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Hogan J, Schneider MF, Pai R, Denburg MR, Kogon A, Brooks ER, Kaskel FJ, Reidy KJ, Saland JM, Warady BA, Furth SL, Patzer RE, Greenbaum LA. Grip strength in children with chronic kidney disease. Pediatr Nephrol 2020; 35:891-899. [PMID: 31932960 PMCID: PMC7313477 DOI: 10.1007/s00467-019-04461-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/04/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relationship between muscle strength and chronic kidney disease (CKD) in children is unknown. This study aims to quantify the association between grip strength (GS) and kidney function and to explore factors associated with grip strength in children and adolescents with CKD. METHODS We included 411 children (699 GS assessments) of the Chronic Kidney Disease in Children (CKiD) study. They were matched by age, sex, and height to a healthy control from the National Health and Nutrition Examination Survey to quantify the relationship between GS and CKD. Linear mixed models were used to identify factors associated with GS among CKD patients. RESULTS Median GS z-score was - 0.72 (IQR - 1.39, 0.11) among CKD patients with CKD stages 2 through 5 having significantly lower GS than CKD stage 1. Compared with healthy controls, CKiD participants had a decreased GS z-score (- 0.53 SD lower, 95% CI - 0.67 to - 0.39) independent of race/ethnicity and body mass index. Factors associated with reduced GS included longer duration of CKD, pre-pubertal status, delayed puberty, neuropsychiatric comorbidities, need of feeding support, need for alkali therapy, and hemoglobin level. Decreased GS was also associated with both a lower frequency and intensity of physical activity. CONCLUSIONS CKD is associated with impaired muscle strength in children independent of growth retardation and BMI. Exposure to CKD for a prolonged time is associated with impaired muscle strength. Potential mediators of the impact of CKD on muscle strength include growth retardation, acidosis, poor nutritional status, and low physical activity. Additional studies are needed to assess the efficacy of interventions targeted at these risk factors.
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Affiliation(s)
- Julien Hogan
- Emory Transplant Center, Department of Surgery, Emory School of Medicine, 5001 Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, GA, 30322, USA. .,Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France.
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rima Pai
- Emory Transplant Center, Department of Surgery, Emory School of Medicine, 5001 Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, GA 30322, USA
| | - Michelle R. Denburg
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy Kogon
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ellen R. Brooks
- Department of Pediatric Kidney Diseases, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Frederick J. Kaskel
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Kimberly J. Reidy
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Jeffrey M. Saland
- Department of Pediatrics, Kravis Children’s Hospital at the Icahn School of Medicine, New York, NY, USA
| | - Bradley A. Warady
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine and Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Susan L. Furth
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E. Patzer
- Emory Transplant Center, Department of Surgery, Emory School of Medicine, 5001 Woodruff Memorial Research Building, 101 Woodruff Circle, Atlanta, GA 30322, USA
| | - Larry A. Greenbaum
- Department of Pediatrics, Emory School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Brooks ER, Lin DC, Langman CB, Thompson JW, St John-Williams L, Furth SL, Warady B, Haymond S. Metabolomic Patterns in Adolescents With Mild to Moderate CKD. Kidney Int Rep 2019; 4:720-723. [PMID: 31080927 PMCID: PMC6506724 DOI: 10.1016/j.ekir.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/26/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ellen R Brooks
- Division of Kidney Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David C Lin
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pathology, Northwestern University Feinberg School of Medicine Chicago, Illinois, USA
| | - Craig B Langman
- Division of Kidney Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J Will Thompson
- Proteomics and Metabolomics Shared Resource, Center for Genomics and Computational Biology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa St John-Williams
- Proteomics and Metabolomics Shared Resource, Center for Genomics and Computational Biology, Duke University Medical Center, Durham, North Carolina, USA
| | - Susan L Furth
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bradley Warady
- Division of Pediatric Nephrology, The Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Shannon Haymond
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pathology, Northwestern University Feinberg School of Medicine Chicago, Illinois, USA
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Brooks ER, Haymond S, Rademaker A, Pierce C, Helenowski I, Passman R, Vicente F, Warady BA, Furth SL, Langman CB. Contribution of symmetric dimethylarginine to GFR decline in pediatric chronic kidney disease. Pediatr Nephrol 2018; 33:697-704. [PMID: 29214443 DOI: 10.1007/s00467-017-3842-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/17/2017] [Revised: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND In pediatric chronic kidney disease (pCKD), traditional factors (proteinuria, etiology, and race) do not fully explain disease progression. The levels of methylated arginine derivatives (MADs: asymmetric and symmetric dimethylarginine, respectively) rise in CKD and increase with CKD progression. The impact of MADs on glomerular filtration rate (GFR) decline has not been examined in pCKD. The aim of this study was to examine the additive impact of baseline (BL) levels of MADs on directly measured GFR (mGFR) decline per year (ml/min/1.73 m2/year) for a period of up to 4 years. METHODS Plasma and data, including mGFR by plasma iohexol clearance, were provided by the prospective, observational Chronic Kidney Disease in Children study. BL MADs were analyzed by high-performance liquid chromatography-tandem mass spectrometry. RESULTS For 352 pCKD subjects, the median [interquartile range] BL mGFR was 45 [35, 57] ml/min/1.73 m2. The levels of BL MADs were inversely related to the initial mGFR and its decline over time (p < 0.0005) but not to the rate of decline. Covariates, non-glomerulopathy and Tanner stage of ≥ 3 demonstrated weaker relationships between BL levels and beginning mGFR (p = 0.004 and p = 0.002, respectively). CONCLUSIONS In pCKD, higher concentrations of BL MADs were inversely related to BL mGFR. MADs did not affect the CKD progression rate. Quantification of this relationship is novel to the pCKD literature.
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Affiliation(s)
- Ellen R Brooks
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Division of Kidney Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Mailstop # 37, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
| | - Shannon Haymond
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alfred Rademaker
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher Pierce
- Department of Epidemiology, University Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Irene Helenowski
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Rod Passman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Department of Internal Medicine, Northwestern Medical Group, Chicago, IL, USA
| | - Faye Vicente
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, The Children's Mercy Hospital, Kansas City, MO, USA
| | - Susan L Furth
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Kidney Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Mailstop # 37, 225 E. Chicago Ave, Chicago, IL, 60611, USA
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Brooks ER, Hoppe B, Milliner DS, Salido E, Rim J, Krevitt LM, Olson JB, Price HE, Vural G, Langman CB. Assessment of Urine Proteomics in Type 1 Primary Hyperoxaluria. Am J Nephrol 2016; 43:293-303. [PMID: 27161247 DOI: 10.1159/000445448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/12/2016] [Accepted: 03/12/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) and idiopathic hypercalciuria (IHC) are stone-forming diseases that may result in the formation of calcium (Ca) oxalate (Ox) stones, nephrocalcinosis, and progressive chronic kidney disease (CKD). Poorer clinical outcome in PH1 is segregated by the highest urine (Ur)-Ox (UrOx), while IHC outcomes are not predictable by UrCa. We hypothesized that differences would be found in selected Ur-protein (PRO) patterns in PH1 and IHC, compared to healthy intra-familial sibling controls (C) of PH1 patients. We also hypothesized that the PRO patterns associated with higher UrOx levels would reflect injury, inflammation, biomineralization, and abnormal tissue repair processes in PH1. METHODS Twenty four-hour Ur samples were obtained from 3 cohorts: PH1 (n = 47); IHC (n = 35) and C (n = 13) and were analyzed using targeted platform-based multi-analyte profile immunoassays and for UrOx and UrCa by biochemical measurements. RESULTS Known stone matrix constituents, osteopontin, calbindin, and vitronectin were lowest in PH1 (C > IHC > PH1; p < 0.05). Ur-interleukin-10; chromogranin A; epidermal growth factor (EGF); insulin-like growth factor-1 (IGF-1), and macrophage inflammatory PRO-1α (MIP-1α) were higher in PH1 > C (p = 0.03 to p < 0.05). Fetuin A; IGF-1, MIP-1α, and vascular cell adhesion molecule-1 were highest in PH1 > IHC (p < 0.001 to p = 0.005). CONCLUSION PH1 Ur-PROs reflected overt inflammation, chemotaxis, oxidative stress, growth factors (including EGF), and pro-angiogenic and calcification regulation/inhibition compared to the C and IHC cohorts. Many of the up- and downregulated PH1-PROs found in this study are also found in CKD, acute kidney injury, stone formers, and/or stone matrices. Further data analyses may provide evidence for PH1 unique PROs or demonstrate a poorer clinical outcome.
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Affiliation(s)
- Ellen R Brooks
- Feinberg School of Medicine, Northwestern University, Department of Pediatrics, Chicago, Ill., USA
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Denburg MR, Kumar J, Jemielita T, Brooks ER, Skversky A, Portale AA, Salusky IB, Warady BA, Furth SL, Leonard MB. Fracture Burden and Risk Factors in Childhood CKD: Results from the CKiD Cohort Study. J Am Soc Nephrol 2015; 27:543-50. [PMID: 26139439 DOI: 10.1681/asn.2015020152] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/29/2015] [Indexed: 12/30/2022] Open
Abstract
Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter. We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponding to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2- to 3-fold higher than published general population rates. The only gender difference in fracture risk was a 2.6-fold higher risk in males aged ≥15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P≤0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazard ratio, 4.87; 95% CI, 2.21-10.75; P<0.001). In conclusion, children with CKD have a high burden of fracture. Regarding modifiable factors, higher average parathyroid hormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.
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Affiliation(s)
- Michelle R Denburg
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Juhi Kumar
- Weill Cornell Medical College, New York, New York
| | - Thomas Jemielita
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen R Brooks
- Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy Skversky
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Anthony A Portale
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Isidro B Salusky
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bradley A Warady
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and
| | - Susan L Furth
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, California
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Akchurin OM, Schneider MF, Mulqueen L, Brooks ER, Langman CB, Greenbaum LA, Furth SL, Moxey-Mims M, Warady BA, Kaskel FJ, Skversky AL. Medication adherence and growth in children with CKD. Clin J Am Soc Nephrol 2014; 9:1519-25. [PMID: 24970873 DOI: 10.2215/cjn.01150114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor growth is a consequence of CKD, but can often be partially or fully prevented or corrected with the use of a number of medications. The extent of nonadherence with medications used to treat or mitigate growth failure in CKD has not been examined prospectively in children with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The prevalence of both prescription of and nonadherence to recombinant human growth hormone (rhGH), phosphate binders, alkali, active vitamin D, nutritional vitamin D, iron, and erythrocyte-stimulating agents was summarized over the first seven visits of the Chronic Kidney Disease in Children cohort study. The association between self-reported nonadherence to each medication group and the mean annual change in age- and sex-specific height z score was quantified using seven separate linear regression models with generalized estimating equations. RESULTS Of 834 participants, 597 reported use of at least one of these medication groups and had adherence data available. Nonadherence ranged from 4% over all visits for erythrocyte-stimulating agents to 22% over all visits for nutritional vitamin D. Of the study participants, 451 contributed data to at least one of the analyses of adherence and changes in height z score. Children nonadherent to rhGH had no change in height z score, whereas those adherent to rhGH had a significant improvement of 0.16 SDs (95% confidence interval, 0.05 to 0.27); the effect size was slightly larger and remained significant after adjustment. Among participants with height≤3rd percentile and after adjustment, adherence to rhGH was associated with a 0.33 SD (95% confidence interval, 0.10 to 0.56) greater change in height z score. Nonadherence with other medication groups was not significantly associated with a change in height z score. CONCLUSIONS Self-reported nonadherence to rhGH was associated with poorer growth velocity in children with CKD, suggesting an opportunity for intervention and improved patient outcome.
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Affiliation(s)
- Oleh M Akchurin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Michael F Schneider
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lucy Mulqueen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ellen R Brooks
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Craig B Langman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Larry A Greenbaum
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Susan L Furth
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marva Moxey-Mims
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Bradley A Warady
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Frederick J Kaskel
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Amy L Skversky
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Brooks ER, Langman CB, Wang S, Price HE, Hodges AL, Darling L, Yang AZ, Smith FA. Methylated arginine derivatives in children and adolescents with chronic kidney disease. Pediatr Nephrol 2009; 24:129-34. [PMID: 18830716 DOI: 10.1007/s00467-008-0972-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 06/01/2008] [Accepted: 07/01/2008] [Indexed: 11/30/2022]
Abstract
Asymmetric dimethylarginine (ADMA), a methylated L: -arginine (Arg) derivative is associated with endothelial dysfunction, vasoconstriction, and hypertension in animals and humans. We examined the relationship between these derivatives, estimated glomerular filtration rate (eGFR), and awake (AW) and asleep (AS) blood pressure (BP) load in children and adolescents (n = 28) with stage 2-3 chronic kidney disease (CKD) and in matched intra-familial controls (n = 10). Plasma L: -Arg, ADMA, and symmetric dimethylarginine (SDMA) levels were measured by high-performance liquid chromatography-tandem mass spectrometry. Subjects wore a 24-hr ambulatory BP monitor with BP load >95th percentile. ADMA, SDMA/ADMA ratio and SDMA were 38-200% higher in CKD patients while L: -Arg/ADMA and L: -Arg/SDMA ratios and the L: -Arg level were 11-64% lower. The eGFR explained 42-60% of L: -Arg/SDMA, SDMA/ADMA, and SDMA variability (n = 38). Using linear regression, SDMA and SDMA/ADMA separately explained 15-38% of AW and AS systolic (S) BP and diastolic (D) BP load variability (p < 0.001-0.022). Using multivariate stepwise regression with eGFR held constant, SDMA/ADMA was a significant independent variable for AW DBP load (p = 0.03). In conclusion, BP load and a disproportionate elevation of SDMA are seen in children and adolescents with stage 2-3 (mild-moderate) CKD. SDMA is a strong marker for reduced eGFR and serves as a moderate but significant indicator of 24-hr BP load variability.
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Affiliation(s)
- Ellen R Brooks
- Department of Pediatrics, Division of Kidney Diseases, Children's Memorial Hospital and Northwestern University Feinberg Medical School, Chicago, IL, USA.
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Brooks ER, Fatallah-Shaykh SA, Langman CB, Wolf KM, Price HE. Bioelectric Impedance Predicts Total Body Water, Blood Pressure, and Heart Rate During Hemodialysis in Children and Adolescents. J Ren Nutr 2008; 18:304-11. [DOI: 10.1053/j.jrn.2007.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Indexed: 11/11/2022] Open
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Wang S, Vicente FB, Miller A, Brooks ER, Price HE, Smith FA. Measurement of arginine derivatives in pediatric patients with chronic kidney disease using high-performance liquid chromatography-tandem mass spectrometry. ACTA ACUST UNITED AC 2007; 45:1305-12. [PMID: 17663630 DOI: 10.1515/cclm.2007.277] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 02/07/2023]
Abstract
AbstractClin Chem Lab Med 2007;45:1305–12.
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Affiliation(s)
- Sihe Wang
- Department of Pathology and Laboratory Medicine, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Fathallah-Shaykh SA, Brooks ER, Langman CB, Kensey KR. Sodium modeling attenuates rises in whole-blood viscosity during chronic hemodialysis in children with large inter-dialytic weight gain. Pediatr Nephrol 2006; 21:1179-84. [PMID: 16721594 DOI: 10.1007/s00467-006-0101-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 08/03/2005] [Revised: 01/17/2006] [Accepted: 01/19/2006] [Indexed: 10/24/2022]
Abstract
Elevated whole-blood viscosity (WBV) is a risk factor for atherosclerosis and thrombosis. We analyzed WBV during hemodialysis (HD) in children and tested the hypothesis that sodium modeling (NaM) attenuates an increase in WBV. Each of six children underwent two control (C) and two NaM HD sessions, B and E. Rapid decline in sodium (Na) concentration occurred at the beginning of HD in B and at the end in E. We measured WBV at different shear rates (SRs) and documented the amount of fluid removed (FR), change in blood volume (BV), and hematocrit (Hct) before, during, and after HD. The percent increase of WBV in control sessions was significantly different at 2 h and 3 h during and after HD from baseline values. The mean percent change in WBV from baseline increased linearly over time during HD (R2>0.90). Hct, FR, and BV correlated with WBV (P<0.05). The effects of NaM on attenuation of WBV were statistically significant in three subjects with >5% inter-dialytic weight gain (IDWG) (P<0.05). WBV increased during HD in children. NaM appears to attenuate the rise in WBV in children with large IDWG.
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Affiliation(s)
- Sahar A Fathallah-Shaykh
- Division of Kidney Diseases, Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Abstract
The increasing prevalence of chronic kidney disease (CKD) in the United States demands a closer evaluation of and attention to associated morbidities, and, particularly, the rising mortality related to cardiovascular disease in all age groups. Patients with CKD demonstrate an increased risk of coronary artery disease due to calcium deposition and subsequent arterial stiffening, in addition to left ventricular dysfunction with associated heart failure and arrhythmias. While clearly impacted by the traditional risk factors for development of cardiovascular disease (CVD), patients with CKD are also affected by non-traditional risk factors, including calcium overloading related to aggressive management of secondary hyperparathyroidism. Recent data have shown that a substantial number of patients with CKD are deficient in vitamin D on a nutritional basis, in addition to the known decrease in the kidney-produced active metabolite during progressive CKD. Historically, vitamin D has been described as an endocrine hormone that regulates blood calcium and parathyroid hormone levels. It has become increasingly clear, through the recognition of a vitamin D receptor in most tissues, that vitamin D possesses functions well beyond calcium homeostasis, such that a deficiency may contribute to the development of CVD. In this brief review, the role of vitamin D activation through its vitamin D receptor will serve as an introduction to the magnitude of the nutritional deficits in children, adults, and those with CKD. As therapeutic entities in the management of renal osteodystrophy, vitamin D analogues play an important role in cardiovascular health that continues to evolve. Preliminary studies indicate that vitamin D therapy for control of secondary hyperparathyroidism may confer cardioprotection and reduce mortality. Attention to care of osteodystrophy in CKD must take into account heart health as well.
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Affiliation(s)
- Craig B Langman
- Children's Memorial Hospital, 2300 Children's Plaza, MS #37, Chicago, IL 60614, USA.
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Ariceta G, Brooks ER, Langman CB. Assessing cardiovascular risk in children with chronic kidney disease. B-type natriuretic peptide: a potential new marker. Pediatr Nephrol 2005; 20:1701-7. [PMID: 16082547 DOI: 10.1007/s00467-005-1954-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/01/2005] [Revised: 03/21/2005] [Accepted: 03/21/2005] [Indexed: 12/01/2022]
Abstract
Elevated plasma B-type natriuretic peptide (BNP) level is a hallmark of altered left ventricular (LV) structure and function. Measurement of circulating BNP has proved to be a sensitive and specific diagnostic test for congestive heart failure (CHF) and coronary syndrome in adults. Further, BNP levels constitute a strong predictive marker for future cardiovascular (CV) events. In high CV risk populations, such as adults with hypertension or chronic kidney disease (CKD), increased BNP predicts CV morbidity and mortality in symptomatic or asymptomatic patients. However, caution is needed in interpreting plasma BNP levels, as they increase with both age and decreased renal function. Despite increasing evidence of the value of BNP in the medical literature in adults, data in children are limited to those with congenital heart disease. It is appropriate to analyze the potential application of this tool in children with CKD, a well-known factor for CV disease.
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Affiliation(s)
- Gema Ariceta
- Division of Kidney Diseases, Children's Memorial Hospital, Chicago, IL 60614, USA.
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Edwards BJ, Brooks ER, Langman CB. Osteoporosis screening of postmenopausal women in the primary care setting: a case-based approach. ACTA ACUST UNITED AC 2005; 1:70-85. [PMID: 16115586 DOI: 10.1016/s1550-8579(04)80013-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the facts that approximately half of postmenopausal women will sustain an osteoporosis-related fracture and 15% will sustain a hip fracture in their lifetime, 75% of American women between the ages of 45 and 75 years have never discussed osteoporosis with their physician. OBJECTIVE This case-based review addresses screening for osteoporosis in the primary care setting. Topics include epidemiology, assessment of fracture risk, bone mineral density testing, primary prevention of osteoporosis, and thresholds for treatment. METHODS Relevant articles were identified through a search of MEDLINE (1980-2004) using the terms osteoporosis, fractures, randomized controlled trials (RCTs), and epidemiology, pathophysiology, diagnosis, and treatment of osteoporosis. Clinical guidelines on osteoporosis were also reviewed. CONCLUSIONS Osteoporosis is a prevalent disease in postmenopausal women. Osteoporosis-related fractures are a cause of major morbidity and mortality in older adults. Increased awareness of osteoporosis is necessary to stem the mounting number of complications.
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Affiliation(s)
- Beatrice J Edwards
- Bone Health and Osteoporosis Program, Division of Geriatric Medicine, Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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Brooks ER, Howat PM, Cavalier DS. Calcium supplementation and exercise increase appendicular bone density in anorexia: a case study. J Am Diet Assoc 1999; 99:591-3. [PMID: 10333781 DOI: 10.1016/s0002-8223(99)00144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- E R Brooks
- Woman's Health Research Institute, Woman's Hospital, Baton Rouge, LA 70815, USA
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Abstract
The lateral (LAT) spine scan has been suggested as a more sensitive measure than posterior-anterior (PA) scanning for assessing age-related bone loss in normal-weight postmenopausal women. The measurement error of PA and LAT bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) has also been shown to rise with incremental increases in fat and from large variance in fat thickness, respectively. The purpose of this cross-sectional study was to determine specific affects of obesity on paired PA and LAT lumbar (L2-L4) BMD and Z score (BMD of patient versus age-matched reference data-base) correlation in 30 obese postmenopausal women (mean BMI +/- SD = 33.3 +/- 4.06). The mean PA and LAT BMD +/- SD were 0.946 +/- 0.123 and 0.749 +/- 0.134, respectively. The mean PA and LAT Z scores were -0.17 +/- 1.15 and 0.80 +/- 1.7. The correlation between PA and LAT BMD was significantly lower (r = 0.55; P < 0.05) than previously reported, and PA and LAT Z score correlation was (r = 0.57; P = 0.0016). After adjusting for body mass index (BMI), percent body fat, fat mass, and truncal fat by DXA, waist:hip ratio (WHR) and visceral and subcutaneous abdominal fat by computerized axial tomography (CT), PA and LAT Z score correlation increased to r = 0.62; P = 0.0065. In our subjects, the mean LAT Z score was 4.6 times higher than the mean AP Z, contrary to previous observations in normal-weight postmenopausal women. Our findings may be due to increased soft tissue composition and fat inhomogeneity in the LAT scanning field resulting in increased X-ray attenuation in obesity.
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Affiliation(s)
- E R Brooks
- Pennington Biomedical Research Center, Department of Kinesiology, Louisiana State University, Baton Rouge 70808, USA
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Abstract
This investigation evaluated bone density in 36 premenopausal women (mean +/- SD age = 29.5 +/- 8.4 years) an average of 11.4 years after diagnosis for anorexia nervosa. Twenty-nine women were aged 20-45 years, and seven were aged 16-19 years. Body composition, age of menarche, length of amenorrhea, estrogen exposure, and lumbar spine and proximal femur bone density were determined. Average appendicular bone density for those > or = 20 years was found to meet World Health Organization T score criteria for osteopenia: total femur T = -1.22 and femoral neck T = -1.33. The average total lumbar Z score for all 36 participants was -0.95, which was 90% of the mean for their age, and the mean Z scores for adolescent subjects were within 91% of the mean for their age (Z = -0.84). Years of estrogen exposure were correlated with lumbar mineral content (r = 0.50, p = 0.002). A modest but significant inverse relationship was observed between length of amenorrhea and femoral and lumbar bone density. The total proximal femur and trochanteric bone densities were best predicted, using stepwise regression, by the number of years after diagnosis and years of amenorrhea, respectively (R2 = 0.23, p = 0.02 and R2 = 0.21, p = 0.04). Lumbar density was best predicted by years of amenorrhea and current percent of ideal body weight (%IBW)(R2 = 0.25, p = 0.02). Length of amenorrhea, estrogen exposure, and %IBW independently contribute to axial and appendicular bone density. Because of risk for compromised bone density, women with a history of anorexia nervosa should be followed longitudinally to maximize premenopausal bone replacement.
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Affiliation(s)
- E R Brooks
- Woman's Health Research Institute, Woman's Hospital, Baton Rouge, Louisiana, USA
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Hwang DH, Chanmugam PS, Ryan DH, Boudreau MD, Windhauser MM, Tulley RT, Brooks ER, Bray GA. Does vegetable oil attenuate the beneficial effects of fish oil in reducing risk factors for cardiovascular disease? Am J Clin Nutr 1997; 66:89-96. [PMID: 9209174 DOI: 10.1093/ajcn/66.1.89] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Contradictory reports on the protective effect of fish consumption on cardiovascular disease (CVD) risk could be due to variations in the intake of n-3 and n-6 polyunsaturated fatty acids (PUFAs). Metabolic competition between n-3 and n-6 PUFAs suggests that n-6 PUFAs in vegetable oils could attenuate the efficacy of n-3 PUFAs in fish oil to favorably alter endpoints relevant to CVD risk. We determined the effects of varying dietary amounts of fish oil on lipid and thrombotic endpoints relevant to risk factors for CVD and whether these effects were attenuated by vegetable oils. Two randomized, double-blind, placebo-controlled, parallel studies were conducted in human subjects fed varying amounts of n-3 and n-6 PUFAs; n-3 PUFA intake was varied by using fish or placebo oil capsules, and n-6 PUFA intake was modified by incorporating varying amounts of safflower oil into the diet. Endpoints included changes in membrane fatty acid composition, blood lipids, and thrombotic profile. The results indicated that absolute amounts of fish oil, and not the relative amounts of fish and vegetable oil (ratios of n-3 to n-6 PUFAs), determined the magnitude of the reduction of arachidonic acid and increase in eicosapentaenoic acid in phospholipids of plasma and platelets. The suppression of plasma triacylglycerols by fish oil was not affected by varying amounts of dietary n-6 PUFAs. Fibrinogen concentrations decreased with 15 g but not with 9 g fish oil/d fed at the same ratio of n-3 to n-6 PUFAs. The efficacy of fish oil in favorably modifying certain risk factors for CVD was not attenuated by vegetable oil.
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Affiliation(s)
- D H Hwang
- Pennington Biomedical Research Center, Louisiana State University, Baton Route, USA.
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Abstract
The relationship of disinhibition and dietary restraint with body mass was studied in a sample of 293 women. Results suggested that higher body mass was associated with an interaction of disinhibition and dietary restraint. The association of disinhibition with higher body mass was moderated by increased dietary restraint. Symptoms of an eating disorder were more strongly associated with disinhibition than with dietary restraint. These results suggest that dieting may moderate the increased body mass associated with overeating. Psychological and eating problems associated with dietary restraint were found to be of less significance than those associated with disinhibition.
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Affiliation(s)
- D A Williamson
- Pennington Biomedical Research Center, Department of Psychology, Louisiana State University, Baton Rouge 70803, USA
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Lawson OJ, Williamson DA, Champagne CM, DeLany JP, Brooks ER, Howat PM, Wozniak PJ, Bray GA, Ryan DH. The association of body weight, dietary intake, and energy expenditure with dietary restraint and disinhibition. Obes Res 1995; 3:153-61. [PMID: 7719961 DOI: 10.1002/j.1550-8528.1995.tb00131.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The hypotheses that dieting and/or overeating are associated with adiposity, eating disturbances, and lowered energy expenditure were tested in this study. A sample of 44 premenopausal women scoring high and low on measures of dietary restraint and disinhibition of dietary control, as measured by the Three Factor Eating Questionnaire, was studied. A 2 x 2 factorial design was employed (High/Low restraint x High/Low Disinhibition). Dependent variables were: body composition, dietary intake, activity, resting metabolic rate, and thermic effect of food. Unrestrained overeaters (Low Restraint/High Disinhibition group) were very obese. High Dietary Restraint was associated with intent to diet and controlled eating. High scores on the Disinhibition Scale were associated with episodic overeating. Groups did not differ in resting metabolic rate (controlled for fat-free mass). Lower thermic effect of food was found to be associated with the obesity found in High Disinhibition subjects. Thus, Dietary Restraint was not associated with significant adverse effects upon physical or psychological health. High Disinhibition, however, was associated with adiposity and significant disturbances of eating.
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Affiliation(s)
- O J Lawson
- Louisiana State University, Pennington Biomedical Research Center, Baton Rouge 70803-5501, USA
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Brooks ER. The starting point. Nursing diagnosis makes nurses' point of view count, and their practice accountable. Nurs Manag (Harrow) 1983; 14:35-7. [PMID: 6553216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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