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Westenberg LB, Pol RA, van der Weijden J, de Borst MH, Bakker SJ, van Londen M. Central Body Fat Distribution and Kidney Function after Living Kidney Donation. Clin J Am Soc Nephrol 2024; 19:503-513. [PMID: 38190119 PMCID: PMC11020429 DOI: 10.2215/cjn.0000000000000403] [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: 09/06/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND In most screening guidelines, high body mass index (BMI) is considered a contraindication for kidney donation. New insights suggest that central body fat distribution might provide greater power in assessing kidney risk. This study aimed to determine whether BMI and central body fat distribution measures are associated with long-term kidney function after donor nephrectomy. We hypothesized that higher BMI, waist circumference (WC), and waist-to-height ratio (WHtR) were associated with lower kidney function long term after donation. METHODS The study population consisted of living kidney donors. BMI, WC, and WHtR were measured during donor screening. The outcome postdonation kidney function was assessed using measured GFR (mGFR) (mGFR, 125 I-iothalamate infusion) at 3 months ( n =1042), 5 years ( n =556), and 10 years ( n =210) of follow-up. Primary multivariable linear regression analyses were performed with BMI and WC and secondary analyses with WHtR. Linear mixed models were performed to investigate change in postdonation eGFR. RESULTS The donor age was 52±11 years, and 48% were male. The mean BMI was 26.1±3.6 kg/m 2 , and WC was 91±11 cm. Higher predonation BMI was associated with lower mGFR throughout follow-up: -1.35 (95% confidence interval [CI], -1.95 to -0.80), -1.55 (95% CI, -2.50 to -0.65), and -2.35 (95% CI, -4.10 to -0.60) ml/min per m 2 per 5 kg/m 2 higher BMI at 3 months, 5, and 10 years after donation, respectively, adjusted for sex, age, and predonation GFR. For WC, differences in mGFR were -1.30 (95% CI, -1.70 to -0.90), -1.50 (95% CI, -2.20 to -0.80), and -1.70 (95% CI, -3.00 to -0.50) ml/min per m 2 per 10 cm higher WC at 3 months, 5, and 10 years after donation, respectively. In male donors, BMI and WC were significantly associated with a negative postdonation change in eGFR. CONCLUSIONS Higher BMI and WC were independently associated with lower GFR (long term) after living kidney donation.
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Affiliation(s)
- Lisa B. Westenberg
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A. Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jessica van der Weijden
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Vinke JSJ, Kremer D, Knobbe TJ, Grote Beverborg N, Berger SP, Bakker SJ, de Borst MH, Eisenga MF. Iron Status and Cause-Specific Mortality After Kidney Transplantation. Kidney Med 2024; 6:100766. [PMID: 38375423 PMCID: PMC10874991 DOI: 10.1016/j.xkme.2023.100766] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Affiliation(s)
- Joanna Sophia J. Vinke
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
| | - Daan Kremer
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
| | - Tim J. Knobbe
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
| | - Niels Grote Beverborg
- Department of Cardiology, University Medical Center Groningen; Groningen, the Netherlands
| | - Stefan P. Berger
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
| | - Stephan J.L. Bakker
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
| | - Martin H. de Borst
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
| | - Michele F. Eisenga
- Department of Nephrology, University Medical Center Groningen; Groningen, the Netherlands
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Groothof D, Shehab NB, Erler NS, Bakker SJ. Integer Cystatin C Values: Impact on Discordance Group Assignment and Accuracy of GFR-Estimating Equations. J Am Soc Nephrol 2023; 34:1915-1916. [PMID: 37921832 PMCID: PMC10635606 DOI: 10.1681/asn.0000000000000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Dion Groothof
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naser B.N. Shehab
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole S. Erler
- Department of Biostatistics, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Groothof D, Post A, Bakker SJ. Tolvaptan, Kidney Function Decline, and Potential Confounding by Muscle Wasting. Kidney Med 2023; 5:100711. [PMID: 37850076 PMCID: PMC10577130 DOI: 10.1016/j.xkme.2023.100711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Szili-Torok T, de Borst MH, Garcia E, Gansevoort RT, Dullaart RP, Connelly MA, Bakker SJ, Tietge UJ. Fasting Ketone Bodies and Incident Type 2 Diabetes in the General Population. Diabetes 2023; 72:1187-1192. [PMID: 37352012 PMCID: PMC10450821 DOI: 10.2337/db22-0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/04/2023] [Indexed: 06/25/2023]
Abstract
With rising incidence and prevalence of type 2 diabetes, prevention including identification of prospective biomarkers becomes increasingly relevant. Although ketone bodies recently received a renewed interest as potential biomarkers, data linking these metabolites to diabetes risk are scarce. Therefore, the present prospective study investigated a potential association between fasting ketone bodies and incident type 2 diabetes in the general population. This study from the PREVEND cohort included 3,307 participants from the general population initially free of diabetes or impaired fasting glucose. Baseline fasting ketone body concentrations were measured by nuclear magnetic resonance spectroscopy. One hundred twenty-six participants (3.8%) developed type 2 diabetes during a median (interquartile range) follow-up of 7.3 (6.3-7.6) years. In Kaplan-Meier analysis, sex-stratified ketone body levels strongly positively associated with incident type 2 diabetes, which was confirmed in Cox regression analyses adjusted for several potential confounders. There was no significant interaction by sex. Both 3-β-hydroxybutyrate and acetoacetate+acetone individually associated with incident type 2 diabetes. In conclusion, fasting plasma ketone body levels are strongly positively associated with incident type 2 diabetes in the general population independent of several other recognized risk factors. These results may have important implications for diabetes prevention including dietary strategies. ARTICLE HIGHLIGHTS The identification of biomarkers that predict type 2 diabetes is increasingly relevant for personalized medicine strategies. Data regarding ketone bodies and incident type 2 diabetes are scarce. This study shows that ketone bodies, either combined or as individual subspecies, are strongly associated with incident type 2 diabetes in the general population, independent of potential confounders. These results may have important implications for diabetes prevention including dietary strategies.
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Affiliation(s)
- Tamas Szili-Torok
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Erwin Garcia
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC
| | - Ron T. Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Robin P.F. Dullaart
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Stephan J.L. Bakker
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Uwe J.F. Tietge
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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Vinke JSJ, Gorter AR, Eisenga MF, Dam WA, van der Meer P, van den Born J, Bakker SJ, Hoes MF, de Borst MH. Iron deficiency is related to lower muscle mass in community-dwelling individuals and impairs myoblast proliferation. J Cachexia Sarcopenia Muscle 2023; 14:1865-1879. [PMID: 37386912 PMCID: PMC10401536 DOI: 10.1002/jcsm.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Loss of muscle mass is linked with impaired quality of life and an increased risk of morbidity and premature mortality. Iron is essential for cellular processes such as energy metabolism, nucleotide synthesis and numerous enzymatic reactions. As the effects of iron deficiency (ID) on muscle mass and function are largely unknown, we aimed to assess the relation between ID and muscle mass in a large population-based cohort, and subsequently studied effects of ID on cultured skeletal myoblasts and differentiated myocytes. METHODS In a population-based cohort of 8592 adults, iron status was assessed by plasma ferritin and transferrin saturation, and muscle mass was estimated using 24-h urinary creatinine excretion rate (CER). The relationships of ferritin and transferrin saturation with CER were assessed by multivariable logistic regression. Furthermore, mouse C2C12 skeletal myoblasts and differentiated myocytes were subjected to deferoxamine with or without ferric citrate. Myoblast proliferation was measured with a colorimetric 5-bromo-2'-deoxy-uridine ELISA assay. Myocyte differentiation was assessed using Myh7-stainings. Myocyte energy metabolism, oxygen consumption rate and extracellular acidification rate were assessed using Seahorse mitochondrial flux analysis, and apoptosis rate with fluorescence-activated cell sorting. RNA sequencing (RNAseq) was used to identify ID-related gene and pathway enrichment in myoblasts and myocytes. RESULTS Participants in the lowest age- and sex-specific quintile of plasma ferritin (OR vs middle quintile 1.62, 95% CI 1.25-2.10, P < 0.001) or transferrin saturation (OR 1.34, 95% CI 1.03-1.75, P = 0.03) had a significantly higher risk of being in the lowest age- and sex-specific quintile of CER, independent of body mass index, estimated GFR, haemoglobin, hs-CRP, urinary urea excretion, alcohol consumption and smoking status. In C2C12 myoblasts, deferoxamine-induced ID reduced myoblast proliferation rate (P-trend <0.001) but did not affect differentiation. In myocytes, deferoxamine reduced myoglobin protein expression (-52%, P < 0.001) and tended to reduce mitochondrial oxygen consumption capacity (-28%, P = 0.10). Deferoxamine induced gene expression of cellular atrophy markers Trim63 (+20%, P = 0.002) and Fbxo32 (+27%, P = 0.048), which was reversed by ferric citrate (-31%, P = 0.04 and -26%, P = 0.004, respectively). RNAseq indicated that both in myoblasts and myocytes, ID predominantly affected genes involved in glycolytic energy metabolism, cell cycle regulation and apoptosis; co-treatment with ferric citrate reversed these effects. CONCLUSIONS In population-dwelling individuals, ID is related to lower muscle mass, independent of haemoglobin levels and potential confounders. ID impaired myoblast proliferation and aerobic glycolytic capacity, and induced markers of myocyte atrophy and apoptosis. These findings suggest that ID contributes to loss of muscle mass.
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Affiliation(s)
- Joanna Sophia J. Vinke
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Alan R. Gorter
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Michele F. Eisenga
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Wendy A. Dam
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Peter van der Meer
- Department of CardiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Jacob van den Born
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Stephan J.L. Bakker
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Martijn F. Hoes
- Department of Clinical GeneticsMaastricht University Medical Center+MaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastrichtThe Netherlands
| | - Martin H. de Borst
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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van den Berg PF, Aboumsallem JP, Screever EM, Shi C, de Wit S, Bracun V, Yousif LI, Geerlings L, Wang D, Ho JE, Bakker SJ, van der Vegt B, Silljé HH, de Boer RA, Meijers WC. Fibrotic Marker Galectin-3 Identifies Males at Risk of Developing Cancer and Heart Failure. JACC CardioOncol 2023; 5:445-453. [PMID: 37614579 PMCID: PMC10443113 DOI: 10.1016/j.jaccao.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 08/25/2023] Open
Abstract
Background Cancer and heart failure (HF) are the leading causes of death in the Western world. Shared mechanisms such as fibrosis may underlie either disease entity, furthermore it is unknown whether this relationship is sex-specific. Objectives We sought to investigate how fibrosis-related biomarker galectin-3 (gal-3) aids in identifying individuals at risk for new-onset cancer and HF, and how this differs between sexes. Methods Gal-3 was measured at baseline and at 4-year follow-up in 5,786 patients of the PREVEND (Prevention of Renal and Vascular Endstage Disease) study. The total follow-up period was 11.5 years. An increase of ≥50% in gal-3 levels between measurements was considered relevant. We performed sex-stratified log-rank tests and Cox regression analyses overall and by sex to evaluate the association of gal-3 over time with both new-onset cancer and new-onset HF. Results Of the 5,786 healthy participants (50% males), 399 (59% males) developed new-onset cancer, and 192 (65% males) developed new-onset HF. In males, an increase in gal-3 was significantly associated with new-onset cancer (both combined and certain cancer-specific subtypes), after adjusting for age, body mass index, hypertension, smoking status, estimated glomerular filtration rate, diabetes mellitus, triglycerides, coronary artery disease, and C-reactive protein (HR: 1.89; 95% CI: 1.32-2.71; P < 0.001). Similar analyses demonstrated an association with new-onset HF in males (HR: 1.77; 95% CI: 1.07-2.95; P = 0.028). In females, changes in gal-3 over time were neither associated with new-onset cancer nor new-onset HF. Conclusions Gal-3, a marker of fibrosis, is associated with new-onset cancer and new-onset HF in males, but not in females.
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Affiliation(s)
- Pieter F. van den Berg
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joseph Pierre Aboumsallem
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elles M. Screever
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Canxia Shi
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne de Wit
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Valentina Bracun
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Laura I. Yousif
- Department of Cardiology, Thorax Center, Erasmus Medical center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lotte Geerlings
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dongyu Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jennifer E. Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Stephan J.L. Bakker
- Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Herman H.W. Silljé
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, Thorax Center, Erasmus Medical center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wouter C. Meijers
- Department of Experimental Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Cardiology, Thorax Center, Erasmus Medical center, University Medical Center Rotterdam, Rotterdam, the Netherlands
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van den Berg TA, Nieuwenhuijs-Moeke GJ, Lisman T, Moers C, Bakker SJ, Pol RA. Pathophysiological Changes in the Hemostatic System and Antithrombotic Management in Kidney Transplant Recipients. Transplantation 2023; 107:1248-1257. [PMID: 36529881 PMCID: PMC10205120 DOI: 10.1097/tp.0000000000004452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/17/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
Nowadays, the main cause for early graft loss is renal graft thrombosis because kidney transplant outcomes have improved drastically owing to advances in immunological techniques and immunosuppression. However, data regarding the efficacy of antithrombotic therapy in the prevention of renal graft thrombosis are scarce. Adequate antithrombotic management requires a good understanding of the pathophysiological changes in the hemostatic system in patients with end-stage kidney disease (ESKD). Specifically, ESKD and dialysis disrupt the fine balance between pro- and anticoagulation in the body, and further changes in the hemostatic system occur during kidney transplantation. Consequently, kidney transplant recipients paradoxically are at risk for both thrombosis and bleeding. This overview focuses on the pathophysiological changes in hemostasis in ESKD and kidney transplantation and provides a comprehensive summary of the current evidence for antithrombotic management in (adult) kidney transplant recipients.
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Affiliation(s)
- Tamar A.J. van den Berg
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Ton Lisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Cyril Moers
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert A. Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
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Yepes-Calderón M, Kremer D, Post A, Sotomayor CG, Seidel U, Huebbe P, Knobbe TJ, Lüersen K, Eisenga MF, Corpeleijn E, de Borst MH, Navis GJ, Rimbach G, Bakker SJ. Urinary Copper Excretion Is Associated with Long-Term Graft Failure in Kidney Transplant Recipients. Am J Nephrol 2023; 54:425-433. [PMID: 37231776 PMCID: PMC10687917 DOI: 10.1159/000531147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In chronic kidney disease, proteinuria increases urinary copper excretion, inducing oxidative tubular damage and worsening kidney function. We investigated whether this phenomenon occurred in kidney transplant recipients (KTRs). In addition, we studied the associations of urinary copper excretion with the biomarker of oxidative tubular damage urinary liver-type fatty-acid binding protein (u-LFABP) and death-censored graft failure. METHODS This prospective cohort study was performed in the Netherlands between 2008 and 2017, including outpatient KTR with a functioning graft for longer than 1 year, who were extensively phenotyped at baseline. Twenty-four-hour urinary copper excretion was measured by inductively coupled plasma mass spectrometry. Multivariable linear and Cox regression analyses were performed. RESULTS In 693 KTR (57% men, 53 ± 13 years, estimated glomerular filtration rate [eGFR] 52 ± 20 mL/min/1.73 m2), baseline median urinary copper excretion was 23.6 (interquartile range 11.3-15.9) µg/24 h. Urinary protein excretion was positively associated with urinary copper excretion (standardized β = 0.39, p < 0.001), and urinary copper excretion was positively associated with u-LFABP (standardized β = 0.29, p < 0.001). During a median follow-up of 8 years, 109 (16%) KTR developed graft failure. KTR with relatively high copper excretion were at higher risk of long-term graft failure (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.32-1.86 per log2, p < 0.001), independent of multiple potential confounders like eGFR, urinary protein excretion, and time after transplantation. A dose-response relationship was observed over increasing tertiles of copper excretion (HR: 5.03, 95% CI: 2.75-9.19, tertile 3 vs. 1, p < 0.001). u-LFABP was a significant mediator of this association (74% of indirect effect, p < 0.001). CONCLUSION In KTR, urinary protein excretion is positively correlated with urinary copper excretion. In turn, higher urinary copper excretion is associated with an independent increased risk of kidney graft failure, with a substantial mediating effect through oxidative tubular damage. Further studies are warranted to investigate whether copper excretion-targeted interventions could improve kidney graft survival.
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Affiliation(s)
- Manuela Yepes-Calderón
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrian Post
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Camilo G. Sotomayor
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Clinical Hospital University of Chile, Independencia, Chile
| | - Ulrike Seidel
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - Patricia Huebbe
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - Tim J. Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Kai Lüersen
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan J. Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerald Rimbach
- Institute of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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10
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Kremer D, Bakker SJ, Berger SP. Half a Century of Graft Survival After Deceased-Donor Kidney Transplantation: A Case Report. Kidney Int Rep 2023; 8:1123-1124. [PMID: 37180516 PMCID: PMC10166725 DOI: 10.1016/j.ekir.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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11
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Yeung SM, Gritter M, Wouda RD, Bakker SJ, van Zanden JJ, Rotmans JI, Hoorn EJ, Vogt L, de Borst MH. Short-Term Effects of Potassium Chloride Supplementation on Fibroblast Growth Factor 23 and Phosphate in CKD. Clin J Am Soc Nephrol 2023; 18:99-101. [PMID: 36357127 PMCID: PMC10101571 DOI: 10.2215/cjn.09340822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Stanley M.H. Yeung
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Gritter
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rosa D. Wouda
- Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelmer J. van Zanden
- Certe, Division of Clinical Chemistry, Martini Hospital, Groningen, The Netherlands
| | - Joris I. Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewout J. Hoorn
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van Vliet IMY, Post A, Kremer D, Boslooper-Meulenbelt K, van der Veen Y, de Jong MFC, Pol RA, Jager-Wittenaar H, Navis GJ, Bakker SJL, Gan C, Sanders J, Verschuuren E, Damman K, Lexmond W, Blokzijl J, de Borst M, Erasmus M, Porte R, de Boer M, Pol R, Berger S, Eisenga M, Neto AG, Kremer D, van Londen M, Jong JA, Siebelink M, van Pelt L, Niesters H, Bodewes F, Hepkema B, Ranchor A, Douwes R, Jager‐Wittenaar H, Navis GJ, Bakker SJ. Muscle mass, muscle strength and mortality in kidney transplant recipients: results of the TransplantLines Biobank and Cohort Study. J Cachexia Sarcopenia Muscle 2022; 13:2932-2943. [PMID: 36891995 PMCID: PMC9745460 DOI: 10.1002/jcsm.13070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/10/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Survival of kidney transplant recipients (KTR) is low compared with the general population. Low muscle mass and muscle strength may contribute to lower survival, but practical measures of muscle status suitable for routine care have not been evaluated for their association with long-term survival and their relation with each other in a large cohort of KTR. METHODS Data of outpatient KTR ≥ 1 year post-transplantation, included in the TransplantLines Biobank and Cohort Study (ClinicalTrials.gov Identifier: NCT03272841), were used. Muscle mass was determined as appendicular skeletal muscle mass indexed for height2 (ASMI) through bio-electrical impedance analysis (BIA), and by 24-h urinary creatinine excretion rate indexed for height2 (CERI). Muscle strength was determined by hand grip strength indexed for height2 (HGSI). Secondary analyses were performed using parameters not indexed for height2. Cox proportional hazards models were used to investigate the associations between muscle mass and muscle strength and all-cause mortality, both in univariable and multivariable models with adjustment for potential confounders, including age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR) and proteinuria. RESULTS We included 741 KTR (62% male, age 55 ± 13 years, BMI 27.3 ± 4.6 kg/m2), of which 62 (8%) died during a median [interquartile range] follow-up of 3.0 [2.3-5.7] years. Compared with patients who survived, patients who died had similar ASMI (7.0 ± 1.0 vs. 7.0 ± 1.0 kg/m2; P = 0.57), lower CERI (4.2 ± 1.1 vs. 3.5 ± 0.9 mmol/24 h/m2; P < 0.001) and lower HGSI (12.6 ± 3.3 vs. 10.4 ± 2.8 kg/m2; P < 0.001). We observed no association between ASMI and all-cause mortality (HR 0.93 per SD increase; 95% confidence interval [CI] [0.72, 1.19]; P = 0.54), whereas CERI and HGSI were significantly associated with mortality, independent of potential confounders (HR 0.57 per SD increase; 95% CI [0.44, 0.81]; P = 0.002 and HR 0.47 per SD increase; 95% CI [0.33, 0.68]; P < 0.001, respectively), and associations of CERI and HGSI with mortality remained independent of each other (HR 0.68 per SD increase; 95% CI [0.47, 0.98]; P = 0.04 and HR 0.53 per SD increase; 95% CI [0.36, 0.76]; P = 0.001, respectively). Similar associations were found for unindexed parameters. CONCLUSIONS Higher muscle mass assessed by creatinine excretion rate and higher muscle strength assessed by hand grip strength are complementary in their association with lower risk of all-cause mortality in KTR. Muscle mass assessed by BIA is not associated with mortality. Routine assessment using both 24-h urine samples and hand grip strength is recommended, to potentially target interdisciplinary interventions for KTR at risk for poor survival to improve muscle status.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Boslooper-Meulenbelt
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne van der Veen
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C.T. Gan
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J.S.F. Sanders
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - E.A.M. Verschuuren
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - K. Damman
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - W.S. Lexmond
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J. Blokzijl
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.H. de Borst
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.E. Erasmus
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.J. Porte
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.T. de Boer
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.A. Pol
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - S.P. Berger
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.F. Eisenga
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - A.W. Gomes Neto
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - D. Kremer
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M. van Londen
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J.H. Annema‐de Jong
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.J. Siebelink
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - L.J. van Pelt
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - H.G.M. Niesters
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - F.A.J.A. Bodewes
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - B.G. Hepkema
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - A.V. Ranchor
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.M. Douwes
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Harriët Jager‐Wittenaar
- Department of Oral and Maxillofacial Surgery University of Groningen, University Medical Center Groningen Groningen The Netherlands
- Research Group Healthy Ageing, Health Care and Nursing Hanze University of Applied Sciences Groningen The Netherlands
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology University of Groningen, University Medical Center Groningen Groningen The Netherlands
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13
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Knobbe TJ, Kremer D, Abma FI, Annema C, Berger SP, Navis GJ, van der Mei SF, Bültmann U, Visser A, Bakker SJ. Employment Status and Work Functioning among Kidney Transplant Recipients. Clin J Am Soc Nephrol 2022; 17:1506-1514. [PMID: 36162849 PMCID: PMC9528259 DOI: 10.2215/cjn.05560522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/10/2022] [Accepted: 08/18/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES To date, employment figures of kidney transplant recipients in Europe are inconsistent. Additionally, little is known about work functioning of employed kidney transplant recipients and work functioning trajectories before and after transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the ongoing TransplantLines Biobank and Cohort study and from community-dwelling employed adults were used. Health-related work functioning of kidney transplant recipients was assessed with the Work Role Functioning Questionnaire 2.0 and compared with potential kidney donors and community-dwelling employed adults. RESULTS We included 668 kidney transplant recipients of working age (59% men, age 51±11 years) at median 3 (interquartile range, 2-10) years after transplantation, 246 potential kidney donors of working age (43% men, age 53±9 years), and 553 community-dwelling employed adults (70% men, age 45±11 years). The proportion of employed kidney transplant recipients was lower compared with potential kidney donors (56% versus 79%). If employed, the work functioning score of kidney transplant recipients was slightly lower compared with employed potential kidney donors yet higher compared with community-dwelling employed adults (medians 91 [interquartile range, 76-98], 94 [interquartile range, 85-99], and 88 [interquartile range, 79-95], respectively). Backward linear regression analyses revealed that lower educational level, having a kidney from a deceased donor, presence of tingling or numbness of hands or feet, presence of concentration/memory problems, presence of anxiety, and presence of severe fatigue were independently associated with lower work functioning among kidney transplant recipients. Additional subgroup analyses showed that work functioning scores were lower before transplantation than at 12 months after transplantation (83 [interquartile range, 66-93] versus 92 [interquartile range, 88-98], respectively; P=0.002). CONCLUSIONS Stable employed kidney transplant recipients report to function well at work. In addition, this study shows that self-reported work functioning is higher after successful kidney transplantation compared with before transplantation. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER TransplantLines Biobank and Cohort study, NCT03272841 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_09_26_CJN05560522.mp3.
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Affiliation(s)
- Tim J. Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Femke I. Abma
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijrike F. van der Mei
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- University Medical Center Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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14
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Groothof D, Post A, Polinder‐Bos HA, Erler NS, Flores‐Guerrero JL, Kootstra‐Ros JE, Pol RA, de Borst MH, Gansevoort RT, Gans RO, Kremer D, Kieneker LM, Bano A, Muka T, Franco OH, Bakker SJ. Muscle mass and estimates of renal function: a longitudinal cohort study. J Cachexia Sarcopenia Muscle 2022; 13:2031-2043. [PMID: 35596604 PMCID: PMC9398222 DOI: 10.1002/jcsm.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Creatinine is the most widely used test to estimate the glomerular filtration rate (GFR), but muscle mass as key determinant of creatinine next to renal function may confound such estimates. We explored effects of 24-h height-indexed creatinine excretion rate (CER index) on GFR estimated with creatinine (eGFRCr ), muscle mass-independent cystatin C (eGFRCys ), and the combination of creatinine and cystatin C (eGFRCr-Cys ) and predicted probabilities of discordant classification given age, sex, and CER index. METHODS We included 8076 adults enrolled in the PREVEND study. Discordant classification was defined as not having eGFRCr <60 mL/min per 1.73 m2 when eGFRCys was <60 mL/min/1.73 m2 . Baseline effects of age and sex on CER index were quantified with linear models using generalized least squares. Baseline effects of CER index on eGFR were quantified with quantile regression and logistic regression. Effects of annual changes in CER index on trajectories of eGFR were quantified with linear mixed-effects models. Missing observations in covariates were multiply imputed. RESULTS Mean (SD) CER index was 8.0 (1.7) and 6.1 (1.3) mmol/24 h per meter in male and female participants, respectively (Pdifference < 0.001). In male participants, baseline CER index increased until 45 years of age followed by a gradual decrease, whereas a gradual decrease across the entire range of age was observed in female participants. For a 70-year-old male participant with low muscle mass (CER index of 2 mmol/24 h per meter), predicted baseline eGFRCr and eGFRCys disagreed by 24.7 mL/min/1.73 m2 (and 30.1 mL/min/1.73 m2 when creatinine was not corrected for race). Percentages (95% CI) of discordant classification in male and female participants aged 60 years and older with low muscle mass were 18.5% (14.8-22.1%) and 15.2% (11.4-18.5%), respectively. For a 70-year-old male participant who lost muscle during follow-up, eGFRCr and eGFRCys disagreed by 1.5, 5.0, 8.5, and 12.0 mL/min/1.73 m2 (and 6.7, 10.7, 13.5, and 15.9 mL/min/1.73 m2 when creatinine was not corrected for race) at baseline, 5 years, 10 years, and 15 years of follow-up, respectively. CONCLUSIONS Low muscle mass may cause considerable overestimation of single measurements of eGFRCr . Muscle wasting may cause spurious overestimation of repeatedly measured eGFRCr . Implementing muscle mass-independent markers for estimating renal function, like cystatin C as superior alternative to creatinine, is crucial to accurately assess renal function in settings of low muscle mass or muscle wasting. This would also eliminate the negative consequences of current race-based approaches.
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Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Harmke A. Polinder‐Bos
- Department of Internal Medicine, Erasmus Medical CenterErasmus University RotterdamRotterdamthe Netherlands
| | - Nicole S. Erler
- Department of Biostatistics, Erasmus Medical CenterErasmus University RotterdamRotterdamthe Netherlands
| | - Jose L. Flores‐Guerrero
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Jenny E. Kootstra‐Ros
- Department of Laboratory MedicineUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Robert A. Pol
- Department of Surgery, Division of Vascular and Transplantation SurgeryUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Ron T. Gansevoort
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Reinold O.B. Gans
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Lyanne M. Kieneker
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Department of CardiologyBern University Hospital, University of BernBernSwitzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
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15
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Guedes Rodrigues F, Bruins M, Vliegenthart R, Sotomayor Campos C, Kremer D, Navis G, J.L. Bakker S, De Borst M, Keyzer C. MO982: Determinants of Coronary Artery Calcium Score in Stable Kidney Transplant Recipients 12 Months After Transplantation. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Cardiovascular disease remains the primary cause of death after kidney transplantation. Vascular calcification may at least in part explain excess cardiovascular morbidity and mortality, but little is known about the drivers of vascular calcification after kidney transplantation. Remarkably, some patients with kidney failure develop extensive calcifications, whereas others remain free of calcifications. This study aimed to assess the severity of CAC score and investigate potential determinants of vascular calcification in stable kidney transplant recipients (KTRs) at 12 months after transplantation. The second aim was to compare the characteristics of KTRs without any calcifications versus those with a relatively high CAC score.
METHOD
Adult KTRs with no prior coronary artery disease and eGFR >30 mL/min/1.73 m2 who visited our center between June 2018 and June 2021 underwent non-contrast computed tomography (CT) of the heart to quantify the coronary artery calcium (CAC)-score, calculated by the Agatston method. CAC-score percentiles were calculated using a CAC nomogram available at https://www.calciumscorecalculator.com. Clinical, laboratory, lifestyle and nutritional data, including bioimpedance analysis (BIA), were collected as part of the TransplantLines Biobank and Cohort Study1. The association between potential determinants and CAC-score percentiles was first studied in univariable multinomial logistic regression analysis and subsequently all variables with P < 0.10 were included in a multivariable multinomial logistic regression analysis to study independent determinants of CAC. We subsequently performed a case control analysis, comparing KTRs without calcifications (no-CAC, n = 36) versus those with relatively high calcium score (CAC ≥75th percentile, n = 36), matched by age, sex and dialysis vintage.
RESULTS
A total of 203 KTRs (54.0 ± 14.7 year old, 61.1% male) at 12 months after transplantation were included in the main analysis. Participants were categorized into three groups according to CAC-score percentiles {P = 0% (CAC = 0), n = 68; P ≥1%—P ≤ 75% [CAC = 67.5 (6.5–247.0)], n = 52; P > 75%, [CAC = 0], 581 (148.0–1652), n = 83}. Individuals in the highest CAC-score percentile group had lower educational level, heart rate, urinary protein excretion, urinary magnesium excretion, physical functioning score and phase angle assessed by BIA (a marker of both hydration status and body cell mass/integrity), and higher prevalence of diabetes mellitus, dialysis vintage, serum triglycerides, PTH, alkaline phosphatase, calcium, use of statins, use of antihypertensives and use of diuretics. In multivariable-adjusted multinomial logistic regression analysis, donor living status and phase angle were inversely associated with CAC-score >75% (Table 1). In the matched case control analysis, KTR with CAC-score >75% had lower plasma magnesium, albuminuria, and phase angle, and were less likely a recipient from a living donor (Table 2).
CONCLUSION
This study identifies phase angle, reflecting body cell integrity, as an independent determinant of CAC at 12 months after kidney transplantation. Interestingly, in two subgroups with similar dialysis vintage, KTRs with a CAC score of zero were more likely to have received a kidney from a living donor, and had higher plasma magnesium levels, compared with KTRs with relatively high CAC scores. Futures studies should address whether improving magnesium status could retard calcification progression after kidney transplantation.
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Affiliation(s)
| | - Megan Bruins
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Daan Kremer
- University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- University Medical Center Groningen, Groningen, The Netherlands
| | | | - Martin De Borst
- University Medical Center Groningen, Groningen, The Netherlands
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16
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Luo LI, Kieneker L, van der Vegt B, J.L. Bakker S, Gruppen E, F. Casteleijn N, De Boer R, Suthahar N, Gansevoort R. MO504: Urinary Albumin Excretion and Cancer Risk. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Accumulating evidence has shown that chronic kidney disease (CKD) is associated with cancer development. However, the main focus in these studies was on patients with moderately or severely impaired kidney function, rather than on patients with milder CKD defined by higher albuminuria. We hypothesized that albuminuria may have an association with cancer risk that is independent of kidney function. This study examined therefore the association between urinary albumin excretion (UAE), considered the gold standard for albuminuria assessment, and the risk of cancer incidence, independent of estimated glomerular filtration rate (eGFR).
METHOD
We included 8490 subjects in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and women. UAE was measured in two 24-h urine specimens at baseline (1997–8). Cancer incidence was ascertained by record linkage with the nationwide network and registry of histo and cytopathology in the Netherlands (PALGA). Non-melanoma skin cancer was excluded from analyses. eGFR was calculated by the 2012 CKD-EPI creatinine-cystatin C equation. Cox proportional hazards regression models were used to calculate hazard ratios [HRs, [95% confidence intervals (95% CIs)] crude and additionally adjusted for age, sex, BMI, smoking, alcohol, educational level, diabetes and baseline eGFR. To detect potential reverse causation, we excluded subjects with a follow-up time of <1 year and recalculated the fully adjusted models.
RESULTS
Overall, 50% of the included subjects were female, and the mean age was 49.8 ± 12.7 years old. Median baseline UAE was 9.4 (IQR: 6.3–17.8) mg/24 h, and the mean baseline eGFR was 94.6 ± 17.3 mL/min/1.73 m2. At baseline, subjects who had higher UAE were more likely to be male, older, have lower eGFR and to have hypertension or diabetes. During a median follow-up of 17.7 (IQR: 17.67–17.71) years, 1789 subjects developed a de novo cancer. In the age- and sex-adjusted model, every doubling of UAE was associated with a 7% (HR: 1.07, 95% CI 1.04–1.10) higher risk of overall cancer. This association remained essentially unchanged after additional multivariable adjustments, including eGFR (HR: 1.06, 95% CI 1.02–1.09). UAE was also independently associated with an increased risk of development of several site-specific cancers including urothelial cell carcinoma (HR: 1.13, 95% CI 1.02–1.25), as well as lung cancer (HR: 1.13, 95% CI 1.04–1.22), haematological cancer (HR: 1.12, 95% CI 1.00–1.25), and head and neck cancer (HR: 1.29, 95% CI 1.06–1.57). We did not observe significant associations of UAE with melanoma, breast, prostate and colorectal cancers. Additionally, the associations of UAE with overall cancer, UCC, lung cancer and head and neck cancer remained significant in the fully adjusted models after we excluded subjects with a follow-up time of <1 year.
CONCLUSION
Higher albuminuria, assessed in 24-h urine, is associated with an increased risk of overall cancer and several site-specific cancers, independent of baseline eGFR. Future studies are warranted to corroborate these findings and to examine mechanisms underlying these associations.
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Affiliation(s)
- LI Luo
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lyanne Kieneker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eke Gruppen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niek F. Casteleijn
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf De Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Navin Suthahar
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Klont F, Stepanović S, Kremer D, Bonner R, Touw DJ, Hak E, Bakker SJ, Hopfgartner G. Untargeted ‘SWATH’ mass spectrometry-based metabolomics for studying chronic and intermittent exposure to xenobiotics in cohort studies. Food Chem Toxicol 2022; 165:113188. [DOI: 10.1016/j.fct.2022.113188] [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] [Received: 01/28/2022] [Revised: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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18
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Liu EE, Suthahar N, Paniagua SM, Wang D, Lau ES, Li SX, Jovani M, Takvorian KS, Kreger BE, Benjamin EJ, Meijers WC, Bakker SJ, Kieneker LM, Gruppen EG, van der Vegt B, de Bock GH, Gansevoort RT, Hussain SK, Hoffmann U, Splansky GL, Vasan RS, Larson MG, Levy D, Cheng S, de Boer RA, Ho JE. Association of Cardiometabolic Disease With Cancer in the Community. JACC CardioOncol 2022; 4:69-81. [PMID: 35492825 PMCID: PMC9040108 DOI: 10.1016/j.jaccao.2022.01.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/03/2022] Open
Abstract
Background Obesity and cardiometabolic dysfunction have been associated with cancer risk and severity. Underlying mechanisms remain unclear. Objectives The aim of this study was to examine associations of obesity and related cardiometabolic traits with incident cancer. Methods FHS (Framingham Heart Study) and PREVEND (Prevention of Renal and Vascular End-Stage Disease) study participants without prevalent cancer were studied, examining associations of obesity, body mass index (BMI), waist circumference, visceral adipose tissue (VAT) and subcutaneous adipose tissue depots, and C-reactive protein (CRP) with future cancer in Cox models. Results Among 20,667 participants (mean age 50 years, 53% women), 2,619 cancer events were observed over a median follow-up duration of 15 years. Obesity was associated with increased risk for future gastrointestinal (HR: 1.30; 95% CI: 1.05-1.60), gynecologic (HR: 1.62; 95% CI: 1.08-2.45), and breast (HR: 1.32; 95% CI: 1.05-1.66) cancer and lower risk for lung cancer (HR: 0.62; 95% CI: 0.44-0.87). Similarly, waist circumference was associated with increased risk for overall, gastrointestinal, and gynecologic but not lung cancer. VAT but not subcutaneous adipose tissue was associated with risk for overall cancer (HR: 1.22; 95% CI: 1.05-1.43), lung cancer (HR: 1.92; 95% CI: 1.01-3.66), and melanoma (HR: 1.56; 95% CI: 1.02-2.38) independent of BMI. Last, higher CRP levels were associated with higher risk for overall, colorectal, and lung cancer (P < 0.05 for all). Conclusions Obesity and abdominal adiposity are associated with future risk for specific cancers (eg, gastrointestinal, gynecologic). Although obesity was associated with lower risk for lung cancer, greater VAT and CRP were associated with higher lung cancer risk after adjusting for BMI.
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Affiliation(s)
- Elizabeth E. Liu
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Navin Suthahar
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Samantha M. Paniagua
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dongyu Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily S. Lau
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shawn X. Li
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manol Jovani
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Gastroenterology, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky, USA
| | | | - Bernard E. Kreger
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- The Framingham Heart Study, Framingham, Massachusetts, USA
| | - Emelia J. Benjamin
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiology and Preventative Medicine Sections, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Wouter C. Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J.L. Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lyanne M. Kieneker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eke G. Gruppen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ron T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Shehnaz K. Hussain
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, USA
| | - Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ramachandran S. Vasan
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiology and Preventative Medicine Sections, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martin G. Larson
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel Levy
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer E. Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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19
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Post A, Kremer D, Swarte JC, Sokooti S, Vogelpohl FA, Groothof D, Kema I, Garcia E, Connelly MA, Wallimann T, Dullaart RP, Franssen CF, Bakker SJ. Plasma creatine concentration is associated with incident hypertension in a cohort enriched for the presence of high urinary albumin concentration: the Prevention of Renal and Vascular Endstage Disease study. J Hypertens 2022; 40:229-239. [PMID: 34371517 PMCID: PMC8728759 DOI: 10.1097/hjh.0000000000002996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE : Hypertension is a major risk factor for cardiovascular disease, kidney disease, and premature death. Increased levels of creatine kinase are associated with development of hypertension. However, it is unknown if creatine, a substrate of CK, is associated with the development of hypertension. We therefore, aimed to investigate the association between plasma creatine concentration and incident hypertension. METHODS We measured fasting plasma creatine concentrations by nuclear magnetic resonance spectroscopy in participants of the population-based PREVEND study. The study outcome was incident hypertension, defined as either a SBP of at least 140 mmHg, a DBP of at least 90 mmHg, or the new usage of antihypertensive drugs. Participants with hypertension at baseline were excluded. RESULTS We included 3135 participants (46% men) aged 49 ± 10 years. Mean plasma creatine concentrations were 36.2 ± 17.5 μmol/l, with higher concentrations in women than in men (42.2 ± 17.6 versus 29.2 ± 17.6 μmol/l; P < 0.001). During a median of 7.1 [interquartile range: 3.6-7.6] years of follow-up, 927 participants developed incident hypertension. Higher plasma creatine concentrations were associated with an increased risk of incident hypertension [HR per doubling of plasma creatine: 1.21 (95% confidence interval: 1.10-1.34); P < 0.001], which remained significant after adjustment for potential confounders. Sex-stratified analyses demonstrated higher plasma creatine that was independently associated with an increased risk of incident hypertension in men [hazard ratio: 1.26 (95% CI 1.11-1.44); P < 0.001], but not in women (hazard ratio: 1.13 (95% CI 0.96-1.33); P = 0.14]. Causal pathway analyses demonstrate that the association was not explained by sodium or protein intake. CONCLUSION Higher plasma creatine is associated with an increased risk of hypertension in men. Future studies are warranted to determine the underlying mechanisms.
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Affiliation(s)
| | | | | | | | | | | | - Ido.P. Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Erwin Garcia
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Margery A. Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
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20
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van der Weijden J, Mahesh SV, van Londen M, Bakker SJ, Sanders JS, Navis G, Pol RA, Roodnat JI, Kho MM, Yakar D, Kwee TC, Nolte IM, Berger SP, De Borst MH. Early increase in single-kidney glomerular filtration rate after living kidney donation predicts long-term kidney function. Kidney Int 2022; 101:1251-1259. [DOI: 10.1016/j.kint.2022.01.034] [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] [Received: 11/18/2021] [Revised: 12/30/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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21
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Ma Y, He FJ, Sun Q, Yuan C, Kieneker LM, Curhan GC, MacGregor GA, Bakker SJ, Campbell NR, Wang M, Rimm EB, Manson JE, Willet WC, Hofman A, Gansevoort RT, Cook NR, Hu FB. 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk. N Engl J Med 2022; 386:252-263. [PMID: 34767706 PMCID: PMC9153854 DOI: 10.1056/nejmoa2109794] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [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: 01/22/2023]
Abstract
BACKGROUND The relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method. METHODS We included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was assessed with the use of at least two 24-hour urine samples per participant. The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and combined the results using a random-effects meta-analysis. RESULTS Among 10,709 participants, who had a mean (±SD) age of 51.5±12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (P≤0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94). CONCLUSIONS Higher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose-response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels. (Funded by the American Heart Association and the National Institutes of Health.).
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Feng J. He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
| | - Qi Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Changzheng Yuan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lyanne M. Kieneker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gary C. Curhan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Graham A. MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
| | - Stephan J.L. Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Norm R.C. Campbell
- Departments of Medicine, Community Health Sciences, and Physiology and Pharmacology, O’Brien Institute of Public Health and Libin Cardiovascular Institute of Alberta at the University of Calgary, Canada
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Walter C. Willet
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ron T. Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nancy R. Cook
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank B. Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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22
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van den Berg TA, Lisman T, Dor FJ, Moers C, Minnee RC, Bakker SJ, Pol RA. Antithrombotic Management in Adult Kidney Transplantation - A European survey study. Eur Surg Res 2021; 63:000521327. [PMID: 34872084 PMCID: PMC9808647 DOI: 10.1159/000521327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023]
Abstract
In kidney transplantation (KTx), renal graft thrombosis (RGT) is one of the main reasons for early graft loss. Although evidence-based guidance on prevention of RGT is lacking, thromboprophylaxis is widely used. The aim of this survey was to obtain a European view of the different thromboprophylactic strategies applied in KTx. An online 22-question survey, addressed to KTx professionals, was distributed by e-mail and via platforms of the European Society for Organ Transplantation. Seventy-five responses (21 countries, 51 centers) were received: 75% had over 10 years' clinical experience, 64% were surgeons, 29% nephrologists and 4% urologists. A written antithrombotic management protocol was available in 75% of centers. In 8 (16%) of centers respondents contradicted each other regarding the availability of a written protocol. Thromboprophylaxis is preferred by 78% of respondents, independent of existing antithrombotic management protocols. Ninety-two percent of respondents indicated that an anticipated bleeding risk is the main reason to discontinue chronic antithrombotic therapy preoperatively. Intraoperatively, 32% of respondents administer unfractionated heparin (400 - 10.000 international units with a median of 5000) in selected cases. Despite an overall preference for perioperative thromboprophylaxis in KTx, there is a high variation within Europe regarding type, timing and dosage, most likely due to the paucity of high-quality studies. Further research is warranted in order to develop better guidelines.
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Affiliation(s)
- Tamar A.J. van den Berg
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Department of Surgery, Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ton Lisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Department of Surgery, Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank J.M.F. Dor
- Department of Surgery and Cancer, Imperial College, London, UK,Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Cyril Moers
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert C. Minnee
- Department of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,*Robert A. Pol,
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23
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Kremer D, Pieters TT, Verhaar MC, Berger SP, Bakker SJ, van Zuilen AD, Joles JA, Vernooij RW, van Balkom BW. A systematic review and meta-analysis of COVID-19 in kidney transplant recipients: Lessons to be learned. Am J Transplant 2021; 21:3936-3945. [PMID: 34212499 PMCID: PMC9292797 DOI: 10.1111/ajt.16742] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 04/21/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients (KTR) may be at increased risk of adverse COVID-19 outcomes, due to prevalent comorbidities and immunosuppressed status. Given the global differences in COVID-19 policies and treatments, a robust assessment of all evidence is necessary to evaluate the clinical course of COVID-19 in KTR. Studies on mortality and acute kidney injury (AKI) in KTR in the World Health Organization COVID-19 database were systematically reviewed. We selected studies published between March 2020 and January 18th 2021, including at least five KTR with COVID-19. Random-effects meta-analyses were performed to calculate overall proportions, including 95% confidence intervals (95% CI). Subgroup analyses were performed on time of submission, geographical region, sex, age, time after transplantation, comorbidities, and treatments. We included 74 studies with 5559 KTR with COVID-19 (64.0% males, mean age 58.2 years, mean 73 months after transplantation) in total. The risk of mortality, 23% (95% CI: 21%-27%), and AKI, 50% (95% CI: 44%-56%), is high among KTR with COVID-19, regardless of sex, age and comorbidities, underlining the call to accelerate vaccination programs for KTR. Given the suboptimal reporting across the identified studies, we urge researchers to consistently report anthropometrics, kidney function at baseline and discharge, (changes in) immunosuppressive therapy, AKI, and renal outcome among KTR.
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Affiliation(s)
- Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tobias T. Pieters
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan D. van Zuilen
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands
| | - Jaap A. Joles
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands
| | - Robin W.M. Vernooij
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, UMC Utrecht, Utrecht, The Netherlands,Correspondence Robin W.M. Vernooij and Bas W.M. van Balkom, Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands. Emails: (R. W. M. V.); (B. W. M. v. B.)
| | - Bas W.M. van Balkom
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands,Correspondence Robin W.M. Vernooij and Bas W.M. van Balkom, Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands. Emails: (R. W. M. V.); (B. W. M. v. B.)
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24
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Gomes-Neto AW, Douwes RM, Gan CT, Corpeleijn E, Annema C, Navis G, Berger SP, Bakker SJ. Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2021; 16:1686-1694. [PMID: 34750161 PMCID: PMC8729428 DOI: 10.2215/cjn.06600521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Many kidney transplant recipients suffer from fatigue and poor health-related quality of life. Airflow limitation may be an underappreciated comorbidity among kidney transplant recipients, which could contribute to fatigue and lower health-related quality of life in this population. In this study, we compared the prevalence of airflow limitation between kidney transplant recipients and healthy controls and investigated associations of airflow limitation with fatigue and health-related quality of life in kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the ongoing TransplantLines Biobank and Cohort study were used. Airflow limitation was defined as forced exhaled volume in 1 second less than the fifth percentile of the general population. Fatigue and health-related quality of life were assessed using checklist individual strength 20 revised (CIS20-R) and Short Form-36 (SF-36) questionnaires. RESULTS A total of 539 kidney transplant recipients (58% men; mean age 56±13 years) and 244 healthy controls (45% men; mean age 57±10 years) were included. Prevalence of airflow limitation was higher in kidney transplant recipients than in healthy controls (133 [25%] versus 25 [10%]). In multinomial regression models, airflow limitation was independently associated with fatigue severity (odds ratio moderate fatigue, 1.68; 95% confidence interval, 0.92 to 3.09 and odds ratio severe fatigue, 2.51; 95% confidence interval, 1.39 to 4.55; P=0.007) and lower physical health-related quality of life (-0.11 SDs; 95% confidence interval, -0.19 to -0.02; P=0.01) in kidney transplant recipients. In exploratory mediation analyses, fatigue accounted for 79% of the association of airflow limitation with physical health-related quality of life. CONCLUSIONS Airflow limitation is common among kidney transplant recipients. Its occurrence is associated with more than two times higher risk of severe fatigue, and it is associated with lower physical health-related quality of life. Mediation analyses suggest that airflow limitation causes fatigue, which in turn, decreases physical health-related quality of life. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER TransplantLines: The Transplantation Biobank, NCT03272841 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN06600521.mp3.
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Affiliation(s)
- Tim J. Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - António W. Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne M. Douwes
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C. Tji Gan
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Quint EE, Zogaj D, Banning LB, Benjamens S, Annema C, Bakker SJ, Nieuwenhuijs-Moeke GJ, Segev DL, McAdams-DeMarco MA, Pol RA. Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis. Transplant Direct 2021; 7:e701. [PMID: 34036171 PMCID: PMC8133203 DOI: 10.1097/txd.0000000000001156] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Frailty is a multidimensional condition and is the result of the body's age-associated decline in physical, cognitive, physiological, and immune reserves. The aim of this systematic review is to assess the quality of evidence of the included studies, determine the prevalence of frailty among kidney transplant candidates, and evaluate the relationship between frailty and associated patient characteristics and outcomes after kidney transplantation. METHODS A systematic search was performed for relevant literature on frailty and kidney transplantation. This was followed by a meta-analysis for patient characteristics and outcomes reported by a minimum of 2 studies including mean age, gender, mean body mass index, type of kidney transplantation, dialysis, previous kidney transplantation, comorbidities, hypertension, race, preemptive kidney transplantation, delayed graft function, and length of stay. RESULTS A total of 18 studies were included in the systematic review and 14 of those studies were suitable for meta-analysis. The overall pooled prevalence of frailty before transplantation was estimated at 17.1% (95% confidence interval [CI], 15.4-18.7). Frailty was significantly associated with higher age (mean difference, 3.6; 95% CI, 1.4-5.9), lower rate of preemptive transplantation (relative risk, 0.60; 95% CI, 0.4-0.9), longer duration of delayed graft function (relative risk, 1.80; 95% CI, 1.1-3.0), and length of stay longer than 2 wk (odds ratio, 1.64; 95% CI, 1.2-2.3). CONCLUSIONS One in 6 kidney transplant recipients is frail before transplantation. The presence of frailty is associated with lower rates of preemptive transplantation, older recipient age, higher rates of delayed graft function, and longer length of stay. Future research is required to explore the association of frailty with other adverse outcomes after kidney transplantation and the effects of intervention programs to improve the different frailty domains.
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Affiliation(s)
- Evelien E. Quint
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Donika Zogaj
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Louise B.D. Banning
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stan Benjamens
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Division of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Robert A. Pol
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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26
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Sotomayor CG, te Velde-Keyzer CA, Diepstra A, van Londen M, Pol RA, Post A, Gans RO, Nolte IM, Slart RH, de Borst MH, Berger SP, Rodrigo R, Navis GJ, de Boer RA, Bakker SJ. Galectin-3 and Risk of Late Graft Failure in Kidney Transplant Recipients: A 10-year Prospective Cohort Study. Transplantation 2021; 105:1106-1115. [PMID: 32639409 PMCID: PMC8078111 DOI: 10.1097/tp.0000000000003359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Galectin-3 may play a causal role in kidney inflammation and fibrosis, which may also be involved in the development of kidney graft failure. With novel galectin-3-targeted pharmacological therapies increasingly coming available, we aimed to investigate whether galectin-3 is associated with risk of late graft failure in kidney transplant recipients (KTR). METHODS We studied adult KTR who participated in TransplantLines Insulin Resistance and Inflammation Biobank and Cohort Study, recruited in a university setting (2001-2003). Follow-up was performed for a median of 9.5 (interquartile range, 6.2-10.2) years. Overall and stratified (Pinteraction < 0.05) multivariable-adjusted Cox proportional-hazards regression analyses were performed to study the association of galectin-3 with risk of graft failure (restart of dialysis or retransplantation). RESULTS Among 561 KTR (age 52 ± 12 y; 54% males), baseline median galectin-3 was 21.1 (interquartile range, 17.0-27.2) ng/mL. During follow-up, 72 KTR developed graft failure (13, 18, and 44 events over increasing tertiles of galectin-3). Independent of adjustment for donor, recipient, and transplant characteristics, galectin-3-associated with increased risk of graft failure (hazard ratios [HR] per 1 SD change, 2.12; 95% confidence interval [CI], 1.63-2.75; P < 0.001), particularly among KTR with systolic blood pressure ≥140 mmHg (HR, 2.29; 95% CI, 1.80-2.92; P < 0.001; Pinteraction = 0.01) or smoking history (HR, 2.56; 95% CI, 1.95-3.37; P < 0.001; Pinteraction = 0.03). Similarly, patients in the highest tertile of galectin-3 were consistently at increased risk of graft failure. CONCLUSIONS Serum galectin-3 levels are elevated in KTR, and independently associated with increased risk of late graft failure. Whether galectin-3-targeted therapies may represent novel opportunities to decrease the long-standing high burden of late graft failure in stable KTR warrants further studies.
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Affiliation(s)
- Camilo G. Sotomayor
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Radiology, Clinical Hospital of the University of Chile, University of Chile, Santiago, Chile
| | - Charlotte A. te Velde-Keyzer
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Diepstra
- Division of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A. Pol
- Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrian Post
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk O.B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ilja M. Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H.J.A. Slart
- Department of Nuclear and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin H. de Borst
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ramón Rodrigo
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gerjan J. Navis
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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27
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Shahabeddin Parizi A, Krabbe PF, Buskens E, van der Bij W, Blokzijl H, Hanewinkel V, Annema C, Bakker SJ, Vermeulen KM. Health items with a novel patient-centered approach provided information for preference-based transplant outcome measure. J Clin Epidemiol 2020; 126:93-105. [DOI: 10.1016/j.jclinepi.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022]
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28
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Zhu Y, Minović I, Dekker LH, Eggersdorfer ML, van Zon SK, Reijneveld SA, Kootstra-Ros JE, Kema IP, Bakker SJ, Navis GJ, Riphagen IJ. Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study. Nutrients 2020; 12:nu12092659. [PMID: 32878227 PMCID: PMC7551314 DOI: 10.3390/nu12092659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/06/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022] Open
Abstract
Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60–75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.
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Affiliation(s)
- Yinjie Zhu
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
- Correspondence: ; Tel.: +31(0)62-665-2320
| | - Isidor Minović
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
| | - Louise H. Dekker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
| | | | - Sander K.R. van Zon
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.K.R.v.Z.); (S.A.R.)
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (S.K.R.v.Z.); (S.A.R.)
| | - Jenny E. Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
| | - Ido P. Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (L.H.D.); (S.J.L.B.); (G.J.N.)
| | - Ineke J. Riphagen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (I.M.); (J.E.K.-R.); (I.P.K.); (I.J.R.)
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29
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Swarte JC, Eelderink C, Douwes RM, Said MY, Hu S, Post A, Westerhuis R, Bakker SJ, Harmsen HJ. Effect of High versus Low Dairy Consumption on the Gut Microbiome: Results of a Randomized, Cross-Over Study. Nutrients 2020; 12:nu12072129. [PMID: 32708991 PMCID: PMC7400927 DOI: 10.3390/nu12072129] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/25/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
The influence of dairy on the gut microbiome has not been studied extensively. We performed a randomized cross-over study to analyze the effect of high dairy intake on the gut microbiome. Subjects were randomly assigned to a high-dairy diet (HDD) (5-6 dairy portions per day) and a low-dairy diet (LDD) (≤1 dairy portion per day) for 6 weeks with a washout period of 4 weeks in between both diets. The gut microbiome was assessed using 16S rRNA gene sequencing. Compositionality and functionality of the gut microbiome was assessed using Quantitative Insights Into Microbial Ecology (QIIME) and Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt). Stool consistency was evaluated using the Bristol stool chart. In total, 46 healthy overweight subjects (BMI range 25-30 kg/m2) completed both intervention periods. During the HDD, there was a significantly higher abundance of the genera Streptococcus, Leuconostoc, and Lactococcus, and the species Streptococcus thermophilus, Erysipelatoclostridium ramosum and Leuconostoc mesenteroides (pFDR < 0.10). Furthermore, during the HDD, there was a significantly lower abundance of the genera Faecalibacterium and Bilophila, and the species Faecalibacterium prausnitzii, Clostridium aldenense, Acetivibrio ethanolgignens, Bilophila wadsworthia and Lactococcus lactis (pFDR < 0.10). There were eight subjects who became constipated during the HDD and these subjects all had a lower abundance of F. prausnitzii. This is the first cross-over study in which the effect of an HDD compared to an LDD on the gut microbiome has been studied. An HDD led to a significantly different composition of the gut microbiome, with a particularly lower abundance of F. prausnitzii and a higher abundance of S. thermophilus. Constipation was observed in several subjects during the HDD. Predicted metabolic pathways were not significantly altered due to an HDD.
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Affiliation(s)
- J. Casper Swarte
- Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (C.E.); (R.M.D); (M.Y.S.); (A.P.); (S.J.L.B.)
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-(0)-503-613-677
| | - Coby Eelderink
- Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (C.E.); (R.M.D); (M.Y.S.); (A.P.); (S.J.L.B.)
| | - Rianne M. Douwes
- Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (C.E.); (R.M.D); (M.Y.S.); (A.P.); (S.J.L.B.)
| | - M. Yusof Said
- Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (C.E.); (R.M.D); (M.Y.S.); (A.P.); (S.J.L.B.)
| | - Shixian Hu
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Genetics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Adrian Post
- Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (C.E.); (R.M.D); (M.Y.S.); (A.P.); (S.J.L.B.)
| | - Ralf Westerhuis
- Dialyses Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Stephan J.L. Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (C.E.); (R.M.D); (M.Y.S.); (A.P.); (S.J.L.B.)
| | - Hermie J.M. Harmsen
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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30
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Sotomayor CG, te Velde-Keyzer CA, de Borst MH, Navis GJ, Bakker SJ. Lifestyle, Inflammation, and Vascular Calcification in Kidney Transplant Recipients: Perspectives on Long-Term Outcomes. J Clin Med 2020; 9:E1911. [PMID: 32570920 PMCID: PMC7355938 DOI: 10.3390/jcm9061911] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
After decades of pioneering and improvement, kidney transplantation is now the renal replacement therapy of choice for most patients with end-stage kidney disease (ESKD). Where focus has traditionally been on surgical techniques and immunosuppressive treatment with prevention of rejection and infection in relation to short-term outcomes, nowadays, so many people are long-living with a transplanted kidney that lifestyle, including diet and exposure to toxic contaminants, also becomes of importance for the kidney transplantation field. Beyond hazards of immunological nature, a systematic assessment of potentially modifiable-yet rather overlooked-risk factors for late graft failure and excess cardiovascular risk may reveal novel targets for clinical intervention to optimize long-term health and downturn current rates of premature death of kidney transplant recipients (KTR). It should also be realized that while kidney transplantation aims to restore kidney function, it incompletely mitigates mechanisms of disease such as chronic low-grade inflammation with persistent redox imbalance and deregulated mineral and bone metabolism. While the vicious circle between inflammation and oxidative stress as common final pathway of a multitude of insults plays an established pathological role in native chronic kidney disease, its characterization post-kidney transplant remains less than satisfactory. Next to chronic inflammatory status, markedly accelerated vascular calcification persists after kidney transplantation and is likewise suggested a major independent mechanism, whose mitigation may counterbalance the excess risk of cardiovascular disease post-kidney transplant. Hereby, we first discuss modifiable dietary elements and toxic environmental contaminants that may explain increased risk of cardiovascular mortality and late graft failure in KTR. Next, we specify laboratory and clinical readouts, with a postulated role within persisting mechanisms of disease post-kidney transplantation (i.e., inflammation and redox imbalance and vascular calcification), as potential non-traditional risk factors for adverse long-term outcomes in KTR. Reflection on these current research opportunities is warranted among the research and clinical kidney transplantation community.
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Affiliation(s)
- Camilo G. Sotomayor
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (C.A.t.V.-K.); (M.H.d.B.); (G.J.N.); (S.J.L.B.)
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31
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Veenhof H, Koster RA, Junier LA, Berger SP, Bakker SJ, Touw DJ. Volumetric absorptive microsampling and dried blood spot microsampling vs. conventional venous sampling for tacrolimus trough concentration monitoring. ACTA ACUST UNITED AC 2020; 58:1687-1695. [DOI: 10.1515/cclm-2019-1260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/27/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Objectives
Monitoring tacrolimus blood concentrations is important for preventing allograft rejection in transplant patients. Our hospital offers dried blood spot (DBS) sampling, giving patients the opportunity to sample a drop of blood from a fingerprick at home, which can be sent to the laboratory by mail. In this study, both a volumetric absorptive microsampling (VAMS) device and DBS sampling were compared to venous whole blood (WB) sampling.
Methods
A total of 130 matched fingerprick VAMS, fingerprick DBS and venous WB samples were obtained from 107 different kidney transplant patients by trained phlebotomists for method comparison using Passing-Bablok regression. Bias was assessed using Bland-Altman. A multidisciplinary team pre-defined an acceptance limit requiring >80% of all matched samples within 15% of the mean of both samples. Sampling quality was evaluated for both VAMS and DBS samples.
Results
32.3% of the VAMS samples and 6.2% of the DBS samples were of insufficient quality, leading to 88 matched samples fit for analysis. Passing-Bablok regression showed a significant difference between VAMS and WB, with a slope of 0.88 (95% CI 0.81–0.97) but not for DBS (slope 1.00; 95% CI 0.95–1.04). Both VAMS (after correction for the slope) and DBS showed no significant bias in Bland-Altman analysis. For VAMS and DBS, the acceptance limit was met for 83.0% and 96.6% of the samples, respectively.
Conclusions
VAMS sampling can replace WB sampling for tacrolimus trough concentration monitoring, but VAMS sampling is currently inferior to DBS sampling, both regarding sample quality and agreement with WB tacrolimus concentrations.
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Affiliation(s)
- Herman Veenhof
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands
| | - Remco A. Koster
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands
- PRA Health Sciences, Bioanalytical Laboratory , Assen , The Netherlands
| | - Lenneke A.T. Junier
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands
| | - Stefan P. Berger
- University of Groningen , Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Stephan J.L. Bakker
- University of Groningen , Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Daan J. Touw
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , PO Box 30.001, 9700 RB Groningen , The Netherlands
- University of Groningen , Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands , Phone: +31 503614071, Fax: +31 503612417
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32
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Sotomayor CG, Minović I, Eggersdorfer ML, Riphagen IJ, de Borst MH, Dekker LH, Nolte IM, Frank J, van Zon SK, Reijneveld SA, van der Molen JC, Vos MJ, Kootstra-Ros JE, Rodrigo R, Kema IP, Navis GJ, Bakker SJ. Duality of Tocopherol Isoforms and Novel Associations with Vitamins Involved in One-Carbon Metabolism: Results from an Elderly Sample of the LifeLines Cohort Study. Nutrients 2020; 12:nu12020580. [PMID: 32102191 PMCID: PMC7071362 DOI: 10.3390/nu12020580] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022] Open
Abstract
Whether the affinity of serum vitamin E with total lipids hampers the appropriate assessment of its association with age-related risk factors has not been investigated in epidemiological studies. We aimed to compare linear regression-derived coefficients of the association of non-indexed and total lipids-indexed vitamin E isoforms with clinical and laboratory characteristics pertaining to the lipid, metabolic syndrome, and one-carbon metabolism biological domains. We studied 1429 elderly subjects (non-vitamin supplement users, 60-75 years old, with low and high socioeconomic status) from the population-based LifeLines Cohort and Biobank Study. We found that the associations of tocopherol isoforms with lipids were inverted in total lipids-indexed analyses, which may be indicative of overcorrection. Irrespective of the methods of standardization, we consistently found positive associations of α-tocopherol with vitamins of the one-carbon metabolism pathway and inverse associations with characteristics related to glucose metabolism. The associations of γ-tocopherol were often opposite to those of α-tocopherol. These data suggest that tocopherol isoforms and one-carbon metabolism are related, with beneficial and adverse associations for α-tocopherol and γ-tocopherol, respectively. Whether tocopherol isoforms, or their interplay, truly affect the one-carbon metabolism pathway remains to be further studied.
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Affiliation(s)
- Camilo G. Sotomayor
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.L.E.); (M.H.d.B.); (L.H.D.); (G.J.N.)
- Correspondence: ; Tel.: +31-050-361-0881
| | - Isidor Minović
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (I.M.); (I.J.R.); (J.C.v.d.M.); (M.J.V.); (J.E.K.-R.); (I.P.K.)
| | - Manfred L. Eggersdorfer
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.L.E.); (M.H.d.B.); (L.H.D.); (G.J.N.)
| | - Ineke J. Riphagen
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (I.M.); (I.J.R.); (J.C.v.d.M.); (M.J.V.); (J.E.K.-R.); (I.P.K.)
| | - Martin H. de Borst
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.L.E.); (M.H.d.B.); (L.H.D.); (G.J.N.)
| | - Louise H. Dekker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.L.E.); (M.H.d.B.); (L.H.D.); (G.J.N.)
| | - Ilja M. Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany;
| | - Sander K.R. van Zon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands (S.A.R.)
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands (S.A.R.)
| | - Jan C. van der Molen
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (I.M.); (I.J.R.); (J.C.v.d.M.); (M.J.V.); (J.E.K.-R.); (I.P.K.)
| | - Michel J. Vos
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (I.M.); (I.J.R.); (J.C.v.d.M.); (M.J.V.); (J.E.K.-R.); (I.P.K.)
| | - Jenny E. Kootstra-Ros
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (I.M.); (I.J.R.); (J.C.v.d.M.); (M.J.V.); (J.E.K.-R.); (I.P.K.)
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago CP 8380453, Chile;
| | - Ido P. Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (I.M.); (I.J.R.); (J.C.v.d.M.); (M.J.V.); (J.E.K.-R.); (I.P.K.)
| | - Gerjan J. Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.L.E.); (M.H.d.B.); (L.H.D.); (G.J.N.)
| | - Stephan J.L. Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.L.E.); (M.H.d.B.); (L.H.D.); (G.J.N.)
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Swarte JC, Douwes RM, Hu S, Vich Vila A, Eisenga MF, van Londen M, Gomes-Neto AW, Weersma RK, Harmsen HJ, Bakker SJ. Characteristics and Dysbiosis of the Gut Microbiome in Renal Transplant Recipients. J Clin Med 2020; 9:E386. [PMID: 32024079 PMCID: PMC7074359 DOI: 10.3390/jcm9020386] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 12/30/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
Renal transplantation is life-changing in many aspects. This includes changes to the gut microbiome likely due to exposure to immunosuppressive drugs and antibiotics. As a consequence, renal transplant recipients (RTRs) might suffer from intestinal dysbiosis. We aimed to investigate the gut microbiome of RTRs and compare it with healthy controls and to identify determinants of the gut microbiome of RTRs. Therefore, RTRs and healthy controls participating in the TransplantLines Biobank and Cohort Study (NCT03272841) were included. We analyzed the gut microbiome using 16S rRNA sequencing and compared the composition of the gut microbiome of RTRs to healthy controls using multivariate association with linear models (MaAsLin). Fecal samples of 139 RTRs (50% male, mean age: 58.3 ± 12.8 years) and 105 healthy controls (57% male, mean age: 59.2 ± 10.6 years) were collected. Median time after transplantation of RTRs was 6.0 (1.5-12.5)years. The microbiome composition of RTRs was significantly different from that of healthy controls, and RTRs had a lower diversity of the gut microbiome (p < 0.01). Proton-pump inhibitors, mycophenolate mofetil, and estimated glomerular filtration rate (eGFR) are significant determinants of the gut microbiome of RTRs (p < 0.05). Use of mycophenolate mofetil correlated to a lower diversity (p < 0.01). Moreover, significant alterations were found in multiple bacterial taxa between RTRs and healthy controls. The gut microbiome of RTRs contained more Proteobacteria and less Actinobacteria, and there was a loss of butyrate-producing bacteria in the gut microbiome of RTRs. By comparing the gut microbiome of RTRs to healthy controls we have shown that RTRs suffer from dysbiosis, a disruption in the balance of the gut microbiome.
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Affiliation(s)
- J. Casper Swarte
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Rianne M. Douwes
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Shixian Hu
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Arnau Vich Vila
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Michele F. Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - António W. Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Hermie J.M. Harmsen
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
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van den Berg EH, Gruppen EG, Blokzijl H, Bakker SJ, Dullaart RP. Higher Sodium Intake Assessed by 24 Hour Urinary Sodium Excretion Is Associated with Non-Alcoholic Fatty Liver Disease: The PREVEND Cohort Study. J Clin Med 2019; 8:jcm8122157. [PMID: 31817623 PMCID: PMC6947413 DOI: 10.3390/jcm8122157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/29/2019] [Revised: 11/30/2019] [Accepted: 12/04/2019] [Indexed: 01/05/2023] Open
Abstract
A higher sodium intake is conceivably associated with insulin resistant conditions like obesity, but associations of non-alcoholic fatty liver disease (NAFLD) with a higher sodium intake determined by 24 hours (24 h) urine collections are still unclear. Dietary sodium intake was measured by sodium excretion in two complete consecutive 24 h urine collections in 6132 participants of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort. Fatty Liver Index (FLI) ≥60 and Hepatic Steatosis Index (HSI) >36 were used as proxies of suspected NAFLD. 1936 (31.6%) participants had an FLI ≥60, coinciding with the increased prevalence of type 2 diabetes (T2D), metabolic syndrome, hypertension and history of cardiovascular disease. Sodium intake was higher in participants with an FLI ≥60 (163.63 ± 61.81 mmol/24 h vs. 136.76 ± 50.90 mmol/24 h, p < 0.001), with increasing incidence in ascending quartile categories of sodium intake (p < 0.001). Multivariably, an FLI ≥60 was positively associated with a higher sodium intake when taking account for T2D, a positive cardiovascular history, hypertension, alcohol intake, smoking and medication use (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.44–1.64, p < 0.001). Additional adjustment for the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) diminished this association (OR 1.30, 95% CI 1.21–1.41, p < 0.001). HSI >36 showed similar results. Associations remained essentially unaltered after adjustment for body surface area or waist/hip ratio. In conclusion, suspected NAFLD is a feature of higher sodium intake. Insulin resistance-related processes may contribute to the association of NAFLD with sodium intake.
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Affiliation(s)
- Eline H. van den Berg
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands; (E.G.G.)
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-50-3616161
| | - Eke G. Gruppen
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands; (E.G.G.)
- Department of Nephrology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands;
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands;
| | - Stephan J.L. Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands;
| | - Robin P.F. Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands; (E.G.G.)
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Gacitúa TA, Sotomayor CG, Groothof D, Eisenga MF, Pol RA, de Borst MH, Gans RO, Berger SP, Rodrigo R, Navis GJ, Bakker SJ. Plasma Vitamin C and Cancer Mortality in Kidney Transplant Recipients. J Clin Med 2019; 8:E2064. [PMID: 31771233 PMCID: PMC6947225 DOI: 10.3390/jcm8122064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023] Open
Abstract
There is a changing trend in mortality causes in kidney transplant recipients (KTR), with a decline in deaths due to cardiovascular causes along with a relative increase in cancer mortality rates. Vitamin C, a well-known antioxidant with anti-inflammatory and immune system enhancement properties, could offer protection against cancer. We aimed to investigate the association of plasma vitamin C with long-term cancer mortality in a cohort of stable outpatient KTR without history of malignancies other than cured skin cancer. Primary and secondary endpoints were cancer and cardiovascular mortality, respectively. We included 598 KTR (mean age 51 ± 12 years old, 55% male). Mean (SD) plasma vitamin C was 44 ± 20 μmol/L. At a median follow-up of 7.0 (IQR, 6.2-7.5) years, 131 patients died, of which 24% deaths were due to cancer. In Cox proportional hazards regression analyses, vitamin C was inversely associated with cancer mortality (HR 0.50; 95%CI 0.34-0.74; P < 0.001), independent of potential confounders, including age, smoking status and immunosuppressive therapy. In secondary analyses, vitamin C was not associated with cardiovascular mortality (HR 1.16; 95%CI 0.83-1.62; P = 0.40). In conclusion, plasma vitamin C is inversely associated with cancer mortality risk in KTR. These findings underscore that relatively low circulating plasma vitamin C may be a meaningful as yet overlooked modifiable risk factor of cancer mortality in KTR.
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Affiliation(s)
- Tomás A. Gacitúa
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Camilo G. Sotomayor
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Dion Groothof
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Michele F. Eisenga
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Robert A. Pol
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Martin H. de Borst
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Rijk O.B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Stefan P. Berger
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, CP 8380453 Santiago, Chile;
| | - Gerjan J. Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
| | - Stephan J.L. Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (T.A.G.); (D.G.); (M.F.E.); (M.H.d.B.); (S.P.B.); (G.J.N.)
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Ebtehaj S, Gruppen EG, Bakker SJ, Dullaart RP, Tietge UJ. HDL (High-Density Lipoprotein) Cholesterol Efflux Capacity Is Associated With Incident Cardiovascular Disease in the General Population. Arterioscler Thromb Vasc Biol 2019; 39:1874-1883. [DOI: 10.1161/atvbaha.119.312645] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective:
Focus is shifting from HDL-C (high-density lipoprotein cholesterol) as predictive biomarker for cardiovascular disease (CVD) towards antiatherogenic HDL functionalities. Still, limited data exist on the prospective association of HDL function metrics with CVD events. The current work aimed to determine, if baseline HDL-C efflux capacity (CEC) is associated with future CVD events in the general population.
Approach and Results:
We performed a prospective study among participants of the PREVEND (Prevention of Renal and Vascular End-stage Disease) cohort (follow-up, 12 years). From the overall n=8592 subjects 325 with previous CVD events were excluded; of the remaining 8267 eligible participants all subjects with new CVD events during follow-up were selected and individually matched to controls for age, sex, smoking status, and HDL-C levels. CEC at baseline was quantified using human THP-1-derived macrophage foam cells and apolipoprotein B-depleted plasma. Despite identical HDL-C and apoA (apolipoprotein)-I levels between cases (n=351) and controls (n=354) CEC was significantly lower in cases (0.93±0.29 versus 1.01±0.24 arbitrary units;
P
<0.001). In all subjects combined, CEC correlated positively with HDL-C and apoA-I and negatively with body mass index, hsCRP (high-sensitivity C-reactive protein), and urinary albumin excretion. CEC was inversely associated with incident CVD events, both expressed per quartile and per 1 SD change (odds ratio, 0.73; 95% CI, 0.62–0.86;
P
<0.001); this association remained significant after adjustments for HDL-C, hsCRP, kidney function, and several other clinical covariates.
Conclusions:
Combined these data demonstrate that in the general population baseline CEC is significantly associated with the future development of CVD events independent of HDL-C and apoA-I plasma levels.
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Affiliation(s)
- Sanam Ebtehaj
- From the Department of Pediatrics (S.E., U.J.F.T.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Eke G. Gruppen
- Department of Endocrinology (E.G.G., R.P.F.D.), University of Groningen, University Medical Center Groningen, the Netherlands
- Department of Nephrology (E.G.G., S.J.L.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Stephan J.L. Bakker
- Department of Nephrology (E.G.G., S.J.L.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Robin P.F. Dullaart
- Department of Endocrinology (E.G.G., R.P.F.D.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Uwe J.F. Tietge
- From the Department of Pediatrics (S.E., U.J.F.T.), University of Groningen, University Medical Center Groningen, the Netherlands
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden (U.J.F.T.)
- Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Sweden (U.J.F.T.)
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Stapleton CP, Heinzel A, Guan W, van der Most PJ, van Setten J, Lord GM, Keating BJ, Israni AK, de Borst MH, Bakker SJ, Snieder H, Weale ME, Delaney F, Hernandez‐Fuentes MP, Reindl-Schwaighofer R, Oberbauer R, Jacobson PA, Mark PB, Chapman FA, Phelan PJ, Kennedy C, Sexton D, Murray S, Jardine A, Traynor JP, McKnight AJ, Maxwell AP, Smyth LJ, Oetting WS, Matas AJ, Mannon RB, Schladt DP, Iklé DN, Cavalleri GL, Conlon PJ. The impact of donor and recipient common clinical and genetic variation on estimated glomerular filtration rate in a European renal transplant population. Am J Transplant 2019; 19:2262-2273. [PMID: 30920136 PMCID: PMC6989089 DOI: 10.1111/ajt.15326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/22/2019] [Accepted: 02/11/2019] [Indexed: 01/25/2023]
Abstract
Genetic variation across the human leukocyte antigen loci is known to influence renal-transplant outcome. However, the impact of genetic variation beyond the human leukocyte antigen loci is less clear. We tested the association of common genetic variation and clinical characteristics, from both the donor and recipient, with posttransplant eGFR at different time-points, out to 5 years posttransplantation. We conducted GWAS meta-analyses across 10 844 donors and recipients from five European ancestry cohorts. We also analyzed the impact of polygenic risk scores (PRS), calculated using genetic variants associated with nontransplant eGFR, on posttransplant eGFR. PRS calculated using the recipient genotype alone, as well as combined donor and recipient genotypes were significantly associated with eGFR at 1-year posttransplant. Thirty-two percent of the variability in eGFR at 1-year posttransplant was explained by our model containing clinical covariates (including weights for death/graft-failure), principal components and combined donor-recipient PRS, with 0.3% contributed by the PRS. No individual genetic variant was significantly associated with eGFR posttransplant in the GWAS. This is the first study to examine PRS, composed of variants that impact kidney function in the general population, in a posttransplant context. Despite PRS being a significant predictor of eGFR posttransplant, the effect size of common genetic factors is limited compared to clinical variables.
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Affiliation(s)
- Caragh P. Stapleton
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andreas Heinzel
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Weihua Guan
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Peter J. van der Most
- Departments of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jessica van Setten
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Graham M. Lord
- King’s College London, MRC Centre for Transplantation, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’, NHS Foundation Trust and King’s College London, London, UK
| | - Brendan J. Keating
- Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ajay K. Israni
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Departments of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michael E. Weale
- Division of Genetics & Molecular Medicine, King’s College London, London, UK
| | - Florence Delaney
- King’s College London, MRC Centre for Transplantation, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’, NHS Foundation Trust and King’s College London, London, UK
| | | | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Pamala A. Jacobson
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, UK
| | - Fiona A. Chapman
- Institute of Cardiovascular and Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, UK
| | - Paul J. Phelan
- Department of Nephrology, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Claire Kennedy
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Donal Sexton
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Susan Murray
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Alan Jardine
- Institute of Cardiovascular and Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, UK
| | - Jamie P. Traynor
- Institute of Cardiovascular and Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, UK
| | | | | | - Laura J. Smyth
- Centre for Public Health, Queen’s University of Belfast, Belfast, UK
| | - William S. Oetting
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Arthur J. Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Roslyn B. Mannon
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | | | - Gianpiero L. Cavalleri
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter J. Conlon
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Oosterwijk MM, Soedamah-Muthu SS, Geleijnse JM, Bakker SJ, Navis G, Binnenmars SH, Gant CM, Laverman GD. High Dietary Intake of Vegetable Protein Is Associated With Lower Prevalence of Renal Function Impairment: Results of the Dutch DIALECT-1 Cohort. Kidney Int Rep 2019; 4:710-719. [PMID: 31080926 PMCID: PMC6506707 DOI: 10.1016/j.ekir.2019.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/31/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Dietary protein intake may influence development of renal function impairment in diabetes mellitus type 2 (T2DM). We assessed the association between sources of protein and prevalence of renal function impairment. METHODS Cross-sectional analyses were performed in baseline data of 420 patients of the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1) study. Protein intake was assessed using a Food Frequency Questionnaire, modified for accurate assessment of protein intake, including types and sources of protein. Renal function impairment was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2 (Chronic Kidney Disease Epidemiology Collaboration formula). RESULTS Among 420 patients with T2DM, 99 renal function impairment cases were identified. Multivariate Cox proportional hazard models were used and adjusted for the main lifestyle and dietary factors. The prevalence ratios in the fully adjusted model were 1 (reference), 0.74 (95% confidence interval [CI]: 0.44-1.27; P = 0.28) and 0.47 (95% CI: 0.23-0.98; P = 0.04) according to increasing tertiles of vegetable protein intake. For animal protein intake the prevalence ratios were 1 (reference), 1.10 (95% CI: 0.64-1.88; P = 0.74) and 1.06 (95% CI: 0.56-1.99; P = 0.87) according to increasing tertiles of intake. Theoretical replacement models showed that replacing 3 energy percent from animal protein by vegetable protein lowered the prevalence ratio for the association with renal function impairment to 0.20 (95% CI: 0.06-0.63; P = 0.01). CONCLUSION In conclusion, we found that higher intake of vegetable protein was associated with a lower prevalence of renal function impairment, and theoretical replacement of animal protein with vegetable protein was inversely associated with renal function impairment among patients with T2DM.
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Affiliation(s)
- Milou M. Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Sabita S. Soedamah-Muthu
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Institute for Food, Nutrition and Health, University of Reading, Reading, UK
| | | | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S. Heleen Binnenmars
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christina M. Gant
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gozewijn D. Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Veenhof H, Koster RA, Alffenaar JWC, van den Berg AP, de Groot MR, Verschuuren EA, Berger SP, Bakker SJ, Touw DJ. Clinical application of a dried blood spot assay for sirolimus and everolimus in transplant patients. ACTA ACUST UNITED AC 2019; 57:1854-1862. [DOI: 10.1515/cclm-2019-0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/08/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Monitoring of immunosuppressive drugs such as everolimus and sirolimus is important in allograft rejection prevention in transplant patients. Dried blood spots (DBS) sampling gives patients the opportunity to sample a drop of blood from a fingerprick at home, which can be sent to the laboratory by mail.
Methods
A total of 39 sirolimus and 44 everolimus paired fingerprick DBS and whole blood (WB) samples were obtained from 60 adult transplant patients for method comparison using Passing-Bablok regression. Bias was assessed using Bland-Altman. Two validation limits were pre-defined: limits of analytical acceptance were set at >67% of all paired samples within 20% of the mean of both samples and limits of clinical relevance were set in a multidisciplinary team at >80% of all paired samples within 15% of the mean of both samples.
Results
For both sirolimus and everolimus, Passing-Bablok regression showed no differences between WB and DBS with slopes of 0.86 (95% CI slope, 0.72–1.02) and 0.96 (95% CI 0.84–1.06), respectively. Only everolimus showed a significant constant bias of 4%. For both sirolimus and everolimus, limits of analytical acceptance were met (76.9% and 81.8%, respectively), but limits or clinical relevance were not met (77.3% and 61.5%, respectively).
Conclusions
Because pre-defined limits of clinical relevance were not met, this DBS sampling method for sirolimus and everolimus cannot replace WB sampling in our center at this time. However, if the clinical setting is compatible with less strict limits for clinical relevance, this DBS method is suitable for clinical application.
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Affiliation(s)
- Herman Veenhof
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Remco A. Koster
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
- PRA Health Sciences , Bioanalytical Laboratory , Assen , The Netherlands
| | - Jan-Willem C. Alffenaar
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Aad P. van den Berg
- Department of Gastroenterology and Hepatology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Marco R. de Groot
- Department of Hematology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Erik A.M. Verschuuren
- Department of Pulmonology and Tuberculosis , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Stefan P. Berger
- Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
- Department of Pharmacy, Section Pharmacokinetics, Toxicology and Targeting , University of Groningen , Groningen , The Netherlands , Phone: +31 503614071, Fax: +31 503612417
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Messchendorp AL, van Londen M, Taylor JM, de Borst MH, Navis G, Casteleijn NF, Gaillard CA, Bakker SJ, Gansevoort RT. Kidney Function Reserve Capacity in Early and Later Stage Autosomal Dominant Polycystic Kidney Disease. Clin J Am Soc Nephrol 2018; 13:1680-1692. [PMID: 30254028 PMCID: PMC6237049 DOI: 10.2215/cjn.03650318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES It is assumed that in autosomal dominant polycystic kidney disease (ADPKD), kidney function remains in the normal range for several decades because of hyperfiltration of remnant nephrons. In this study, we investigate the extent to which patients with ADPKD hyperfilter. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this cross-sectional study, we measured GFR as urinary clearance using continuous infusion of 125I-iothalamate. Kidney function reserve capacity was determined as increase in measured GFR after adding a dopamine infusion of 4.4-6 mg/h. Potential kidney donors were used as healthy controls and matched by age and sex to patients with ADPKD for comparisons across age groups and CKD stages. Hyperfiltration was defined by a loss of kidney function reserve capacity compared with healthy controls. RESULTS A total of 300 participants were studied. In the youngest age group (18-29 years), measured GFR was not different between patients with ADPKD and healthy controls (103±21 versus 111±9 ml/min per 1.73 m2; P=0.14). In this age group kidney function reserve capacity was higher compared with healthy controls (11.1%±8.3% versus 5.3%±6.5%; P=0.04). Moreover, kidney function reserve capacity was similar to healthy controls in patients with ADPKD with early-stage disease (eGFR≥60 ml/min per 1.73 m2), either overall or when divided into fast or slow progressors according to their Mayo height-adjusted total kidney volume class. However, in patients with ADPKD, lower measured GFR was associated with lower kidney function reserve capacity (β=1.0 [95% confidence interval, 0.5 to 1.5] % per 10 ml/min per 1.73 m2; P<0.001). Kidney function reserve capacity was therefore lower compared with healthy controls at older age and later CKD stages. CONCLUSIONS Patients with early-stage ADPKD, either classified as having rapidly or slowly progressive disease, are able to increase their GFR in response to dopamine. Hyperfiltration, defined by a loss of kidney function reserve capacity, may therefore not be an early phenomenon in ADPKD.
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Affiliation(s)
| | | | | | | | | | - Niek F. Casteleijn
- Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Carlo A.J.M. Gaillard
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | | | | | - on behalf of the DIPAK Consortium
- Departments of Nephrology and
- Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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Corsetti JP, Love TM, Sparks CE, Bakker SJ, Dullaart RP. Insulin resistance involvement in prevalence of familial dysbetalipoproteinemia in ε2ε2 subjects by Bayesian network modeling. Clin Biochem 2018; 59:31-36. [DOI: 10.1016/j.clinbiochem.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
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El Boustany R, Tasevska I, Meijer E, Kieneker LM, Enhörning S, Lefèvre G, Mohammedi K, Marre M, Fumeron F, Balkau B, Bouby N, Bankir L, Bakker SJ, Roussel R, Melander O, Gansevoort RT, Velho G. Plasma copeptin and chronic kidney disease risk in 3 European cohorts from the general population. JCI Insight 2018; 3:121479. [PMID: 29997293 PMCID: PMC6124520 DOI: 10.1172/jci.insight.121479] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 04/10/2018] [Accepted: 05/23/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) is increasing worldwide. The identification of factors contributing to its progression is important for designing preventive measures. Previous studies have suggested that chronically high vasopressin is deleterious to renal function. Here, we evaluated the association of plasma copeptin, a surrogate of vasopressin, with the incidence of CKD in the general population. METHODS We studied 3 European cohorts: DESIR (n = 5,047; France), MDCS-CC (n = 3,643; Sweden), and PREVEND (n = 7,684; the Netherlands). Median follow-up was 8.5, 16.5, and 11.3 years, respectively. Pooled data were analyzed at an individual level for 4 endpoints during follow-up: incidence of stage 3 CKD (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m2); the KDIGO criterion "certain drop in eGFR"; rapid kidney function decline (eGFR slope steeper than -3 ml/min/1.73 m2/yr); and incidence of microalbuminuria. RESULTS The upper tertile of plasma copeptin was significantly and independently associated with a 49% higher risk for stage 3 CKD (P < 0.0001); a 64% higher risk for kidney function decline, as defined by the KDIGO criterion (P < 0.0001); a 79% higher risk for rapid kidney function decline (P < 0.0001); and a 24% higher risk for microalbuminuria (P = 0.008). CONCLUSIONS High copeptin levels are associated with the development and the progression of CKD in the general population. Intervention studies are needed to assess the potential beneficial effect on kidney health in the general population of reducing vasopressin secretion or action. FUNDING INSERM and Danone Research Centre for Specialized Nutrition.
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Affiliation(s)
- Ray El Boustany
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- Danone Nutricia Research, Palaiseau, France
| | - Irina Tasevska
- Departments of Internal Medicine and Clinical Sciences, Lund University, Malmö, Sweden
| | - Esther Meijer
- Department of Internal Medicine, University Medical Center, Division of Nephrology, University of Groningen, Groningen, Netherlands
| | - Lyanne M. Kieneker
- Department of Internal Medicine, University Medical Center, Division of Nephrology, University of Groningen, Groningen, Netherlands
| | - Sofia Enhörning
- Departments of Internal Medicine and Clinical Sciences, Lund University, Malmö, Sweden
| | - Guillaume Lefèvre
- Service de Biochimie et Hormonologie, Assistance Publique — Hôpitaux de Paris, Hôpitaux Universitaires Est Parisien–Tenon, Paris, France
| | - Kamel Mohammedi
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, DHU Fire, Assistance Publique — Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Michel Marre
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, DHU Fire, Assistance Publique — Hôpitaux de Paris, Bichat Hospital, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Frédéric Fumeron
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Beverley Balkau
- Inserm Research Unit 1018, Center for Research in Epidemiology and Population Health, Villejuif, France
- Université Paris Sud, Villejuif, France
| | - Nadine Bouby
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Lise Bankir
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- UPMC University Paris 6, Sorbonne Universités, Paris, France
| | - Stephan J.L. Bakker
- Department of Internal Medicine, University Medical Center, Division of Nephrology, University of Groningen, Groningen, Netherlands
| | - Ronan Roussel
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Diabetology, Endocrinology and Nutrition, DHU Fire, Assistance Publique — Hôpitaux de Paris, Bichat Hospital, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Olle Melander
- Departments of Internal Medicine and Clinical Sciences, Lund University, Malmö, Sweden
| | - Ron T. Gansevoort
- Department of Internal Medicine, University Medical Center, Division of Nephrology, University of Groningen, Groningen, Netherlands
| | - Gilberto Velho
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
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Schutten JC, Joosten MM, de Borst MH, Bakker SJ. Magnesium and Blood Pressure: A Physiology-Based Approach. Adv Chronic Kidney Dis 2018; 25:244-250. [PMID: 29793663 DOI: 10.1053/j.ackd.2017.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022]
Abstract
Hypertension is an important public health challenge because of its high prevalence and strong association with cardiovascular disease and premature death. Hypertension is a major cause of CKD, is present in more than 80% of CKD patients, and contributes to CKD progression. Risk factors for hypertension include, but are not limited to, age, race, family history, obesity, physical inactivity, tobacco use, and inadequate intake of minerals such as calcium, potassium, and magnesium. Magnesium is the second most abundant intracellular cation in the human body and plays an important role in insulin and adenosine triphosphate metabolism. Low dietary magnesium intake has been associated with an increased risk of developing hypertension in prospective cohort studies. Moreover, clinical trials suggest that magnesium supplementation has blood pressure-lowering effects. In addition, emerging data reveal potential mechanisms by which magnesium may influence blood pressure. Here, we will review these mechanisms, using a physiology-based approach, focusing on the effects of magnesium on total peripheral resistance and cardiac output.
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Corsetti JP, Sparks CE, Bakker SJ, Gruppen EG, Dullaart RP. Roles of high apolipoprotein E blood levels and HDL in development of familial dysbetalipoproteinemia in ε2ε2 subjects. Clin Biochem 2018; 52:67-72. [DOI: 10.1016/j.clinbiochem.2017.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
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Joris PJ, Plat J, Bakker SJ, Mensink RP. Effects of long-term magnesium supplementation on endothelial function and cardiometabolic risk markers in overweight/obese adults: A randomized, double-blind, placebo-controlled intervention trial. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.526] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zelle DM, Klaassen G, van Adrichem E, Bakker SJ, Corpeleijn E, Navis G. Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol 2017; 13:152-168. [DOI: 10.1038/nrneph.2016.187] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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de Vries LV, Dobrowolski LC, van den Bosch JJ, Riphagen IJ, Krediet CP, Bemelman FJ, Bakker SJ, Navis G. Effects of Dietary Sodium Restriction in Kidney Transplant Recipients Treated With Renin-Angiotensin-Aldosterone System Blockade: A Randomized Clinical Trial. Am J Kidney Dis 2016; 67:936-44. [DOI: 10.1053/j.ajkd.2015.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/30/2015] [Indexed: 01/13/2023]
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de Jong MA, van Roon AM, Bakker JT, Kersten W, Kamphuisen PW, Gansevoort RT, Bakker SJ, de Borst MH. SP284ARTERIAL STIFFNESS CALCULATED FROM PERIPHERAL ARTERIAL PULSE PRESSURE IS INDEPENDENTLY ASSOCIATED WITH ALL-CAUSE MORTALITY IN THE GENERAL POPULATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw165.01] [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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van den Born JC, Frenay ARS, Bakker SJ, Pasch A, Hillebrands JL, Lambers Heerspink HJ, van Goor H. High urinary sulfate concentration is associated with reduced risk of renal disease progression in type 2 diabetes. Nitric Oxide 2016; 55-56:18-24. [DOI: 10.1016/j.niox.2016.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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Hendriks SH, van Dijk PR, van Hateren KJ, van Pelt JL, Groenier KH, Bilo HJ, Bakker SJ, Landman GW, Kleefstra N. High-sensitive troponin T is associated with all-cause and cardiovascular mortality in stable outpatients with type 2 diabetes (ZODIAC-37). Am Heart J 2016; 174:43-50. [PMID: 26995369 DOI: 10.1016/j.ahj.2015.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to investigate whether high-sensitive cardiac troponin T (hs-cTnT) is associated with all-cause and cardiovascular mortality in stable type 2 diabetes (T2D) outpatients treated in primary care. METHODS Cardiac troponin T was measured with a high-sensitive assay at baseline in patients with T2D participating in the observational ZODIAC study. Cox proportional hazards models were used to investigate the relationship between hs-cTnT and mortality with adjustment for selected confounders. Risk prediction capabilities of hs-cTnT were assessed with Harrell C statistics. RESULTS Complete baseline data were available for 1,133 patients. During median follow-up of 11 (7-14) years, 513 (45%) patients died, of which 218 (42%) died of cardiovascular causes. Of the patients with undetectable hs-cTnT levels (<3 ng/L), only 23% died, compared with 58% with low detectable levels (3-14 ng/L) and 84% with raised levels (≥14 ng/L). Natural log hs-cTnT was significantly associated with all-cause mortality (hazard ratio 1.30, 95% CI 1.19-1.42) and cardiovascular mortality (hazard ratio 1.33, 95% CI 1.15-1.53), independent of potential confounders. The Harrell C statistic for the crude model of hs-cTnT was 0.72 (95% CI 0.70-0.75) for all-cause mortality and 0.74 (95% CI 0.71-0.77) for cardiovascular mortality. CONCLUSIONS Higher levels of hs-cTnT are associated with mortality in stable outpatients with T2D. The high crude Harrell C values and the excellent prognosis of patients with undetectable levels illustrate the strength of hs-cTnT as a potential marker for mortality.
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