years for deaths. Rates of hospitalisations with CV events and HF were lower in practices with higher percentage CKD coding. Trends of a small reduction in AKI but no substantial change in rate of deaths were also observed as CKD coding increased. Compared with patients in the median performing practice (74% coded), patients in practices coding 55% of CKD cases had a higher rate of CV hospitalisations (HR 1.061 (95% CI 1.015 to 1.109)) and HF hospitalisations (HR 1.097 (95% CI 1.013 to 1.187)) and patients in practices coding 88% of CKD cases had a reduced rate of CV hospitalisations (HR 0.957 (95% CI 0.920 to 0.996)) and HF hospitalisations (HR 0.918 (95% CI 0.855 to 0.985)). We estimate that 9.0% of CV hospitalisations and 16.0% of HF hospitalisations could be prevented by improving practice CKD coding from 55% to 88%. Prescription of antihypertensives was the most dominant predictor of a reduction in hospitalisation rates for patients with CKD, followed by albuminuria testing and use of statins. CONCLUSIONS Higher levels of CKD coding by GP practices were associated with lower rates of CV and HF events, which may be driven by increased use of antihypertensives and regular albuminuria testing, although residual confounding cannot be ruled out.
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Affiliation(s)
- Faye Cleary
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lois Kim
- Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Prieto-Merino
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Wheeler
- Department of Renal Medicine, University College London, London, UK
| | | | - Richard Fluck
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Fiona Loud
- Director of Policy, Kidney Care UK, Alton, UK
| | - Sally Hull
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Ahmed S, PrayGod G, R. Lee N, Kelly P, Trilok-Kumar G, Chisenga M, Kweka B, Faurholt-Jepsen D, Krogh-Madsen R, AM Shaw J, M. Paglinawan-Modoc D, Solon J, Frahm Olsen M, Stefanovski D, Cox S, Nitsch D, Keogh R, Filteau S. Long-term health after Severe Acute Malnutrition in children and adults- the role of the Pancreas (SAMPA): Protocol. F1000Res 2022; 11:777. [PMID: 36300035 PMCID: PMC9577280 DOI: 10.12688/f1000research.123389.2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Prenatal growth retardation may increase the risk of later chronic non-communicable diseases (NCDs), including diabetes; however, long-term effects of wasting malnutrition in childhood or adulthood are less studied. Pancreatic exocrine and endocrine functions, both critical for nutrition and NCD aetiology, may not fully recover following malnutrition. However, the evidence and mechanistic information is piecemeal. We hypothesise that wasting malnutrition at any age has long-term detrimental effects on endocrine and exocrine pancreatic structure and function. Methods: The SAMPA international research programme will assess pancreatic structure and function in 3700 participants from ongoing observational nutrition cohorts, two adolescent and four adult, in Zambia, Tanzania, Philippines, and India. Pancreas size, structure, and calcification will be assessed by ultrasound and computed tomography (CT) scan; exocrine function by faecal elastase and serum lipase; and endocrine function by haemoglobin A1c (HbA1c) and blood glucose, insulin and C-peptide concentrations during an oral glucose tolerance test (OGTT). In-depth hormonal analyses of incretins, glucagon, proinsulin and trypsinogen during OGTT and intravenous glucose tolerance tests will be done in subsets of adult participants. Pancreatic size and function outcomes will be compared between people with and without prior wasting malnutrition. Analyses will investigate effect modification by sex, current age, time since malnutrition, current body mass index and dietary patterns. Mathematical modelling of OGTT data will be used to estimate the relative contribution to glucose dysregulation of decreased insulin production, changes in insulin clearance and increased insulin resistance. Proinsulin/insulin ratio will be analysed in archived samples from the Tanzanian cohort using a nested case-control design to investigate whether abnormal values precede diabetes. Conclusions: SAMPA, a large-scale multi-centre research programme using data from people with or without prior wasting malnutrition to assess several aspects of pancreatic phenotype, will provide coherent evidence for future policies and programmes for malnutrition and diabetes.
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Affiliation(s)
- Sana Ahmed
- Institute of Home Economics, University of Delhi, Delhi, 110016, India,
| | - George PrayGod
- National Institute for Medical Research, Mwanza, Tanzania
| | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Populations Studies Foundation, Cebu City, 6000, Philippines
| | - Paul Kelly
- University Teaching Hospital, Lusaka, Zambia,Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geeta Trilok-Kumar
- Institute of Home Economics, University of Delhi, Delhi, 110016, India,Delhi School of Public Health, Institution of Eminence, University of Delhi, Delhi, 110007, India
| | | | - Belinda Kweka
- National Institute for Medical Research, Mwanza, Tanzania
| | | | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - James AM Shaw
- Translational and Clinical Research Institute, Newcastle University, The Medical School, Framlington Place, Newcastle-upon-Tyne, UK
| | | | - Juan Solon
- Nutrition Center of the Philippines, Muntinlupa City, Manila, Philippines
| | - Mette Frahm Olsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, 2100, Denmark,Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, 1017, Denmark
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Philadelphia, USA
| | - Sharon Cox
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ruth Keogh
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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49
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Dashtban A, Mizani MA, Denaxas S, Nitsch D, Quint J, Corbett R, Mamza JB, Morris T, Mamas M, Lawlor DA, Khunti K, Sudlow C, Hemingway H, Banerjee A. A retrospective cohort study predicting and validating impact of the COVID-19 pandemic in individuals with chronic kidney disease. Kidney Int 2022; 102:652-660. [PMID: 35724769 PMCID: PMC9212366 DOI: 10.1016/j.kint.2022.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/26/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) is associated with increased risk of baseline mortality and severe COVID-19, but analyses across CKD stages, and comorbidities are lacking. In prevalent and incident CKD, we investigated comorbidities, baseline risk, COVID-19 incidence, and predicted versus observed one-year excess death. In a national dataset (NHS Digital Trusted Research Environment [NHSD TRE]) for England encompassing 56 million individuals), we conducted a retrospective cohort study (March 2020 to March 2021) for prevalence of comorbidities by incident and prevalent CKD, SARS-CoV-2 infection and mortality. Baseline mortality risk, incidence and outcome of infection by comorbidities, controlling for age, sex and vaccination were assessed. Observed versus predicted one-year mortality at varying population infection rates and pandemic-related relative risks using our published model in pre-pandemic CKD cohorts (NHSD TRE and Clinical Practice Research Datalink [CPRD]) were compared. Among individuals with CKD (prevalent:1,934,585, incident:144,969), comorbidities were common (73.5% and 71.2% with one or more condition[s] in respective data sets, and 13.2% and 11.2% with three or more conditions, in prevalent and incident CKD), and associated with SARS-CoV-2 infection, particularly dialysis/transplantation (odds ratio 2.08, 95% confidence interval 2.04-2.13) and heart failure (1.73, 1.71-1.76), but not cancer (1.01, 1.01-1.04). One-year all-cause mortality varied by age, sex, multi-morbidity and CKD stage. Compared with 34,265 observed excess deaths, in the NHSD-TRE and CPRD databases respectively, we predicted 28,746 and 24,546 deaths (infection rates 10% and relative risks 3.0), and 23,754 and 20,283 deaths (observed infection rates 6.7% and relative risks 3.7). Thus, in this largest, national-level study, individuals with CKD have a high burden of comorbidities and multi-morbidity, and high risk of pre-pandemic and pandemic mortality. Hence, treatment of comorbidities, non-pharmaceutical measures, and vaccination are priorities for people with CKD and management of long-term conditions is important during and beyond the pandemic.
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Affiliation(s)
- Ashkan Dashtban
- Institute of Health Informatics, University College London, London, UK
| | - Mehrdad A Mizani
- Institute of Health Informatics, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Quint
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Richard Corbett
- Department of Nephrology, Imperial College Healthcare NHS Trust, London, UK
| | - Jil B Mamza
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Tamsin Morris
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - Deborah A Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Cathie Sudlow
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; Department of Cardiology, Barts Health NHS Trust, London, UK; Department of Cardiology, University College London Hospitals NHS Trust, London, UK.
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50
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Fabian J, Kalyesubula R, Mkandawire J, Hansen CH, Nitsch D, Musenge E, Nakanga WP, Prynn JE, Dreyer G, Snyman T, Ssebunnya B, Ramsay M, Smeeth L, Tollman S, Naicker S, Crampin A, Newton R, George JA, Tomlinson L. Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study. Lancet Glob Health 2022; 10:e1159-e1169. [PMID: 35839814 DOI: 10.1016/s2214-109x(22)00239-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The burden of kidney disease in many African countries is unknown. Equations used to estimate kidney function from serum creatinine have limited regional validation. We sought to determine the most accurate way to measure kidney function and thus estimate the prevalence of impaired kidney function in African populations. METHODS We measured serum creatinine, cystatin C, and glomerular filtration rate (GFR) using the slope-intercept method for iohexol plasma clearance (mGFR) in population cohorts from Malawi, Uganda, and South Africa. We compared performance of creatinine and cystatin C-based estimating equations to mGFR, modelled and validated a new creatinine-based equation, and developed a multiple imputation model trained on the mGFR sample using age, sex, and creatinine as the variables to predict the population prevalence of impaired kidney function in west, east, and southern Africa. FINDINGS Of 3025 people who underwent measured GFR testing (Malawi n=1020, South Africa n=986, and Uganda n=1019), we analysed data for 2578 participants who had complete data and adequate quality measurements. Among 2578 included participants, creatinine-based equations overestimated kidney function compared with mGFR, worsened by use of ethnicity coefficients. The greatest bias occurred at low kidney function, such that the proportion with GFR of less than 60 mL/min per 1·73 m2 either directly measured or estimated by cystatin C was more than double that estimated from creatinine. A new creatinine-based equation did not outperform existing equations, and no equation, including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 race-neutral equation, estimated GFR within plus or minus 30% of mGFR for 75% or more of the participants. Using a model to impute kidney function based on mGFR, the estimated prevalence of impaired kidney function was more than two-times higher than creatinine-based estimates in populations across six countries in Africa. INTERPRETATION Estimating GFR using serum creatinine substantially underestimates the individual and population-level burden of impaired kidney function in Africa with implications for understanding disease progression and complications, clinical care, and service provision. Scalable and affordable ways to accurately identify impaired kidney function in Africa are urgently needed. FUNDING The GSK Africa Non-Communicable Disease Open Lab. TRANSLATIONS For the Luganda, Chichewa and Xitsonga translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Robert Kalyesubula
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Mkandawire
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Surgery, Pan-African Academy of Christian Surgeons, Malamulo, Thyolo, Malawi; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eustasius Musenge
- Division of Biostatistics and Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wisdom P Nakanga
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi; Institute of Cardiovascular Science, University College London, London, UK
| | - Gavin Dreyer
- Department of Nephrology, Barts Health National Health Service Trust, London, UK
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Billy Ssebunnya
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and their Health Network, Accra, Ghana
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Newton
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurie Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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