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Young HML, Castle EM, Briggs J, Walklin C, Billany RE, Asgari E, Bhandari S, Bishop N, Bramham K, Burton JO, Campbell J, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Haggis L, Hamilton A, Jesky M, Kalra PA, Koufaki P, Macdonald J, McCafferty K, Nixon AC, Noble H, Saynor ZL, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Greenwood SA. The development and internal pilot trial of a digital physical activity and emotional well-being intervention (Kidney BEAM) for people with chronic kidney disease. Sci Rep 2024; 14:700. [PMID: 38184737 PMCID: PMC10771473 DOI: 10.1038/s41598-023-50507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024] Open
Abstract
This trial assessed the feasibility and acceptability of Kidney BEAM, a physical activity and emotional well-being self-management digital health intervention (DHI) for people with chronic kidney disease (CKD), which offers live and on-demand physical activity sessions, educational blogs and videos, and peer support. In this mixed-methods, multicentre randomised waitlist-controlled internal pilot, adults with established CKD were recruited from five NHS hospitals and randomised 1:1 to Kidney BEAM or waitlist control. Feasibility outcomes were based upon a priori progression criteria. Acceptability was primarily explored via individual semi-structured interviews (n = 15). Of 763 individuals screened, n = 519 (68%, 95% CI 65 to 71%) were eligible. Of those eligible, n = 303 (58%, 95% CI 54-63%) did not respond to an invitation to participate by the end of the pilot period. Of the 216 responders, 50 (23%, 95% CI 18-29%) consented. Of the 42 randomised, n = 22 (10 (45%) male; 49 ± 16 years; 14 (64%) White British) were allocated to Kidney BEAM and n = 20 (12 (55%) male; 56 ± 11 years; 15 (68%) White British) to the waitlist control group. Overall, n = 15 (30%, 95% CI 18-45%) withdrew during the pilot phase. Participants completed a median of 14 (IQR 5-21) sessions. At baseline, 90-100% of outcome data (patient reported outcome measures and a remotely conducted physical function test) were completed and 62-83% completed at 12 weeks follow-up. Interview data revealed that remote trial procedures were acceptable. Participants' reported that Kidney BEAM increased their opportunity and motivation to be physically active, however, lack of time remained an ongoing barrier to engagement with the DHI. An randomised controlled trial of Kidney BEAM is feasible and acceptable, with adaptations to increase recruitment, retention and engagement.Trial registration NCT04872933. Date of first registration 05/05/2021.
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Affiliation(s)
- Hannah M L Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
- Diabetes Research Centre, University of Leicester, Leicester, UK.
- National Institute of Health Research Leicester Biomedical Research Centre, Leicester, UK.
| | - Ellen M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - Juliet Briggs
- Renal Department, King's College Hospital, London, UK
| | | | - Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Elham Asgari
- Department of Nephrology, Guys and St Thomas's Hospital, London, UK
| | - Sunil Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Nicolette Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Bramham
- Renal Department, King's College Hospital, London, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicola Cooper
- Department of Population Health Science, University of Leicester, Leicester, UK
| | | | | | - Lynda Haggis
- Renal Department, King's College Hospital, London, UK
| | - Alexander Hamilton
- Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Mark Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - Philip A Kalra
- Department of Nephrology Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Pelagia Koufaki
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Edinburgh, UK
| | - Jamie Macdonald
- Institute for Applied Human Physiology, Bangor University, Bangor, UK
| | | | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - James Tollitt
- Department of Nephrology Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Thomas J Wilkinson
- National Institute of Health Research Leicester Biomedical Research Centre, Leicester, UK
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Greenwood SA, Young HML, Briggs J, Castle EM, Walklin C, Haggis L, Balkin C, Asgari E, Bhandari S, Burton JO, Billany RE, Bishop NC, Bramham K, Campbell J, Chilcot J, Cooper NJ, Deelchand V, Graham-Brown MPM, Hamilton A, Jesky M, Kalra PA, Koufaki P, McCafferty K, Nixon AC, Noble H, Saynor Z, Taal MW, Tollit J, Wheeler DC, Wilkinson TJ, Worboys H, Macdonald JH. Evaluating the effect of a digital health intervention to enhance physical activity in people with chronic kidney disease (Kidney BEAM): a multicentre, randomised controlled trial in the UK. Lancet Digit Health 2024; 6:e23-e32. [PMID: 37968170 DOI: 10.1016/s2589-7500(23)00204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Remote digital health interventions to enhance physical activity provide a potential solution to improve the sedentary behaviour, physical inactivity, and poor health-related quality of life that are typical of chronic conditions, particularly for people with chronic kidney disease. However, there is a need for high-quality evidence to support implementation in clinical practice. The Kidney BEAM trial evaluated the clinical effect of a 12-week physical activity digital health intervention on health-related quality of life. METHODS In a single-blind, randomised controlled trial conducted at 11 centres in the UK, adult participants (aged ≥18 years) with chronic kidney disease were recruited and randomly assigned (1:1) to the Kidney BEAM physical activity digital health intervention or a waiting list control group. Randomisation was performed with a web-based system, in randomly permuted blocks of six. Outcome assessors were masked to treatment allocation. The primary outcome was the difference in the Kidney Disease Quality of Life Short Form version 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between baseline and 12 weeks. The trial was powered to detect a clinically meaningful difference of 3 arbitrary units (AU) in KDQoL-SF1.3 MCS. Outcomes were analysed by an intention-to-treat approach using an analysis of covariance model, with baseline measures and age as covariates. The trial was registered with ClinicalTrials.gov, NCT04872933. FINDINGS Between May 6, 2021, and Oct 30, 2022, 1102 individuals were assessed for eligibility, of whom 340 participants were enrolled and randomly assigned to the Kidney BEAM intervention group (n=173) or the waiting list control group (n=167). 268 participants completed the trial (112 in the Kidney BEAM group and 156 in the waiting list control group). All 340 randomly assigned participants were included in the intention-to treat population. At 12 weeks, there was a significant improvement in KDQoL-SF.13 MCS score in the Kidney BEAM group (from mean 44·6 AU [SD 10·8] at baseline to 47·0 AU [10·6] at 12 weeks) compared with the waiting list control group (from 46·1 AU [10·5] to 45·0 AU [10·1]; between-group difference of 3·1 AU [95% CI 1·8-4·4]; p<0·0001). INTERPRETATION The Kidney BEAM physical activity platform is an efficacious digital health intervention to improve mental health-related quality of life in patients with chronic kidney disease. These findings could facilitate the incorporation of remote digital health interventions into clinical practice and offer a potential intervention worthy of investigation in other chronic conditions. FUNDING Kidney Research UK.
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Affiliation(s)
- Sharlene A Greenwood
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK; Renal Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Hannah M L Young
- NIHR Leicester Biomedical Research Centre, Leicester, UK; Leicester Diabetes Centre, University of Leicester, Leicester, UK; Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Juliet Briggs
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Ellen M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - Christy Walklin
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Lynda Haggis
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Caitlin Balkin
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Elham Asgari
- Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James O Burton
- NIHR Leicester Biomedical Research Centre, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Roseanne E Billany
- NIHR Leicester Biomedical Research Centre, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Bramham
- Women's Health, King's College London, London, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicola J Cooper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | | | - Matthew P M Graham-Brown
- NIHR Leicester Biomedical Research Centre, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Mark Jesky
- Department of Renal Medicine, Nottingham NHS Trust, Nottingham, UK
| | - Philip A Kalra
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Pelagia Koufaki
- Department of Renal Medicine, Queen Margaret University, Edinburgh, UK
| | | | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Zoe Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, UK
| | - James Tollit
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Thomas J Wilkinson
- NIHR Leicester Biomedical Research Centre, Leicester, UK; Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Hannah Worboys
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jamie H Macdonald
- Institute for Applied Human Physiology, Bangor University, Bangor, UK
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Walklin CG, Young HML, Asghari E, Bhandari S, Billany RE, Bishop N, Bramham K, Briggs J, Burton JO, Campbell J, Castle EM, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Hamilton A, Jesky M, Kalra PA, Koufaki P, McCafferty K, Nixon AC, Noble H, Saynor ZL, Sothinathan C, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Macdonald JH, Greenwood SA. The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM). BMC Nephrol 2023; 24:122. [PMID: 37131125 PMCID: PMC10152439 DOI: 10.1186/s12882-023-03173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION NCT04872933. Registered 5th May 2021.
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Affiliation(s)
- C G Walklin
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - E Asghari
- Department of Nephrology, Guy's and St Thomas' NHS Trust, London, UK
| | - S Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - R E Billany
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - N Bishop
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - K Bramham
- Department of Women's Health, King's College London, London, UK
| | - J Briggs
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - J O Burton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - E M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - J Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - V Deelchand
- Department of Nephrology, Royal Free Hospital, London, UK
| | | | - A Hamilton
- Department of Nephrology, Royal Exeter Hospital, Devon, UK
| | - M Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - P A Kalra
- Department of Nephrology, Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - P Koufaki
- Dietetics, Nutrition and Biological Sciences, Queen Margaret University, Edinburgh, UK
| | - K McCafferty
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - A C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - H Noble
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Z L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - C Sothinathan
- Department of Physiotherapy, Chelsea and Westminster NHS Trust, London, UK
| | - M W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - J Tollitt
- Department of Renal Medicine, University College London, London, UK
| | - D C Wheeler
- National Institute of Health Research Leicester Biomedical Research Centre , Leicester, UK
| | - T J Wilkinson
- Institute for Applied Human Physiology, Bangor University, Bangor, Gwynedd, UK
| | - J H Macdonald
- Faculty of life sciences and medicine, King's College London, London, UK
| | - S A Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
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Noble R, Tan MY, McCulloch T, Shantier M, Byrne C, Hall M, Jesky M. Collapsing Glomerulopathy Affecting Native and Transplant Kidneys in Individuals with COVID-19. Nephron Clin Pract 2020; 144:589-594. [PMID: 32894838 PMCID: PMC7573900 DOI: 10.1159/000509938] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022] Open
Abstract
Since the emergency of novel coronavirus COVID-19 (SARS-CoV-2) in December 2019, infections have spread rapidly across the world. The reported incidence of acute kidney injury (AKI) in the context of COVID-19 is variable, and its mechanism is not well understood. Data are emerging about possible mechanisms of AKI including virus-induced cytopathic effect and cytokine storm-induced injury. To date, there have been few reports of kidney biopsy findings in the context of AKI in COVID-19 infection. This article describes 2 cases of collapsing glomerulopathy, 1 in a native kidney and, for the first time, 1 in a kidney transplant. Both individuals were black, and both presented without significant respiratory compromise. Indeed, the 2 patients we describe remained systemically well for the majority of their inpatient stay, which would support the hypothesis that for these patients, AKI was caused by a cytopathic viral effect, rather than that of a cytokine storm or acute tubular necrosis caused by prolonged hypovolaemia or the effect of medication known to exacerbate AKI. Here, we report 2 cases of AKI with collapsing glomerulopathy in COVID-19, one of which is in a kidney transplant recipient, not previously described elsewhere.
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Affiliation(s)
- Rebecca Noble
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mei Ying Tan
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Thomas McCulloch
- Histopathology Department, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mohamed Shantier
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Catherine Byrne
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Matthew Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mark Jesky
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,
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Genovese F, Rasmussen DGK, Karsdal MA, Jesky M, Ferro C, Fenton A, Cockwell P. Imbalanced turnover of collagen type III is associated with disease progression and mortality in high-risk chronic kidney disease patients. Clin Kidney J 2020; 14:593-601. [PMID: 33623684 PMCID: PMC7886548 DOI: 10.1093/ckj/sfz174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022] Open
Abstract
Background Tubulointerstitial fibrosis is a major pathological feature in chronic kidney disease (CKD) and collagen type III (COL3) is a major component of the renal fibrotic scar. We hypothesized that a dysregulated turnover of COL3 is an important determinant of CKD progression. We assessed the relationship between fragments reflecting active formation (PRO-C3) and degradation (C3M) of COL3 and CKD disease progression and mortality in a prospective cohort of CKD patients. Methods We measured PRO-C3 and C3M in urine (uPRO-C3 and uC3M) and serum (sPRO-C3 and sC3M) of 500 patients from the Renal Impairment in Secondary Care study. Disease progression was defined as a decline in estimated glomerular filtration rate >30% or the start of renal replacement therapy within 12 and 30 months. Results Levels of uC3M/creatinine decreased, whereas levels of uPRO-C3/creatinine and sPRO-C3 increased with increasing CKD stage. uC3M/creatinine was inversely and independently associated with disease progression by 12 months {odds ratio [OR] 0.39 [95% confidence interval (CI) 0.18-0.83]; P = 0.01 per doubling of uC3M/creatinine} with development of end-stage renal disease [hazard ratio (HR) 0.70 (95% CI 0.50-0.97); P = 0.03 per doubling of uC3M/creatinine]. sPRO-C3 at baseline was independently associated with increased mortality [HR 1.93 (95% CI 1.21-3.1); P = 0.006 per doubling of sPRO-C3] and disease progression by 30 months [OR 2.16 (95% CI 1.21-3.84); P = 0.009 per doubling of sPRO-C3]. Conclusions Dynamic products of COL3 formation and degradation were independently associated with CKD progression and mortality and may represent an opportunity to link pathological processes with targeted treatments against fibrosis.
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Affiliation(s)
| | | | | | - Mark Jesky
- Department of Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Charles Ferro
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Anthony Fenton
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Cockwell
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
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Rasmussen D, Fenton A, Genovese F, Karsdal MA, Jesky M, Ferro CJ, Cockwell P. FP352IDENTIFICATION OF HIGH-RISK PATIENT CLUSTERS BASED ON EXTRACELLULAR MATRIX TURNOVER. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Anthony Fenton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Mark Jesky
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Charles J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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9
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Holm Nielsen S, Guldager Kring Rasmussen D, Brix S, Fenton A, Jesky M, Ferro CJ, Karsdal M, Genovese F, Cockwell P. A novel biomarker of laminin turnover is associated with disease progression and mortality in chronic kidney disease. PLoS One 2018; 13:e0204239. [PMID: 30273365 PMCID: PMC6166934 DOI: 10.1371/journal.pone.0204239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/05/2018] [Indexed: 01/07/2023] Open
Abstract
Background Patients with chronic kidney disease (CKD) have increased risk of development of end-stage renal disease (ESRD) and early mortality. Fibrosis is the central pathogenic process in CKD and is caused by dysregulated extracellular matrix (ECM) remodeling. The laminin γ1 chain (LAMC1) is a core structural protein present in the basement membrane of several organs, including the kidneys. We hypothesized that dysregulation of LAMC1 remodeling could be associated with a higher risk of adverse clinical outcomes in patients with CKD. Methods A novel immunoassay targeting LG1M, a specific MMP-9-generated neo-epitope fragment of LAMC1, was developed and used to measure the levels of the fragment in urine and serum from 492 patients from the Renal Impairment in Secondary Care (RIISC) study, a prospective cohort of patients with high-risk CKD. Patients were monitored for a median follow-up time of 3.5 years. Associations between serum and urine LG1M levels and progression of CKD at 12 months were assessed by a multivariable logistic regression model. The association with ESRD or mortality was assessed by Kaplan-Meier survival curves and Cox proportional hazards regression. Results Forty-six (11%) of the 416 patients who reached 12-month follow-up had progression of CKD; during the study follow-up, 125 patients (25.4%) developed ESRD and 71 patients (14.4%) died. Serum and urine levels of LG1M correlated with baseline eGFR (r = -0.43, p<0.0001 and r = -0.17, p = 0.0002, respectively). Serum levels of LG1M were higher in patients with one-year progression of CKD compared to those who did not progress (p<0.01). Baseline serum levels of LG1M were associated with development of ESRD (HR 3.2, 95% CI 1.99–5.2 for patients in the highest LG1M tertile compared to patient in the lowest tertile). Baseline urinary levels of LG1M (uLG1M) were significantly associated with mortality (HR 5.0, 95% CI 2.8–8.9, p<0.0001 for patients in the highest LG1M tertile compared to patients in the lowest tertile). Urine LG1M was retained in the model for prediction of mortality (HR per standard deviation of uLG1M: 1.01, 95% CI 1.00–1.02, p = 0.001). Conclusions LG1M, a marker of basement membrane remodeling, is increased in serum and urine of patients with CKD and levels are associated with one-year disease progression, development of ESRD, and mortality.
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Affiliation(s)
- Signe Holm Nielsen
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
- * E-mail:
| | - Daniel Guldager Kring Rasmussen
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anthony Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Charles J. Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Morten Karsdal
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | | | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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10
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Beltrami C, Simpson K, Jesky M, Wonnacott A, Carrington C, Holmans P, Newbury L, Jenkins R, Ashdown T, Dayan C, Satchell S, Corish P, Cockwell P, Fraser D, Bowen T. Association of Elevated Urinary miR-126, miR-155, and miR-29b with Diabetic Kidney Disease. Am J Pathol 2018; 188:1982-1992. [PMID: 29981742 DOI: 10.1016/j.ajpath.2018.06.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022]
Abstract
Effective diabetic kidney disease (DKD) biomarkers remain elusive, and urinary miRNAs represent a potential source of novel noninvasive disease sentinels. We profiled 754 miRNAs in pooled urine samples from DKD patients (n = 20), detecting significantly increased miR-126, miR-155, and miR-29b compared with controls (n = 20). These results were confirmed in an independent cohort of 89 DKD patients, 62 diabetic patients without DKD, and 41 controls: miR-126 (2.8-fold increase; P < 0.0001), miR-155 (1.8-fold increase; P < 0.001), and miR-29b (4.6-fold increase; P = 0.024). Combined receiver operating characteristic curve analysis resulted in an area under the curve of 0.8. A relative quantification threshold equivalent to 80% sensitivity for each miRNA gave a positive signal for 48% of DKD patients compared with 3.6% of diabetic patients without DKD. Laser-capture microdissection of renal biopsy specimens, followed by quantitative RT-PCR, detected miR-155 in glomeruli and proximal and distal tubules, whereas miR-126 and miR-29b were most abundant in glomerular extracts. Subsequent experiments showed miR-126 and miR-29b enrichment in glomerular endothelial cells (GEnCs) compared with podocytes, proximal tubular epithelial cells, and fibroblasts. Significantly increased miR-126 and miR-29b were detected in GEnC conditioned medium in response to tumor necrosis factor-α and transforming growth factor-β1, respectively. Our data reveal an altered urinary miRNA profile associated with DKD and link these variations to miRNA release from GEnCs.
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Affiliation(s)
- Cristina Beltrami
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Kate Simpson
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom; Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, United Kingdom
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Alexa Wonnacott
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Christopher Carrington
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Peter Holmans
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Lucy Newbury
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom; Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, United Kingdom
| | - Robert Jenkins
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Thomas Ashdown
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Colin Dayan
- Diabetes Research Group, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Simon Satchell
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Corish
- BBI Group, The Courtyard, Cardiff, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Donald Fraser
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom; Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, United Kingdom
| | - Timothy Bowen
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom; Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, United Kingdom.
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11
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Rasmussen DGK, Fenton A, Jesky M, Ferro C, Boor P, Tepel M, Karsdal MA, Genovese F, Cockwell P. Urinary endotrophin predicts disease progression in patients with chronic kidney disease. Sci Rep 2017; 7:17328. [PMID: 29229941 PMCID: PMC5725589 DOI: 10.1038/s41598-017-17470-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022] Open
Abstract
Renal fibrosis is the central pathogenic process in progression of chronic kidney disease (CKD). Collagen type VI (COL VI) is upregulated in renal fibrosis. Endotrophin is released from COL VI and promotes pleiotropic pro-fibrotic effects. Kidney disease severity varies considerably and accurate information regarding CKD progression may improve clinical decisions. We tested the hypothesis that urinary endotrophin derived during COL VI deposition in fibrotic human kidneys is a marker for progression of CKD in the Renal Impairment in Secondary Care (RIISC) cohort, a prospective observational study of 499 CKD patients. Endotrophin localised to areas of increased COL VI deposition in fibrotic kidneys but was not present in histologically normal kidneys. The third and fourth quartiles of urinary endotrophin:creatinine ratio (ECR) were independently associated with one-year disease progression after adjustment for traditional risk factors (OR (95%CI) 3.68 (1.06–12.83) and 8.65 (2.46–30.49), respectively). Addition of ECR quartiles to the model for disease progression increased prediction as seen by an increase in category-free net reclassification improvement (0.45, 95% CI 0.16–0.74, p = 0.002) and integrated discrimination improvement (0.04, 95% CI 0.02–0.06, p < 0.001). ECR was associated with development of end-stage renal disease (ESRD). It is concluded that ECR predicts disease progression of CKD patients.
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Affiliation(s)
- Daniel Guldager Kring Rasmussen
- Nordic Bioscience, Herlev, Denmark. .,University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark.
| | - Anthony Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Charles Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Peter Boor
- Division of Nephrology, RWTH University of Aachen, Aachen, Germany.,Institute of Pathology, RWTH University of Aachen, Aachen, Germany
| | - Martin Tepel
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | | | | | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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12
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Mavi BBS, Siddiqui ZA, Sheldon F, Gupta A, Jesky M, Ryan P. A rare presentation of Churg-Strauss syndrome presenting as peripheral neuropathy and testicular abscesses. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415817707689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - Mark Jesky
- Queen Elizabeth Hospital, Birmingham, UK
| | - Peter Ryan
- Sandwell and West Birmingham Hospitals, UK
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13
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Rasmussen D, Genovese F, Fenton A, Boor P, Tepel M, Ferro C, Jesky M, Karsdal M, Cockwell P. SP274URINARY ENDOTROPHIN (PRO-C6), A DYNAMIC PRODUCT OF TYPE VI COLLAGEN FORMATION, PREDICTS DISEASE PROGRESSION AND MORTALITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx145.sp274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Holm Nielsen S, Rasmussen DGK, Fenton A, Jesky M, Ferro C, Karsdal M, Genovese F, Cockwell P. SO015A NOVEL BIOMARKER OF LAMININ TURNOVER IS ASSOCIATED WITH MORTALITY AND DISEASE PROGRESSION IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx102.so015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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McGrogan D, McKevitt G, Stringer S, Cockwell P, Jesky M, Ferro C, Maxwell A, Inston N. Arterial Stiffness and Arteriovenous Fistula Outcomes. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Chand S, Edwards NC, Chue CD, Jesky M, Stringer S, Simmonds MJ, Duff CE, Cockwell P, Harper L, Steeds RP, Townend JN, Ferro CJ, Borrows R. Caveolin-1 single-nucleotide polymorphism and arterial stiffness in non-dialysis chronic kidney disease. Nephrol Dial Transplant 2015; 31:1140-4. [PMID: 26433014 DOI: 10.1093/ndt/gfv350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 07/08/2015] [Accepted: 08/30/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Arteriosclerosis is an independent predictor of increased cardiovascular mortality in chronic kidney disease (CKD). Histologically it is characterized by hypertrophy and fibrosis of the arterial media wall leading to increased arterial stiffness and end-organ damage. Caveolin-1 acts as an intracellular signalling pathway chaperone in human fibrotic and vascular diseases. The purpose of this study was to assess the association between caveolin-1 (CAV1) single-nucleotide polymorphism (SNP) rs4730751 and arterial stiffness as measured by arterial pulse wave velocity (PWV) in an early-stage CKD cohort and in a cohort with more severe CKD. METHODS Two prospectively maintained patient cohorts with non-dialysis CKD were studied: 144 patients in the Chronic Renal Impairment in Birmingham (CRIB) cohort and 147 patients in the Renal Impairment in Secondary Care (RIISC) cohort, with matched exclusion criteria and DNA sampling availability. At entry to each cohort database, each patient's initial arterial PWV was measured, as well as their anthropomorphic and biochemical data. CAV1 rs4730751 SNP genotyping was performed using Taqman technology. RESULTS The CAV1 rs4730751 SNP CC genotype was associated with lower arterial PWV in both CRIB early stage CKD patients [8.1 versus 8.6 m/s; coefficient -0.780 (-1.412, -0.149); P = 0.016] and RIISC more advanced stage CKD patients [8.7 versus 9.4 m/s; coefficient -0.695 (-1.288, -0.102); P = 0.022]; these relationships held following adjustment for other important confounders. CONCLUSIONS This replicated study suggests potential utility of the studied CAV1 SNP as a genetic biomarker in CKD and a role for CAV1 in the development of arteriosclerosis in this setting. Further studies are warranted to further explore the basic science driving these clinical observations.
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Affiliation(s)
- Sourabh Chand
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Nicola C Edwards
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Colin D Chue
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Stephanie Stringer
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Matthew J Simmonds
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Claire E Duff
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Lorraine Harper
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jonathan N Townend
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Charles J Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Richard Borrows
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
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17
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Yadav P, Hutchison CA, Basnayake K, Stringer S, Jesky M, Fifer L, Snell K, Pinney J, Drayson MT, Cook M, Cockwell P. Patients with multiple myeloma have excellent long-term outcomes after recovery from dialysis-dependent acute kidney injury. Eur J Haematol 2015; 96:610-7. [PMID: 26248588 DOI: 10.1111/ejh.12644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to report the long-term outcomes in patients with multiple myeloma (MM) who receive dialysis treatment for acute kidney injury (AKI) due to myeloma cast nephropathy and subsequently recover renal function. METHODS Patients presenting with dialysis-dependent AKI secondary to myeloma cast nephropathy and subsequently recovering independent renal function between January 2005 and December 2012 were included in this study. Both renal and haematological parameters were collected at multiple time points as part of routine clinic practice. Factors associated with renal function and overall survival (OS) were determined. RESULTS Twenty-four patients fulfilled the criteria for inclusion. Mean age was 62.1 years; 75% were male and 75% were of White ethnicity. The median OS was 64.1 months (95% confidence interval [CI] 34.8-93.3). Twenty-three (95.8%) patients remained dialysis-independent until death or end of follow-up; one patient required further haemodialysis treatment during the follow-up period. The independent determinant of worse OS was a known history of chronic kidney disease (CKD) at presentation. Shorter length of time on haemodialysis and higher percentage reduction in clonal serum FLC at day 21 from baseline predicted better excretory renal function (estimated glomerular filtration rate) at 6 months. CONCLUSION In this series, the large majority of patients with MM and dialysis-dependent AKI secondary to myeloma cast nephropathy who recovered independent renal function had no requirement for further dialysis. Survival following recovery of renal function is good, and early variables are independently associated with survival and future renal function.
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Affiliation(s)
- Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Colin A Hutchison
- Department of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Kolitha Basnayake
- Department of Renal Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Jesky
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lesley Fifer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kym Snell
- Department of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Pinney
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark T Drayson
- Division of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Mark Cook
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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18
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Chand S, Chue C, Edwards N, Jesky M, Simmonds M, Duffy C, Gough S, Cockwell P, Harper L, Steeds R, Townend J, Ferro C, Borrows R. SP028CAVEOLIN-1 POLYMORPHISM ASSOCIATION WITH ARTERIAL STIFFNESS IN NON-DIALYSIS CKD. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv187.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Sharma P, Dietrich T, Sidhu A, Vithlani V, Rahman M, Stringer S, Jesky M, Kaur O, Ferro C, Cockwell P, Chapple ILC. The periodontal health component of the Renal Impairment In Secondary Care (RIISC) cohort study: a description of the rationale, methodology and initial baseline results. J Clin Periodontol 2014; 41:653-61. [PMID: 24738870 DOI: 10.1111/jcpe.12263] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity and mortality. There is a need to identify novel and modifiable risk factors in such patients. The periodontal component of the Renal Impairment In Secondary Care (RIISC) study aims to evaluate the association between chronic periodontitis and CKD progression. METHODS The RIISC study is a prospective, observational cohort study of patients with CKD from a renal clinic at a hospital in the West Midlands region of the UK. Patients undergo a periodontal examination and plaque and saliva sampling. To benchmark the oral health status of the RIISC cohort, we compared it to the Adult Dental Health Survey 2009 (ADHS), a representative survey of the oral health of community dwelling adults in the UK. RESULTS Of the first 500 patients recruited into the RIISC study, 469 patients underwent a dental examination and 80 (17%) were edentulous. Among dentate subjects, patients within RIISC were significantly more likely to have any (OR 4.0 95% CI 2.7-5.9) or severe (OR 3.8 95% CI 2.5-5.6) periodontitis compared to the ADHS sample. CONCLUSION The prevalence and severity of chronic periodontitis in this cohort of CKD patients is markedly higher than a geographically matched control population.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham, UK
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20
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Jesky M, Lambert A, Burden ACF, Cockwell P. The impact of chronic kidney disease and cardiovascular comorbidity on mortality in a multiethnic population: a retrospective cohort study. BMJ Open 2013; 3:e003458. [PMID: 24302500 PMCID: PMC3855607 DOI: 10.1136/bmjopen-2013-003458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the impact of chronic kidney disease (CKD) and cardiovascular comorbidity on mortality in a multiethnic primary care population. DESIGN Retrospective cohort study. SETTING Inner-city primary care trust in West Midlands, UK. PARTICIPANTS Individuals aged 40 years and older, of South Asian, black or white ethnicity, registered with a general practice and with their kidney function checked within the last 12 months (n=31 254). OUTCOME MEASURE All-cause mortality. RESULTS Reduced estimated glomerular filtration rate, higher albuminuria, older age, white ethnicity (vs South Asian or black ethnicity) and increasing cardiovascular comorbidities were independent determinants of a higher mortality risk. In the multivariate model including comorbidities and kidney function, the HR for mortality for South Asians was 0.697 (95% CI 0.56 to 0.868, p=0.001) and for blacks it was 0.533 (95% CI 0.403 to 0.704, p<0.001) compared to whites. CONCLUSIONS The HR for death is lower for South Asian and black individuals compared to white individuals. This is, in part, independent of age, gender, socioeconomic status, kidney function and comorbidities. Risk of death is higher in individuals with CKD and with a higher cumulative cardiovascular comorbidity.
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Affiliation(s)
- Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Division of Infection and Immunity, University of Birmingham, Birmingham, UK
| | - Amanda Lambert
- Public Health Intelligence, Birmingham City Council, Birmingham, UK
| | - A C Felix Burden
- Sandwell and West Birmingham Clinical Commissioning Group, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Division of Infection and Immunity, University of Birmingham, Birmingham, UK
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Borras M, Roig J, Betriu A, Vilar A, Hernandez M, Martin M, Fernandez ED, Dounousi E, Kiatou V, Papagianni A, Zikou X, Pappas K, Pappas E, Tatsioni A, Tsakiris D, Siamopoulos KC, Kim JK, Kim Y, Kim SG, Kim HJ, Ahn SY, Chin HJ, Oh KH, Ahn C, Chae DW, Yazici R, Altintepe L, Bakdik S, Guney I, Arslan S, Topal M, Karagoz A, Stefan G, Mircescu G, Capusa C, Stancu S, Petrescu L, Alecu S, Nedelcu D, Bennett AHL, Pham H, Garrity M, Magdeleyns E, Vermeer C, Zhang M, Ni Z, Zhu M, Yan J, Mou S, Wang Q, Qian J, Saade A, Karavetian M, ElZein H, de Vries N, de Haseth DE, Lay Penne E, van Dam B, Bax WA, Bots ML, Grooteman MPC, van den Dorpel RA, Blankenstijn PJ, Nube MJ, Wee PM, Park JH, Jo YI, Lee JH, Cianfrone P, Comi N, Lucisano G, Piraina V, Talarico R, Fuiano G, Toyonaga M, Fukami K, Yamagishi SI, Kaida Y, Nakayama Y, Ando R, Obara N, Ueda S, Okuda S, Granatova J, Havrda M, Hruskova Z, Tesar V, Viklicky O, Rysava R, Rychlik I, Kratka K, Honsova E, Vernerova Z, Maluskova J, Vranova J, Bolkova M, Borecka K, Benakova H, Zima T, Lu KC, Yang HY, Su SL, Cao YH, Lv LL, Liu BC, Zeng R, Gao XF, Deng YY, Boelaert J, t' Kindt R, Glorieux G, Schepers E, Jorge L, Neirynck N, Lynen F, Sandra P, Sandra K, Vanholder R, Yamamoto T, Nameta M, Yoshida Y, Uhlen M, Shi Y, Tang J, Zhang J, An Y, Liao Y, Li Y, Tao Y, Wang L, Koibuchi K, Tanaka K, Aoki T, Miyagi M, Sakai K, Aikawa A, Martins AR, Branco PQ, Serra FM, Matias PJ, Lucas CP, Adragao T, Duarte J, Oliveira MM, Saraiva AM, Barata JD, Masola V, Zaza G, Granata S, Proglio M, Pontrelli P, Abaterusso C, Schena F, Gesualdo L, Gambaro G, Lupo A, Pruijm M, Hofmann L, Stuber M, Zweiacker C, Piskunowicz M, Muller ME, Vogt B, Burnier M, Togashi N, Yamashita T, Mita T, Ohnuma Y, Hasegawa T, Endo T, Tsuchida A, Ando T, Yoshida H, Miura T, Bevins A, Assi L, Ritchie J, Jesky M, Stringer S, Kalra P, Hutchison C, Harding S, Cockwell P, Viccica G, Cupisti A, Chiavistelli S, Borsari S, Pardi E, Centoni R, Fumagalli G, Cetani F, Marcocci C, Scully P, O'Flaherty D, Sankaralingam A, Hampson G, Goldsmith DJ, Pallet N, Chauvet S, Beaune P, Nochy D, Thervet E, Karras A, Bertho G, Gallyamov MG, Saginova EA, Severova MM, Krasnova TN, Kopylova AA, Cho E, Jo SK, Kim MG, Cho WY, kim HK, Trivin C, Metzger M, Boffa JJ, Vrtovsnik F, Houiller P, Haymann JP, Flamant M, Stengel B, Thervet E, Roozbeh J, Yavari V, Pakfetrat M, Zolghadr AA, Kim CS, Kim MJ, Kang YU, Choi JS, Bae EH, Ma SK, Kim SW, Lemoine S, Guebre-Egziabher F, Dubourg L, Hadj-Aissa A, Blumberg S, Katzir Z, Biro A, Cernes R, Barnea Z, Vasquez D, Gordillo R, Aller C, Fernandez B, Jabary N, Perez V, Mendiluce A, Bustamante J, Coca A, Goek ON, Sekula P, Prehn C, Meisinger C, Gieger C, Suhre K, Adamski J, Kastenmuller G, Kottgen A, Kuzniewski M, Fedak D, Dumnicka P, Solnica B, Kusnierz-Cabala B, Kapusta M, Sulowicz W, Drozdz R, Zawada AM, Rogacev KS, Hummel B, Fliser D, Geisel J, Heine GH, Kretschmer A, Volsek M, Krahn T, Kolkhof P, Kribben A, Bruck H, Koh ES, Chung S, Yoon HE, Park CW, Chang YS, Shin SJ, Deagostini MC, Vigotti FN, Ferraresi M, Consiglio V, Scognamiglio S, Moro I, Clari R, Daidola G, Versino E, Piccoli GB, Mammadrahim Agayev M, Mehrali Mammadova I, Qarib Ismayilova S, Anguiano L, Riera M, Pascual J, Barrios C, Betriu A, Valdivielso JM, Fernandez E, Soler MJ, Tsarpali V, Liakopoulos V, Panagopoulou E, Kapoukranidou D, Spaia S, Kostopoulou M, Michalaki A, Nikitidou O, Dombros N, Zhu F, Abba S, Flores-Gama C, Williams C, Cartagena C, Carter M, Kotanko P, Levin NW, Kolesnyk M, Stepanova N, Driyanska V, Stashevska N, Kundin V, Shifris I, Dudar I, Zaporozhets O, Keda T, Ishchenko M, Khil M, Choe JY, Nam SA, Kim J, Cha JH, Gliga ML, Irimescu CG, Caldararu CD, Gliga MG, Toma LV, Gomotarceanu A, Park Y, Kim Y, Jeon J, Kwon SK, Kim SJ, Kim SM, Kim HY, Montero N, Soler MJ, Barrios C, Marquez E, Berrada A, Arias C, Prada JA, Orfila MA, Mojal S, Vilaplana C, Pascual J, Vigotti FN, Attini R, Parisi S, Fassio F, Deagostini MC, Ghiotto S, Ferraresi M, Clari R, Biolcati M, Todros T, Piccoli GB, Jin K, Vaziri ND, Tramonti G, Romiti N, Chieli E, Maksudova AN, Khusnutdinova LA, Tang J, Shi Y, Zhang J, Li Y, An Y, Tao Y, Wang L, Reque JE, Quiroga B, Lopez JM, Verdallez UG, Garcia de Vinuesa M, Goicoechea M, Nayara PG, Arroyo DR, Luno J, Tanaka H, Flores-Gama C, Abbas SR, Williams C, Cartagena C, Carter M, Thijssen S, Kotanko P, Levin NW, Zhu F, Berthoux FC, Azzouz L, Afiani A, Ziane A, Mariat C, Fournier H, Kusztal M, Dzierzek P, Witkowski G, Nurzynski M, Golebiowski T, Weyde W, Klinger M, Altiparmak MR, Seyahi N, Trabulus S, Bolayirli M, Andican ZG, Suleymanlar G, Serdengecti K, Niculae A, Checherita IA, Neagoe DN, Ciocalteu A, Seiler S, Rogacev KS, Pickering JW, Emrich I, Fliser D, Heine G, Bargnoux AS, Obiols J, Kuster N, Fessler P, Badiou S, Dupuy AM, Ribstein J, Cristol JP, Yanagisawa N, Ando M, Ajisawa A, Tsuchiya K, Nitta K, Bouquegneau A, Cavalier E, Krzesinski JM, Delanaye P, Tominaga N, Shibagaki Y, Kida K, Miyake F, Kimura K, Ayvazyan A, Rameev V, Kozlovskaya L, Simonyan A, Scholze A, Marckmann P, Tepel M, Rasmussen LM, Hara M, Ando M, Tsuchiya K, Nitta K, Kanai H, Harada K, Tamura Y, Kawai Y, Al-Jebouri MM, Madash SA, Leonidovna Berezinets O, Nicolaevich Rossolovskiy A. Lab methods / biomarkers. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stringer S, Sharma P, Dutton M, Jesky M, Ng K, Kaur O, Chapple I, Dietrich T, Ferro C, Cockwell P. The natural history of, and risk factors for, progressive chronic kidney disease (CKD): the Renal Impairment in Secondary care (RIISC) study; rationale and protocol. BMC Nephrol 2013; 14:95. [PMID: 23617441 PMCID: PMC3664075 DOI: 10.1186/1471-2369-14-95] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 12/16/2012] [Accepted: 02/11/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects up to 16% of the adult population and is associated with significant morbidity and mortality. People at highest risk from progressive CKD are defined by a sustained decline in estimated glomerular filtration rate (eGFR) and/or the presence of significant albuminuria/proteinuria and/or more advanced CKD. Accurate mapping of the bio-clinical determinants of this group will enable improved risk stratification and direct the development of better targeted management for people with CKD. METHODS/DESIGN The Renal Impairment In Secondary Care study is a prospective, observational cohort study, patients with CKD 4 and 5 or CKD 3 and either accelerated progression and/or proteinuria who are managed in secondary care are eligible to participate. Participants undergo a detailed bio-clinical assessment that includes measures of vascular health, periodontal health, quality of life and socio-economic status, clinical assessment and collection of samples for biomarker analysis. The assessments take place at baseline, and at six, 18, 36, 60 and 120 months; the outcomes of interest include cardiovascular events, progression to end stage kidney disease and death. DISCUSSION The determinants of progression of chronic kidney disease are not fully understood though there are a number of proposed risk factors for progression (both traditional and novel). This study will provide a detailed bio-clinical phenotype of patients with high-risk chronic kidney disease (high risk of both progression and cardiovascular events) and will repeatedly assess them over a prolonged follow up period. Recruitment commenced in Autumn 2010 and will provide many outputs that will add to the evidence base for progressive chronic kidney disease.
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Affiliation(s)
- Stephanie Stringer
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Praveen Sharma
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
- Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham B4 6NN, UK
| | - Mary Dutton
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
| | - Mark Jesky
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Khai Ng
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Okdeep Kaur
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
| | - Iain Chapple
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
- Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham B4 6NN, UK
- MRC Centre for Immune Regulation, Birmingham, UK
| | - Thomas Dietrich
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
- Periodontal Research Group, School of Dentistry, University of Birmingham, Birmingham B4 6NN, UK
| | - Charles Ferro
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Paul Cockwell
- Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
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Susla O, Shin HS, Jung YS, Rim H, Speer T, Owala FO, Razawi M, Holy E, Ferdinand B, Danilo F, Luscher TF, Tanner FC, Markaki A, Kyriazis J, Petrakis I, Mavroeidi V, Perakis K, Fragkiadakis GA, Venyhaki M, Tzanakakis M, Vardaki E, Maraki K, Doskas T, Daphnis E, Bregman R, Vale B, Lemos C, Kawakami L, Silva MI, Zhu F, Kaysen G, Kotanko P, Abbas SR, Dou Y, Heymsfield S, Levin NW, Turkmen K, Kayikcioglu H, Guney I, Altintepe L, Ozbek O, Tonbul HZ, Kaysen GA, Kaysen GA, Usvyat LA, Thijssen S, Levin NW, Kotanko P, Mutluay R, Konca Degertekin C, Derici U, Yilmaz MI, Akkiyal F, Gultekin S, Gonen S, Deger SM, Arinsoy T, Sindel S, Hueso M, Torras J, Carrera M, Vidal A, Navarro E, Rivas I, Rama I, Bolanos N, Varela C, Martinez-Castelao A, Grinyo JM, Harving F, Svensson M, Schmidt EB, Jorgensen KA, Christensen JH, Park JH, Koo EH, Kim HK, Kim MS, Cho AJ, Lee JE, Jang HR, Huh W, Kim DJ, Kim YG, Oh HY, Zawiasa A, Nowak D, Nowicki M, Nathalie N, Griet G, Eva S, Raymond V, Ng KP, Stringer S, Jesky M, Dutton M, Ferro C, Cockwell P, Jia T, Gama Axelsson T, Lindholm B, Heimburger O, Barany P, Stenvinkel P, Qureshi AR, Quiroga B, Goicoechea M, Garcia de Vinuesa S, Verdalles U, Reque J, Panizo N, Arroyo D, Santos A, Macias N, Luno J, Honda H, Hirano T, Ueda M, Kojima S, Mashiba S, Hayase Y, Michihata T, Akizawa T, Gungor O, Sezis Demirci M, Kircelli F, Tatar E, Hur E, Sen S, Toz H, Basci A, Ok E, Sepe V, Albrizio P, Gnecchi M, Cervio E, Esposito P, Rampino T, Libetta C, Dal Canton A, Faria MS, Faria MS, Ribeiro S, Silva G, Nascimento H, Rocha-Pereira P, Miranda V, Vieira E, Santos R, Mendonca D, Quintanilha A, Costa E, Belo L, Santos-Silva A, Pruijm M, Pruijm M, Hofmann L, Heuvelin E, Forni V, Coristine A, Stuber M, Vogt B, Burnier M, Chiappini MG, Ammann T, Muzzi L, Grosso A, Sabry A, Bansal V, Hoppensteadt D, Jeske W, Fareed J. Nutrition, inflammation and oxidative stress - CKD 1-5. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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