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Trujillo J, Alotaibi M, Seif N, Cai X, Larive B, Gassman J, Raphael KL, Cheung AK, Raj DS, Fried LF, Sprague S, Block G, Chonchol M, Middleton JP, Wolf M, Ix JH, Prasad P, Isakova T, Srivastava A. Associations of Kidney Functional Magnetic Resonance Imaging Biomarkers with Markers of Inflammation in Individuals with Chronic Kidney Disease. Kidney360 2024:02200512-990000000-00375. [PMID: 38570905 DOI: 10.34067/kid.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Greater fibrosis and decreased oxygenation may amplify systemic inflammation, but data on the associations of kidney functional magnetic resonance imaging (fMRI) measurements of fibrosis (apparent diffusion coefficient [ADC]) and oxygenation (relaxation rate [R2*]) with systemic markers of inflammation are limited. METHODS We evaluated associations of baseline kidney fMRI-derived ADC and R2* with baseline and follow-up serum interleukin-6 (IL-6) and C-reactive protein (CRP) in 127 participants from the COMBINE trial, a randomized, 12-month trial of nicotinamide and lanthanum carbonate vs. placebo in individuals with CKD stages 3-4. Cross-sectional analyses of baseline kidney fMRI biomarkers and markers of inflammation used multivariable linear regression. Longitudinal analyses of baseline kidney fMRI biomarkers and change in markers of inflammation over time used linear mixed effects models. RESULTS Mean±SD eGFR, ADC, and R2* were 32.2±8.7 ml/min/1.73m2, 1.46±0.17 x10-3 mm2/s, and 20.3±3.1 s-1, respectively. Median [IQR] IL-6 and CRP were 3.7 [2.4-4.9] pg/mL and 2.8 [1.2-6.3] mg/L. After multivariable adjustment, IL-6 and CRP were 13.1% and 27.3% higher per 1 SD decrease in baseline cortical ADC. Baseline cortical R2* did not have a significant association with IL-6 or CRP. Mean annual IL-6 and CRP slopes were 0.98 pg/mL per year and 0.91 mg/L per year, respectively. Baseline cortical ADC and R2* did not have significant associations with change in IL-6 or CRP over time. CONCLUSIONS Lower cortical ADC, suggestive of greater fibrosis, was associated with higher systemic inflammation. Baseline kidney fMRI biomarkers did not associate with changes in systemic markers of inflammation over time.
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Affiliation(s)
- Jacquelyn Trujillo
- The Graduate School, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Manal Alotaibi
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SA
| | - Nay Seif
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medicine, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Xuan Cai
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Kalani L Raphael
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Dominic S Raj
- Division of Renal Diseases and Hypertension, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Linda F Fried
- Division of Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stuart Sprague
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL
| | | | - Michel Chonchol
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, CO
| | - John Paul Middleton
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Myles Wolf
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Joachim H Ix
- Department of Medicine, Renal Section, University of California San Diego School of Medicine, San Diego, CA
| | - Pottumarthi Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- University of Illinois Chicago, Chicago, IL
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Chen DC, Scherzer R, Ix JH, Kramer HJ, Crews DC, Nadkarni G, Gutierrez O, Bullen AL, Ilori T, Garimella PS, Shlipak MG, Estrella MM. Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity. Am J Kidney Dis 2024; 83:489-496.e1. [PMID: 37866793 PMCID: PMC10960714 DOI: 10.1053/j.ajkd.2023.08.021] [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: 04/26/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 10/24/2023]
Abstract
RATIONALE & OBJECTIVE Cystatin C-based estimated glomerular filtration rate (eGFRcys) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFRcr). Obesity may be associated with higher cystatin C levels, independent of kidney function, but it is unknown whether obesity modifies associations of eGFRcys with kidney and cardiovascular outcomes. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS 27,249 US adults in the Reasons for Geographic and Racial Differences in Stroke Study. PREDICTORS eGFRcys, eGFRcr, waist circumference, and body mass index (BMI). OUTCOME All-cause mortality, kidney failure, incident atherosclerotic cardiovascular disease (ASCVD), and incident heart failure (HF). ANALYTICAL APPROACH Multivariable Cox and Fine-Gray models with multiplicative interaction terms were constructed to investigate whether waist circumference quartiles or BMI categories modified associations of eGFRcys with risks of 4 clinical outcomes. RESULTS Participants had a mean age of 65 years; 54% were women, 41% were Black, and 21% had an eGFRcys<60mL/min/1.73m2. The baseline prevalence of abdominal obesity (waist circumference≥88cm for women or≥102cm for men) was 48% and obesity was 38%. In multivariable adjusted analyses, each 15mL/min/1.73m2 lower eGFRcys was associated with higher HR and 95% CI of mortality in each waist circumference quartile (first quartile, 1.19 [1.15-1.24]; second quartile, 1.22 [1.18-1.26]; third quartile, 1.20 [1.16-1.24]; fourth quartile, 1.19 [1.15-1.23]) as well as within each BMI category (BMI<24.9: 1.21 [1.17-1.25]; BMI 25.0-29.9: 1.21 [1.18-1.25]; BMI 30.0-34.9: 1.20 [1.16-1.25]; BMI≥35: 1.17, [1.12-1.22]). Neither waist circumference nor BMI modified the association of eGFRcys with mortality, kidney failure, incident ASCVD, or incident HF (all Pinteraction>0.05). LIMITATIONS Included only Black and White persons in the United States. CONCLUSION Obesity did not modify the association of eGFRcys with all-cause mortality, kidney failure, incident ASCVD, or incident HF. Among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes. PLAIN-LANGUAGE SUMMARY Cystatin C is increasingly used in clinical practice to estimate kidney function, and cystatin C-based eGFR (eGFRcys) may be used to determine risk for adverse clinical outcomes. Adiposity may increase serum levels of cystatin C, independent of kidney function. This cohort study investigated whether associations of eGFRcys with adverse kidney and cardiovascular outcomes are modified by measures of obesity, waist circumference, and body mass index. We found that obesity does not modify associations of eGFRcys with 4 clinical outcomes and conclude that among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.
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Affiliation(s)
- Debbie C Chen
- Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco; Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Genentech, Inc., South San Francisco
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Department of Medicine, San Francisco VA Medical Center, San Francisco
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California at San Diego, San Diego; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Dieg, California
| | - Holly J Kramer
- Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, Illinois
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Girish Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Clinical Intelligence Cente, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Orlando Gutierrez
- Division of Nephrology, UAB Heersink School of Medicine, Birmingham, Alabama
| | - Alexander L Bullen
- Division of Nephrology-Hypertension, University of California at San Diego, San Diego; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Dieg, California
| | - Titilayo Ilori
- Section of Nephrology, Department of Medicine, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, University of California at San Diego, San Diego
| | - Michael G Shlipak
- Department Epidemiology and Biostatistics, University of California at San Francisco, San Francisco; Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Department of Medicine, San Francisco VA Medical Center, San Francisco
| | - Michelle M Estrella
- Division of Nephrology, Department of Medicine, University of California at San Francisco, San Francisco; Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco; Division of Nephrology, San Francisco VA Medical Center, San Francisco; Department of Medicine, San Francisco VA Medical Center, San Francisco.
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Chen DC, Lu K, Scherzer R, Lees JS, Rutherford E, Mark PB, Potok OA, Rifkin DE, Ix JH, Shlipak MG, Estrella MM. Cystatin C- and Creatinine-based Estimated GFR Differences: Prevalence and Predictors in the UK Biobank. Kidney Med 2024; 6:100796. [PMID: 38567244 PMCID: PMC10986041 DOI: 10.1016/j.xkme.2024.100796] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Rationale & Objective Large differences between estimated glomerular filtration rate (eGFR) based on cystatin C (eGFRcys) and creatinine (eGFRcr) occur commonly. A comprehensive evaluation of factors that contribute to these differences is needed to guide the interpretation of discrepant eGFR values. Study Design Cohort study. Setting & Participants 468,969 participants in the UK Biobank. Exposures Candidate sociodemographic, lifestyle factors, comorbidities, medication usage, and physical and laboratory predictors. Outcomes eGFRdiff, defined as eGFRcys minus eGFRcr, categorized into 3 levels: lower eGFRcys (eGFRdiff, less than -15 mL/min/1.73 m2), concordant eGFRcys and eGFRcr (eGFRdiff, -15 to < 15 mL/min/1.73 m2), and lower eGFRcr (eGFRdiff, ≥15 mL/min/1.73 m2). Analytical Approach Multinomial logistic regression models were constructed to identify predictors of lower eGFRcys or lower eGFRcr. We developed 2 prediction models comprising 375,175 participants: (1) a clinical model using clinically available variables and (2) an enriched model additionally including lifestyle variables. The models were internally validated in an additional 93,794 participants. Results Mean ± standard deviation of eGFRcys was 88 ± 16 mL/min/1.73 m2, and eGFRcr was 95 ± 13 mL/min/1.73 m2; 25% and 5% of participants were in the lower eGFRcys and lower eGFRcr groups, respectively. In the multivariable enriched model, strong predictors of lower eGFRcys were older age, male sex, South Asian ethnicity, current smoker (vs never smoker), history of thyroid dysfunction, chronic inflammatory disease, steroid use, higher waist circumference and body fat, and urinary albumin-creatinine ratio >300 mg/g. Odds ratio estimates for these predictors were largely inverse of those in the lower eGFRcr group. The model's area under the curve was 0.75 in the validation set, with good calibration (1.00). Limitations Limited generalizability. Conclusions This study highlights the multitude of demographic, lifestyle, and health characteristics that are associated with large eGFRdiff. The clinical model may identify individuals who are likely to have discrepant eGFR values and thus should be prioritized for cystatin C testing.
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Affiliation(s)
- Debbie C. Chen
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, CA
- Genentech, Inc., South San Francisco, CA
| | - Kaiwei Lu
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Jennifer S. Lees
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Elaine Rutherford
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Renal Unit, Mountainhall Treatment Centre, NHS Dumfries and Galloway, Dumfries, UK
| | - Patrick B. Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - O. Alison Potok
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Dena E. Rifkin
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
- Department Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Michelle M. Estrella
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
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Venishetty N, Berry JD, de Lemos JA, Wu E, Lee MJ, Drawz PE, Nambi V, Ballantyne CM, Killeen AA, Ix JH, Shlipak MG, Ascher SB. Associations of ambulatory blood pressure measurements with high-sensitivity troponin and natriuretic peptide levels in SPRINT. Am J Hypertens 2024:hpae035. [PMID: 38554284 DOI: 10.1093/ajh/hpae035] [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: 11/21/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Nighttime blood pressure (BP) has greater prognostic importance for cardiovascular disease (CVD) than daytime BP, but less is known about nighttime and daytime BP associations with measures of subclinical CVD. METHODS Among 897 Systolic Blood Pressure Intervention Trial Study (SPRINT) participants with 24-hour ambulatory BP monitoring obtained near the 27-month study visit, 849 (95%) had N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measured at the 24-month study visit. Multivariable linear regression analyses were performed to evaluate the associations of nighttime and daytime BP with cardiac biomarker levels. RESULTS Mean age was 69 ±12 years, 28% were African American, and mean nighttime and daytime SBP were 121 ±16 mm Hg and 132 ±14 mm Hg, respectively. In multivariable models, compared with the lowest tertile of nighttime systolic BP, the highest tertile was associated with 48% higher NT-proBNP levels (adjusted geometric mean ratio [GMR] = 1.48, 95% CI: 1.22, 1.79), and 19% higher hs-cTnT levels (adjusted GMR = 1.19, 95% CI: 1.07, 1.32). In contrast, the highest versus lowest tertile of daytime systolic BP was not associated with NT-proBNP (adjusted GMR = 1.09, 95% CI: 0.88, 1.34) but was associated with 16% higher hs-cTnT levels (adjusted GMR = 1.16, 95% CI: 1.04, 1.30). Similar results were observed using diastolic BP. CONCLUSION In SPRINT, both higher nighttime and daytime BP were independently associated with higher hs-cTnT levels, but only higher nighttime BP was associated with higher NT-proBNP levels.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX
| | - Jarett D Berry
- Department of Internal Medicine, University of Texas at Tyler Health Science Center, Tyler, TX
| | - James A de Lemos
- Department of Cardiology, Division of Cardiology, the University of Texas at Southwestern Medical School, Dallas, TX
| | - Elaine Wu
- Department of Cardiology, Division of Cardiology, the University of Texas at Southwestern Medical School, Dallas, TX
| | - Min Jae Lee
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul E Drawz
- Division of Nephrology and Hypertension, University of Minnesota Medical School, Minneapolis, MN
| | - Vijay Nambi
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Christie M Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and UCSF, San Francisco, CA
| | - Simon B Ascher
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and UCSF, San Francisco, CA
- Division of Hospital Medicine, University of California Davis, Sacramento, CA
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Bansal N, Katz R, Seliger S, deFilippi C, Wettersten N, de Lemos JA, Christenson R, Killeen AA, Berry JD, Shlipak MG, Ix JH. Variation of NT-proBNP and High-Sensitivity Cardiac Troponin T Across Levels of Estimated Glomerular Filtration Rate: The SPRINT Trial. Circulation 2024; 149:967-969. [PMID: 38498611 PMCID: PMC10954091 DOI: 10.1161/circulationaha.123.066377] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Nisha Bansal
- Division of Nephrology, University of Washington, Seattle, WA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Stephen Seliger
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Nicholas Wettersten
- Division of Cardiology, VA San Diego Healthcare System, San Diego, San Diego, CA
| | - James A. de Lemos
- Division of Cardiology, University of Texas, Southwestern, Dallas, TX
| | | | - Anthony A. Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Jarett D. Berry
- Division of Cardiology, University of Texas, Southwestern, Dallas, TX
| | - Michael G. Shlipak
- Department of Medicine, University of California San Francisco, and San Francisco Veterans Affairs Hospital, San Francisco, CA
| | - Joachim H. Ix
- Division of Nephrology, University of California San Diego, and Veterans Affairs San Diego Healthcare System, San Diego, CA
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Smith C, Berry JD, Scherzer R, de Lemos JA, Nambi V, Ballantyne CM, Kravitz RL, Killeen AA, Ix JH, Shlipak MG, Ascher SB. Intensive Blood Pressure Lowering in Individuals With Low Diastolic Blood Pressure and Elevated Troponin Levels in SPRINT. J Am Heart Assoc 2024; 13:e032493. [PMID: 38497469 PMCID: PMC11010028 DOI: 10.1161/jaha.123.032493] [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: 09/12/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Among individuals with hypertension and low diastolic blood pressure (DBP), the optimal BP target remains controversial due to concerns that BP lowering may reduce coronary perfusion. We determined the impact of intensive BP control among individuals with elevated systolic BP who have low DBP and elevated hs-cTnT (high-sensitivity cardiac troponin T) levels. METHODS AND RESULTS A total of 8828 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were stratified by baseline DBP. Those with low DBP (<70 mm Hg) were further stratified by elevated hs-cTnT (≥14 ng/L) at baseline. The effects of intensive versus standard BP lowering on a cardiovascular disease composite end point, all-cause death, and 1-year change in hs-cTnT were determined. The combination of low DBP/high hs-cTnT was independently associated with a higher risk for cardiovascular disease and all-cause death, as well as greater 1-year increases in hs-cTnT, compared with DBP ≥70 mm Hg. However, randomization to intensive versus standard BP lowering led to similar reductions in cardiovascular disease risk among individuals with low DBP/high hs-cTnT (hazard ratio [HR], 0.82 [95% CI, 0.57-1.19]), low DBP/low hs-cTnT (HR, 0.48 [95% CI, 0.29-0.79]), and DBP ≥70 mm Hg (HR, 0.73 [95% CI, 0.60-0.89]; P for interaction=0.20). Intensive BP lowering also led to a reduction in all-cause death that was similar across groups (P for interaction=0.57). CONCLUSIONS In this nonprespecified subgroup analysis of SPRINT, individuals with low DBP and elevated hs-cTnT, low DBP and nonelevated hs-cTnT, and DBP ≥70 mm Hg derived similar cardiovascular disease and mortality benefits from intensive BP lowering. These findings warrant confirmation in other studies.
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Affiliation(s)
- Cady Smith
- Department of Internal Medicine University of California Davis Sacramento CA USA
| | - Jarett D Berry
- Department of Internal Medicine University of Texas at Tyler Health Science Center Tyler TX USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CA USA
| | - James A de Lemos
- Divison of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine Houston TX USA
| | - Christie M Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention Baylor College of Medicine Houston TX USA
| | - Richard L Kravitz
- Department of Internal Medicine University of California Davis Sacramento CA USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology University of Minnesota Minneapolis MN USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension University of California San Diego La Jolla CA USA
- Nephrology Section Veterans Affairs San Diego Healthcare System San Diego CA USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CA USA
| | - Simon B Ascher
- Department of Internal Medicine University of California Davis Sacramento CA USA
- Kidney Health Research Collaborative, Department of Medicine San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CA USA
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7
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Peschard VG, Scherzer R, Katz R, Chen TK, Bullen AL, Campos K, Estrella MM, Ix JH, Shlipak MG. Association of Urinary Dickkopf-3 Levels with Cardiovascular Events and Kidney Disease Progression in Systolic Blood Pressure Intervention Trial. Kidney360 2024:02200512-990000000-00356. [PMID: 38472135 DOI: 10.34067/kid.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Urinary Dickkopf-3 (uDKK3) is a tubular epithelial-derived profibrotic protein secreted into the urine under tubular stress. It is associated with kidney disease progression in persons with chronic kidney disease (CKD) and diabetes, and post-operative and contrast-associated acute kidney injury (AKI). We explored associations of uDKK3 with cardiovascular disease (CVD), kidney and mortality outcomes within the subset of Systolic Blood Pressure Intervention Trial (SPRINT) participants with non-diabetic CKD. METHODS We included 2,344 participants with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 at baseline. We used Cox proportional hazards models to evaluate associations of uDKK3 with CVD (acute decompensated heart failure, myocardial infarction, acute coronary syndrome, stroke or CVD death), kidney outcomes (incident end stage kidney disease [ESKD], incident AKI, and eGFR decline ≥30%), and all-cause mortality. We used linear mixed models to examine the association of uDKK3 with annual percentage change in eGFR. Models were adjusted for demographic and clinical characteristics, eGFR and albuminuria. RESULTS Over a median follow up of 3.5 years, there were 292 CVD, 73 ESKD, 183 AKI, 471 eGFR decline, and 228 mortality events. In multivariable models without adjustment for eGFR and albuminuria, uDKK3 was strongly associated with CVD, ESKD, AKI, eGFR decline ≥30%, and mortality. However, after further adjustment for eGFR and albuminuria, uDKK3 was no longer associated with risks for composite CVD (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.92-1.23), ESKD (0.80; 0.62-1.02), AKI (1.01; 0.85-1.21), eGFR decline >30% (0.88; 0.79-0.99) or mortality (1.02; 0.87-1.20). For the linear eGFR change outcome, higher uDKK3 also had no association in the fully adjusted model (-0.03; -0.41-0.36). CONCLUSIONS Among individuals with hypertension and non-diabetic CKD, higher uDKK3 appeared to have associations with a greater risk of CVD events, incident ESKD, incident AKI, eGFR decline ≥30%, and mortality, but was not independent of eGFR and albuminuria.
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Affiliation(s)
- Vanessa-Giselle Peschard
- University of California, San Francisco, California
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Rebecca Scherzer
- University of California, San Francisco, California
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Ronit Katz
- University of Washington, Seattle, Washington
| | - Teresa K Chen
- University of California, San Francisco, California
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Kasey Campos
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michelle M Estrella
- University of California, San Francisco, California
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Joachim H Ix
- University of California, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Michael G Shlipak
- University of California, San Francisco, California
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California
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8
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Bullen AL, Katz R, Garimella PS, Vaingankar S, Judd SE, Rifkin DE, Gutierrez OM, Wang H, Ix JH. Tubule dysfunction and injury and future risk of sepsis-associated acute kidney injury. Clin Nephrol 2024; 101:138-146. [PMID: 38156782 DOI: 10.5414/cn111264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Novel biomarkers can quantify both kidney tubule function, including proximal tubule reabsorptive (urine α-1 microglobulin (uα1m)) and tubule protein synthesis capacities (urine uromodulin (uUMOD)), and tubular injury (urine neutrophil gelatinase-associated lipocalin (uNGAL)). In a blood pressure trial, we reported that lower reabsorptive and synthetic protein capacity at times of health predicted future risk of acute kidney injury (AKI), but most AKI was related to hemodynamic causes in this trial. Associations between tubular function and injury and future AKI related to other causes is unknown. MATERIALS AND METHODS We performed a case-control study in REGARDS, a population-based cohort study, among participants who provided urine at the baseline visit. We matched each septic AKI case by age, sex, race, and time from baseline to hospital admission 1 : 1 to a participant with sepsis who did not develop AKI (controls). Using conditional logistic regression, we evaluated the associations of uα1m, uUMOD, urine ammonium, and uNGAL with septic AKI. RESULTS Mean age was 69 ± 8 years, 44% were female, and 39% were Black participants. Median baseline eGFR among cases and controls was 73 (55, 90) and 82 (65, 92) mL/min/1.73m2, and median albuminuria was 19 (8, 87) vs. 9 (5, 22) mg/g, respectively. No independent associations were observed between the tubule function or injury markers and subsequent risk of septic AKI once models were adjusted for baseline albuminuria, estimated glomerular filtration rate, and other risk factors. CONCLUSION Among community participants, tubule function and injury markers at times of health were not independently associated with future risk of septic AKI.
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9
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Sharma S, Katz R, Chaves PHM, Hoofnagle AN, Kizer JR, Bansal N, Ganz T, Ix JH. Iron Deficiency and Incident Heart Failure in Older Community-Dwelling Individuals. ESC Heart Fail 2024. [PMID: 38407565 DOI: 10.1002/ehf2.14724] [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: 06/07/2023] [Revised: 12/01/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Among persons with prevalent heart failure (HF), iron deficiency has been linked to HF admissions, and intravenous iron replacement improves HF outcomes. Recent studies in persons with chronic kidney disease (CKD) demonstrate that iron deficiency is associated with incident HF. This study aimed to determine the relationship of iron status with incident HF in community-dwelling older adults irrespective of their kidney function. METHODS In this case-cohort study, 1,006 Cardiovascular Health Study participants (785 from the random sub-cohort [including 193 HF cases] and 221 additional HF cases [N = 414 total HF cases]) aged ≥ 65 years without HF (41% with CKD), we used weighted Cox models to evaluate associations of iron status with incident HF. Participants were categorized based on quartiles of transferrin saturation and ferritin as "iron replete" (27.3%), "functional iron deficiency" (7.7%), "iron deficiency" (11.8%), "mixed iron deficiency" (5.6%), "high iron" (9.3%) and "non-classified" (38.1%), consistent with prior studies. RESULTS Compared to older persons who were iron replete, those with iron deficiency were at higher risk of incident HF (HR 1.47; 1.02-2.11) in models adjusting for demographics, HF risk factors, and estimated glomerular filtration rate. Other iron categories did not associate with incident HF. The relationship of iron deficiency with incident HF did not differ by CKD status (interaction P value 0.2). CONCLUSIONS Among community-dwelling elders, iron deficiency is independently associated with incident HF, an association that was similar irrespective of CKD status. Our findings support conduct of clinical trials of iron replacement for prevention of HF in older adults with iron deficiency.
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Affiliation(s)
- Shilpa Sharma
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Nephrology Section, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ronit Katz
- University of Washington, Seattle, WA, USA
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | | | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
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10
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Hsu S, Bansal N, Denburg M, Ginsberg C, Hoofnagle AN, Isakova T, Ix JH, Robinson-Cohen C, Wolf M, Kestenbaum BR, de Boer IH, Zelnick LR. Risk factors for hip and vertebral fractures in chronic kidney disease: the CRIC study. J Bone Miner Res 2024:zjae021. [PMID: 38477777 DOI: 10.1093/jbmr/zjae021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Fracture risk is high in chronic kidney disease (CKD) and underlying pathophysiology and risk factors may differ from the general population. In a cohort study of 3939 participants in the Chronic Renal Insufficiency Cohort (CRIC), we used Cox regression to test associations of putative risk factors with the composite of first hip or vertebral fracture assessed using hospital discharge codes. Mean age was 58 years, 45% were female, 42% were Black, and 13% were Hispanic. There were 82 hip and 24 vertebral fractures over a mean (SD) 11.1 (4.8) years (2.4 events per 1000 person-years [95% CI: 2.0, 2.9]). Measured at baseline, diabetes, lower body mass index (BMI), steroid use, proteinuria, and elevated parathyroid hormone (PTH) were each associated with fracture risk after adjusting for covariates. Lower time-updated estimated glomerular filtration rate (eGFR) was associated with fractures (HR 1.20 per 10 mL/min/1.73m2 lower eGFR; 95% CI: 1.04, 1.38) as were lower time-updated serum calcium and bicarbonate concentrations. Among time-updated categories of kidney function, hazard ratios (95% CI) for incident fracture were 4.53 (1.77, 11.60) for kidney failure treated with dialysis and 2.48 (0.86, 7.14) for post-kidney transplantation, compared with eGFR ≥60. Proton pump inhibitor use, dietary calcium intake, measures of vitamin D status, serum phosphate, urine calcium and phosphate, and plasma fibroblast growth factor-23 were not associated with fracture risk. In conclusion, lower eGFR in CKD is associated with higher fracture risk, which was highest in kidney failure. Diabetes, lower BMI, steroid use, proteinuria, higher serum concentrations of PTH, and lower calcium and bicarbonate concentrations were associated with fractures and may be modifiable risk factors.
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Affiliation(s)
- Simon Hsu
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA
| | - Nisha Bansal
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA
| | - Michelle Denburg
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
- Departments of Pediatrics and Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA
| | | | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Bryan R Kestenbaum
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA
| | - Ian H de Boer
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA
| | - Leila R Zelnick
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA
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11
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Jotwani V, Yang SY, Thiessen-Philbrook H, Parikh CR, Katz R, Tranah GJ, Ix JH, Cummings S, Waikar SS, Shlipak MG, Sarnak MJ, Parikh SM, Arking DE. Mitochondrial genetic variation and risk of chronic kidney disease and acute kidney injury in UK Biobank participants. Hum Genet 2024; 143:151-157. [PMID: 38349571 PMCID: PMC10881785 DOI: 10.1007/s00439-023-02615-4] [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: 05/16/2023] [Accepted: 09/28/2023] [Indexed: 02/22/2024]
Abstract
Experimental models suggest an important role for mitochondrial dysfunction in the pathogenesis of chronic kidney disease (CKD) and acute kidney injury (AKI), but little is known regarding the impact of common mitochondrial genetic variation on kidney health. We sought to evaluate associations of inherited mitochondrial DNA (mtDNA) variation with risk of CKD and AKI in a large population-based cohort. We categorized UK Biobank participants who self-identified as white into eight distinct mtDNA haplotypes, which were previously identified based on their associations with phenotypes associated with mitochondrial DNA copy number, a measure of mitochondrial function. We used linear and logistic regression models to evaluate associations of these mtDNA haplotypes with estimated glomerular filtration rate by serum creatinine and cystatin C (eGFRCr-CysC, N = 362,802), prevalent (N = 416 cases) and incident (N = 405 cases) end-stage kidney disease (ESKD), AKI defined by diagnostic codes (N = 14,170 cases), and urine albumin/creatinine ratio (ACR, N = 114,662). The mean age was 57 ± 8 years and the mean eGFR was 90 ± 14 ml/min/1.73 m2. MtDNA haplotype was significantly associated with eGFR (p = 2.8E-12), but not with prevalent ESKD (p = 5.9E-2), incident ESKD (p = 0.93), AKI (p = 0.26), or urine ACR (p = 0.54). The association of mtDNA haplotype with eGFR remained significant after adjustment for diabetes mellitus and hypertension (p = 1.2E-10). When compared to the reference haplotype, mtDNA haplotypes I (β = 0.402, standard error (SE) = 0.111; p = 2.7E-4), IV (β = 0.430, SE = 0.073; p = 4.2E-9), and V (β = 0.233, SE = 0.050; p = 2.7E-6) were each associated with higher eGFR. Among self-identified white UK Biobank participants, mtDNA haplotype was associated with eGFR, but not with ESKD, AKI or albuminuria.
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Affiliation(s)
- Vasantha Jotwani
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, 4150 Clement Street, Bldg 2, Rm 145, San Francisco, CA, 94121, USA.
| | - Stephanie Y Yang
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Chirag R Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California San Diego, and Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Steve Cummings
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, 4150 Clement Street, Bldg 2, Rm 145, San Francisco, CA, 94121, USA
| | - Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Michael G Shlipak
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, 4150 Clement Street, Bldg 2, Rm 145, San Francisco, CA, 94121, USA
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Samir M Parikh
- Division of Nephrology, Department of Medicine, and Department of Pharmacology, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Dan E Arking
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Kiernan EA, Hu D, Philbrook HT, Ix JH, Bonventre JV, Coca SG, Moledina DG, Fried LF, Shlipak MG, Parikh CR. Urinary Biomarkers and Kidney Injury in VA NEPHRON-D: Phenotyping Acute Kidney Injury in Clinical Trials. Am J Kidney Dis 2024; 83:151-161. [PMID: 37726051 PMCID: PMC10841767 DOI: 10.1053/j.ajkd.2023.07.012] [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: 10/13/2022] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 09/21/2023]
Abstract
RATIONALE & OBJECTIVE Urinary biomarkers of injury, inflammation, and repair may help phenotype acute kidney injury (AKI) observed in clinical trials. We evaluated the differences in biomarkers between participants randomized to monotherapy or to combination renin-angiotensin-aldosterone system (RAAS) blockade in VA NEPHRON-D, where an increased proportion of observed AKI was acknowledged in the combination arm. STUDY DESIGN Longitudinal analysis. SETTING & PARTICIPANTS A substudy of the VA NEPHRON-D trial. PREDICTOR Primary exposure was the treatment arm (combination [RAAS inhibitor] vs monotherapy). AKI is used as a stratifying variable. OUTCOME Urinary biomarkers, including albumin, EGF (epidermal growth factor), MCP-1 (monocyte chemoattractant protein-1), YKL-40 (chitinase 3-like protein 1), and KIM-1 (kidney injury molecule-1). ANALYTICAL APPROACH Biomarkers measured at baseline and at 12 months in trial participants were compared between treatment groups and by AKI. AKI events occurring during hospitalization were predefined safety end points in the original trial. The results were included in a meta-analysis with other large chronic kidney disease trials to assess global trends in biomarker changes. RESULTS In 707 participants followed for a median of 2.2 years, AKI incidence was higher in the combination (20.7%) versus the monotherapy group (12.7%; relative risk [RR], 1.64 [95% CI, 1.16-2.30]). Compared with the monotherapy arm, in the combination arm the urine biomarkers at 12 months were either unchanged (MCP-1: RR, -3% [95% CI, -13% to 9%], Padj=0.8; KIM-1: RR, -10% [95% CI, -20% to 1%], Padj=0.2; EGF, RR-7% [95% CI, -12% to-1%], Padj=0.08) or lower (albuminuria: RR, -24% [95% CI, -37% to-8%], Padj=0.02; YKL: RR, -40% to-44% [95% CI, -58% to-25%], Padj<0.001). Pooled meta-analysis demonstrated reduced albuminuria in the intervention arm across 3 trials and similar trajectories in other biomarkers. LIMITATIONS Biomarker measurement was limited to 2 time points independent of AKI events. CONCLUSIONS Despite the increased risk of serum creatinine-defined AKI, combination RAAS inhibitor therapy was associated with unchanged or decreased urinary biomarkers at 12 months. This suggests a possible role for kidney biomarkers to further characterize kidney injury in clinical trials. PLAIN-LANGUAGE SUMMARY The VA NEPHRON-D trial investigated inhibition of the renin-angiotensin-aldosterone system (RAAS) hormonal axis on kidney outcomes in a large population of diabetic chronic kidney disease patients. The trial was stopped early due to increased events of serum creatinine-defined acute kidney injury in the combination therapy arm. Urine biomarkers can serve as an adjunct to serum creatinine in identifying kidney injury. We found that urinary biomarkers in the combination therapy group were not associated with a pattern of harm and damage to the kidney, despite the increased number of kidney injury events in that group. This suggests that serum creatinine alone may be insufficient for defining kidney injury and supports further exploration of how other biomarkers might improve identification of kidney injury in clinical trials.
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Affiliation(s)
- Elizabeth A Kiernan
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Hu
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Heather Thiessen Philbrook
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California-San Diego, San Diego, California; Veterans Affairs San Diego Healthcare System, San Diego, CA
| | | | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis G Moledina
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Linda F Fried
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
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13
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Ginsberg C, Blackwell T, Cheng JH, Potok OA, Cauley JA, Ensrud KE, Hsu S, Kado DM, Orwoll E, Cawthon PM, Ix JH. The Vitamin D Metabolite Ratio Is Associated With Volumetric Bone Density in Older Men. J Clin Endocrinol Metab 2024; 109:e513-e521. [PMID: 37804103 PMCID: PMC10795912 DOI: 10.1210/clinem/dgad587] [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: 07/19/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
CONTEXT Serum 25-hydroxyvitamin D (25(OH)D) is the current marker of vitamin D adequacy, but its relationship with bone health has been inconsistent. The ratio of 24,25-dihydroxyvitamin D3 to 25(OH)D3 (vitamin D metabolite ratio or VMR) is a marker of vitamin D that has been associated with longitudinal changes in bone mineral density (BMD) and fracture risk. OBJECTIVE High-resolution peripheral quantitative computed tomography (HR-pQCT) provides information on bone health beyond standard dual-energy x-ray absorptiometry, in that it measures volumetric BMD (vBMD) as well bone strength. The relationship of the VMR with vBMD and bone strength remains unknown. METHODS We evaluated the associations of the VMR and 25(OH)D3 with vBMD and bone strength in the distal radius and tibia, assessed by HR-pQCT in 545 older men participating in the Osteoporotic Fractures in Men (MrOS) Study. Primary outcomes were vBMD and estimated failure load (EFL, a marker of bone strength) at the distal radius and tibia. RESULTS The mean age was 84 ± 4 years, 88.3% were White, and 32% had an estimated glomerular filtration rate <60 mL/min/1.73 m2. In adjusted models, each twofold higher VMR was associated with a 9% (3%, 16%) higher total vBMD and a 13% (5%, 21%) higher EFL at the distal radius. Results were similar at the distal tibia. 25(OH)D3 concentrations were not associated with any of the studied outcomes. CONCLUSION Among older men, a higher VMR was associated with greater vBMD and bone strength while 25(OH)D3 was not. The VMR may serve as a valuable marker of skeletal health in older men.
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Affiliation(s)
- Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego, CA 92037, USA
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, Department of Epidemiology, University of California, SanFrancisco, San Francisco, CA 94107, USA
| | - Jonathan H Cheng
- Division of Nephrology-Hypertension, University of California, San Diego, CA 92037, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - O Alison Potok
- Division of Nephrology-Hypertension, University of California, San Diego, CA 92037, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Kristine E Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN 55417, USA
| | - Simon Hsu
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Deborah M Kado
- Department of Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Eric Orwoll
- Division of Endocrinology, Metabolism and Clinical Nutrition, Department of Medicine, Oregon Health and Sciences University, Portland, OR 97239, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, Department of Epidemiology, University of California, SanFrancisco, San Francisco, CA 94107, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, CA 92037, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
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14
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Bullen AL, Katz R, Poursadrolah S, Short SAP, Long DL, Cheung KL, Sharma S, Al-Rousan T, Fregoso A, Schulte J, Gutierrez OM, Shlipak MG, Cushman M, Ix JH, Rifkin DE. Plasma proenkephalin A and incident chronic kidney disease and albuminuria in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. BMC Nephrol 2024; 25:16. [PMID: 38200454 PMCID: PMC10782722 DOI: 10.1186/s12882-023-03432-7] [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: 04/11/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Plasma proenkephalin A (PENK-A) is a precursor of active enkephalins. Higher blood concentrations have been associated with estimated glomerular filtration rate (eGFR) decline in European populations. Due to the significant disparity in incident chronic kidney disease (CKD) between White and Black people, we evaluated the association of PENK-A with incident CKD and other kidney outcomes among a biracial cohort in the U.S. METHODS In a nested cohort of 4,400 participants among the REasons for Geographic And Racial Differences in Stroke, we determined the association between baseline PENK-A concentration and incident CKD using the creatinine-cystatin C CKD-EPI 2021 equation without race coefficient, significant eGFR decline, and incident albuminuria between baseline and a follow-up visit 9.4 years later. We tested for race and sex interactions. We used inverse probability sampling weights to account for the sampling design. RESULTS At baseline, mean (SD) age was 64 (8) years, 49% were women, and 52% were Black participants. 8.5% developed CKD, 21% experienced ≥ 30% decline in eGFR and 18% developed albuminuria. There was no association between PENK-A and incident CKD and no difference by race or sex. However, higher PENK-A was associated with increased odds of progressive eGFR decline (OR: 1.12; 95% CI 1.00, 1.25). Higher PENK-A concentration was strongly associated with incident albuminuria among patients without diabetes mellitus (OR: 1.29; 95% CI 1.09, 1.53). CONCLUSION While PENK-A was not associated with incident CKD, its associations with progression of CKD and incident albuminuria, among patients without diabetes, suggest that it might be a useful tool in the evaluation of kidney disease among White and Black patients.
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Affiliation(s)
- Alexander L Bullen
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.
| | - Ronit Katz
- University of Washington, Seattle, WA, USA
| | - Sayna Poursadrolah
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katharine L Cheung
- Division of Nephrology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Shilpa Sharma
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Nephrology Section, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Tala Al-Rousan
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Alma Fregoso
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Orlando M Gutierrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dena E Rifkin
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
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15
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Raphael KL, Katz R, Larive B, Kendrick C, Isakova T, Sprague S, Wolf M, Raj DS, Fried LF, Gassman J, Hoofnagle A, Cheung AK, Ix JH. Oral Sodium Bicarbonate and Bone Turnover in CKD: A Secondary Analysis of the BASE Pilot Trial. J Am Soc Nephrol 2024; 35:57-65. [PMID: 38170601 PMCID: PMC10786609 DOI: 10.1681/asn.0000000000000264] [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: 08/07/2023] [Accepted: 10/18/2023] [Indexed: 01/05/2024] Open
Abstract
SIGNIFICANCE STATEMENT In CKD, metabolic acidosis is commonly treated with alkali in the hope that it will improve bone health. In a post hoc analysis of the Bicarbonate Administration to Stabilize eGFR Pilot Trial, we investigated whether sodium bicarbonate affects serum levels of bone turnover markers and other hormones related to bone health in individuals with CKD who have normal to slightly reduced total CO2 (20-28 mEq/L). Sodium bicarbonate increased serum levels of α-klotho but had no significant effect on other bone health markers, including intact fibroblast growth factor-23 (iFGF-23), intact parathyroid hormone (iPTH), and bone-specific alkaline phosphatase (B-SAP). Further study is needed to determine the effect of bicarbonate administration on clinical aspects of bone health. BACKGROUND Treatment with alkali has been hypothesized to improve bone health in CKD by mitigating adverse effects of acid on bone mineral. We investigated the effect of treatment with sodium bicarbonate on bone turnover markers and other factors related to bone metabolism in CKD. METHODS This is a post hoc analysis of the Bicarbonate Administration to Stabilize eGFR Pilot Trial in which 194 individuals with CKD and serum total CO2 20-28 mEq/L were randomly assigned to placebo or one of two doses of sodium bicarbonate (0.5 or 0.8 mEq/kg lean body weight per day) for 28 weeks. The following serum measurements were performed at baseline, week 12, and week 28: B-SAP, c-telopeptide, procollagen type I intact N-terminal propeptide, iPTH, iFGF-23, soluble klotho, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and tartrate-resistant acid phosphatase 5b. The difference (sodium bicarbonate versus placebo) in mean change of each bone biomarker from baseline was determined using linear mixed models. RESULTS One hundred sixty-eight participants submitted samples for post hoc investigations. Mean eGFR was 37±10 ml/min per 1.73 m2 and mean total CO2 was 24±3 mEq/L at baseline. Sodium bicarbonate induced a dose-dependent increase in soluble klotho levels compared with placebo. There was no significant effect of treatment with either dose of sodium bicarbonate on any of the other bone biomarkers, including iFGF-23, iPTH, and B-SAP. Effects on bone biomarkers were similar in those with baseline serum total CO2 <24 mEq/L compared with those with total CO2 ≥24 mEq/L. CONCLUSIONS In this pilot trial of individuals with CKD and total CO2 20-28 mEq/L, sodium bicarbonate treatment increased serum klotho levels but did not affect other bone health markers over 28 weeks. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER ClinicalTrials.gov, NCT02521181.
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Affiliation(s)
- Kalani L. Raphael
- University of Utah Health and VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Ronit Katz
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | | | | | - Tamara Isakova
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Sprague
- Division of Nephrology & Hypertension, Northshore University Health System-University of Chicago, Evanston, Illinois
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Dominic S. Raj
- George Washington University School of Medicine, Washington, DC
| | - Linda F. Fried
- University of Pittsburgh and VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | | | - Andy Hoofnagle
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Alfred K. Cheung
- University of Utah Health and VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Joachim H. Ix
- University of California San Diego and VA San Diego Health Care System, San Diego, California
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16
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Bullen AL, Vaingankar S, Madero M, Lopez Gil S, Macedo E, Ix JH, Rifkin DE, Garimella PS. Urine Uromodulin, Kidney Tubulointerstitial Fibrosis, and Furosemide Response. Nephron Clin Pract 2023:000534578. [PMID: 38043509 DOI: 10.1159/000534578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/07/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Interstitial fibrosis and tubular atrophy (IFTA) are common findings on biopsy in chronic kidney disease (CKD) and strongly predictive of kidney failure. IFTA is poorly correlated with estimated glomerular filtration rate (eGFR) and albuminuria, the most common metrics of kidney disease. Thus, IFTA is prognostically important, yet its presence and severity are invisible to the clinician except when kidney biopsies are obtained. OBJECTIVES To investigate 1) the cross-sectional association between urine uromodulin (uUMOD) and IFTA, and 2) to determine whether uUMOD levels were associated with diuretic response after a furosemide stress test. METHODS We performed logistic regression to evaluate the association between uUMOD and fibrosis. We used linear regression models to assess the association of uUMOD with urine output. RESULTS Among 52 participants, the mean age was 42 ± 16 years, 48% were women, 23% had diabetes, and the median eGFR was 56 ml/min/1.73m2. The mean uUMOD concentration was 5.1 (8.4) mcg/mL. Each halving of uUMOD was associated with 1.74 higher odds (95% CI 1.10, 2.75) of grade 2 or 3 fibrosis. However, this association was no longer significant after adjusting for baseline eGFR and albuminuria. Each halving of urine uromodulin was associated with a decreased response to furosemide. This association was also no longer significant after adjusting for baseline eGFR and albuminuria. CONCLUSION In a population of individuals with a wide range of kidney function undergoing clinically indicated kidney biopsies, we did not find an association between uUMOD and interstitial fibrosis or response to loop diuretics after adjusting for eGFR and albuminuria.
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Bene-Alhasan Y, Siscovick DS, Ix JH, Kizer JR, Tracy R, Djoussé L, Mukamal KJ. The determinants of fasting and post-load non-esterified fatty acids in older adults: The cardiovascular health study. Metabol Open 2023; 20:100261. [PMID: 38115866 PMCID: PMC10728567 DOI: 10.1016/j.metop.2023.100261] [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: 05/29/2023] [Revised: 09/29/2023] [Accepted: 10/21/2023] [Indexed: 12/21/2023] Open
Abstract
Aim Non-esterified fatty acids (NEFA) are potential targets for prevention of key cardiometabolic diseases of aging, but their population-level correlates remain uncertain. We sought to identify modifiable factors associated with fasting and post-load NEFA levels in older adults. Methods We used linear regression to determine the cross-sectional associations of demographic, anthropometric, and lifestyle characteristics and medication use with serum fasting and post-load NEFA concentrations amongst community-dwelling older adults enrolled in the Cardiovascular Health Study (n = 1924). Results Fasting NEFA levels generally demonstrated a broader set of determinants, while post-load NEFA were more consistently associated with metabolic factors. Waist circumference and weight were associated with higher fasting and post-load NEFA. Cigarette smoking and caffeine intake were associated with lower levels of both species, and moderate alcohol intake was associated with higher fasting levels whereas greater consumption was associated with lower post-load levels. Unique factors associated with higher fasting NEFA included female sex, higher age, loop and thiazide diuretic use and calcium intake, while factors associated with lower fasting levels included higher educational attainment, beta-blocker use, and protein intake. Hours spent sleeping during the daytime were associated with higher post-load NEFA, while DASH score was associated with lower levels. Conclusion Fasting and post-load NEFA have both common and unique modifiable risk factors, including sociodemographics, anthropometric, medications, and diet. Post-load NEFA were particularly sensitive to metabolic factors, while a broader range of determinants were associated with fasting levels. These factors warrant study as targets for lowering levels of NEFA in older adults.
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Affiliation(s)
- Yakubu Bene-Alhasan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Joachim H. Ix
- Department of Medicine, University of California San Diego and Veterans Affairs San Diego Healthcare System, CA, USA
| | - Jorge R. Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, VT, USA
| | - Luc Djoussé
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, USA
| | - Kenneth J. Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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18
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Schrauben SJ, Sapa H, Xie D, Zhang X, Anderson AH, Shlipak MG, Hsu CY, Shafi T, Mehta R, Bhat Z, Brown J, Charleston J, Chen J, He J, Ix JH, Rao P, Townsend R, Kimmel PL, Vasan RS, Feldman HI, Seegmiller JC, Brunengraber H, Hostetter TH, Schelling JR. Association of urine and plasma ADMA with atherosclerotic risk in DKD cardiovascular disease risk in diabetic kidney disease: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Nephrol Dial Transplant 2023; 38:2809-2815. [PMID: 37230949 PMCID: PMC10689177 DOI: 10.1093/ndt/gfad103] [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: 01/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with atherosclerotic cardiovascular disease (ASCVD) risk, especially among those with diabetes. Altered metabolism of solutes that accumulate in CKD [asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and trimethylamine N-oxide (TMAO)] may reflect pathways linking CKD with ASCVD. METHODS This case-cohort study included Chronic Renal Insufficiency Cohort participants with baseline diabetes, estimated glomerular filtration rate <60 mL/min/1.73 m2, and without prior history for each outcome. The primary outcome was incident ASCVD (time to first myocardial infarction, stroke or peripheral artery disease event) and secondary outcome was incident heart failure. The subcohort comprised randomly selected participants meeting entry criteria. Plasma and urine ADMA, SDMA and TMAO concentrations were determined by liquid chromatography-tandem mass spectrometry. Associations of uremic solute plasma concentrations and urinary fractional excretions with outcomes were evaluated by weighted multivariable Cox regression models, adjusted for confounding covariables. RESULTS Higher plasma ADMA concentrations (per standard deviation) were associated with ASCVD risk [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.01-1.68]. Lower fractional excretion of ADMA (per standard deviation) was associated with ASCVD risk (HR 1.42, 95% CI 1.07-1.89). The lowest quartile of ADMA fractional excretion was associated with greater ASCVD risk (HR 2.25, 95% CI 1.08-4.69) compared with the highest quartile. Plasma SDMA and TMAO concentration and fractional excretion were not associated with ASCVD. Neither plasma nor fractional excretion of ADMA, SDMA and TMAO were associated with incident heart failure. CONCLUSION These data suggest that decreased kidney excretion of ADMA leads to increased plasma concentrations and ASCVD risk.
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Affiliation(s)
- Sarah J Schrauben
- Department of Medicine, Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Dawei Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaoming Zhang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda Hyre Anderson
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Chi-yuan Hsu
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA
| | - Tariq Shafi
- Department of Medicine, Division of Nephrology, Houston Methodist Hospital, Houston, TX, USA
| | - Rupal Mehta
- Department of Medicine, Division of Nephrology and Hypertension, Northwestern University, Chicago, IL, USA
| | - Zeenat Bhat
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Julie Brown
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeanne Charleston
- Department of Internal Medicine, Section of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joachim H Ix
- Department of Medicine, Division of Nephrology-Hypertension, UC San Diego School of Medicine, San Diego, CA, USA
| | - Pandurango Rao
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Ray Townsend
- Department of Medicine, Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Ramachandran S Vasan
- The University of Texas School of Public Health San Antonio, San Antonio, TX, USA
| | - Harold I Feldman
- Department of Medicine, Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Jesse C Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Henri Brunengraber
- Departments of Nutrition and Biochemistry, Case Western University School of Medicine, Cleveland, OH, USA
| | - Thomas H Hostetter
- Department of Medicine, Division of Nephrology, University of North Carolina, Chapel Hill, NC, USA
| | - Jeffrey R Schelling
- Departments of Physiology & Biophysics and Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Ascher SB, Berry JD, Katz R, de Lemos JA, Bansal N, Garimella PS, Hallan SI, Wettersten N, Jotwani VK, Killeen AA, Ix JH, Shlipak MG. Changes in Natriuretic Peptide Levels and Subsequent Kidney Function Decline in SPRINT. Am J Kidney Dis 2023:S0272-6386(23)00933-2. [PMID: 37992982 DOI: 10.1053/j.ajkd.2023.09.018] [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: 04/28/2023] [Revised: 08/03/2023] [Accepted: 09/17/2023] [Indexed: 11/24/2023]
Abstract
RATIONALE & OBJECTIVE Novel approaches to the assessment of kidney disease risk during hypertension treatment are needed because of the uncertainty of how intensive blood pressure (BP) lowering impacts kidney outcomes. We determined whether longitudinal N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements during hypertension treatment are associated with kidney function decline. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS 8,005 SPRINT (Systolic Blood Pressure Intervention Trial) participants with NT-proBNP measurements at baseline and 1 year. EXPOSURE 1-year change in NT-proBNP categorized as a ≥25% decrease, ≥25% increase, or <25% change (stable). OUTCOME Annualized change in estimated glomerular filtration rate (eGFR) and ≥30% decrease in eGFR. ANALYTICAL APPROACH Linear mixed-effect and logistic regression models were used to evaluate the association of changes in NT-proBNP with subsequent annualized change in eGFR and ≥30% decrease in eGFR, respectively. Analyses were stratified by baseline chronic kidney disease (CKD) status. RESULTS Compared with stable 1-year NT-proBNP levels, a ≥25% decrease in NT-proBNP was associated with a slower decrease in eGFR in participants with CKD (adjusted difference, 1.09%/y; 95% CI, 0.35-1.83) and without CKD (adjusted difference, 0.51%/y; 95% CI, 0.21-0.81; P = 0.4 for interaction). Meanwhile, a ≥25% increase in NT-proBNP in participants with CKD was associated with a faster decrease in eGFR (adjusted difference, -1.04%/y; 95% CI, -1.72 to -0.36) and risk of a ≥30% decrease in eGFR (adjusted odds ratio, 1.44; 95% CI, 1.06-1.96); associations were stronger in participants with CKD than in participants without CKD (P = 0.01 and P < 0.001 for interaction, respectively). Relationships were similar irrespective of the randomized BP arm in SPRINT (P > 0.2 for interactions). LIMITATIONS Persons with diabetes and proteinuria >1 g/d were excluded. CONCLUSIONS Changes in NT-proBNP during BP treatment are independently associated with subsequent kidney function decline, particularly in people with CKD. Future studies should assess whether routine NT-proBNP measurements may be useful in monitoring kidney risk during hypertension treatment. PLAIN-LANGUAGE SUMMARY N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker in the blood that reflects mechanical stress on the heart. Measuring NT-proBNP may be helpful in assessing the risk of long-term losses of kidney function. In this study, we investigated the association of changes in NT-proBNP with subsequent kidney function among individuals with and without chronic kidney disease. We found that increases in NT-proBNP are associated with a faster rate of decline of kidney function, independent of baseline kidney measures. The associations were more pronounced in individuals with chronic kidney disease. Our results advance the notion of considering NT-proBNP as a dynamic tool for assessing kidney disease risk.
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Affiliation(s)
- Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco; Division of Hospital Medicine, University of California, Davis, Sacramento.
| | - Jarett D Berry
- Divison of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - James A de Lemos
- Divison of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nisha Bansal
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla
| | - Stein I Hallan
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Nephrology, St Olav University Hospital, Trondheim, Norway
| | - Nicholas Wettersten
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla; Cardiology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Vasantha K Jotwani
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco
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20
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Le D, Chen J, Shlipak MG, Ix JH, Sarnak MJ, Gutierrez OM, Schelling JR, Bonventre JV, Sabbisetti VS, Schrauben SJ, Coca SG, Kimmel PL, Vasan RS, Grams ME, Parikh C, Coresh J, Rebholz CM. Plasma Biomarkers and Incident CKD Among Individuals Without Diabetes. Kidney Med 2023; 5:100719. [PMID: 37841418 PMCID: PMC10568645 DOI: 10.1016/j.xkme.2023.100719] [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] [Indexed: 10/17/2023] Open
Abstract
Rationale & Objective Biomarkers of kidney disease progression have been identified in individuals with diabetes and underlying chronic kidney disease (CKD). Whether or not these markers are associated with the development of CKD in a general population without diabetes or CKD is not well established. Study Design Prospective observational cohort. Setting & Participants In the Atherosclerosis Risk in Communities) study, 948 participants were studied. Exposures The baseline plasma biomarkers of kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein-1 (MCP-1), soluble urokinase plasminogen activator receptor (suPAR), tumor necrosis factor receptor 1 (TNFR-1), tumor necrosis factor receptor 2 (TNFR-2), and human cartilage glycoprotein-39 (YKL-40) measured in 1996-1998. Outcome Incident CKD after 15 years of follow-up defined as ≥40% estimated glomerular filtration rate decline to <60 mL/min/1.73 m2 or dialysis dependence through United States Renal Data System linkage. Analytical Approach Logistic regression and C statistics. Results There were 523 cases of incident CKD. Compared with a random sample of 425 controls, there were greater odds of incident CKD per 2-fold higher concentration of KIM-1 (OR, 1.49; 95% CI, 1.25-1.78), suPAR (OR, 2.57; 95% CI, 1.74-3.84), TNFR-1 (OR, 2.20; 95% CI, 1.58-3.09), TNFR-2 (OR, 2.03; 95% CI, 1.37-3.04). After adjustment for all biomarkers, KIM-1 (OR, 1.42; 95% CI, 1.19-1.71), and suPAR (OR, 1.86; 95% CI, 1.18-2.92) remained associated with incident CKD. Compared with traditional risk factors, the addition of all 6 biomarkers improved the C statistic from 0.695-0.731 (P < 0.01) and using the observed risk of 12% for incident CKD, the predicted risk gradient changed from 5%-40% (for the 1st-5th quintile) to 4%-44%. Limitations Biomarkers and creatinine were measured at one time point. Conclusions Higher levels of KIM-1, suPAR, TNFR-1, and TNFR-2 were associated with higher odds of incident CKD among individuals without diabetes. Plain-Language Summary For people with diabetes or kidney disease, several biomarkers have been shown to be associated with worsening kidney disease. Whether these biomarkers have prognostic significance in people without diabetes or kidney disease is less studied. Using the Atherosclerosis Risk in Communities study, we followed individuals without diabetes or kidney disease for an average of 15 years after biomarker measurement to see if these biomarkers were associated with the development of kidney disease. We found that elevated levels of KIM-1, suPAR, TNFR-1, and TNFR-2 were associated with the development of kidney disease. These biomarkers may help identify individuals who would benefit from interventions to prevent the development of kidney disease.
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Affiliation(s)
- Dustin Le
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California; Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California: Kidney Research Innovation Hub of San Diego, San Diego, California
| | - Mark J. Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Orlando M. Gutierrez
- Division of Nephrology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey R. Schelling
- Department of Physiology and Biophysics and Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Joseph V. Bonventre
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Venkata S. Sabbisetti
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sarah J. Schrauben
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paul L. Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ramachandran S. Vasan
- Framingham Heart Study of the National Heart, Lung, and Blood Institute and Boston University School of Medicine, Framingham, MA
| | - Morgan E. Grams
- Division of Precision Medicine, Department of Medicine, New York University, NY
| | - Chirag Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Casey M. Rebholz
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chronic Kidney Disease Biomarkers Consortium
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California; Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California: Kidney Research Innovation Hub of San Diego, San Diego, California
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
- Division of Nephrology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Department of Physiology and Biophysics and Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
- Framingham Heart Study of the National Heart, Lung, and Blood Institute and Boston University School of Medicine, Framingham, MA
- Division of Precision Medicine, Department of Medicine, New York University, NY
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Sheshadri A, Lai M, Hsu FC, Bauer SR, Chen SH, Tse W, Jotwani V, Tranah GJ, Lai JC, Hallan S, Fielding RA, Liu C, Ix JH, Coca SG, Shlipak MG. Structured Moderate Exercise and Biomarkers of Kidney Health in Sedentary Older Adults: The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial. Kidney Med 2023; 5:100721. [PMID: 37915963 PMCID: PMC10616412 DOI: 10.1016/j.xkme.2023.100721] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Rationale & Objective In the Lifestyle Interventions and Independence for Elders (LIFE) trial, a structured exercise intervention slowed kidney function decline in sedentary older adults. Biomarkers of kidney health could distinguish potential mechanisms for this beneficial effect. Study Design Randomized controlled trial. Setting & Population A total of 1,381 sedentary adults aged 70-89 years enrolled in the LIFE trial. Intervention Structured, 2-year, moderate-intensity exercise intervention versus health education. Outcomes Physical activity was measured by step count. Primary outcomes were changes in 14 serum and urine biomarkers of kidney health collected at baseline, year 1, and year 2. We determined the effect of randomization on changes in kidney measures and then evaluated observational associations of achieved activity on each measure. Results Participants assigned to exercise walked on average 291 more steps per day than participants assigned to health education. The intervention was not significantly associated with changes in biomarkers of kidney health. In observational analyses, persons in the highest versus lowest quartile of activity (≥3,470 vs <1,568 steps/day) had significant improvement in urine albumin (mean, -0.22 mg albumin/g urine creatinine [interquartile range (IQR), -0.37 to -0.06]), alpha-1-microglobulin (-0.18 mg/L [-0.28 to -0.08]), trefoil factor-3 (-0.24 pg/mL [-0.35 to -0.13]), epidermal growth factor (0.19 pg/mL [0.06-0.32]), uromodulin (0.06 pg/mL [0.00-0.12]), interleukin 18 (-0.09 pg/mL [-0.15 to -0.03]), neutrophil gelatinase-associated lipocalin (-0.16 pg/mL [-0.24 to -0.07]), monocyte chemoattractant protein-1 (-0.25 pg/mL [-0.36 to -0.14]), clusterin (-0.16 pg/mL [-0.30 to -0.02]), serum tumor necrosis factor receptor-1 (-0.25 mg/dL [-0.39 to -0.11]) and tumor necrosis factor receptor-2 (-0.30 mg/dL [-0.44 to -0.16]). In sensitivity analyses, incremental changes in activity were most impactful on urine interleukin 18 and serum tumor necrosis factor-1. Limitations The original study was not designed to assess the impact on kidney health. Non-white individuals and patients with advanced chronic kidney disease are underrepresented. Conclusions Randomization to structured exercise did not improve kidney health at a group level. However, higher exercise was associated with concurrent improvements in biomarkers of glomerular injury, tubular function/repair, tubular injury, generalized inflammation, and tubulointerstitial repair/fibrosis. Plain-Language Summary In the Lifestyle Interventions For Elders (LIFE) study, randomization to an exercise and physical activity intervention improved the slope of estimated glomerular filtration rate over 2 years compared with health education among older adults. In this study, we sought to determine whether there were specific biomarkers of kidney health that were affected by the exercise and physical activity intervention to investigate potential mechanisms for this positive impact on kidney decline. We found that randomization to the intervention did not improve any of the 14 measures of kidney tubule health. However, in observational analyses, higher activity was independently associated with improvements in several domains, especially tubular injury and generalized inflammation. These results help to clarify the impact of physical activity on kidney health.
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Affiliation(s)
- Anoop Sheshadri
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Mason Lai
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Scott R. Bauer
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Warren Tse
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Vasantha Jotwani
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | | | - Jennifer C. Lai
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Stein Hallan
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger A. Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Christine Liu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Geriatric Research Education and Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA
| | - Joachim H. Ix
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Steven G. Coca
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael G. Shlipak
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
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Faulkner SC, Matheson MB, Greenberg JH, Garimella PS, Furth SL, Ix JH, Bakhoum CY. Association of clinical characteristics with urine uromodulin in children with chronic kidney disease. Pediatr Nephrol 2023; 38:3859-3862. [PMID: 36988691 PMCID: PMC10528151 DOI: 10.1007/s00467-023-05947-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Uromodulin is the most abundant protein in the urine of healthy adults, and higher urine concentrations mark better tubular health. Greater kidney size and function are predictors of higher uromodulin levels in adults. Urine uromodulin has not yet been studied in children with chronic kidney disease (CKD). Thus, we sought to determine the relationship between age and kidney function with urine uromodulin levels in children with CKD. METHODS In the CKD in Children (CKiD) cohort, we utilized multivariable linear regression to evaluate the relationship of age and eGFR with urine uromodulin levels. The primary outcome was uromodulin indexed to urine creatinine (Umod/Cr, mg/g), which was log2-transformed given its skewed distribution. RESULTS Among 677 CKiD participants, the median age was 11.8 years (8.2-15.3), the median eGFR was 49 ml/min/1.73 m2 (37-63), the etiology of CKD was glomerular disease in 31%, and the median Umod/Cr level was 0.114 mg/g (0.045-0.226). In the multivariable models, each one-year older age was associated with 0.18 (12%) lower log2(Umod/Cr) and 0.20 (13%) lower log2(Umod/Cr) among those with non-glomerular and glomerular disease, respectively (p < 0.001). However, we did not find a statistically significant association between eGFR and Umod/Cr in either participants with non-glomerular or glomerular disease (p = 0.13 and p = 0.58, respectively). CONCLUSIONS Among children with CKD, older age is significantly associated with lower Umod/Cr, independent of eGFR. Further studies are needed to comprehensively evaluate age-specific reference ranges for urine uromodulin and to evaluate the longitudinal relationship of uromodulin with both age and eGFR in children with CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Sophia C Faulkner
- Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA
| | - Matthew B Matheson
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - Jason H Greenberg
- Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA
- Department of Pediatrics, Section of Pediatric Nephrology, Yale University, New Haven, CT, USA
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Nephrology Section, Medicine Service, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Christine Y Bakhoum
- Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA.
- Department of Pediatrics, Section of Pediatric Nephrology, Yale University, New Haven, CT, USA.
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23
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Ginsberg C, Ix JH. New Insights into the Effects of Etelcalcetide on Bone Health. Clin J Am Soc Nephrol 2023; 18:1388-1390. [PMID: 37791911 PMCID: PMC10637471 DOI: 10.2215/cjn.0000000000000316] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
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24
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Drawz PE, Lenoir KM, Rai NK, Rastogi A, Chu CD, Rahbari-Oskoui FF, Whelton PK, Thomas G, McWilliams A, Agarwal AK, Suarez MM, Dobre M, Powell J, Rocco MV, Lash JP, Oparil S, Raj DS, Dwyer JP, Rahman M, Soman S, Townsend RR, Pemu P, Horwitz E, Ix JH, Tuot DS, Ishani A, Pajewski NM. Effect of Intensive Blood Pressure Control on Kidney Outcomes: Long-Term Electronic Health Record-Based Post-Trial Follow-Up of SPRINT. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00273. [PMID: 37883184 PMCID: PMC10861101 DOI: 10.2215/cjn.0000000000000335] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Intensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values. METHODS SPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m 2 and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m 2 , respectively. RESULTS EHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m 2 per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m 2 per year (95% CI, -1.08 to -0.85) in the intensive treatment group ( P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m 2 per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m 2 per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70). CONCLUSIONS Intensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.
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Affiliation(s)
- Paul E. Drawz
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Kristin M. Lenoir
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nayanjot Kaur Rai
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Anjay Rastogi
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Chi D. Chu
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - George Thomas
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Andrew McWilliams
- Department of Internal Medicine, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
| | - Anil K. Agarwal
- Department of Medicine, Veterans Affairs Central California Health Care System, Fresno, California
| | - Maritza Marie Suarez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - James Powell
- Division of General Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Michael V. Rocco
- Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - James P. Lash
- Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Suzanne Oparil
- Division of Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, Alabama
| | - Dominic S. Raj
- Division of Kidney Diseases and Hypertension, George Washington University, Washington, DC
| | - Jamie P. Dwyer
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Sandeep Soman
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Raymond R. Townsend
- Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Edward Horwitz
- Division of Nephrology & Hypertension, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California San Diego, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Delphine S. Tuot
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Areef Ishani
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Hughes-Austin JM, Katz R, Majka DS, Criqui MH, Robinson WH, Firestein GS, Hundley WG, Ix JH. Serum reactivity to citrullinated protein/peptide antigens and left ventricular structure and function in the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One 2023; 18:e0291967. [PMID: 37874814 PMCID: PMC10597499 DOI: 10.1371/journal.pone.0291967] [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: 12/28/2022] [Accepted: 09/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Antibodies to citrullinated protein antigens have been linked to altered left ventricular (LV) structure and function in patients with rheumatoid arthritis (RA). Serum reactivity to several citrullinated protein/peptide antigens has been identified in RA, which are detectable years before RA onset and in individuals who may never develop RA. Among community-living individuals without heart failure (HF) at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated associations between serum reactivity to citrullinated protein/peptide antigens, LV mass, LV ejection fraction (LVEF), and incident HF. METHODS Among 1232 MESA participants, we measured serum reactivity to 28 different citrullinated proteins/peptides using a multiplex bead-based array. Each antibody was defined as having extremely high reactivity (EHR) if >95th percentile cut-off in MESA. Number of EHR antibody responses to citrullinated protein/peptide antigens were summed for each participant (range 0-28). LV mass(g) and LVEF(%) were measured on cardiac MRI. Associations between EHR antibodies and LV mass and LVEF were evaluated using linear regression. Cox proportional hazards models were used to evaluate associations between EHR antibodies and incident HF during 11 years of follow-up, adjusting for age, gender, race/ethnicity, smoking status, systolic blood pressure, use of anti-hypertensive medications, self-reported arthritis, IL-6, body surface area, and estimated glomerular filtration rate. RESULTS Mean age was 65±10, 50% were female, 40% were White, 21% were Black, 26% were Hispanic/Latino, and 14% were Chinese. Twenty-seven percent of MESA participants had extremely high reactivity to ≥ 1 citrullinated protein/peptide antigen. In fully adjusted analysis, every additional EHR antibody was significantly associated with 0.1% lower LVEF (95% CI: -0.17%, -0.02%). No association was observed with LV mass (β per additional EHR antibody) = 0.13±0.15 (p = 0.37)). Neither the presence nor number of EHR antibodies was associated with incident HF during follow-up (HR per additional EHR antibody = 1.008 (95% CI: 0.97, 1.05)). CONCLUSION Greater number of extremely highly reactive antibodies was associated with lower LVEF, but not with LV mass or incident HF. Thus, serum reactivity to citrullinated protein/peptide antigens was associated with subtle subclinical changes in myocardial contractility, but the significance in relation to clinically apparent HF is uncertain.
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Affiliation(s)
- Jan M. Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, United States of America
| | - Ronit Katz
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Darcy S. Majka
- Division of Rheumatology, DuPage Medical Group, Chicago, Illinois, United States of America
| | - Michael H. Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - William H. Robinson
- Division of Immunology and Rheumatology, Stanford University, Stanford, California, United States of America
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Gary S. Firestein
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California, United States of America
| | - W. Gregory Hundley
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, La Jolla, California, United States of America
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Cheng JH, Hoofnagle AN, Katz R, Kritchevsky SB, Shlipak MG, Sarnak MJ, Ix JH, Ginsberg C. Development and Validation of Novel Free Vitamin D Equations: The Health Aging and Body Composition Study. JBMR Plus 2023; 7:e10781. [PMID: 37701148 PMCID: PMC10494503 DOI: 10.1002/jbm4.10781] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/05/2023] [Accepted: 05/22/2023] [Indexed: 09/14/2023] Open
Abstract
Vitamin D deficiency is prevalent in 25% of Americans. However, 25(OH)D may not be an accurate measure of vitamin D because the majority (85%-90%) of 25(OH)D is bound to vitamin D binding protein (VDBP), which varies by over 30% across individuals. Free 25(OH)D may be a better measure, but it is difficult to measure accurately and precisely. The existing free 25(OH)D estimating equation does not include VDBP phenotypes; therefore, new equations that include this variable may be more accurate. A total of 370 participants in the Health, Aging, and Body Composition Study, a cohort of healthy community-dwelling individuals aged 70-79 years old, underwent VDBP and vitamin D metabolite [25(OH)D, 24,25(OH)2D, 1,25(OH)2D, free 25(OH)D] measurements and were randomly allocated into equation development (two out of three) and internal validation (one out of three) groups. New equations were developed with multiple linear regression and were internally validated with Bland-Altman plots. The mean age was 75 ± 3 years, 53% were female, and the mean measured free 25(OH)D was 5.37 ± 1.81 pg/mL. Three equations were developed. The first equation included albumin, 25(OH)D3, 25(OH)D2, VDBP, 1,25(OH)2D3, and 24,25(OH)2D3. The second equation included all variables in Eq. (1) plus VDBP phenotypes. The third equation included albumin, 25(OH)D3, intact parathyroid hormone, and 1,25(OH)2D3. In internal validation, all three new equations predicted free 25(OH)D values within 30% and 15% of the measured free 25(OH)D concentrations in 76%-80% and 48%-52% of study participants, respectively. Equation (2) was the most precise, with a mean bias of 0.06 (95% limits of agreement -2.41 to 2.30) pg/mL. The existing equation estimated free 25(OH)D within 30% and 15% of measured free 25(OH)D in 43% and 22% of participants, respectively. Free 25(OH)D can be estimated with clinically available biomarkers as well as with more laboratory-intensive biomarkers with moderate precision. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jonathan H. Cheng
- Division of Nephrology‐HypertensionUniversity of CaliforniaSan DiegoCAUSA
- Nephrology SectionVeterans Affairs San Diego Healthcare SystemSan DiegoCAUSA
| | - Andrew N. Hoofnagle
- Department of Laboratory Medicine and Medicine and the Kidney Research InstituteUniversity of WashingtonSeattleWAUSA
| | - Ronit Katz
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWAUSA
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric MedicineWake Forest School of MedicineWinston‐SalemNCUSA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, Veterans Affairs Medical CenterUniversity of CaliforniaSan FranciscoCAUSA
| | - Mark J. Sarnak
- Department of Medicine, Division of NephrologyTufts Medical CenterBostonMAUSA
| | - Joachim H. Ix
- Division of Nephrology‐HypertensionUniversity of CaliforniaSan DiegoCAUSA
- Nephrology SectionVeterans Affairs San Diego Healthcare SystemSan DiegoCAUSA
| | - Charles Ginsberg
- Division of Nephrology‐HypertensionUniversity of CaliforniaSan DiegoCAUSA
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Vasquez-Rios G, Katz R, Levitan EB, Cushman M, Parikh CR, Kimmel PL, Bonventre JV, Waikar SS, Schrauben SJ, Greenberg JH, Sarnak MJ, Ix JH, Shlipak MG, Gutierrez OM. Urinary Biomarkers of Kidney Tubule Health and Mortality in Persons with CKD and Diabetes Mellitus. Kidney360 2023; 4:e1257-e1264. [PMID: 37533144 PMCID: PMC10547219 DOI: 10.34067/kid.0000000000000226] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
Key Points Among adults with diabetes and CKD, biomarkers of kidney tubule health were associated with a greater risk of death, independent of eGFR, albuminuria, and additional risk factors. Higher urine levels of YKL-40 and KIM-1 were associated with a greater risk of death. For cause-specific death, UMOD was independently and inversely associated with the risk of cardiovascular death. Background Kidney disease assessed by serum creatinine and albuminuria are strongly associated with mortality in diabetes. These markers primarily reflect glomerular function and injury. Urine biomarkers of kidney tubule health were recently associated with the risk of kidney failure in persons with CKD and diabetes. Associations of these biomarkers with risk of death are poorly understood. Methods In 560 persons with diabetes and eGFR ≤60 ml/min per 1.73 m2 from the Reasons for Geographic and Racial Differences in Stroke study (47% male, 53% Black), we measured urine biomarkers of kidney tubule health at baseline: monocyte chemoattractant protein-1 (MCP-1), alpha-1-microglobulin, kidney injury molecule-1 (KIM-1), EGF, chitinase-3-like protein 1 (YKL-40), and uromodulin (UMOD). Cox proportional hazards regression was used to examine the associations of urine biomarkers with all-cause and cause-specific mortality in nested models adjusted for urine creatinine, demographics, mortality risk factors, eGFR, and urine albumin. Results The mean (SD) age was 70 (9.6) years, and baseline eGFR was 40 (3) ml/min per 1.73 m2. There were 310 deaths over a mean follow-up of 6.5 (3.2) years. In fully adjusted models, each two-fold higher urine concentration of KIM-1 and YKL-40 were associated with all-cause mortality (hazard ratio [HR] 1.15, 95% confidence interval [CI], 1.01 to 1.31 and 1.13, 95% CI, 1.07 to 1.20, respectively). When examining cause-specific mortality, higher UMOD was associated with a lower risk of cardiovascular death (adjusted HR per two-fold higher concentration 0.87, 95% CI, 0.77 to 0.99), and higher MCP-1 was associated with higher risk of cancer death (HR per two-fold higher concentration 1.52, 95% CI, 1.05 to 2.18). Conclusion Among persons with diabetes and CKD, higher urine KIM-1 and YKL-40 were associated with a higher risk of all-cause mortality independently of established risk factors. Urine UMOD and MCP-1 were associated with cardiovascular and cancer-related death, respectively.
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Affiliation(s)
- George Vasquez-Rios
- Division of Nephrology , Department of Internal Medicine , Icahn School of Medicine at Mount Sinai , Manhattan , New York
| | - Ronit Katz
- Department of Obstetrics and Gynecology , University of Washington , Seattle , Washington
| | - Emily B Levitan
- Department of Epidemiology , University of Alabama at Birmingham , Birmingham , Alabama
| | - Mary Cushman
- Departments of Medicine and Pathology and Laboratory Medicine , Larner College of Medicine at the University of Vermont , Burlington , Vermont
| | - Chirag R Parikh
- Section of Nephrology , Department of Internal Medicine , Johns Hopkins School of Medicine , Baltimore , Maryland
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases , Bethesda , Maryland
| | - Joseph V Bonventre
- Division of Nephrology , Department of Medicine , Brigham and Women's Hospital , Boston , Massachusetts
| | - Sushrut S Waikar
- Section of Nephrology , Department of Medicine , Boston Medical Center , Boston , Massachusetts
| | - Sarah J Schrauben
- Department of Medicine , Perelman School of Medicine , Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania
| | - Jason H Greenberg
- Section of Nephrology , Department of Pediatrics , Program of Applied Translational Research , Yale University School of Medicine , New Haven , Connecticut
| | - Mark J Sarnak
- Division of Nephrology , Department of Medicine , Tufts Medical Center , Boston , Massachusetts
| | - Joachim H Ix
- Division of Nephrology-Hypertension , Department of Medicine , University of California San Diego , San Diego , California
- Veterans Affairs San Diego Healthcare System , San Diego , California
| | - Michael G Shlipak
- Kidney Health Research Collaborative , San Francisco Veterans Affairs Healthcare System and University of California , San Francisco , California
| | - Orlando M Gutierrez
- Departments of Medicine and Epidemiology , University of Alabama at Birmingham , Birmingham , Alabama
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Garimella PS, Scherzer R, Kestenbaum BR, Hoofnagle AN, Jotwani V, Gustafson D, Karim R, Sharma A, Cohen M, Dumond J, Abraham A, Estrella M, Shlipak MG, Ix JH. Tubular Secretory Solute Clearance and HIV Infection. J Acquir Immune Defic Syndr 2023; 93:319-326. [PMID: 36988544 PMCID: PMC10313730 DOI: 10.1097/qai.0000000000003200] [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: 02/17/2022] [Accepted: 12/05/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Tubular secretion is an important kidney function responsible for the clearance of numerous medications, including antibiotics and antivirals. It is unknown whether persons living with HIV have lower secretion compared with HIV-uninfected persons, which might predispose them to the risk of progressive kidney disease or adverse drug events. SETTING AND METHODS We evaluated a panel of 6 endogenous secretory solutes in 199 women living with HIV (WLWH) and 100 women without HIV enrolled in the Women's Interagency HIV Study. Secretory clearance was estimated as the urine-to-plasma ratio of each solute, with adjustment for urine tonicity. Using multivariable linear regression analysis, we compared differences in levels of secretory solute clearance between women with and without HIV and evaluated characteristics associated with secretion. RESULTS WLWH were older (median 40 vs. 38 years) but had similar estimated glomerular filtration rate (eGFR, 96 vs. 100 mL/minute/1.73 m 2 ) compared with those without HIV. African American and Latino race, diabetes, diastolic blood pressure, smoking, hepatitis C, peak HIV viral load, and current and nadir CD4 count were associated with differences in clearance of at least 1 marker after multivariable adjustment. The secretory clearance of 3 solutes (cinnamoylglycine, kynurenic acid, and pyridoxic acid) were on average 10%-15% lower among WLWH compared with those without HIV independent of eGFR, albuminuria and chronic kidney disease risk factors, including HCV, and injection drug use. CONCLUSIONS HIV is associated with reduced secretion among women with preserved eGFR. The implications of these findings for drug dosing and adverse events need to be evaluated.
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Affiliation(s)
- Pranav S. Garimella
- Kidney Research Innovation Hub of San Diego and Division of Nephrology and Hypertension, University of California San Diego, San Diego, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
| | | | - Andrew N. Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Medical Center, New York, NY, USA
| | - Roksana Karim
- Department of Clinical Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mardge Cohen
- Stroger Hospital of Cook County Health and Human Services, Chicago, IL, USA
| | - Julie Dumond
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Denver, CO, USA
| | - Michelle Estrella
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Joachim H. Ix
- Kidney Research Innovation Hub of San Diego and Division of Nephrology and Hypertension, University of California San Diego, San Diego, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Jiang K, Greenberg JH, Abraham A, Xu Y, Schelling JR, Feldman HI, Schrauben SJ, Waikar SS, Shlipak MG, Wettersten N, Coca SG, Vasan RS, Gutierrez OM, Ix JH, Warady BA, Kimmel PL, Bonventre JV, Parikh CR, Mitsnefes MM, Denburg MR, Furth S. Associations of Biomarkers of Kidney Tubule Health, Injury, and Inflammation with Left Ventricular Hypertrophy in Children with CKD. Kidney360 2023; 4:1039-1047. [PMID: 37303083 PMCID: PMC10476681 DOI: 10.34067/kid.0000000000000183] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
Key Points Higher plasma and urine kidney injury molecule-1, urine monocyte chemoattractant protein-1, and lower urine alpha-1-microglobulin were associated with left ventricular hypertrophy, even after adjustment for confounders. Biomarkers of tubular injury, dysfunction, and inflammation may indicate the severity of kidney pathology and are associated with left ventricular hypertrophy. Background Left ventricular hypertrophy (LVH) is common in children with CKD and is associated with an increased risk of cardiovascular disease and mortality. We have shown that several plasma and urine biomarkers are associated with increased risk of CKD progression. As CKD is associated with LVH, we sought to investigate the association between the biomarkers and LVH. Methods In the CKD in Children Cohort Study, children aged 6 months to 16 years with an eGFR of 30–90 ml/min per 1.73 m2 were enrolled at 54 centers in the United States and Canada. We measured plasma biomarkers kidney injury molecule-1 (KIM-1), tumor necrosis factor receptor-1, tumor necrosis factor receptor-2, soluble urokinase-type plasminogen activator receptor and urine KIM-1, monocyte chemoattractant protein-1 (MCP-1), YKL-40, alpha-1-microglobulin (alpha-1m), and epidermal growth factor in stored plasma and urine collected 5 months after enrollment. Echocardiograms were performed 1 year after enrollment. We assessed the cross-sectional association between the log2 biomarker levels and LVH (left ventricular mass index greater than or equal to the 95th percentile) using a Poisson regression model, adjusted for age, sex, race, body mass index, hypertension, glomerular diagnosis, urine protein-to-creatinine ratio, and eGFR at study entry. Results Among the 504 children, LVH prevalence was 12% (n =59) 1 year after enrollment. In a multivariable-adjusted model, higher plasma and urine KIM-1 and urine MCP-1 concentrations were associated with a higher prevalence of LVH (plasma KIM-1 prevalence ratio [PR] per log2: 1.27, 95% confidence interval [CI], 1.02 to 1.58; urine KIM-1 PR: 1.21, 95% CI, 1.11 to 1.48; and urine MCP-1 PR: 1.18, 95% CI, 1.04 to 1.34). After multivariable adjustment for covariates, lower urine alpha-1m was also associated with a higher prevalence of LVH (PR: 0.90, 95% CI, 0.82 to 0.99). Conclusions Higher plasma and urine KIM-1, urine MCP-1, and lower urine alpha-1m were each associated with LVH prevalence in children with CKD. These biomarkers may better inform risk and help elucidate the pathophysiology of LVH in pediatric CKD.
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Affiliation(s)
- Kuan Jiang
- Yale School of Medicine, New Haven, Connecticut
| | | | - Alison Abraham
- University of Colorado, Anschutz Medical Campus, Denver, Colorado
- Johns Hopkins University, Baltimore, Maryland
| | - Yunwen Xu
- Johns Hopkins University, Baltimore, Maryland
| | | | - Harold I. Feldman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah J. Schrauben
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Steven G. Coca
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joachim H. Ix
- University of California San Diego, San Diego, California
| | | | | | | | | | | | | | - Susan Furth
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bullen AL, Fregoso A, Ascher SB, Shlipak MG, Ix JH, Rifkin DE. Markers of Kidney Tubule Dysfunction and Major Adverse Kidney Events. Nephron Clin Pract 2023; 147:713-716. [PMID: 37524063 DOI: 10.1159/000531946] [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: 05/04/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Serum creatinine and albuminuria are primary markers of glomerular function and injury, respectively. Tubular secretion, acid-base homeostasis, protein reabsorption, among other tubular functions, are largely ignored. This mini-review aimed to discuss how two tubular functions, secretion, and acid-base homeostasis are associated with major adverse kidney events (MAKEs). SUMMARY Proximal tubular secretion is an essential function that allows the elimination of endogenous substances and drugs. Recently discovered endogenous markers in urine and plasma allow a noninvasive way of assessing tubular secretion markers. Several studies have found an association between these markers and a higher risk of chronic kidney disease (CKD) progression and mortality. In a study we recently performed among patients with CKD and at risk of cardiovascular events, lower tubular secretion was associated with an increased risk of acute kidney injury and metabolic acidosis, independent of baseline eGFR and albuminuria. The kidney tubules also play a crucial role in acid-base homeostasis. Although the standard clinical assessment of acidosis consists of measuring serum bicarbonate, urinary ammonium excretion decreases before over metabolic acidosis. Urinary ammonium excretion is associated with CKD progression, a higher risk of kidney failure, and an increased mortality risk, independent of baseline eGFR and albuminuria. KEY MESSAGES Novel biomarkers of kidney tubular health consistently associate with MAKEs, above and beyond baseline eGFR, albuminuria, and other CKD risk factors. Tubular markers may provide new opportunities to improve kidney prognosis, drug dosing, and monitoring for adverse events.
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Affiliation(s)
- Alexander L Bullen
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Alma Fregoso
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California, USA
- Division of Hospital Medicine, University of California Davis, Sacramento, California, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Dena E Rifkin
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
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Dugar A, Hoofnagle AN, Sanchez AP, Ward DM, Corey-Bloom J, Cheng JH, Ix JH, Ginsberg C. The Vitamin D Metabolite Ratio (VMR) is a Biomarker of Vitamin D Status That is Not Affected by Acute Changes in Vitamin D Binding Protein. Clin Chem 2023; 69:718-723. [PMID: 37220642 PMCID: PMC10320009 DOI: 10.1093/clinchem/hvad050] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/23/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND 25-hydroxyvitamin D[25(OH)D] may be a poor marker of vitamin D status due to variability in levels of vitamin D binding protein (VDBP). The vitamin D metabolite ratio (VMR) is the ratio of 24,25-dihydroxyvitamin D[24,25(OH)2D3] to 25(OH)D3 and has been postulated to reflect vitamin D sufficiency independent of variability in VDBP. Therapeutic plasma exchange (TPE) is a procedure that removes plasma, including VDBP, and may lower bound vitamin D metabolite concentrations. Effects of TPE on the VMR are unknown. METHODS We measured 25(OH)D, free 25(OH)D, 1,25-dihydroxyvitamin D[1,25(OH)2D], 24,25(OH)2D3, and VDBP in persons undergoing TPE, before and after treatment. We used paired t-tests to assess changes in these biomarkers during a TPE procedure. RESULTS Study participants (n = 45) had a mean age of 55 ± 16 years; 67% were female; and 76% were white. Compared to pretreatment concentrations, TPE caused a significant decrease in total VDBP by 65% (95%CI 60,70%), as well as all the vitamin D metabolites-25(OH)D by 66% (60%,74%), free 25(OH)D by 31% (24%,39%), 24,25(OH)2D3 by 66% (55%,78%) and 1,25(OH)2D by 68% (60%,76%). In contrast, there was no significant change in the VMR before and after a single TPE treatment, with an observed mean 7% (-3%, 17%) change in VMR. CONCLUSIONS Changes in VDBP concentration across TPE parallel changes in 25(OH)D, 1,25(OH)2D, and 24,25(OH)2D3, suggesting that concentrations of these metabolites reflect underlying VDBP concentrations. The VMR is stable across a TPE session despite a 65% reduction in VDBP. These findings suggest that the VMR is a marker of vitamin D status independent of VDBP levels.
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Affiliation(s)
- Anushree Dugar
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Andrew N Hoofnagle
- Departments of Laboratory Medicine and Medicine and the Kidney Research Institute, University of Washington, Seattle, WA, United States
| | - Amber P Sanchez
- Division of Nephrology-Hypertension, University of California, San Diego, CA, United States
| | - David M Ward
- Division of Nephrology-Hypertension, University of California, San Diego, CA, United States
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, United States
| | - Jonathan H Cheng
- Division of Nephrology-Hypertension, University of California, San Diego, CA, United States
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, CA, United States
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego, CA, United States
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Cheung KL, Crews DC, Cushman M, Yuan Y, Wilkinson K, Long DL, Judd SE, Shlipak MG, Ix JH, Bullen AL, Warnock DG, Gutiérrez OM. Risk Factors for Incident CKD in Black and White Americans: The REGARDS Study. Am J Kidney Dis 2023; 82:11-21.e1. [PMID: 36621640 PMCID: PMC10293023 DOI: 10.1053/j.ajkd.2022.11.015] [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: 03/22/2022] [Accepted: 11/22/2022] [Indexed: 01/07/2023]
Abstract
RATIONALE & OBJECTIVE Little information exists on the incidence of and risk factors for chronic kidney disease (CKD) in contemporary US cohorts and whether risk factors differ by race, sex, or region in the United States. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 4,198 Black and 7,799 White participants aged at least 45 years, recruited from 2003 through 2007 across the continental United States, with baseline estimated glomerular filtration rate (eGFR)>60mL/min/1.73m2 and eGFR assessed again approximately 9 years later. EXPOSURES Age, sex, race (Black or White), region ("stroke belt" or other), education, income, systolic blood pressure, body mass index, diabetes, coronary heart disease, hyperlipidemia, smoking, and albuminuria. OUTCOMES (1) eGFR change and (2) incident CKD defined as eGFR<60mL/min/1.73m2 and≥40% decrease from baseline or kidney failure. ANALYTICAL APPROACH Linear regression and modified Poisson regression were used to determine the association of risk factors with eGFR change and incident CKD overall and stratified by race, sex, and region. RESULTS Mean age of participants was 63±8 (SD) years, 54% were female, and 35% were Black. After 9.4±1.0 years of follow-up, CKD developed in 9%. In an age-, sex-, and race-adjusted model, Black race (β =-0.13; P<0.001) was associated with higher risk of eGFR change, but this was attenuated in the fully adjusted model (β=0.02; P=0.5). Stroke belt residence was independently associated with eGFR change (β =-0.10; P<0.001) and incident CKD (relative risk, 1.14 [95% CI, 1.01-1.30]). Albuminuria was more strongly associated with eGFR change (β of-0.26 vs-0.17; P=0.01 for interaction) in Black compared with White participants. Results were similar for incident CKD. LIMITATIONS Persons of Hispanic ethnicity were excluded; unknown duration and/or severity of risk factors. CONCLUSIONS Established CKD risk factors accounted for higher risk of incident CKD in Black versus White individuals. Albuminuria was a stronger risk factor for eGFR decrease and incident CKD in Black compared with White individuals. Living in the US stroke belt is a novel risk factor for CKD.
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Affiliation(s)
- Katharine L Cheung
- Divisions of Nephrology, Larner College of Medicine at The University of Vermont, Burlington, Vermont.
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
| | - Mary Cushman
- Hematology/Oncology, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont
| | - Ya Yuan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katherine Wilkinson
- Larner College of Medicine at The University of Vermont, Burlington, Vermont
| | - D Leann Long
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Judd
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael G Shlipak
- Division of Nephrology, University of California, San Francisco, San Francisco, California
| | - Joachim H Ix
- Division of Nephrology, University of California, San Diego, La Jolla, California
| | - Alexander L Bullen
- Division of Nephrology, University of California, San Diego, La Jolla, California
| | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Orlando M Gutiérrez
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
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Pao AC, Shahzad SR, Song S, Ganesan C, Conti S, Leppert J, Cheung AK, Ix JH, Isakova T, Wolf M, Raj DS, Sprague SM, Fried LF, Gassman J, Fong P, Koike S, Raphael KL. Response to Alkali Administration in Women and Men With and Without CKD. Kidney Med 2023; 5:100670. [PMID: 37492113 PMCID: PMC10363557 DOI: 10.1016/j.xkme.2023.100670] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Alan C. Pao
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Department of Urology, Stanford University School of Medicine, Palo Alto, California
| | - Sheikh R. Shahzad
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Shen Song
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Calyani Ganesan
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Simon Conti
- Department of Urology, Stanford University School of Medicine, Palo Alto, California
| | - John Leppert
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Department of Urology, Stanford University School of Medicine, Palo Alto, California
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego School of Medicine, San Diego, California
| | - Tamara Isakova
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Dominic S. Raj
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - Stuart M. Sprague
- Department of Medicine, Northshore University Health System, University of Chicago, Evanston, Illinois
| | - Linda F. Fried
- Department of Medicine, University of Pittsburgh and Renal Section, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peter Fong
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - Seiji Koike
- Biostatistics and Design Program, Oregon Health and Science University, Portland, Oregon
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Malhotra R, Rahimi S, Agarwal U, Katz R, Kumar U, Garimella PS, Gupta V, Chopra T, Kotanko P, Ikizler TA, Larsen B, Cadmus-Bertram L, Ix JH. The Impact of a Wearable Activity Tracker and Structured Feedback Program on Physical Activity in Hemodialysis Patients: The Step4Life Pilot Randomized Controlled Trial. Am J Kidney Dis 2023; 82:75-83. [PMID: 36801430 PMCID: PMC10962931 DOI: 10.1053/j.ajkd.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 12/18/2022] [Indexed: 02/19/2023]
Abstract
RATIONALE & OBJECTIVE People with end-stage kidney disease (ESKD) have very low physical activity, and the degree of inactivity is strongly associated with morbidity and mortality. We assessed the feasibility and effectiveness of a 12-week intervention coupling a wearable activity tracker (FitBit) and structured feedback coaching versus wearable activity tracker alone on changes in physical activity in hemodialysis patients. STUDY DESIGN Randomized controlled trial. SETTING & PARTICIPANTS 55 participants with ESKD receiving hemodialysis who were able to walk with or without assistive devices recruited from a single academic hemodialysis unit between January 2019 and April 2020. INTERVENTIONS All participants wore a Fitbit Charge 2 tracker for a minimum of 12 weeks. Participants were randomly assigned 1:1 to a wearable activity tracker plus a structured feedback intervention versus the wearable activity tracker alone. The structured feedback group was counseled weekly on steps achieved after randomization. OUTCOME The outcome was step count, and the main parameter of interest was the absolute change in daily step count, averaged per week, from baseline to completion of 12 weeks intervention. In the intention-to-treat analysis, mixed-effect linear regression analysis was used to evaluate change in daily step count from baseline to 12-weeks in both arms. RESULTS Out of 55 participants, 46 participants completed the 12-week intervention (23 per arm). The mean age was 62 (± 14 SD) years; 44% were Black, and 36% were Hispanic. At baseline, step count (structured feedback intervention: 3,704 [1,594] vs wearable activity tracker alone: 3,808 [1,890]) and other participant characteristics were balanced between the arms. We observed a larger change in daily step count in the structured feedback arm at 12 weeks relative to use of the wearable activity tracker alone arm (Δ 920 [±580 SD] versus Δ 281 [±186 SD] steps; between-group difference Δ 639 [±538 SD] steps; P<0.05). LIMITATIONS Single-center study and small sample size. CONCLUSION This pilot randomized controlled trial demonstrated that structured feedback coupled with a wearable activity tracker led to a greater daily step count that was sustained over 12 weeks relative to a wearable activity tracker alone. Future studies are required to determine longer-term sustainability of the intervention and potential health benefits in hemodialysis patients. FUNDING Grants from industry (Satellite Healthcare) and government (National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT05241171.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California.
| | - Sina Rahimi
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Ushma Agarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Ujjala Kumar
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Vineet Gupta
- Division of Hospital Medicine, Department of Medicine, University of California-San Diego, San Diego, California
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Peter Kotanko
- Renal Research Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - T Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California-San Diego, San Diego, California
| | | | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California; Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, California
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Sharma S, Ix JH. Kidney clearance of fibroblast growth factor-23 in humans. Curr Opin Nephrol Hypertens 2023; 32:330-334. [PMID: 37195253 PMCID: PMC10442065 DOI: 10.1097/mnh.0000000000000900] [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: 05/18/2023]
Abstract
PURPOSE OF REVIEW Recent studies have shed light on factors influencing FGF23 regulation in terms of its production and cleavage. However, less is known about FGF23 elimination from circulation. The kidney's role in FGF23 elimination will be the focus of this review. RECENT FINDINGS Marked abnormalities in FGF23 physiology have been observed in persons with reduced kidney function compared with healthy persons and raise the question of whether the kidney may be directly regulating FGF23 concentrations. FGF23 concentrations rise dramatically after onset of acute kidney injury and early chronic kidney disease and are associated with poor clinical outcomes. New studies leveraging measurements of FGF23 in the aorta and renal veins concurrently demonstrate that the human kidney efficiently extracts both intact and C-terminal FGF23 from the circulation independent of kidney function and catabolize the hormone. Additionally, the kidney's reduction of PTH predicts the amount it will reduce both C-terminal and intact FGF23. SUMMARY The human kidney removes both intact FGF23 and its C-terminal fragments. FGF23 catabolism within the kidney may be influenced by PTH concentrations, and other factors. Future studies to understand regulation of these hormones and the kidney's role in this interplay are timely.
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Affiliation(s)
- Shilpa Sharma
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Nephrology Section, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Joachim H. Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA
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Wettersten N, Katz R, Greenberg JH, Gutierrez OM, Lima JAC, Sarnak MJ, Schrauben S, Deo R, Bonventre J, Vasan RS, Kimmel PL, Shlipak M, Ix JH. Association of Kidney Tubule Biomarkers With Cardiac Structure and Function in the Multiethnic Study of Atherosclerosis. Am J Cardiol 2023; 196:11-18. [PMID: 37086700 PMCID: PMC10204591 DOI: 10.1016/j.amjcard.2023.02.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 04/24/2023]
Abstract
Markers of glomerular disease, estimated glomerular filtration rate (eGFR) and albuminuria, are associated with cardiac structural abnormalities and incident cardiovascular disease (CVD). We aimed to determine whether biomarkers of kidney tubule injury, function, and systemic inflammation are associated with cardiac structural abnormalities. Among 393 Multi-Ethnic Study of Atherosclerosis participants without diabetes, CVD, or chronic kidney disease, we assessed the association of 12 biomarkers of kidney tubule injury, function, and systemic inflammation with the left ventricular mass/volume ratio (LVmvr) and left ventricular ejection fraction (LVEF) on cardiac magnetic resonance imaging using linear regression. The average age was 60 ± 10 years; 48% were men; mean eGFR was 96±16 ml/min/1.73 m2; mean LVmvr was 0.93±0.18 g/ml, and mean LVEF was 62±6%. Each twofold greater concentration of plasma soluble urokinase plasminogen activator receptor was associated with a 0.04 g/ml (95% confidence interval [CI] 0.01 to 0.08 g/ml) higher LVmvr and 2.1% (95% CI 0.6 to 3.5%) lower LVEF, independent of risk factors for CVD, eGFR, and albuminuria. Each twofold greater plasma monocyte chemoattractant protein 1 was associated with higher LVmvr with a similar coefficient to that of plasma soluble urokinase plasminogen activator receptor. Each twofold greater concentration of plasma chitinase-3-like protein 1 and urine alpha-1-microglobulin was associated with a 1.1% (95% CI 0.4 to 1.7%) and 1.2% (95% CI 0.2 to 2.2%) lower LVEF, respectively. In conclusion, abnormal kidney tubule health may lead to cardiac dysfunction above and beyond eGFR and albuminuria.
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Affiliation(s)
- Nicholas Wettersten
- Cardiology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California; Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California.
| | - Ronit Katz
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Orlando M Gutierrez
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Sarah Schrauben
- Renal-Electrolyte and Hypertension Division, and Department of Epidemiology, Biostatistics and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bonventre
- Division of Renal Medicine and Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramachandran S Vasan
- Department of Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Michael Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Health Care System, University of California, San Francisco, California
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California
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Khan MB, Scherzer R, Lewis CE, Malhotra R, Ix JH, Shlipak MG, Gutiérrez OM. Associations of Urine Biomarkers of Kidney Tubule Health With Incident Hypertension and Longitudinal Blood Pressure Change in Middle-Aged Adults: The CARDIA Study. Hypertension 2023; 80:1353-1362. [PMID: 36987923 PMCID: PMC10192098 DOI: 10.1161/hypertensionaha.123.21084] [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: 02/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Urine biomarkers of kidney tubule injury associate with incident hypertension in older adults with comorbidities, but less is known about these associations in younger adults. METHODS In 1170 participants of the CARDIA study (Coronary Artery Risk Development in Young Adults; mean age, 45 years; 40% Black people; 56% women) without hypertension, cardiovascular disease, or kidney disease at baseline, we examined associations of urine MCP-1 (monocyte chemoattractant protein-1), α1m (alpha-1-microglobulin), KIM-1 (kidney injury molecule-1), EGF (epidermal growth factor), IL (interleukin)-18, YKL-40 (chitinase-3-like protein 1), and UMOD (uromodulin) with incident hypertension (onset of systolic blood pressure [BP] ≥130 mm Hg or diastolic BP ≥80 mm Hg or initiation of hypertension medications) and longitudinal BP change in models adjusted for hypertension risk factors, estimated glomerular filtration rate, and albuminuria. RESULTS After a median 9.9 (interquartile range, 5.9-10.2) years, 376 participants developed incident hypertension. In demographic-adjusted analyses, higher tertiles of EGF associated with lower risk of incident hypertension in both Black and White participants. After multivariable adjustment, the risk of incident hypertension remained lower in tertile 2 (hazard ratio, 0.70 [95% CI, 0.50-0.97]) and tertile 3 (hazard ratio, 0.58 [0.39-0.85]) of EGF versus tertile 1. In fully adjusted models, participants in EGF tertile 3 had smaller 10-year increases in systolic (-3.4 [95% CI, -6.1 to -0.7] mm Hg) and diastolic BP (-2.6 [95% CI, -4.6 to -0.6] mm Hg) than tertile 1. Other biomarkers showed inconsistent associations with incident hypertension and BP change. CONCLUSIONS In middle-aged adults without hypertension, cardiovascular disease, or kidney disease, higher urine EGF associated with lower risk of incident hypertension and lower 10-year BP elevations.
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Affiliation(s)
- Muhammad B. Khan
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Rebecca Scherzer
- Department of Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, San Francisco, CA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Rakesh Malhotra
- Division of Nephrology-Hypertension, University of California, San Diego and Nephrology Section Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California, San Diego and Nephrology Section Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Michael G. Shlipak
- Department of Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, San Francisco, CA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Orlando M. Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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Ferrè S, Liu YL, Lambert JW, Katz R, Gianella FG, Drew DA, Shlipak MG, Moe OW, Ix JH, Toto RD, Neyra JA. Serum Magnesium Levels and Cardiovascular Outcomes in Systolic Blood Pressure Intervention Trial Participants. Kidney Med 2023; 5:100634. [PMID: 37235044 PMCID: PMC10206180 DOI: 10.1016/j.xkme.2023.100634] [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] [Indexed: 03/30/2023] Open
Abstract
Rationale and Objective Serum magnesium levels have been inversely yet inconsistently associated with cardiovascular (CV) outcomes. In this study, we examined the association of serum magnesium levels with CV outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT) participants. Study Design Case-control post hoc analysis of SPRINT. Setting & Participants A total of 2,040 SPRINT participants with available serum samples at baseline level were included in this study. Case participants (n = 510) who experienced a CV event during the SPRINT observation period (median follow-up of 3.2 years) and control participants (n = 1,530) without CV events were sampled in a 1:3 ratio for measurements of serum magnesium level at baseline and 2-year follow-up. Predictors Baseline serum magnesium levels and 2-year percentage change in serum magnesium levels (ΔSMg). Outcome SPRINT primary composite CV outcome. Analytical Approach Multivariable conditional logistic regression analysis, accounting for matching factors, was used to evaluate the association of baseline and ΔSMg with CV outcomes. Individual matching of cases and controls was based on the SPRINT treatment arm allocation (standard vs intensive) and prevalence of chronic kidney disease (CKD). Results The median serum magnesium level at baseline was similar among the case and control groups. In a fully adjusted model, each standard deviation (SD) (0.18 mg/dL) higher of the baseline serum magnesium level was independently associated with a lower risk for composite CV outcomes in all study participants (adjusted odds ratio 95% CI, 0.79 [0.70-0.89]). This association was similar when serum magnesium levels were analyzed in quartiles but dissipated in the standard (vs intensive) arm of SPRINT (0.88 [0.76-1.02] vs 0.65 [0.53-0.79], respectively; Pinteraction = 0.06). The presence or absence of CKD at baseline did not modify this association. ΔSMg was not independently associated with CV outcomes occurring after 2 years. Limitations ΔSMg was small in magnitude, limiting effect size. Conclusions Higher baseline serum magnesium levels were independently associated with reduced risk for CV outcomes in all study participants, but ΔSMg was not associated with CV outcomes.
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Affiliation(s)
- Silvia Ferrè
- Department of Scientific Activities, National Kidney Foundation, New York, NY
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yu-Lun Liu
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Fabiola G. Gianella
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - David A. Drew
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Health Care System, San Francisco, CA
| | - Orson W. Moe
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joachim H. Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA
| | - Robert D. Toto
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier A. Neyra
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
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Cronjé HT, Mi MY, Austin TR, Biggs ML, Siscovick DS, Lemaitre RN, Psaty BM, Tracy RP, Djoussé L, Kizer JR, Ix JH, Rao P, Robbins JM, Barber JL, Sarzynski MA, Clish CB, Bouchard C, Mukamal KJ, Gerszten RE, Jensen MK. Plasma Proteomic Risk Markers of Incident Type 2 Diabetes Reflect Physiologically Distinct Components of Glucose-Insulin Homeostasis. Diabetes 2023; 72:666-673. [PMID: 36749929 PMCID: PMC10130486 DOI: 10.2337/db22-0628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
High-throughput proteomics allows researchers to simultaneously explore the roles of thousands of biomarkers in the pathophysiology of diabetes. We conducted proteomic association studies of incident type 2 diabetes and physiologic responses to an intravenous glucose tolerance test (IVGTT) to identify novel protein contributors to glucose homeostasis and diabetes risk. We tested 4,776 SomaScan proteins measured in relation to 18-year incident diabetes risk in participants from the Cardiovascular Health Study (N = 2,631) and IVGTT-derived measures in participants from the HERITAGE Family Study (N = 752). We characterize 51 proteins that were associated with longitudinal diabetes risk, using their respective 39, 9, and 8 concurrent associations with insulin sensitivity index (SI), acute insulin response to glucose (AIRG), and glucose effectiveness (SG). Twelve of the 51 diabetes associations appear to be novel, including β-glucuronidase, which was associated with increased diabetes risk and lower SG, suggesting an alternative pathway to insulin for glucose disposal; and plexin-B2, which also was associated with increased diabetes risk, but with lower AIRG, and not with SI, indicating a mechanism related instead to pancreatic dysfunction. Other novel protein associations included alcohol dehydrogenase-1C, fructose-bisphosphate aldolase-B, sorbitol dehydrogenase with elevated type 2 diabetes risk, and a leucine-rich repeat containing protein-15 and myocilin with decreased risk. ARTICLE HIGHLIGHTS Plasma proteins are associated with the risk of incident diabetes in older adults independent of various demographic, lifestyle, and biochemical risk factors. These same proteins are associated with subtle differences in measures of glucose homeostasis earlier in life. Proteins that are associated with lower insulin sensitivity in individuals without diabetes tend to be associated with appropriate compensatory mechanisms, such as a stronger acute insulin response or higher glucose effectiveness. Proteins that are associated with future diabetes risk, but not with insulin insensitivity, tend to be associated with lower glucose effectiveness and/or impaired acute insulin response.
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Affiliation(s)
- Héléne T. Cronjé
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Michael Y. Mi
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Thomas R. Austin
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Mary L. Biggs
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, Health Systems and Population Health, University of Washington, Seattle, WA
| | - Russell P. Tracy
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Luc Djoussé
- Division of Aging, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jorge R. Kizer
- Cardiology Section San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, CA
| | - Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jeremy M. Robbins
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jacob L. Barber
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Mark A. Sarzynski
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | | | | | - Kenneth J. Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robert E. Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Majken K. Jensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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40
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Mehta R, Buzkova P, Patel H, Cheng J, Kizer JR, Gottdiener JS, Psaty B, Khan SS, Ix JH, Isakova T, Shlipak MG, Bansal N, Shah SJ. Cardiac Mechanics and Kidney Function Decline in the Cardiovascular Health Study. Kidney360 2023; 4:622-630. [PMID: 36888990 PMCID: PMC10278816 DOI: 10.34067/kid.0000000000000100] [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] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/26/2023] [Indexed: 03/10/2023]
Abstract
Key Points Two-dimensional speckle-tracking echocardiography (2D-STE) can detect early changes in cardiac mechanics and may be able to identify individuals at risk for kidney disease progression. Novel indices of cardiac mechanics on 2D-STE may identify a population that may benefit from early diagnosis, monitoring, and treatment. Novel pharmacologic therapies may be beneficial in patients with subclinical myocardial dysfunction at risk for kidney function decline. Background Clinical heart failure frequently coexists with CKD and may precipitate kidney function decline. However, whether earlier-stage myocardial dysfunction assessable by speckle-tracking echocardiography (STE) is a contributor to kidney function decline remains unknown. Methods We studied 2135 Cardiovascular Health Study participants who were free of clinical heart failure and had year 2 baseline 2D-STE and two measurements of eGFR (year 2 and year 9). “Archival” speckle tracking of digitized echocardiogram videotapes was used to measure left ventricular longitudinal strain (LVLS), LV early diastolic strain rate (EDSR), left atrial reservoir strain (LARS), right ventricular free wall strain (RVFWS), and mitral annular velocity (e′). Multivariable Poisson regression models that adjusted for demographics and cardiovascular risk factors (RFs) were used to investigate the independent associations of cardiac mechanics indices and decline in kidney function defined as a 30% decline in eGFR over 7 years. Results In RF models, LVLS, EDSR, RVFWS, and e′ were all significantly associated with the prevalence of kidney disease. After multivariable adjustment, left atrial dysfunction (relative risk [RR], 1.18; 95% confidence interval [CI], 1.01 to 1.38 per SD lower LARS) and left ventricular diastolic dysfunction (RR, 1.21; 95% CI, 1.04 to 1.41 per SD lower EDSR) were each significantly associated with 30% decline in eGFR. Conclusions Subclinical myocardial dysfunction suggesting abnormal diastolic function detected by 2D-STE was independently associated with decline in kidney function over time. Further studies are needed to understand the mechanisms of these associations and to test whether interventions that may improve subclinical myocardial dysfunction can prevent decline of kidney function.
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Affiliation(s)
- Rupal Mehta
- Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois
- Center for Translational Metabolism and Heath, Northwestern University, Chicago, Illinois
- Jesse Brown Veterans Administration Hospital System, Chicago, Illinois
| | | | - Harnish Patel
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jeanette Cheng
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jorge R. Kizer
- Cardiology Section, San Francisco Veterans Administration Health Care System, and Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | | | - Bruce Psaty
- University of Washington, Seattle, Washington
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Joachim H. Ix
- Division of Nephrology, Department of Medicine, University of California San Diego, San Diego, California
- Veterans Affairs, San Diego Healthcare System, San Diego, California
| | - Tamara Isakova
- Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois
- Center for Translational Metabolism and Heath, Northwestern University, Chicago, Illinois
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, University of California, San Francisco, San Francisco, California
| | | | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
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Ascher SB, Garimella PS, Ix JH. Urine-to-Plasma Urea Ratio: Disentangling Tubular Concentrating Ability From GFR. Am J Kidney Dis 2023; 81:382-383. [PMID: 36529560 DOI: 10.1053/j.ajkd.2022.10.006] [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] [Received: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, San Francisco, California; Division of Hospital Medicine, University of California, Davis, Sacramento, California
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, San Diego, California
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California.
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Ahiawodzi P, Solaru KW, Chaves PHM, Ix JH, Kizer JR, Tracy RP, Newman A, Siscovick D, Djousse L, Mukamal KJ. Non-esterified fatty acids and risk of peripheral artery disease in older adults: The cardiovascular health study. Atherosclerosis 2023; 370:25-32. [PMID: 36754661 PMCID: PMC10079601 DOI: 10.1016/j.atherosclerosis.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 01/07/2023] [Accepted: 01/24/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS Non-esterified fatty acids have been implicated in the pathogenesis of diabetes and cardiovascular disease. No longitudinal study has assessed their effects on peripheral artery disease (PAD). We determined the relationships between NEFAs and incident clinical PAD and abnormal ankle-brachial index (ABI) in a population-based cohort of older persons. METHODS We evaluated 4575 community living participants aged >65 years who underwent measurement of circulating NEFAs in fasting specimens and ABI in 1992-1993. Participants were assessed annually for clinical PAD until 2015 and underwent repeat ABI in 1998-1999. We used Cox proportional hazards regression to model the associations between NEFAs and risk of clinical PAD and logistic regression to model the associations of NEFAs with incident abnormal ABI. RESULTS Mean age was 74.8 years, 59% were female, and 17% were Black. NEFAs were associated with higher risk of clinical PAD in unadjusted and adjusted models. The adjusted hazard ratios for incident clinical PAD were 1.51 (95%CI = 1.06-2.13, p = 0.02) across extreme tertiles, and 1.14 (95%CI = 0.99-1.31, p = 0.08) per standard deviation higher NEFA. The corresponding odds ratios for abnormal ABI were 0.95 (95%CI = 0.69-1.32, p = 0.76) across extreme tertiles, and 1.03 (95%CI = 0.89-1.20, p = 0.68) per standard deviation higher NEFA. Relationships appeared similar irrespective of sex, race, or pre-existing cardiovascular disease, but were stronger later than earlier in follow-up. CONCLUSIONS Higher serum levels of NEFAs are significantly associated with increased likelihood of clinical PAD over long-term follow-up but not with 6-year decline in ABI. NEFAs may offer a potential target for intervention against clinical PAD.
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Affiliation(s)
- Peter Ahiawodzi
- Department of Public Health, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA.
| | - Khendi White Solaru
- Cardiology, Cardiology-Vascular Medicine, CWRU School of Medicine, Cleveland, OH, USA
| | - Paulo H M Chaves
- Benjamin Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Joachim H Ix
- Divisions of Nephrology-Hypertension, University of California, San Diego, CA, USA
| | - Jorge R Kizer
- Division of Cardiology, Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Russell P Tracy
- Department of Pathology, Departments of Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA
| | - Anne Newman
- Departments of Epidemiology, Departments of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Siscovick
- Division of Research, Evaluation and Policy, The New York Academy of Medicine, New York, NY, USA
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kenneth J Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Ginsberg C, Hoofnagle AN, Katz R, Cheng JH, Hsu S, Budoff MJ, Kado DM, Kestenbaum B, Siscovick DS, Michos ED, Ix JH, de Boer IH. Vitamin D Metabolite Ratio and Coronary Artery Calcification in the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2023; 16:e015055. [PMID: 36943910 DOI: 10.1161/circimaging.122.015055] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Charles Ginsberg
- Division of Nephrology-Hypertension, University of California, San Diego (C.G., J.H.C., J.H.I.)
| | - Andrew N Hoofnagle
- Departments of Laboratory Medicine and Medicine and the Kidney Research Institute (A.N.H.), University of Washington, Seattle
| | - Ronit Katz
- Department of Obstetrics and Gynecology (R.K.), University of Washington, Seattle
| | - Jonathan H Cheng
- Division of Nephrology-Hypertension, University of California, San Diego (C.G., J.H.C., J.H.I.)
| | - Simon Hsu
- Division of Nephrology and Kidney Research Institute (S.H., B.K., I.H.d.B.), University of Washington, Seattle
| | - Matthew J Budoff
- Cedars-Sinai Heart Institute and David Geffen School of Medicine UCLA, Los Angeles, CA (M.J.B.)
| | - Deborah M Kado
- Department of Medicine, Stanford University, Palo Alto, CA (D.M.K.)
| | - Bryan Kestenbaum
- Division of Nephrology and Kidney Research Institute (S.H., B.K., I.H.d.B.), University of Washington, Seattle
| | | | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego (C.G., J.H.C., J.H.I.)
- Nephrology Section, Veterans Affairs San Diego Healthcare System, CA (J.H.I.)
| | - Ian H de Boer
- Division of Nephrology and Kidney Research Institute (S.H., B.K., I.H.d.B.), University of Washington, Seattle
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Hughes-Austin JM, Katz R, Firestein G, Robinson W, Criqui MH, Ix JH. Abstract P677: Association of Antibodies to Citrullinated Protein Antigens (ACPA) With Coronary Artery Calcium and Abdominal Aorta Calcium in a Multi-Ethnic Community-Dwelling Population. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background:
Patients with rheumatoid arthritis (RA) have double the risk of cardiovascular (CV) events and greater extent of coronary artery calcium (CAC) compared to the general population. Antibodies to citrullinated protein antigens (ACPA) have been linked to CAC in patients with RA; and RA-related autoimmunity has been associated with CAC in Black women without RA. ACPA are detectable years before RA onset and in some individuals who do not develop RA. Given the association between vascular calcification and CV events in the general population, we investigated associations between ACPA and coronary and abdominal aorta calcification (AAC).
Methods:
In a randomly selected subset of 1968 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), we measured ACPA using a multiplex array of 28 different ACPA. Each ACPA was defined as positive if >95
th
percentile cut-off in MESA. The number of (+) ACPA were summed for each participant (range 0-28). We measured AAC and CAC using computed tomography scans. We evaluated associations between number of ACPA, individual ACPA and AAC and CAC using multivariable linear regression, adjusting for covariates and testing for interactions with gender and race/ethnicity.
Results:
Among 1828 MESA participants with complete data, average age was 65(10); were 50% female, 40% White, 13% Chinese, 21% Black, 26% Hispanic/Latino and 27% positive (+) for at least one ACPA. Among ACPA(+) participants, median number of ACPA was 1 (1, 6) and ranged from 1-28 ACPA. Number of ACPA was neither significantly associated with CAC severity (p=0.06) nor AAC severity (p=0.48). These associations did not differ by gender or race. However, several individual ACPA were associated with CAC and AAC. In particular, for every SD higher citrullinated ApoA antibody concentration (anti-cit-ApoA), CAC severity was 0.15 (0.07)% higher (p=0.03); and AAC severity was 0.07 (0.04) % lower (p=0.08) in fully adjusted analysis. Associations between anti-cit-ApoA and AAC severity were modified by gender (p
interaction
=0.02), where in women for every SD higher anti-cit-ApoA, AAC severity was 0.15 (0.06)% lower (p=0.007); and in men, AAC severity was 0.03 (0.05)% higher, although this association was not statistically significant (p=0.55). For every SD higher citrullinated Fibrinogen antibody (anti-cit-Fibrinogen) concentration, CAC severity was 0.14 (0.07) % higher (p=0.05); and AAC severity was 0.10 (0.04) % lower (p=0.01) in fully adjusted analysis. There was no significant interaction between anti-cit-Fibrinogen and gender or race.
Conclusion:
In a community-dwelling population without RA, ACPA were associated with higher CAC severity and lower AAC severity, independent of traditional CV risk factors. Because we did not expect the inverse association between ACPA and AAC severity, continued research is needed to better understand mechanisms explaining this association.
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Affiliation(s)
| | | | | | | | | | - Joachim H Ix
- UNIVERSITY OF CALIFORNIA SAN DIEGO, San Diego, CA
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Bene-Alhasan Y, Siscovick DS, Ix JH, Kizer JR, Tracy R, Djousse L, Mukamal KJ. Abstract P308: The Determinants of Fasting and Post-Load Non-Esterified Fatty Acids in Older Adults: The Cardiovascular Health Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Aim:
Non-esterified fatty acids (NEFA) are associated with key cardiometabolic diseases of aging and are potential targets for prevention, but their population-level correlates remain uncertain. We sought to identify modifiable factors associated with higher fasting and post-load NEFA levels in older adults.
Methods:
We used linear multivariable regression models to determine the cross-sectional associations of demographic, anthropometric, lifestyle characteristics, and medication use with serum fasting and post-load NEFA concentrations amongst community-dwelling older adults enrolled in the Cardiovascular Health Study (n = 1,924).
Results:
In general, fasting NEFA levels demonstrated a broader set of determinants, while post-load NEFA were more consistently associated with metabolic factors. Waist circumference and weight were associated with higher fasting and post-load NEFA. Cigarette smoking and caffeine intake were associated with lower levels of both species, and moderate alcohol intake was associated with higher fasting levels whereas greater consumption was associated with lower post-load levels. Unique factors associated with higher fasting NEFA included female sex, higher age, loop and thiazide diuretic use and calcium intake, while factors associated with lower fasting levels included higher educational attainment, beta-blocker use, and protein intake. Hours spent sleeping during the daytime were associated with higher post-load NEFA, while DASH score were associated with lower levels.
Conclusion:
Fasting and post-load NEFA appear to have both common and unique modifiable risk factors, including sociodemographics, anthropometric, medications, and diet. Post-load NEFA were particularly sensitive to metabolic factors, while a broader range of determinants were associated with fasting levels. These factors warrant further study as targets for lowering levels of NEFA in older adults..
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Affiliation(s)
| | | | | | | | - Russell Tracy
- Univ of California, San Francisco, San Francisco, CA
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46
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Wettersten N, Duff S, Horiuchi Y, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT, Ix JH. Implications of worsening renal function before hospitalization for acute heart failure. ESC Heart Fail 2023; 10:532-541. [PMID: 36325747 PMCID: PMC9871662 DOI: 10.1002/ehf2.14221] [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] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). METHODS AND RESULTS We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in-hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One-hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16-1.28, 95% confidence interval [CI] 1.00-1.55) and lower diastolic blood pressure (OR 0.97-0.98, 95% CI 0.96-0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0-2.2). WRF across definitions was not associated with a higher odds of adverse in-hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. CONCLUSIONS Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in-hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular MedicineSan Diego Veterans Affairs Medical CenterSan DiegoCaliforniaUSA
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Stephen Duff
- School of MedicineUniversity College DublinDublinIreland
| | - Yu Horiuchi
- Division of CardiologyMitsui Memorial HospitalTokyoJapan
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital BaselUniversity of BaselBaselSwitzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of AthensAthensGreece
| | - Richard Nowak
- Department of Emergency MedicineHenry Ford Hospital SystemDetroitMichiganUSA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Michael C. Kontos
- Division of Cardiology, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Chad M. Cannon
- Department of Emergency MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Gerhard A. Müeller
- Department of Nephrology and Rheumatology, University Medical Center GöttingenUniversity of GöttingenGöttingenGermany
| | - Robert Birkhahn
- Department of Emergency MedicineNew York MethodistBrooklynNew YorkUSA
| | - Pam Taub
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Gary M. Vilke
- Department of Emergency MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University HospitalUniversity College DublinDublinIreland
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Niall Mahon
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVAUniversity of ValenciaValenciaSpain
- CIBER in Cardiovascular DiseasesMadridSpain
| | - Carlo Briguori
- Department of Cardiology, Interventional CardiologyMediterranea CardiocentroNaplesItaly
| | - Claudio Passino
- Department of Cardiology and Cardiovascular MedicineFondazione Gabriele MonasterioPisaItaly
| | - Alan Maisel
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | | | - Joachim H. Ix
- Division of Nephrology‐Hypertension, Department of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
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Berry JD, Chen H, Nambi V, Ambrosius WT, Ascher SB, Shlipak MG, Ix JH, Gupta R, Killeen A, Toto RD, Kitzman DW, Ballantyne CM, de Lemos JA. Effect of Intensive Blood Pressure Control on Troponin and Natriuretic Peptide Levels: Findings From SPRINT. Circulation 2023; 147:310-323. [PMID: 36533535 DOI: 10.1161/circulationaha.122.059960] [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: 03/23/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Given the important role of cardiac injury and neurohormonal activation in the pathways leading from hypertension to heart failure and strong associations observed between hypertension and its sequelae on hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, we hypothesized that intensive systolic blood pressure (SBP) lowering would decrease levels of hs-cTnT and NT-proBNP. METHODS hs-cTnT and NT-proBNP were measured at baseline and 1 year from stored specimens in SPRINT (Systolic Blood Pressure Intervention Trial). Changes in biomarkers were evaluated continuously on the log scale and according to categories (≥50% increase, ≥50% decrease, or <50% change). The effect of intensive SBP lowering on continuous and categorical changes in biomarker levels were assessed using linear and multinomial logistic regression models, respectively. The association between changes in biomarkers on heart failure and death was assessed using multivariable-adjusted Cox proportional hazards models. RESULTS Randomization to intensive SBP lowering (versus standard SBP management) resulted in a 3% increase in hs-cTnT levels over 1-year follow-up (geometric mean ratio, 1.03 [95% CI, 1.01-1.04]) and a higher proportion of participants with ≥50% increase (odds ratio, 1.47 [95% CI, 1.13, 1.90]). In contrast, randomization to intensive SBP lowering led to a 10% decrease in NT-proBNP (geometric mean ratio, 0.90 [95% CI, 0.87-0.93]) and a lower probability of ≥50% increase in NT-proBNP (odds ratio, 0.57 [95% CI, 0.46-0.72]). The association of randomized treatment assignment on change in hs-cTnT was completely attenuated after accounting for changes in estimated glomerular filtration rate over follow-up, whereas the association of treatment with NT-proBNP was completely attenuated after adjusting for change in SBP. Increases in hs-cTnT and NT-proBNP from baseline to 1 year were associated with higher risk for heart failure and death, with no significant interactions by treatment assignment. CONCLUSIONS Intensive SBP lowering increased hs-cTnT, mediated by the effect of SBP lowering on reduced kidney filtration. In contrast, intensive SBP lowering decreased NT-proBNP, a finding that was explained by the decrease in SBP. These findings highlight the importance of noncardiac factors influencing variation in cardiac biomarkers and raise questions about the potential role of hs-cTnT as a surrogate marker for heart failure or death in SBP-lowering studies.
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Affiliation(s)
- Jarett D Berry
- Department of Internal Medicine, University of Texas at Tyler School of Medicine (J.D.B.)
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas (J.D.B., R.D.T., J.A.d.)
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences (H.C., W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX (V.N.)
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences (H.C., W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco (S.B.A., M.G.S.)
- Division of Hospital Medicine, University of California Davis, Sacramento (S.B.A.)
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco (S.B.A., M.G.S.)
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California San Diego (J.H.I.)
- Nephrology Section, Veterans Affairs San Diego Healthcare System, CA (J.H.I.)
| | - Rajesh Gupta
- Department of Medicine, Division of Cardiology, University of Toledo Medical Center, OH (R.G.)
| | - Anthony Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (A.K.)
| | - Robert D Toto
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas (J.D.B., R.D.T., J.A.d.)
| | - Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics (D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Christie M Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention (C.M.B.), Baylor College of Medicine, Houston, TX
| | - James A de Lemos
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas (J.D.B., R.D.T., J.A.d.)
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Malhotra R, Katz R, Kimmel PL, Vasan RS, Schelling JS, Greenberg JH, Parikh CR, Bonventre JV, Al-Rousan T, Sarnak MJ, Gutierrez OM, Shlipak MG, Ix JH. Biomarkers of kidney tubule injury and dysfunction and risk of incident hypertension in community-living individuals: results from the multi-ethnic study of atherosclerosis. Nephrol Dial Transplant 2023; 38:246-248. [PMID: 36307927 PMCID: PMC9869850 DOI: 10.1093/ndt/gfac293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Paul L Kimmel
- Division of Kidney, Urology and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ramachandran S Vasan
- Division of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey S Schelling
- Division of Nephrology, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, John Hopkins School of Medicine, Baltimore, MA, USA
| | - Joseph V Bonventre
- Renal Division and Division of Engineering in Medicine, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Orlando M Gutierrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, CA, USA
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Chen TK, Coca SG, Thiessen-Philbrook HR, Heerspink HJ, Obeid W, Ix JH, Fried LF, Bonventre JV, El-Khoury JM, Shlipak MG, Parikh CR. Urinary Biomarkers of Tubular Health and Risk for Kidney Function Decline or Mortality in Diabetes. Am J Nephrol 2023; 53:775-785. [PMID: 36630924 PMCID: PMC10006337 DOI: 10.1159/000528918] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Diabetes is a leading cause of end-stage kidney disease (ESKD). Biomarkers of tubular health may prognosticate chronic kidney disease (CKD) progression beyond estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). METHODS We examined associations of five urinary biomarkers of tubular injury and repair (NGAL, KIM-1, IL-18, MCP-1, YKL-40) with kidney function decline (first occurrence of a decrease in eGFR ≥30 mL/min/1.73 m2 if randomization eGFR ≥60 or ≥50% if randomization eGFR <60; ESKD) and all-cause mortality among 1,135 VA NEPHRON-D trial participants with baseline UACR ≥300 mg/g and available urine samples. Covariates included age, sex, race, BMI, systolic BP, HbA1c, treatment arm, eGFR, and UACR. In a subset of participants with 12-month samples (n = 712), we evaluated associations of KIM-1, MCP-1, and YKL-40 change (from baseline to 12 months) with eGFR decline (from 12 months onward). RESULTS At baseline, mean age was 65 years, mean eGFR was 56 mL/min/1.73 m2, and median UACR was 840 mg/g. Over a median of 2.2 years, 13% experienced kidney function decline and 9% died. In fully adjusted models, the highest versus lowest quartiles of MCP-1 and YKL-40 were associated with 2.18- and 1.76-fold higher risks of kidney function decline, respectively. One-year changes in KIM-1, MCP-1, and YKL-40 were not associated with subsequent eGFR decline. Higher baseline levels of NGAL, IL-18, MCP-1, and YKL-40 levels (per 2-fold higher) were independently associated with 10-40% higher risk of mortality. CONCLUSION Among Veterans with diabetes and CKD, urinary biomarkers of tubular health were associated with kidney function decline and mortality.
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Affiliation(s)
- Teresa K. Chen
- Kidney Health Research Collaborative and Department of Medicine, University of California, San Francisco, California and San Francisco VA Health Care System, San Francisco, California, USA
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Heather R. Thiessen-Philbrook
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Wassim Obeid
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, and Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Linda F. Fried
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Departments of Medicine, Epidemiology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph V. Bonventre
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joe M. El-Khoury
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative and Department of Medicine, University of California, San Francisco, California and San Francisco VA Health Care System, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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50
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Malhotra R, Chopra T, Ix JH. Interpreting Estimated GFR Variability and Its Clinical Significance. Kidney Med 2023; 5:100599. [PMID: 36718188 PMCID: PMC9883260 DOI: 10.1016/j.xkme.2023.100599] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, CA,Address for Correspondence: Rakesh Malhotra, MD, MPH, Division of Nephrology and Hypertension, University of California San Diego, 9452 Medical Ctr Dr, La Jolla, CA 92037.
| | - Tushar Chopra
- Division of Nephrology, University of Virginia, Charlottesville, VA
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, CA
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