1
|
Calice-Silva V, Bensenor IM, Titan SM, Cavalcante MRN, Lotufo PA. Association between branched-chain amino acids and renal function in the ELSA-Brasil study. Clin Nutr 2024; 43:1051-1056. [PMID: 38555679 DOI: 10.1016/j.clnu.2024.02.008] [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: 07/27/2023] [Revised: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND & AIMS Epidemiologic studies show high circulating Branched-chain amino acids (BCAA) are associated with excess body weight, impaired fasting glucose, insulin resistance, high blood pressure, and dyslipidemia. There is scarce data on the association between renal function and circulating levels of BCAA. Therefore, we aim to study this association in a sample of the Brazilian Longitudinal Study of Adults (ELSA-Brasil) METHODS: We analyzed participants who had at the baseline BCAA: valine, isoleucine, and leucine measured through nuclear magnetic resonance. The outcomes evaluated were estimated glomerular function (eGFR - CKD-EPI without race) and 12h-albumin-creatinine ratio (ACR). In addition, we built unadjusted and adjusted multivariable linear regression models to investigate the association between the BCAA (total and individual) and eGFR and ACR. RESULTS We studied 4912 participants (age 51.7(±9.0) years, 53.4% women, 59.5% White (59.5%), 32.7% hypertension, and 18.2% diabetes). The mean BCAA level was 429.15 ± 87.15. The mean eGFR was 84.95 ± 15 ml/min/1.73 m2, and the median ACR was 6.5 (1.8-4920) mg/g. Descriptive analyses comparing eGFR stratified <60 ml/min/1.73 m2 and ACR≥30 mg/g demonstrate that BCAA levels are higher in patients with eGFR<60 and ACR ≥30. Regarding eGFR, an inverse association was detected with BCAA levels when adjusted for demographic variables, and it is not maintained after adjustments for other confounders. Also, a positive association was found for ACR≥30 mg/g, and BCAA levels, and this association is not confirmed after adjustments. CONCLUSIONS BCAA levels were inversely associated with eGFR and positively associated with ACR. Further studies are necessary to allow the comprehension of those associations.
Collapse
Affiliation(s)
- Viviane Calice-Silva
- Pro-rim Foundation, Joinville, Brazil; School of Medicine, UNIVILLE, Joinville, Brazil; Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Sao Paulo, Brazil.
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Sao Paulo, Brazil
| | - Silvia M Titan
- Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Sao Paulo, Brazil
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Sao Paulo, Brazil
| |
Collapse
|
2
|
Levey AS, Titan SM, Inker LA. Estimating Glomerular Filtration Rate in African American Individuals-Reply. JAMA Intern Med 2020; 180:1549-1550. [PMID: 32702130 DOI: 10.1001/jamainternmed.2020.2377] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Silvia M Titan
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
3
|
Baptista AL, Padilha K, Malagrino PA, Venturini G, Zeri AC, Dos Reis LM, Martins JS, Jorgetti V, Pereira AC, Titan SM, Moyses RM. Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients. JBMR Plus 2020; 4:e10372. [PMID: 32666023 PMCID: PMC7340447 DOI: 10.1002/jbm4.10372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022] Open
Abstract
Bone biopsy is still the gold standard to assess bone turnover (T), mineralization (M), and volume (V) in CKD patients, and serum biomarkers are not able to replace histomorphometry. Recently, metabolomics has emerged as a new technique that could allow for the identification of new biomarkers useful for disease diagnosis or for the understanding of pathophysiologic mechanisms, but it has never been assessed in the chronic kidney disease-mineral and bone disorder (CKD-MBD) scenario. In this study, we investigated the association between serum metabolites and the bone TMV classification in patients with end-stage renal disease by using serum NMR spectroscopy and bone biopsy of 49 hemodialysis patients from a single center in Brazil. High T was identified in 21 patients and was associated with higher levels of dimethylsulfone, glycine, citrate, and N-acetylornithine. The receiver-operating characteristic curve for the combination of PTH and these metabolites provided an area under the receiver-operating characteristic curve (AUC) of 0.86 (0.76 to 0.97). Abnormal M was identified in 30 patients and was associated with lower ethanol. The AUC for age, diabetes mellitus, and ethanol was 0.83 (0.71 to 0.96). Low V was identified in 17 patients and was associated with lower carnitine. The association of age, phosphate, and carnitine provided an AUC of 0.83 (0.70 to 0.96). Although differences among the curves by adding selected metabolites to traditional models were not statistically significant, the accuracy of the diagnosis according to the TMV classification seemed to be improved. This is the first study to evaluate the TMV classification system in relation to the serum metabolome assessed by NMR spectroscopy, showing that selected metabolites may help in the evaluation of bone phenotypes in CKD-MBD. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Aline L Baptista
- Laboratório de Investigação Médica/LIM 16, Nephrology Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Kallyandra Padilha
- Laboratório de Genética e Cardiologia Molecular Instituto do Coração (INCOR), Faculdade de Medicina, Universidade de São Paulo São Paulo Brazil
| | - Pamella A Malagrino
- Laboratório de Genética e Cardiologia Molecular Instituto do Coração (INCOR), Faculdade de Medicina, Universidade de São Paulo São Paulo Brazil
| | - Gabriela Venturini
- Laboratório de Genética e Cardiologia Molecular Instituto do Coração (INCOR), Faculdade de Medicina, Universidade de São Paulo São Paulo Brazil
| | - Ana Cm Zeri
- Biosciences National Laboratory LNBio Campinas Brazil
| | - Luciene M Dos Reis
- Laboratório de Investigação Médica/LIM 16, Nephrology Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Janaina S Martins
- Endocrine Unit Massachusetts General Hospital Boston MA USA.,Endocrine Unit, Medicine, Harvard Medical School Boston MA USA
| | - Vanda Jorgetti
- Laboratório de Investigação Médica/LIM 16, Nephrology Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Alexandre C Pereira
- Laboratório de Genética e Cardiologia Molecular Instituto do Coração (INCOR), Faculdade de Medicina, Universidade de São Paulo São Paulo Brazil
| | - Silvia M Titan
- Nephrology Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Rosa Ma Moyses
- Laboratório de Investigação Médica/LIM 16, Nephrology Division Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| |
Collapse
|
4
|
Abstract
Assessment of GFR is central to clinical practice, research, and public health. Current Kidney Disease Improving Global Outcomes guidelines recommend measurement of serum creatinine to estimate GFR as the initial step in GFR evaluation. Serum creatinine is influenced by creatinine metabolism as well as GFR; hence, all equations to estimate GFR from serum creatinine include surrogates for muscle mass, such as age, sex, race, height, or weight. The guideline-recommended equation in adults (the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation) includes a term for race (specified as black versus nonblack), which improves the accuracy of GFR estimation by accounting for differences in non-GFR determinants of serum creatinine by race in the study populations used to develop the equation. In that study, blacks had a 16% higher average measured GFR compared with nonblacks with the same age, sex, and serum creatinine. The reasons for this difference are only partly understood, and the use of race in GFR estimation has limitations. Some have proposed eliminating the race coefficient, but this would induce a systematic underestimation of measured GFR in blacks, with potential unintended consequences at the individual and population levels. We propose a more cautious approach that maintains and improves accuracy of GFR estimates and avoids disadvantaging any racial group. We suggest full disclosure of use of race in GFR estimation, accommodation of those who decline to identify their race, and shared decision making between health care providers and patients. We also suggest mindful use of cystatin C as a confirmatory test as well as clearance measurements. It would be preferable to avoid specification of race in GFR estimation if there was a superior, evidence-based substitute. The goal of future research should be to develop more accurate methods for GFR estimation that do not require use of race or other demographic characteristics.
Collapse
Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
| | - Silvia M Titan
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California, San Francisco, California; and
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
5
|
Levey AS, Tighiouart H, Titan SM, Inker LA. Estimation of Glomerular Filtration Rate With vs Without Including Patient Race. JAMA Intern Med 2020; 180:793-795. [PMID: 32176270 PMCID: PMC7076535 DOI: 10.1001/jamainternmed.2020.0045] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/04/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew S. Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Silvia M. Titan
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
6
|
Titan SM, Pecoits-Filho R, Barreto SM, Lopes AA, Bensenor IJ, Lotufo PA. GlycA, a marker of protein glycosylation, is related to albuminuria and estimated glomerular filtration rate: the ELSA-Brasil study. BMC Nephrol 2017; 18:367. [PMID: 29262791 PMCID: PMC5738692 DOI: 10.1186/s12882-017-0779-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022] Open
Abstract
Background Systemic inflammation has been implicated in several chronic diseases. GlycA is a new nuclear mass resonance (NMR) spectroscopy-derived biomarker of systemic inflammation that reflects protein glycosylation. We evaluated the association of GlycA with albuminuria and eGFR in the ELSA-Brasil Study. Methods The cross-sectional association between GlycA (automated NMR LipoProfile(®) test spectra, LabCorp, Raleigh, NC), and overnight 12 h–albuminuria and CKD-EPI eGFR was evaluated among 5050 participants. Results GlycA was higher among older, women, smokers, alcohol abstemious, obese and in those with diabetes, hypertension or dyslipidemia. In addition, both eGFR and albuminuria were associated to GlycA. In linear regression, GlycA was independently associated with log albuminuria (B 0.03; 95%CI 0.02–0.04, P < 0.0001, per 1sd increase) and inversely related to eGFR (B -0.53; 95%CI -0.99 – -0.07, P < 0.02), even after adjustments including hsCRP. In logistic regression, GlycA was independently related to the risk of A2 or A3 albuminuria (OR 1.42, 95%CI 1.27–1.57, p < 0.0001, per 1sd increase), of having an eGFR < 60 ml/min/1.73m2 (OR 1.26, 95%CI 1.12–1.41, p = 0.0003, per 1 sd) or of a combined diagnosis of both conditions (OR 1.35, 95%CI 1.23–1.46, p < 0.0001, per 1 sd). In the ROC curve, GlycA had a higher AUC in comparison to hsCRP (AUC 0.67 vs. 0.62, p = 0.06) for the association with albuminuria A2 or A3. Conclusions The present study demonstrates that GlycA is associated with albuminuria and eGFR, independently of major risk factors for CKD progression, including (and with a stronger association than) hsCRP. GlycA should be further evaluated in CKD progression.
Collapse
Affiliation(s)
- Silvia M Titan
- Nephrology Unit, Department of Medicine, Medical School, University of Sao Paulo, Av Dr Enéas de Carvalho Aguiar 255, Cerqueira César, São Paulo - SP, 05403-000, Brazil. .,Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Av Prof. Lineu Prestes 2565, Butantã, São Paulo - SP, 05508-000, Brazil.
| | - Roberto Pecoits-Filho
- Department of Medicine, Medical School, Pontifícia Universidade Católica do Paraná, R. Imac. Conceição 1155. Prado Velho, Curitiba, PR, 80215-901, Brazil
| | - Sandhi M Barreto
- Department of Social and Preventive Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190. Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Antônio Alberto Lopes
- Clinical Epidemiology and Evidence Based-Medicine, University Hospital Professor Edgard Santos, Federal University of Bahia, Rua Augusto Viana, sn°. Canela, Salvador, BA, 40110-060, Brazil
| | - Isabela J Bensenor
- Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Av Prof. Lineu Prestes 2565, Butantã, São Paulo - SP, 05508-000, Brazil.,General Medicine Unit, Department of Medicine, Medical School, University of Sao Paulo, Av Dr Enéas de Carvalho Aguiar 255, Cerqueira César, São Paulo - SP, 05403-000, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, Hospital Universitario, University of São Paulo, Av Prof. Lineu Prestes 2565, Butantã, São Paulo - SP, 05508-000, Brazil.,General Medicine Unit, Department of Medicine, Medical School, University of Sao Paulo, Av Dr Enéas de Carvalho Aguiar 255, Cerqueira César, São Paulo - SP, 05403-000, Brazil
| |
Collapse
|
7
|
Titan SM, Vieira JM, Dominguez WV, Moreira SRS, Pereira AB, Barros RT, Zatz R. Urinary MCP-1 and RBP: independent predictors of renal outcome in macroalbuminuric diabetic nephropathy. J Diabetes Complications 2012; 26:546-53. [PMID: 22981148 DOI: 10.1016/j.jdiacomp.2012.06.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 05/07/2012] [Accepted: 06/15/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Albuminuria has been considered a sine qua non condition for the diagnosis of diabetic nephropathy (DN) and has been widely used as a surrogate outcome of chronic kidney disease (CKD). However, recent data suggest that albuminuria may fail as a biomarker in a subset of patients, and the search for novel markers is intense. METHODS We analyzed the role of urinary RBP and of serum and urinary cytokines (TGF-beta, MCP-1 and VEGF) as predictors of the risk of dialysis, doubling of serum creatinine or death (primary outcome, PO) in 56 type 2 diabetic patients with macroalbuminuric DN. RESULTS Mean follow-up time was 30.7±10 months. Urinary RBP and MCP-1 were significantly higher in patients presenting the PO, whereas no difference was shown for TGF-β or VEGF. In the Cox regression, urinary RBP, MCP-1 and VEGF were positively associated and serum VEGF was inversely related to the risk of the PO. However, after adjustments for creatinine clearance, proteinuria, and blood pressure only urinary RBP (OR 11.6; 95% CI 2.7-49.2, p=0.001 for log RBP) and urinary MCP-1 (OR 11.0; 95% CI 1.6-76.4, p=0.02 for log MCP-1) remained as significant independent predictors of the PO. CONCLUSION Urinary RBP and MCP-1 are independently related to the risk of CKD progression in patients with macroalbuminuric DN. Whether these biomarkers have a role in the setting of normoalbuminuria and microalbuminuria in DN should be further investigated.
Collapse
Affiliation(s)
- S M Titan
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
8
|
Titan SM, Gebara OCE, Callas SHV, Hoff AO, Hoff PM, Galvão PCA. Case report: a rare cause of metabolic alkalosis. Clin Kidney J 2011; 4:164-6. [PMID: 25984146 PMCID: PMC4421598 DOI: 10.1093/ndtplus/sfr036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/28/2011] [Indexed: 11/12/2022] Open
Abstract
A case of a 66-year-old white man with recent onset of oedema, hypertension, metabolic alkalosis and profound hypokalaemia is described. The initial laboratorial workup showed that urinary chloride concentration and potassium excretion were increased, suggesting a state of hyperaldosteronism. Nonetheless, renin activity was low and aldosterone levels were normal. The metabolic alkalosis seen in this case was due to a rare cause, the ectopic adrenocorticotropic hormone syndrome. A literature review in the subject is presented.
Collapse
Affiliation(s)
- Silvia M Titan
- Nephrology Division, Hospital das Clínicas, Sao Paulo University Medical School, Sao Paulo, Brazil
| | | | | | - Ana O Hoff
- Endocrinology Division, Fleury Laboratory, Sao Paulo, Brazil
| | | | | |
Collapse
|
9
|
Abstract
Background: Progression and long-term renal outcome of lupus nephritis (LN) in male patients is a controversial subject in the literature. The aim of this study was to evaluate the influence of male gender on the renal outcome of LN. Methods: All male (M) LN patients who fulfilled American College of Rheumatology lupus criteria and who were referred for a kidney biopsy from 1999 to 2009 were enrolled in the study. Subjects with end-stage renal disease at baseline, or follow-up time below 6 months, were excluded. Cases were randomly matched to female (F) patients according to the class of LN, baseline estimated glomerular filtration rate (eGFR, Modification of Diet in Renal Disease simplified formula) and follow-up time. Treatment was decided by the clinical staff based on usual literature protocols. The primary endpoint was doubling of serum creatinine and/or end-stage renal disease. The secondary endpoint was defined as a variation of glomerular filtration rate (GFR) per year (ΔGFR/y index), calculated as the difference between final and initial eGFR adjusted by follow-up time for each patient. Results: We included 93 patients (31 M : 62 F). At baseline, M and F patients were not statistically different regarding WHO LN class (II 9.7%, IV 71%, V 19.3%), eGFR (M 62.4 ± 36.4 ml/min/1.73 m2 versus F 59.9 ± 32.7 ml/min/1.73 m2), follow-up time (M 44.2 ± 27.3 months versus F 39.9 ± 27.9 months), and 24-hour proteinuria (M 5.3 ± 4.6 g/day versus F 5.2 ± 3.0 g/day), as well as age, albumin, C3, antinuclear antibody, anti-DNA antibody and haematuria. There was no difference in the primary outcome (M 19% versus F 13%, log-rank p = 0.62). However, male gender was significantly associated with a worse renal function progression, as measured by ΔGFR/y index (β coefficient for male gender −12.4, 95% confidence interval −22.8 to −2.1, p = 0.02). The multivariate linear regression model showed that male gender remained statistically associated with a worse renal outcome even after adjustment for eGFR, proteinuria, albumin and C3 complement at baseline. Conclusion: In our study, male gender presented a worse evolution of LN (measured by an under GFR recovering) when compared with female patients with similar baseline features and treatment. Factors that influence the progression of LN in men and sex-specific treatment protocols should be further addressed in new studies.
Collapse
Affiliation(s)
- AL Resende
- Nephrology Department, São Paulo University Medical School, São Paulo, SP, Brazil
| | - SM Titan
- Nephrology Department, São Paulo University Medical School, São Paulo, SP, Brazil
| | - RT Barros
- Nephrology Department, São Paulo University Medical School, São Paulo, SP, Brazil
| | - V Woronik
- Nephrology Department, São Paulo University Medical School, São Paulo, SP, Brazil
| |
Collapse
|
10
|
Titan SM, Zatz R, Graciolli FG, dos Reis LM, Barros RT, Jorgetti V, Moysés RMA. FGF-23 as a predictor of renal outcome in diabetic nephropathy. Clin J Am Soc Nephrol 2010; 6:241-7. [PMID: 20966122 DOI: 10.2215/cjn.04250510] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Fibroblast growth factor 23 (FGF-23) has emerged as a new factor in mineral metabolism in chronic kidney disease (CKD). An important regulator of phosphorus homeostasis, FGF-23 has been shown to independently predict CKD progression in nondiabetic renal disease. We analyzed the relation between FGF-23 and renal outcome in diabetic nephropathy (DN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS DN patients participating in a clinical trial (enalapril+placebo versus enalapril+losartan) had baseline data collected and were followed until June 2009 or until the primary outcome was reached. Four patients were lost to follow-up. The composite primary outcome was defined as death, doubling of serum creatinine, and/or dialysis need. RESULTS At baseline, serum FGF-23 showed a significant association with serum creatinine, intact parathyroid hormone, proteinuria, urinary fractional excretion of phosphate, male sex, and race. Interestingly, FGF-23 was not related to calcium, phosphorus, 25OH-vitamin D, or 24-hour urinary phosphorus. Mean follow-up time was 30.7±10 months. Cox regression showed that FGF-23 was an independent predictor of the primary outcome, even after adjustment for creatinine clearance and intact parathyroid hormone (10 pg/ml FGF-23 increase = hazard ratio, 1.09; 95% CI, 1.01 to 1.16, P=0.02). Finally, Kaplan-Meier analysis showed a significantly higher risk of the primary outcome in patients with FGF-23 values of >70 pg/ml. CONCLUSIONS FGF-23 is a significant independent predictor of renal outcome in patients with macroalbuminuric DN. Further studies should clarify whether this relation is causal and whether FGF-23 should be a new therapeutic target for CKD prevention.
Collapse
Affiliation(s)
- Silvia M Titan
- Sao Paulo University Medical School, Av Dr Enéas de Carvalho Aguiar, 255, Nephrology Department, 05403-000, São Paulo, SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
11
|
Unger MD, Cuppari L, Titan SM, Magalhães MCT, Sassaki AL, dos Reis LM, Jorgetti V, Moysés RMA. Vitamin D status in a sunny country: where has the sun gone? Clin Nutr 2010; 29:784-8. [PMID: 20637530 DOI: 10.1016/j.clnu.2010.06.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 06/20/2010] [Accepted: 06/22/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Hypovitaminosis D [serum 25 vitamin D<30 ng/ml] is related to the development of metabolic bone disease and greater risk of chronic illnesses. However, it is frequently under-diagnosed, mainly in countries where UV radiation is abundant. We prospectively determined the prevalence and the predictors of serum 25 vitamin D (s25(OH)D) in a healthy Brazilian population after the winter and after the summer. METHODS 603 (118M and 485F) healthy Brazilian volunteers aged 18-90 years from a universitary hospital were selected after the winter of 2006. From the initial sample, 209 volunteers (31M and 178F) accepted to participate in a second health check after the subsequent summer. RESULTS After the winter, median s25(OH)D was 21.4 ng/mL and 77.4% of the population presented hypovitaminosis D. s25(OH)D was significantly related to age, BMI, PTH and race. In multivariate linear regression analysis, s25(OH)D was significantly and independently dependent on age, glycemia and skin color. Significant increase in s25(OH)D was verified after summer [10.6 (3.7-19.3 ng/ml); p<0.001] and this improvement was dependent on age. We also observed a significant decrease in hyperparathyroidism prevalence (20.8% vs. 4.9%; P<0.0001). CONCLUSION In São Paulo, at the end of winter, we observed a high prevalence of hypovitaminosis D and secondary hyperparathyroidism in healthy adults. s25(OH)D was dependent on age and skin color. After summer, we observed a decrease in the prevalence of hypovitaminosis D. This unexpected finding emphasizes the need for a strong recommendation to monitor s25(OH)D, even in a sunny country such as Brazil.
Collapse
Affiliation(s)
- Marianna D Unger
- Nephrology Department, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Boekholdt SM, Titan SM, Wiersinga WM, Chatterjee K, Basart DCG, Luben R, Wareham NJ, Khaw KT. Initial thyroid status and cardiovascular risk factors: the EPIC-Norfolk prospective population study. Clin Endocrinol (Oxf) 2010; 72:404-10. [PMID: 19486022 DOI: 10.1111/j.1365-2265.2009.03640.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [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] [Indexed: 11/28/2022]
Abstract
CONTEXT Thyroid status affects several aspects of cardiovascular risk profile, including lipid levels and blood pressure. Whether thyroid status affects the risk of coronary heart disease (CHD) and all-cause mortality remains controversial. DESIGN The EPIC-Norfolk prospective population study. Mean follow-up was 10.6 years. PATIENTS Study participants were 11 554 men and women aged 45-79 years, who were living in Norfolk, UK. MEASUREMENTS Baseline cardiovascular risk factors were recorded and concentrations of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured in baseline samples. Regression analyses were performed to assess the association between thyroid hormone levels and cardiovascular risk factors. A proportional hazards model was used to estimate the risk of CHD and all-cause mortality by baseline thyroid status. No information was available on thyroid treatment during follow-up. RESULTS Thyroid abnormalities were common, particularly among women. Thyroid abnormalities were associated with an altered cardiovascular risk profile. Even within the normal range, thyroid hormone levels, TSH more strongly than FT4, were associated with lipid levels and blood pressure among both men and women. We did not observe a significant association between subclinical thyroid abnormalities and risk of CHD or all-cause mortality. CONCLUSIONS Despite the association between thyroid hormone levels and cardiovascular risk factors, thyroid status was not statistically significantly associated with the risk of future CHD or all-cause mortality in this large cohort.
Collapse
|
13
|
Titan SM, Bingham S, Welch A, Luben R, Oakes S, Day N, Khaw KT. Frequency of eating and concentrations of serum cholesterol in the Norfolk population of the European prospective investigation into cancer (EPIC-Norfolk): cross sectional study. BMJ 2001; 323:1286-8. [PMID: 11731392 PMCID: PMC60303 DOI: 10.1136/bmj.323.7324.1286] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the relation between self reported eating frequency and serum lipid concentrations in a free living population. DESIGN Cross sectional population based study. SETTING Norfolk, England. PARTICIPANTS 14 666 men and women aged 45-75 years from the Norfolk cohort of the European prospective investigation into cancer (EPIC-Norfolk). MAIN OUTCOME MEASURES Concentrations of blood lipids. RESULTS Mean concentrations of total cholesterol and low density lipoprotein cholesterol decreased in a continuous relation with increasing daily frequency of eating in men and women. No consistent relation was observed for high density lipoprotein cholesterol, body mass index, waist to hip ratio, or blood pressure. Mean cholesterol concentrations differed by about 0.25 mmol/l between people eating more than six times a day and those eating once or twice daily; this difference was reduced to 0.15 mmol/l after adjustment for possible confounding variables, including age, obesity, cigarette smoking, physical activity, and intake of energy and nutrients (alcohol, fat, fatty acids, protein, and carbohydrate). CONCLUSIONS Concentrations of total cholesterol and low density lipoprotein cholesterol are negatively and consistently associated with frequency of eating in a general population. The effects of eating frequency on lipid concentrations induced in short term trials in animals and human volunteers under controlled laboratory conditions can be observed in a free living general population. We need to consider not just what we eat but how often we eat.
Collapse
Affiliation(s)
- S M Titan
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND The most abundant Na+/H+ exchanger in the apical membrane of proximal tubules is the type 3 isoform (NHE3), and its activity is acutely inhibited by parathyroid hormone (PTH). In the present study, we investigate whether changes in protein abundance as well as in mRNA levels play a significant role in the long-term modulation of NHE3 by PTH. METHODS Three groups of animals were compared: (1) HP: animals submitted to hyperparathyroidism by subcutaneous implantation of PTH pellets, providing threefold basal levels of this hormone (2.1 U. h-1); (2) control: sham-operated rats in which placebo pellets were implanted; (3) PTX: animals submitted to hypoparathyroidism by thyroparathyroidectomy followed by subcutaneous implantation of thyroxin pellets, which provided basal levels of thyroid hormone. After eight days, we measured bicarbonate reabsorption in renal proximal tubules by in vivo microperfusion. NHE3 activity was also measured in brush border membrane (BBM) vesicles by proton dependent uptake of 22Na. NHE3 expression was evaluated by Northern blot, Western blot and immunohistochemistry. RESULTS Bicarbonate reabsorption in renal proximal tubules was significantly decreased in HP rats. Na+/H+ exchange activity in isolated BBM vesicles was 6400 +/- 840, 9225 +/- 505, and 12205 +/- 690 cpm. mg-1. 15 s-1 in HP, sham, and PTX groups, respectively. BBM NHE3 protein abundance decreased 39.3 +/- 8.2% in HP rats and increased 54.6 +/- 7.8% in PTX rats. Immunohistochemistry showed that expression of NHE3 protein in apical BBM was decreased in HP rats and was increased in PTX rats. Northern blot analysis of total kidney RNA showed that the abundance of NHE3 mRNA was 20.3 +/- 1.3% decreased in HP rats and 27. 7 +/- 2.1% increased in PTX. CONCLUSIONS Our results indicate that the chronic inhibitory effect of PTH on the renal proximal tubule NHE3 is associated with changes in the expression of NHE3 mRNA levels and protein abundance.
Collapse
Affiliation(s)
- A C Girardi
- Instituto de Ciências Biomédicas, Departamento de Fisiologia e Biofísica, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
15
|
Benseñor IM, Pereira AC, Tannuri AC, Valeri CM, Akashi D, Fucciolo DQ, Isa FK, Lobato ML, Titan SM, Galvão TG, Lotufo PA. [Systemic arterial hypertension and psychiatric morbidity in the outpatient care setting of a tertiary hospital]. Arq Neuropsiquiatr 1998; 56:406-11. [PMID: 9754421 DOI: 10.1590/s0004-282x1998000300009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Arterial hypertension is one of the most important risk factor for cardiovascular disease, the main cause of death in Brazil. Hypertensive patients that have treated in tertiary care hospitals have shown elevated co-morbidity including psychiatric disturbances. Our objective is to study psychiatric co-morbidity among severe hypertensive patients. This study was performed in an out-patient clinic of tertiary medical care setting. Forty-one patients were enrolled in this research (26 women, 15 men). They were submitted to a clinical interview and answering the PRIME-MD, a specific questionnaire for diagnosis of psychiatric disturbances (by a general practitioner). Frequencies of psychiatric disturbances were different in men and women: 63.4% of the women in this study showed some type of psychiatric disturbance versus 36.6% of men (p = 0.012). The majority of the diagnosis were mood disturbances, mainly depression associated or not with anxious disturbances. Mean age of psychiatric disturbance patients was 47.1 years versus 59.3 years in the patients without psychiatric disturbances (p = 0.0049), showing the presence of psychiatric disturbances in younger patients. Other factors as systolic arterial blood pressure, diastolic arterial blood pressure and body mass index did not show any differences associated with psychiatric disturbance. We conclude that there is a great co-morbidity between high complexity hospitals hypertensive patients and that this type of disturbance is more frequent in women and in younger patients.
Collapse
Affiliation(s)
- I M Benseñor
- Serviço de Clínica Geral do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brasil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|