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Chen S, Zhou Y, Liang G, Wu W, Huang Z, Shi L, Gao Y, Gu X, Wang D. Predictive effect of estimated glomerular filtrate rate by creatinine or cystatin C on mortality in patients with coronary artery disease. Ren Fail 2024; 46:2327494. [PMID: 38566467 PMCID: PMC10993740 DOI: 10.1080/0886022x.2024.2327494] [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: 11/01/2023] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Renal dysfunction leads to poor prognosis of patients with coronary artery disease (CAD). Current studies have reported the prognosis or mortality of various diseases using different estimated glomerular filtrate rate (eGFR) formulas, while the performance of these equations is unclear in CAD patients. We aim to evaluate the predict effect of creatinine-based eGFR (eGFRcr), cystatin C-based eGFR (eGFRcys), and both creatinine and cystatin C-based eGFR (eGFRcr-cys) in CAD patients. METHODS A total of 23,178 patients with CAD were included from CIN-II cohort study. The association of eGFRcr, eGFRcys and eGFRcr-cys with cardiovascular and all-cause mortality was detected by Cox regression analysis. The predictive effect of eGFRcr, eGFRcys and eGFRcr-cys on mortality was assessed. RESULTS During a median follow up of 4.3 years, totally 2051 patients (8.8%) experience all-cause mortality, of which 1427 patients (6.2%) died of cardiovascular disease. For the detection of cardiovascular mortality among CAD patients, eGFRcr-cys had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.730, which was significantly better than eGFRcr (AUC = 0.707, p < 0.001) and eGFRcys (AUC = 0.719, p < 0.001). Similar results were observed in all-cause mortality. Restricted cubic spline showed a U-shaped association between eGFRcr and all outcomes in patients with both reduced and supranormal eGFR levels, while a L-shaped association in eGFRcys and eGFRcr-cys. CONCLUSIONS Estimated GFR based on both creatinine and cystatin C has highest predictive effect for cardiovascular and all-cause mortality among CAD patients. Meanwhile, supranormal eGFRcr may indicate a higher risk of mortality.
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Affiliation(s)
- Shiqun Chen
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Yang Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Southern Medical University, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guoxiao Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Southern Medical University, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Medical University, Dongguan, China
| | - Wanying Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Southern Medical University, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Lile Shi
- Zhuhai People’s Hospital, Zhuhai hospital affiliated with Jinan University, Zhuhai, China
| | - Yuwei Gao
- Zhuhai People’s Hospital, Zhuhai hospital affiliated with Jinan University, Zhuhai, China
- Zhuhai People’s hospital, Jinan university, Zhuhai, China
| | - Xia Gu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang, China
- Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Dongmei Wang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cadres Health Management Center, Guangzhou, China
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Huang J, Li H, Yang X, Qian C, Wei Y, Sun M. The relationship between dietary inflammatory index (DII) and early renal injury in population with/without hypertension: analysis of the National health and nutrition examination survey 2001-2002. Ren Fail 2024; 46:2294155. [PMID: 38178375 PMCID: PMC10773634 DOI: 10.1080/0886022x.2023.2294155] [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: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Inflammation plays a crucial role in occurrence of kidney injury, and specific dietary patterns can influence systemic inflammation levels. However, the relationship between dietary inflammatory potential and early-stage kidney damage remains unclear. METHOD 2,108 participants was recruited from 2001-2002 National Health and Nutrition Examination Survey (NHANES). Dietary Inflammatory Index (DII) is utilized to assess dietary inflammatory potential, calculated through a 24-h dietary recall questionnaire. Early renal injury was evaluated using urinary albumin to creatinine (UACR), cystatin C (CysC), β-2 microglobulin (β2M), and estimated glomerular filtration rate (eGFR) based on serum creatinine (eGFRs), cystatin C (eGFRc), and both Scr and CysC (eGFRs&c). Participant characteristics were analyzed, and association between DII, hypertension, and early renal injury markers was explored using multiple linear and logistic regression models. RESULTS The average age of participants was 53.9 years. DII exhibited a positive correlation with UACR (β = -0.048[0.017,0.078]), β2M (β = 0.019[0.010,0.027]), CysC (β = 0.012 [0.004,0.021]). Conversely, a negative correlation was observed between DII and eGFRc (β = -1.126[-1.554, -0.699]), eGFRs&c (β=-1.101[-1.653, -0.549]). A significant association was observed between hypertension and abnormality of early kidney damage markers. Subgroup analysis reveals that the positive correlation between DII and the occurrence of abnormal markers of early kidney damage is only observed in individuals with hypertension. Furthermore, an interaction between DII and hypertension was detected in eGFRs&c (OR:1.250[1.042, 1.499], p for interaction = 0.03). CONCLUSION Higher levels of DII may be associated with occurrence of early kidney damage. For individuals with hypertension, avoiding excessive consumption of pro-inflammatory foods may reduce the risk of renal injury.
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Affiliation(s)
- Jingda Huang
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Huimin Li
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Xu Yang
- Department of Neurology, People’s hospital of Jilin province, Changchun, China
| | - Chuyue Qian
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Yihui Wei
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Mindan Sun
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
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Lees JS, Fabian J, Shlipak MG. Cystatin C should be routinely available for estimating kidney function. Curr Opin Nephrol Hypertens 2024; 33:337-343. [PMID: 38411195 DOI: 10.1097/mnh.0000000000000980] [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] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW In this report, we summarize why the availability of cystatin C is important across a variety of clinical scenarios, the recent literature on when, why and in whom cystatin C testing should be considered, and how nephrologists can take practical steps to incorporate cystatin C testing into their practice. RECENT FINDINGS Large intra-individual discrepancies between estimated glomerular filtration rate by creatinine (eGFRcr) and estimated glomerular filtration rate by creatinine eGFRcys (known as eGFRdiff) are observed in at least 1 in 4 people. These differences are seen more commonly among more vulnerable individuals: older adults, females, non-White individuals and those living with multiple medical conditions. A large eGFRdiff, where eGFRcys is lower than eGFRcr, is associated with a plethora of adverse outcomes, including medication-associated adverse events, acute kidney injury, cardiovascular disease, kidney failure and all-cause mortality. Among studies that have measured GFR, eGFRcr-cys usually provides the most accurate estimation of kidney function compared to mGFR, including among participants with large discrepancies between eGFRcr and eGFRcys. SUMMARY Cystatin C improves sensitivity and specificity of chronic kidney disease diagnosis, improves detection of harmful acute and chronic changes in kidney function, improves precision of treatment eligibility and safety, and may reduce healthcare inequalities. Better education, curiosity, and motivation among nephrologists could substantially improve the availability and utilization of cystatin C.
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Affiliation(s)
- Jennifer S Lees
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, California, USA
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Bi S, Jiang Y, Guan G, Sun X, Wang X, Zhang L, Jing X. Prognostic Value of Myosteatosis and Creatinine-to- Cystatin C Ratio in Patients with Pancreatic Cancer Who Underwent Radical Surgery. Ann Surg Oncol 2024; 31:2913-2924. [PMID: 38319516 DOI: 10.1245/s10434-024-14969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Myosteatosis is correlated with poor prognosis in some malignancies. The creatinine-to-cystatin ratio (CCR) is revealed to predict gastric cancer prognosis. However, the prognostic abilities of CCR and the combination of CCR and myosteatosis in patients with pancreatic cancer (PC) who underwent radical surgery remains unclear. METHODS The retrospective cohort study included 215 patients with PC who underwent radical surgery (January 2016-October 2021). Clinicopathological and serological data were collected on admission. Myosteatosis and other body composition indices were assessed by using computed tomography. The cutoff value of CCR was determined by using the Youden index. Risk factors responsible for poor overall survival (OS) and disease-free survival (DFS) were determined by the Cox proportional hazards model. RESULTS The myosteatosis group included 104 patients (average age, 61.3 ± 9.1 years). The best cutoff value for CCR was 1.09. CCR ≤ 1.09 was an independent predictive biomarker inversely corelated with OS (P = 0.036). Myosteatosis was an independent risk factor associated with OS and DFS (P = 0.032 and P = 0.004, respectively). Patients with concomitant myosteatosis and CCR ≤ 1.09 had the worst OS (P = 0.016). CONCLUSIONS Myosteatosis and CCR are prognostic biomarkers for survival in PC patients who underwent radical surgery. Patients with the coexistence of myosteatosis and CCR ≤ 1.09 deserve more attention.
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Affiliation(s)
- Shenghua Bi
- Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yueping Jiang
- Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ge Guan
- Liver Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xueguo Sun
- Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaowei Wang
- Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lingyun Zhang
- Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xue Jing
- Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Zhou SP, Wang Q, Chen P, Zhai X, Zhao J, Bai X, Li L, Guo HP, Ning XY, Zhang XJ, Ye HY, Dong ZY, Chen XM, Wang HY. Assessment of the Added Value of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging in Identifying Non-Diabetic Renal Disease in Patients With Type 2 Diabetes Mellitus. J Magn Reson Imaging 2024; 59:1593-1602. [PMID: 37610209 DOI: 10.1002/jmri.28973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Identification of non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus (T2DM) may help tailor treatment. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is a promising tool to evaluate renal function but its potential role in the clinical differentiation between diabetic nephropathy (DN) and NDRD remains unclear. PURPOSE To investigate the added role of IVIM-DWI in the differential diagnosis between DN and NDRD in patients with T2DM. STUDY TYPE Prospective. POPULATION Sixty-three patients with T2DM (ages: 22-69 years, 17 females) confirmed by renal biopsy divided into two subgroups (28 DN and 35 NDRD). FIELD STRENGTH/SEQUENCE 3 T/ T2 weighted imaging (T2WI), and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). ASSESSMENT The parameters derived from IVIM-DWI (true diffusion coefficient [D], pseudo-diffusion coefficient [D*], and pseudo-diffusion fraction [f]) were calculated for the cortex and medulla, respectively. The clinical indexes related to renal function (eg cystatin C, etc.) and diabetes (eg diabetic retinopathy [DR], fasting blood glucose, etc.) were measured and calculated within 1 week before MRI scanning. The clinical model based on clinical indexes and the IVIM-based model based on IVIM parameters and clinical indexes were established and evaluated, respectively. STATISTICAL TESTS Student's t-test; Mann-Whitney U test; Fisher's exact test; Chi-squared test; Intraclass correlation coefficient; Receiver operating characteristic analysis; Hosmer-Lemeshow test; DeLong's test. P < 0.05 was considered statistically significant. RESULTS The cortex D*, DR, and cystatin C values were identified as independent predictors of NDRD in multivariable analysis. The IVIM-based model, comprising DR, cystatin C, and cortex D*, significantly outperformed the clinical model containing only DR, and cystatin C (AUC = 0.934, 0.845, respectively). DATA CONCLUSION The IVIM parameters, especially the renal cortex D* value, might serve as novel indicators in the differential diagnosis between DN and NDRD in patients with T2DM. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Shao-Peng Zhou
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xue Zhai
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Zhao
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xu Bai
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Li
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
| | - Hui-Ping Guo
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xue-Yi Ning
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Jing Zhang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hui-Yi Ye
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhe-Yi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Hai-Yi Wang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Bi S, Jing X. ASO Author Reflections: Impact of Myosteatosis and Creatinine-to- Cystatin C Ratio on Prognosis After Pancreatic Radical Surgery. Ann Surg Oncol 2024; 31:2963-2964. [PMID: 38334850 DOI: 10.1245/s10434-024-15026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Shenghua Bi
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xue Jing
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Won MH, Yun KH, Kim H, Son YJ. Prognostic role of sarcopenia on major adverse cardiac events among patients who underwent successful percutaneous coronary intervention: a retrospective cohort study. Eur J Cardiovasc Nurs 2024; 23:287-295. [PMID: 37579073 DOI: 10.1093/eurjcn/zvad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
AIMS We investigated the prevalence of sarcopenia and its influence on 1-year major adverse cardiac events (MACEs) in patients after successful percutaneous coronary intervention (PCI). METHODS AND RESULTS This retrospective medical record review using purposive sampling was conducted at a tertiary care university hospital in Korea. Medical records of a total of 303 patients (≥40 years) who underwent successful PCI between January 2014 and December 2020 were analysed. We retrospectively assessed sarcopenia at initial admission. Sarcopenia was assessed by a sarcopenia index based on a ratio of serum creatinine to serum cystatin C. MACE rates were evaluated within l year after PCI. A Kaplan-Meier analysis with a log-rank test was performed to compare the time with 1-year MACE event-free survival between groups with and without sarcopenia. Cox proportional hazards regression was conducted to assess sarcopenia's influence on MACE. The prevalence of sarcopenia and 1-year MACE after PCI were 24.8 and 8.6%, respectively. We found that sarcopenia at admission (hazard ratio, 3.01; 95% confidence interval, 1.22-7.38, P = 0.017) was significantly associated with 1-year MACE among patients after PCI. CONCLUSION Expanding knowledge of sarcopenia among cardiovascular nurses may aid in early recognition of patients at risk of sarcopenia. Our finding implies that the sarcopenia index based on serum creatinine and cystatin C may be available as a prognostic factor for MACE in patients undergoing PCI. Future studies should be conducted to prospectively validate the sarcopenia index with a multi-centre, large sample.
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Affiliation(s)
- Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, South Korea
| | - Heeseon Kim
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, South Korea
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Filler G, Ahmad F, Bhayana V, Díaz González de Ferris ME, Sharma AP. Limitations of U25 CKiD and CKD-EPI eGFR formulae in patients 2-20 years of age with measured GFR > 60 mL/min/1.73 m 2-a cross-sectional study. Pediatr Nephrol 2024; 39:1169-1176. [PMID: 37840039 DOI: 10.1007/s00467-023-06185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND When applying Pierce U25 formula for estimating glomerular filtration rate (eGFR), we observed a higher proportion of eGFR < 90 mL/min/1.73 m2 (chronic kidney disease (CKD) stage 2). We compared agreement and accuracy of the Pierce U25 (ages 2-25), Pottel (ages 2-100), and CKD-EPI (ages 18-100) formulae to GFR measurements. METHODS Post hoc analysis of the three eGFRs compared to 367 99m technetium-diethylene-triamine penta-acetic acid (99Tc DTPA) GFR measurements (240 patients) using 3 sampling points and Brockner/Mørtensen correction (body surface area calculation based on ideal weight) on simultaneous serum creatinine and cystatin C measurements. RESULTS Overall, the U25 formula performed well with a Spearman r of 0.8102 (95% confidence interval 0.7706 to 0.8435, p < 0.0001) while diagnostic accuracy was low in patients with normal mGFR. The U25 formula reclassified 29.5% of patients with normal mGFR as CKD stage 2; whereas the average of the modified Schwartz formula based on serum creatinine and the Filler formula based on cystatin C, only over-diagnosed CKD stage 2 in 8.5%, 24.5% within 10% and 62.7% within 30%. We therefore combined both. The average Schwartz/Filler eGFR had 36.5% of results within 10%, 84.7% within 30%, and normal mGFR accuracy was 26.8%, 63.9% for 10% and 30%, respectively, outperforming the CKD-EPI and Pottel formulae. CONCLUSIONS The Pierce U25 formula results correlated well with mGFR < 75 mL/min/1.73 m2. Over the entire GFR range, accuracy was better for patients with a higher mGFR, when averaging the combined Schwartz/Filler formulae. More work is needed to prospectively confirm our findings in other centers.
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Affiliation(s)
- Guido Filler
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada.
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Road East, E3-206, London, ON, N6A 5W9, Canada.
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, N6A 5W9, Canada.
| | - Fateh Ahmad
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada
| | | | - Ajay P Sharma
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada
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Abd Elhameed ZA, Tag El Din LM, Sherif T, Abdel Aal AM, Moeen AM, Abd El Hakeem EN, Abdelrahman EM. Plasma metadherin mRNA expression in bladder cancer. Egypt J Immunol 2024; 31:28-43. [PMID: 38615202] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Urinary bladder cancer (BC) is the ninth most common cancer worldwide. At present, the clinical diagnosis of BC depends on self-reported symptoms, tissue biopsy specimens by cystoscopy and from voided urine cytology. However, cystoscopy is an invasive examination and voided urine cytology has low sensitivity, which might provoke misdiagnosis. The search for cancer biomarkers in blood is worthy of intense attention due to patients' comfort and ease of sampling. This work aimed to study expression of mRNA metadherin (MTDH) in plasma, serum BC specific antigen 1 (BLCA-1) and cystatin C as biomarkers of BC and their relation to different disease stages. This study included 59 BC patients, 11 patients with benign bladder lesion and 18 subjects as normal controls. MTDH expression was assessed by real time polymerase chain reaction, BLCA-1, and cystatin C by the enzyme linked immunosorbent assay. The three biomarkers were elevated in BC patients than patients with benign bladder diseases and controls. Patients with BC grade 3 and 4 had higher cystatin C, BLCA-1 and MTDH in comparison to patients with grade 1 and grade 2 (p=0.000). The receiver operating characteristic curve analysis showed that BLCA-1 at a cutoff point of 32.5 ng/ml and area under the curve of 1.00, had 100% accuracy, 100% sensitivity, 100% specificity, 100% positive predictive values and 100% negative predictive value. In conclusion, BLCA-1 was a better biomarker than cystatin C and MTDH. Cystatin C, BLCA-1 and MTDH levels, can differentiate between benign bladder lesion and BC and correlated with tumor grades.especially with OL-HDF compared to HF-HD, with acceptable albumin loss in the dialysate.
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Affiliation(s)
- Zeinab A Abd Elhameed
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Lubna M Tag El Din
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tahra Sherif
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal M Abdel Aal
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Moeen
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa N Abd El Hakeem
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman M Abdelrahman
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Adachi E, Saito M, Otani A, Koga M, Yotsuyanagi H. Favorable Virological Outcome, Characteristics of Injection Site Reactions, Decrease in Renal Function Biomarkers in Asian People with HIV Receiving Long-Acting Cabotegravir Plus Rilpivirine. AIDS Res Hum Retroviruses 2024; 40:216-222. [PMID: 38164081 DOI: 10.1089/aid.2023.0108] [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] [Indexed: 01/03/2024] Open
Abstract
Long-acting cabotegravir plus rilpivirine has revolutionized the concept of antiretroviral therapy, but as the causes of virological failure and satisfaction can depend on patient background, real-world data are needed. In this single-center study, we reviewed clinical records of people with HIV (PWH) who received injectable cabotegravir plus rilpivirine between June 2022 and January 2023. We assessed virological and safety outcomes, including injection site reactions (ISRs) and changes in serum creatinine and cystatin C. Seventy-four patients were included. There were no virological failures. Approximately 80% of individuals achieved HIV-RNA undetectable in all visits up to 14 months (median 13 months) after switching. Pain upon injection was significantly more common at the rilpivirine injection site, while delayed pain was significantly more common at the cabotegravir injection site. The serum creatinine (mean difference -0.12 mg/dL, p < .0001) and the cystatin C (mean difference -0.077 mg/dL, p < .0001) decreased significantly after switching, and in multivariable regression analysis, baseline characteristics did not affect the decrease in these renal function markers. Long-acting cabotegravir plus rilpivirine showed excellent antiviral efficacy and safety in PWH in Japan. ISRs were characterized differently at the cabotegravir and rilpivirine injection sites. Although cystatin C showed decrease after the regimen switch, further confirmation is needed whether cabotegravir plus rilpivirine can improve renal function.
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Affiliation(s)
- Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Makoto Saito
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Amato Otani
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Michiko Koga
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Yu M, Zhang C, Wan S, Lu Y, Wang Y, Liu T, Wang H, Chen W, Liu Y. NEW PREDICTIVE BIOMARKERS FOR SCREENING COVID-19 PATIENTS WITH RHABDOMYOLYSIS IN COMBINATION WITH CYSTATIN C. Shock 2024; 61:549-556. [PMID: 38010067 DOI: 10.1097/shk.0000000000002258] [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] [Indexed: 11/29/2023]
Abstract
ABSTRACT Purpose: Cystatin C (CysC) has been linked to the prognosis of corona virus disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM). Methods: A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed. Results: According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO 2 (hazard ratio [HR], 0.946; 95% confidence interval [CI], 0.906-0.987; P = 0.011), CysC (HR, 2.124; 95% CI, 1.223-3.689; P = 0.008), aspartate aminotransferase (AST) (HR, 1.009; 95% CI, 1.000-1.018; P = 0.041), and hypersensitive C-reactive protein (HR, 1.005; 95% CI, 1.000-1.010; P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC receiver operating characteristic curves. LDH*CysC and AST*CysC had better predictive values than CysC and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC ( P < 0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC ( P < 0.05, vs CysC). Conclusion: CysC is an essential evaluation indicator for COVID-19 patients' prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.
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Affiliation(s)
- Mengyang Yu
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Chengying Zhang
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Sitong Wan
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food Quality, China Agricultural University, Beijing, China
| | - Yang Lu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Yufei Wang
- Clinical Laboratory Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Ting Liu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Huimin Wang
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Wei Chen
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
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12
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Tu X, Lin T, Huang L, Tang T, Xie D, Gao L, Jiang T, Yue J. The diagnostic performance of Cr/CysC for sarcopenia and its predictive value on clinical outcomes in hospitalized older patients: a prospective cohort study. Eur Geriatr Med 2024; 15:579-588. [PMID: 38393457 DOI: 10.1007/s41999-024-00948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The utilization of the creatinine-to-cystatin C ratio (Cr/CysC) represents an innovative method for predicting sarcopenia. Our objectives encompassed the evaluation of sarcopenia diagnostic accuracy for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score, as well as an exploration of the predictive value of Cr/CysC concerning clinical outcomes within hospitalized older individuals. METHODS We employed receiver operating characteristic (ROC) curves and calculated areas under the curves (AUCs) to assess the diagnostic accuracy. Furthermore, we applied univariate and multivariate Cox proportional-hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) of risk factors affecting prognosis. RESULTS Our study included 312 participants, comprising 167 men and 145 women, with an average age of 71 years. Among males, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.717 [95% CI 0.642-0.784], 0.669 (95% CI 0.592-0.739), 0.845 (95% CI 0.781-0.896), 0.882 (95% CI 0.823-0.926), and 0.938 (95% CI 0.890-0.969), respectively. In females, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.706 (95% CI 0.625-0.779), 0.631 (95% CI 0.547-0.710), 0.763 (95% CI 0.686-0.830), 0.789 (95% CI 0.714-0.853), and 0.898 (95% CI 0.837-0.942), respectively. After adjusting for age, sex, physical exercise, smoking, drinking, hypertension, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and cancer, sarcopenia identified by Cr/CysC (adjusted HR = 2.176, 95% CI 1.062-4.460, P = 0.034) was independently associated with poor overall survival in hospitalized older patients. CONCLUSIONS Cr/CysC has satisfactory diagnostic accuracy for sarcopenia diagnosis and predictive value for poor outcomes in hospitalized older patients. The combination of Cr/CysC and SARC-CalF may provide a more accurate screening for sarcopenia and the Ishii score may be the most accurate clinical method for detecting sarcopenia.
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Affiliation(s)
- Xiangping Tu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Li Huang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Tianjiao Tang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Dongmei Xie
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Langli Gao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Tingting Jiang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China.
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Lambert M, Alonso M, Munzer C, Zimoch MC, Malard L, Gambart M, Castex MP, Martins C, Pasquet M, Chatelut E. Prospective validation of an equation based on plasma cystatin C for monitoring the glomerular filtration rate in children treated with cisplatin or ifosfamide for cancer. Cancer Chemother Pharmacol 2024; 93:393-395. [PMID: 37789166 DOI: 10.1007/s00280-023-04597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
We recently proposed an equation to estimate the glomerular filtration rate (GFR) in children with cancer based on plasma cystatin C and serum creatinine levels together with body weight (the "CysPed equation"). The current clinical study reports a prospective evaluation of this equation in 18 children treated by nephrotoxic chemotherapy. The CysPed equation resulted in less bias and greater precision compared to two equations previously proposed equations by Schwartz, with or without plasma cystatin C. Moreover, the decrease in GFR due to chemotherapy was clearly identified by the CysPed equation. This equation may be used to monitor the renal function in childhood cancer units.
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Affiliation(s)
- Marie Lambert
- CRCT, Université de Toulouse, Inserm, Toulouse, France
- Oncopole Claudius-Regaud, IUCT-Oncopole, 1, Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France
| | - Mathieu Alonso
- Unité de Radiopharmacie, CHU de Toulouse-Purpan, Toulouse, France
| | - Caroline Munzer
- Unité de Recherche Clinique Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
- Unité d'Hémato-Oncologie, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Marie-Christine Zimoch
- Oncopole Claudius-Regaud, IUCT-Oncopole, 1, Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France
| | - Laurence Malard
- Oncopole Claudius-Regaud, IUCT-Oncopole, 1, Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France
| | - Marion Gambart
- Unité d'Hémato-Oncologie, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Marie-Pierre Castex
- Unité d'Hémato-Oncologie, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Carla Martins
- Unité de Recherche Clinique Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Marlène Pasquet
- Unité d'Hémato-Oncologie, Hôpital des Enfants, CHU Toulouse, Toulouse, France
- CRCT, Equipe 16, IUCT-Oncopole, Toulouse, France
| | - Etienne Chatelut
- CRCT, Université de Toulouse, Inserm, Toulouse, France.
- Oncopole Claudius-Regaud, IUCT-Oncopole, 1, Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France.
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Hu W, Huang Y, Kou P, Huang X. Increased serum cystatin C levels in patients with idiopathic epiretinal membrane. Clin Exp Optom 2024; 107:318-323. [PMID: 37218573 DOI: 10.1080/08164622.2023.2215381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
CLINICAL RELEVANCE Increased serum cystatin C may play a role in the pathogenesis of idiopathic epiretinal membrane (IERM). Physicians should be aware of this relationship and should refer patients to the ophthalmology clinic for screening. BACKGROUND To evaluate the serum cystatin C level in patients with IERM, and its associations with visual acuity. METHODS Sixty-eight patients with IERM and sixty-nine controls were enrolled in this cross-sectional study. Based on the results of optical coherence tomography, patients with IERM were divided into four stages (I, II, III and IV). Serum cystatin C was measured in all participants. Serum cystatin C levels were compared between the control group and IERM group and between the IERM group with different optical coherence tomography stages. Multiple linear regression was used to evaluate the relationship between serum cystatin C and IERM stages and best corrected visual acuity. RESULTS Serum cystatin C level was higher in the IERM group than in the control group (P < 0.001). There were statistically significant differences in serum cystatin C among different stages of IERM (PI vs II = 0.011, PI vs IV < 0.001 and PIII vs IV = 0.040, respectively). There were significant differences in best corrected visual acuity among different stages of IERM (PI vs III = 0.018, PI vs IV < 0.001, PII vs IV < 0.001 and PIII vs IV < 0.001, respectively). Regression analysis showed a positive correlation between serum cystatin C and best corrected visual acuity (t = 2.238 P = 0.029). The cut-off value of receiver operation characteristic curve of serum cystatin C for IERM was 0.775. CONCLUSION This study revealed that serum cystatin C may be involved in the pathogenesis of IERM and can predict its occurrence. Elevated serum cystatin C appears to be associated with the severity of the disease and relatively poor vision acuity in IERM patients.
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Affiliation(s)
- Weiwen Hu
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Hainan, People's Republic of China
| | - Yikeng Huang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Pengyuan Kou
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Hainan, People's Republic of China
| | - Xionggao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Hainan, People's Republic of China
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Hingorani SR, Schmicker RH, Halloran B, Brophy P, Heagerty PJ, Juul S, Goldstein SL, Askenazi D. Association Between Urinary Biomarkers and CKD in Extremely Low Gestational Age Neonates. Am J Kidney Dis 2024; 83:497-507. [PMID: 37926336 PMCID: PMC10960703 DOI: 10.1053/j.ajkd.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023]
Abstract
RATIONALE & OBJECTIVE Children born before 28 weeks' gestation are at increased risk of chronic kidney disease (CKD). Urine biomarkers may shed light on mechanistic pathways and improve the ability to forecast CKD. We evaluated whether urinary biomarkers in neonates of low gestational age (GA) are associated with a reduced estimated glomerular filtration rate (eGFR) over time. STUDY DESIGN A cohort study of neonates with an exploratory case-control study of a subset of the cohort. SETTING & PARTICIPANTS 327 neonates born at 24-27 weeks' gestation with 2-year eGFR data from the PENUT (Preterm Erythropoietin Neuroprotection Trial) and the REPaIReD (Recombinant Erythropoietin for Prevention of Infant Renal Disease) study. EXPOSURES 11 urinary biomarkers measured at 27, 30, and 34 weeks' postmenstrual age for the primary cohort study and 10 additional biomarkers for the exploratory case-control study. OUTCOMES eGFR<90mL/min/1.73m2 at 2 years corrected for GA. ANALYTICAL APPROACH Linear mixed models to assess differences in biomarker values between neonates in whom CKD did and did not develop, accounting for multiple comparisons using Bonferroni-Holm correction in the cohort study only. Cohort analyses were adjusted for sex, GA, and body mass index. Cases were matched to controls on these variables in the case-control study. RESULTS After adjusting for weeks of GA, urinary levels of α-glutathione-S-transferase (log difference, 0.27; 95% CI, 0.12-0.43), albumin (log difference, 0.13; 95% CI, 0.02-0.25), and cystatin C (log difference, 0.19; 95% CI, 0.04-0.34) were higher in those in whom CKD developed than in those in whom it did not. Urinary albumin and cystatin C levels did not remain significantly different after Bonferroni-Holm correction. In the exploratory case-control analysis, there were no differences in any biomarkers between cases and controls. LIMITATIONS Early deaths and a high number of subjects without eGFR at 2 years corrected for GA. CONCLUSIONS Measurement of urinary biomarkers may assist in monitoring neonates who are at risk for CKD. Additional studies are needed to confirm these findings. FUNDING Grants from government (National Institutes of Health). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT01378273. PLAIN-LANGUAGE SUMMARY Approximately 15 million neonates worldwide are born prematurely, and 2 million are born before 28 weeks' gestation. Many of these children go on to experience chronic kidney disease. Urine biomarkers may allow for early recognition of those at risk for the development of kidney disease. In this study of more than 300 children born before 28 weeks' gestational age, we found higher mean urinary levels of α-glutathione-S-transferase at 27, 30, and 34 weeks in children whose estimated glomerular filtration rate was<90mL/min/1.73m2 at 2 years compared with children whose estimated glomerular filtration rate was>90mL/min/1.73m2 at 2 years. Measurement of urinary biomarkers may assist in monitoring neonates who are at risk for chronic kidney disease. Additional studies are needed to confirm our findings.
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Affiliation(s)
- Sangeeta R Hingorani
- Divisions of Nephrology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington.
| | - Robert H Schmicker
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Brian Halloran
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Patrick Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Sandra Juul
- Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David Askenazi
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
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Fu EL, Levey AS, Coresh J, Grams ME, Faucon AL, Elinder CG, Dekker FW, Delanaye P, Inker LA, Carrero JJ. Accuracy of GFR estimating equations based on creatinine, cystatin C or both in routine care. Nephrol Dial Transplant 2024; 39:694-706. [PMID: 37813817 DOI: 10.1093/ndt/gfad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND New equations to estimate glomerular filtration rate based on creatinine (eGFRcr), cystatin C (eGFRcys) or both (eGFRcr-cys) have been developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the European Kidney Function Consortium (EKFC). There is a need to evaluate the performance of these equations in diverse European settings to inform implementation decisions, especially among people with key comorbid conditions. METHODS We performed a cross-sectional study including 6174 adults referred for single-point plasma clearance of iohexol in Stockholm, Sweden, with 9579 concurrent measurements of creatinine and cystatin C. We assessed the performance of the CKD-EPI 2009/2012/2021, EKFC 2021/2023, revised Lund-Malmö (RLM) 2011 and Caucasian, Asian, Pediatric and Adult (CAPA) 2014 equations against measured GFR (mGFR). RESULTS Mean age was 56 years, median mGFR was 62 mL/min/1.73 m2 and 40% were female. Comorbid conditions were common: cardiovascular disease (30%), liver disease (28%), diabetes (26%) and cancer (26%). All eGFRcr-cys equations had small bias and P30 (the percentage of estimated values within 30% of mGFR) close to 90%, and performed better than eGFRcr or eGFRcys equations. Among eGFRcr equations, CKD-EPI 2009 and CKD-EPI 2021 showed larger bias and lower P30 than EKFC 2021 and RLM. There were no meaningful differences in performance across eGFRcys equations. Findings were consistent across comorbid conditions, and eGFRcr-cys equations showed good performance in patients with liver disease, cancer and heart failure. CONCLUSIONS In conclusion, eGFRcr-cys equations performed best, with minimal variation among equations in this Swedish cohort. The lower performance of CKD-EPI eGFRcr equations compared with EKFC and RLM may reflect differences in population characteristics and mGFR methods. Implementing eGFRcr equations will require a trade-off between accuracy and uniformity across regions.
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Affiliation(s)
- Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew S Levey
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Anne-Laure Faucon
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- INSERM UMR 1018, Department of Clinical Epidemiology, Paris-Saclay University, Paris, France
| | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Intervention, and Technology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Engström J, Koozi H, Didriksson I, Larsson A, Friberg H, Frigyesi A, Spångfors M. Plasma neutrophil gelatinase-associated lipocalin independently predicts dialysis need and mortality in critical COVID-19. Sci Rep 2024; 14:6695. [PMID: 38509165 PMCID: PMC10954663 DOI: 10.1038/s41598-024-57409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a novel kidney injury and inflammation biomarker. We investigated whether NGAL could be used to predict continuous renal replacement therapy (CRRT) and mortality in critical coronavirus disease 2019 (COVID-19). This prospective multicenter cohort study included adult COVID-19 patients in six intensive care units (ICUs) in Sweden between May 11, 2020 and May 10, 2021. Blood was sampled at admission, days two and seven in the ICU. The samples were batch analyzed for NGAL, creatinine, and cystatin c after the end of the study period. Initiation of CRRT and 90-day survival were used as dependent variables in regression models. Of 498 included patients, 494 were analyzed regarding CRRT and 399 were analyzed regarding survival. Seventy patients received CRRT and 154 patients did not survive past 90 days. NGAL, in combination with creatinine and cystatin c, predicted the subsequent initiation of CRRT with an area under the curve (AUC) of 0.95. For mortality, NGAL, in combination with age and sex, had an AUC of 0.83. In conclusion, NGAL is a valuable biomarker for predicting subsequent initiation of CRRT and 90-day mortality in critical COVID-19. NGAL should be considered when developing future clinical scoring systems.
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Affiliation(s)
- Jonas Engström
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden.
- Department of Anesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, 291 85, Sweden.
| | - Hazem Koozi
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Anesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, 291 85, Sweden
| | - Ingrid Didriksson
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, 751 05, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Attila Frigyesi
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, 221 85, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Anesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, 291 85, Sweden
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Comte D. Cystatine C : un indicateur clé pour évaluer les risques rénaux et cardiovasculaires. Rev Med Suisse 2024; 20:615. [PMID: 38506468 DOI: 10.53738/revmed.2024.20.866.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Denis Comte
- Avec la collaboration du groupe MIAjour, Service de médecine interne, Centre hospitalier universitaire vaudois, Lausanne
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Yan AF, Williams MY, Shi Z, Oyekan R, Yoon C, Bowen R, Chertow GM. Bias and Accuracy of Glomerular Filtration Rate Estimating Equations in the US: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e241127. [PMID: 38441895 PMCID: PMC10915689 DOI: 10.1001/jamanetworkopen.2024.1127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Importance There is increasing concern that continued use of a glomerular filtration rate (GFR) estimating equation adjusted for a single racial group could exacerbate chronic kidney disease-related disparities and inequalities. Objective To assess the performance of GFR estimating equations across varied patient populations. Data Sources PubMed, Embase, Web of Science, ClinicalTrials.gov, and Scopus databases were systematically searched from January 2012 to February 2023. Study Selection Inclusion criteria were studies that compared measured GFR with estimated GFR in adults using established reference standards and methods. A total of 6663 studies were initially identified for screening and review. Data Extraction and Synthesis Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 authors independently extracted data on studies that examined the bias and accuracy of GFR estimating equations. For each outcome, a random-effects model was used to calculate pooled estimates. Data analysis was conducted from March to December 2023. Main Outcomes and Measures The primary outcomes were bias and accuracy of estimated GFRs in Black vs non-Black patients, as well as in individuals with chronic conditions. Bias was defined as the median difference between the measured GFR and the estimated GFR. Accuracy was assessed with P30 (the proportion of persons in a data set whose estimated GFR values were within 30% of measured GFR values) and measures of heterogeneity. Results A total of 12 studies with a combined 44 721 patients were included. Significant heterogeneity was found in the bias of various GFR estimation equations. Race-corrected equations and creatinine-based equations tended to overestimate GFR in Black populations and showed mixed results in non-Black populations. For creatinine-based equations, the mean bias in subgroup analysis was 2.1 mL/min/1.73 m2 (95% CI, -0.2 mL/min/1.73 m2 to 4.4 mL/min/1.73 m2) in Black persons and 1.3 mL/min/1.73 m2 (95% CI, 0.0 mL/min/1.73 m2 to 2.5 mL/min/1.73 m2) in non-Black persons. Equations using only cystatin C had small biases. Regarding accuracy, heterogeneity was high in both groups. The overall P30 was 84.5% in Black persons and 87.8% in non-Black persons. Creatinine-based equations were more accurate in non-Black persons than in Black persons. For creatinine-cystatin C equations, the P30 was higher in non-Black persons. There was no significant P30 difference in cystatin C-only equations between the 2 groups. In patients with chronic conditions, P30 values were generally less than 85%, and the biases varied widely. Conclusions and Relevance This systematic review and meta-analysis of GFR estimating equations suggests that there is bias in race-based GFR estimating equations, which exacerbates kidney disease disparities. Development of a GFR equation independent of race is a crucial starting point, but not the sole solution. Addressing the disproportionate burden of kidney failure on Black individuals in the US requires an enduring, multifaceted approach that should include improving diagnostics, tackling social determinants of health, confronting systemic racism, and using effective disease prevention and management strategies.
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Affiliation(s)
- Alice F Yan
- Department of Research, Patient Care Services, Stanford Healthcare, Palo Alto, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Michelle Y Williams
- Department of Research, Patient Care Services, Stanford Healthcare, Palo Alto, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Zumin Shi
- Human Nutritition Department, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Richard Oyekan
- Department of Research, Patient Care Services, Stanford Healthcare, Palo Alto, California
| | - Carol Yoon
- Department of Research, Patient Care Services, Stanford Healthcare, Palo Alto, California
| | - Raffick Bowen
- Department of Pathology, Stanford Healthcare, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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Asakage A, Ishihara S, Boutin L, Dépret F, Sugaya T, Sato N, Gayat E, Mebazaa A, Deniau B. Predictive Performance of Neutrophil Gelatinase Associated Lipocalin, Liver Type Fatty Acid Binding Protein, and Cystatin C for Acute Kidney Injury and Mortality in Severely Ill Patients. Ann Lab Med 2024; 44:144-154. [PMID: 37749888 PMCID: PMC10628750 DOI: 10.3343/alm.2023.0083] [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: 02/25/2023] [Revised: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common condition in severely ill patients associated with poor outcomes. We assessed the associations between urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes. Methods We assessed the predictive performances of uNGAL, uLFABP, and uCysC measured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes. The primary outcome was the occurrence of AKI during ICU stay; secondary outcomes were 28-day and 1-yr allcause mortality. Results In total, 1,759 patients were admitted to the ICU, and 728 (41.4%) developed AKI. Median (interquartile range, IQR) uNGAL, uLFABP, and uCysC concentrations on admission were 147.6 (39.9-827.7) ng/mL, 32.4 (10.5-96.0) ng/mL, and 0.33 (0.12-2.05) mg/L, respectively. Biomarker concentrations on admission were higher in patients who developed AKI and associated with AKI severity. Three hundred fifty-six (20.3%) and 647 (37.9%) patients had died by 28 days and 1-yr, respectively. Urinary biomarker concentrations at ICU discharge were higher in non-survivors than in survivors. The areas under the ROC curve (95% confidence interval) of uLFABP for the prediction of AKI, 28-day mortality, and 1-yr mortality (0.70 [0.67-0.72], 0.63 [0.59-0.66], and 0.57 [0.51-0.63], respectively) were inferior to those of the other biomarkers. Conclusions uNGAL, uLFABP, and uCysC concentrations on admission were associated with poor outcomes. However, their predictive performance, individually and in combination, was limited. Further studies are required to confirm our results.
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Affiliation(s)
- Ayu Asakage
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
| | - Shiro Ishihara
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Louis Boutin
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - François Dépret
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Takeshi Sugaya
- Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Etienne Gayat
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Benjamin Deniau
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
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Sun H, Li Q, Jin Z, Lu Y, Ju Y. Simultaneous determination of multiple urine biomarkers for kidney injury using SPE combined with LC-MS/MS. Clin Chim Acta 2024; 555:117790. [PMID: 38246210 DOI: 10.1016/j.cca.2024.117790] [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: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Urinary biomarkers such as low molecular weight proteins and small molecular weight metabolites are crucial in the diagnosis of kidney injury. The objective of this study was to develop and preliminarily validate a sensitive and specific method using solid-phase extraction (SPE) in conjunction with liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the simultaneous measurement of these biomarkers in human urine. METHOD This study presents the development of a solid-phase extraction method integrated with LC-MS/MS analyzing biomarkers including creatinine, urea, β2-microglobulin, α1-microglobulin, and cystatin C in human urine. An enhanced solid-phase cartridge technique was employed for peptide purification and dilution of small molecule metabolites during sample preparation. RESULTS The developed LC-MS/MS method achieved satisfactory separation of the five analytes within 15 min. Accuracy levels ranged from -8.6% to 13.6%. Both intra-assay and inter-assay imprecision rates were maintained below 7.9% for all analytes. CONCLUSIONS The established LC-MS/MS method effectively quantifies creatinine, urea, β2-microglobulin, α1-microglobulin and cystatin C concurrently. This offers a viable alternative for the detection of kidney injury biomarkers in human urine, demonstrating potential for clinical application in kidney injury diagnosis.
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Affiliation(s)
- Hewei Sun
- Shanghai Center for Clinical Laboratory, Shanghai, PR China
| | - Qing Li
- Shanghai Center for Clinical Laboratory, Shanghai, PR China
| | - Zhonggan Jin
- Shanghai Center for Clinical Laboratory, Shanghai, PR China
| | - Yide Lu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, PR China
| | - Yi Ju
- Shanghai Center for Clinical Laboratory, Shanghai, PR China.
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22
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Ebert N. [Novel equations for estimating renal function: significance for drug dose adjustment]. Inn Med (Heidelb) 2024; 65:280-285. [PMID: 38252158 DOI: 10.1007/s00108-023-01649-0] [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] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Important therapeutic decisions depend on kidney function, which is why its correct assessment is of great importance. It also plays an important role for drug dose adjustments in patients with impaired kidney function. OBJECTIVES In clinical practice, kidney function is almost always estimated using mathematical glomerular filtration rate (GFR) equations. To estimate GFR, the patient's age and gender as well as kidney-specific endogenous biomarkers are required. This work aims to provide an overview of the advantages and disadvantages of the biomarkers serum creatinine and cystatin C in assessing kidney function. Particularly in patients with significantly reduced or increased muscle mass, creatinine is not suitable for determining GFR, and cystatin C should be used. Currently recommended GFR estimating equations are described, illustrating for which patient groups they can be used. CURRENT DATA A large number of high-ranking publications are available investigating the validity of GFR estimating equations and the optimal choice of endogenous biomarkers. However, there are still large gaps when it comes to drug approval studies in older patients and children. CONCLUSION Estimated GFR (eGFR) is only a rough estimate of kidney function and should not be interpreted as an exact number. Drug dose adjustments may be necessary in patients with an eGFR of < 50 ml/min and should be verified particularly in severely impaired GFR (< 30 ml/min). There are tools available online for this purpose.
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Affiliation(s)
- Natalie Ebert
- Institut für Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Deutschland.
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23
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Fu EL, Carrero JJ, Sang Y, Evans M, Ishigami J, Inker LA, Grams ME, Levey AS, Coresh J, Ballew SH. Association of Low Glomerular Filtration Rate With Adverse Outcomes at Older Age in a Large Population With Routinely Measured Cystatin C. Ann Intern Med 2024; 177:269-279. [PMID: 38285982 DOI: 10.7326/m23-1138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The commonly accepted threshold of glomerular filtration rate (GFR) to define chronic kidney disease (CKD) is less than 60 mL/min/1.73 m2. This threshold is based partly on associations between estimated GFR (eGFR) and the frequency of adverse outcomes. The association is weaker in older adults, which has created disagreement about the appropriateness of the threshold for these persons. In addition, the studies measuring these associations included relatively few outcomes and estimated GFR on the basis of creatinine level (eGFRcr), which may be less accurate in older adults. OBJECTIVE To evaluate associations in older adults between eGFRcr versus eGFR based on creatinine and cystatin C levels (eGFRcr-cys) and 8 outcomes. DESIGN Population-based cohort study. SETTING Stockholm, Sweden, 2010 to 2019. PARTICIPANTS 82 154 participants aged 65 years or older with outpatient creatinine and cystatin C testing. MEASUREMENTS Hazard ratios for all-cause mortality, cardiovascular mortality, and kidney failure with replacement therapy (KFRT); incidence rate ratios for recurrent hospitalizations, infection, myocardial infarction or stroke, heart failure, and acute kidney injury. RESULTS The associations between eGFRcr-cys and outcomes were monotonic, but most associations for eGFRcr were U-shaped. In addition, eGFRcr-cys was more strongly associated with outcomes than eGFRcr. For example, the adjusted hazard ratios for 60 versus 80 mL/min/1.73 m2 for all-cause mortality were 1.2 (95% CI, 1.1 to 1.3) for eGFRcr-cys and 1.0 (CI, 0.9 to 1.0) for eGFRcr, and for KFRT they were 2.6 (CI, 1.2 to 5.8) and 1.4 (CI, 0.7 to 2.8), respectively. Similar findings were observed in subgroups, including those with a urinary albumin-creatinine ratio below 30 mg/g. LIMITATION No GFR measurements. CONCLUSION Compared with low eGFRcr in older patients, low eGFRcr-cys was more strongly associated with adverse outcomes and the associations were more uniform. PRIMARY FUNDING SOURCE Swedish Research Council, National Institutes of Health, and Dutch Kidney Foundation.
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Affiliation(s)
- Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (E.L.F.)
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, and Division of Nephrology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden (J.-J.C.)
| | - Yingying Sang
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York (Y.S.)
| | - Marie Evans
- Department of Clinical Intervention and Technology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden (M.E.)
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (J.I.)
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts (L.A.I., A.S.L.)
| | - Morgan E Grams
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York (M.E.G.)
| | - Andrew S Levey
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts (L.A.I., A.S.L.)
| | - Josef Coresh
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (J.C., S.H.B.)
| | - Shoshana H Ballew
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (J.C., S.H.B.)
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24
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Lu JJ, Liu TT. Serum Cystatin C as a Risk Factor for Supratherapeutic Digoxin Concentration in Elderly Patients with Heart Failure and Chronic Kidney Disease. Am J Cardiovasc Drugs 2024; 24:303-311. [PMID: 38300453 DOI: 10.1007/s40256-024-00629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Digoxin is primarily metabolized by the kidney, and its toxicity is strongly associated with high concentrations, particularly in elderly patients. The purpose of this study was to evaluate the predictive performance of renal function biomarkers for supratherapeutic digoxin concentrations in elderly patients with heart failure (HF) and chronic kidney disease (CKD). METHODS Data were retrospectively obtained from elderly patient with HF and CKD who received digoxin treatment from January 2022 and December 2022. Logistic regression was used to assess independent risk factors for supratherapeutic concentrations. The predictive performance of serum creatinine, serum cystatin C, and blood urea nitrogen on supratherapeutic concentrations was compared by receiver operating characteristic analysis. RESULTS A total of 115 elderly patients with HF and CKD were enrolled in our study. Supratherapeutic concentrations were detected in 49 patients. Logistic regression analysis showed that estimated glomerular filtration rate calculated by serum cystatin C [eGFRCysC, odds ratio (OR): 0.962, P = 0.006], heart rate (OR: 1.024, P = 0.040), and NYHA class (OR: 3.099, P = 0.010) were independent risk factors for supratherapeutic concentration. Cutoff value for eGFRCysC between the two groups was 41 ml/min/1.73m2. Predictive performance of serum cystatin C was further improved in patients with obesity, CKD stage 4-5, and older than 75 years compared with normal weight, CKD stage 3, and aged 60-75-year-old patients. CONCLUSIONS Serum cystatin C is a sensitive renal function biomarker to predict supratherapeutic digoxin concentration in elderly patients with HF and CKD.
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Affiliation(s)
- Jie-Jiu Lu
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Tao-Tao Liu
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Hsu BG, Wang CH, Lai YH, Kuo CH, Lin YL. Novel equations incorporating the sarcopenia index based on serum creatinine and cystatin C to predict appendicular skeletal muscle mass in patients with nondialysis CKD. Clin Nutr 2024; 43:765-772. [PMID: 38335801 DOI: 10.1016/j.clnu.2024.01.029] [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: 10/03/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND & AIMS Skeletal muscle mass measurements are important for customizing nutritional strategies for patients with chronic kidney disease (CKD). The serum creatinine-to-cystatin C ratio (Cr/CysC) is a potential indicator of sarcopenia. We developed simple equations to predict the appendicular skeletal muscle mass (ASM) of patients with CKD using readily available parameters and Cr/CysC. METHODS Overall, 573 patients with nondialysis CKD stages 3-5 were included for developing and validating the equations. The participants were randomly divided into development and validation groups in a 2:1 ratio. ASM was measured using the Body Composition Monitor (BCM), a multifrequency bioelectrical impedance spectroscopy device. The height, weight, anthropometric data, and handgrip strength (HGS) of the participants were obtained. Equations were generated using stepwise multiple linear regression models. The prognostic significance of the predicted ASM was evaluated in a CKD registry comprising 1043 patients. RESULTS The optimal equation without anthropometric data and HGS (Equation 1) was as follows: ASM (kg) = -7.949 - 0.049 × Age (years) - 2.213 × Woman + 0.090 × Height (cm) + 0.210 × Weight (kg) + 1.141 × Cr/CysC. The modified equation (Equation 2) with anthropometric data and HGS was as follows: ASM (kg) = -4.468 - 0.050 × Age (years) - 2.285 × Woman+ 0.079 × Height (cm) + 0.228 × Weight (kg) - 0.127 × Mid-arm muscular circumference (cm) + 1.127 × Cr/CysC. Both equations exhibited strong correlations with the ASM measured via BCM in the validation cohort (r = 0.944 and 0.943 for Equations 1 and 2, respectively) with minimal bias. When Equation 1 was applied to the CKD registry, the estimated ASM index (ASM/Height2) significantly predicted overall mortality over a median of 54 months. CONCLUSIONS Novel ASM equations offer a simple method for predicting skeletal muscle mass and can provide valuable prognostic information regarding patients with nondialysis CKD.
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Affiliation(s)
- Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; School of Medicine, Tzu Chi University, Hualien 97004, Taiwan.
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; School of Medicine, Tzu Chi University, Hualien 97004, Taiwan.
| | - Yu-Hsien Lai
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; School of Medicine, Tzu Chi University, Hualien 97004, Taiwan.
| | - Chiu-Huang Kuo
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan.
| | - Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; School of Medicine, Tzu Chi University, Hualien 97004, Taiwan.
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Pottel H, Delanaye P, Cavalier E. Exploring Renal Function Assessment: Creatinine, Cystatin C, and Estimated Glomerular Filtration Rate Focused on the European Kidney Function Consortium Equation. Ann Lab Med 2024; 44:135-143. [PMID: 37909162 PMCID: PMC10628758 DOI: 10.3343/alm.2023.0237] [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: 06/05/2023] [Revised: 08/25/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
Serum creatinine and serum cystatin C are the most widely used renal biomarkers for calculating the estimated glomerular filtration rate (eGFR), which is used to estimate the severity of kidney damage. In this review, we present the basic characteristics of these biomarkers, their advantages and disadvantages, some basic history, and current laboratory measurement practices with state-of-the-art methodology. Their clinical utility is described in terms of normal reference intervals, graphically presented with age-dependent reference intervals, and their use in eGFR equations.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
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Niedziałkowski P, Jurczak P, Orlikowska M, Wcisło A, Ryl J, Ossowski T, Czaplewska P. Phospholipid-functionalized gold electrode for cellular membrane interface studies - interactions between DMPC bilayer and human cystatin C. Biochim Biophys Acta Biomembr 2024; 1866:184266. [PMID: 38151198 DOI: 10.1016/j.bbamem.2023.184266] [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] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
This work describes the electrochemical studies on the interactions between V57G mutant of human cystatin C (hCC V57G) and membrane bilayer immobilized on the surface of a gold electrode. The electrode was modified with 6-mercaptohexan-1-ol (MCH) and 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC). DMPC was used as a membrane mimetic for monitoring electrochemical changes resulting from the interactions between the functionalized electrode surface and human cystatin C. The interactions between the modified electrode and hCC V57G were investigated by cyclic voltammetry and electrochemical impedance spectroscopy in a phosphate buffered saline (PBS) containing Fe(CN)63-/4- as a redox probe. The electrochemical measurements confirm that fabricated electrode is sensitive to hCC V57G at the concentration of 1 × 10-14 M. The incubation studies carried out at higher concentrations resulted in insignificant changes observed in cyclic voltammetry and electrochemical impedance spectroscopy measurements. The calculated values of surface coverage θR confirm that the electrode is equally covered at higher concentrations of hCC V57G. Measurements of wettability and surface free energy made it possible to determine the influence of individual structural elements of the modified gold electrode on its properties, and thus allowed to understand the nature of the interactions. Contact angle values confirmed the results obtained during electrochemical measurements, indicating the sensitivity of the electrode towards hCC V57G at the concentration of 1 × 10-14 M. In addition, the XPS spectra confirmed the successful anchoring of hCC V57G to the DMPC-functionalized surface.
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Affiliation(s)
- Paweł Niedziałkowski
- Department of Analytical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, Gdańsk 80-308, Poland.
| | - Przemysław Jurczak
- Department of Biomedical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, Gdańsk 80-308, Poland; Specialist Laboratories, Intercollegiate Faculty of Biotechnology UG&MUG, Abrahama 58, Gdańsk 80-307, Poland.
| | - Marta Orlikowska
- Department of Biomedical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, Gdańsk 80-308, Poland
| | - Anna Wcisło
- Department of Analytical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, Gdańsk 80-308, Poland
| | - Jacek Ryl
- Division of Electrochemistry and Surface Physical Chemistry, Institute of Nanotechnology and Materials Engineering and Advanced Materials Center, Gdańsk University of Technology, Narutowicza 11/12, Gdańsk 80-233, Poland
| | - Tadeusz Ossowski
- Department of Analytical Chemistry, Faculty of Chemistry, University of Gdansk, Wita Stwosza 63, Gdańsk 80-308, Poland
| | - Paulina Czaplewska
- Specialist Laboratories, Intercollegiate Faculty of Biotechnology UG&MUG, Abrahama 58, Gdańsk 80-307, Poland
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Delanaye P, Rule AD, Schaeffner E, Cavalier E, Shi J, Hoofnagle AN, Nyman U, Björk J, Pottel H. Performance of the European Kidney Function Consortium (EKFC) creatinine-based equation in United States cohorts. Kidney Int 2024; 105:629-637. [PMID: 38101514 DOI: 10.1016/j.kint.2023.11.024] [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: 06/27/2023] [Revised: 09/28/2023] [Accepted: 11/05/2023] [Indexed: 12/17/2023]
Abstract
Estimating glomerular filtration rate (GFR) is important in daily practice to assess kidney function and adapting the best clinical care of patients with and without chronic kidney disease. The new creatinine-based European Kidney Function Consortium (EKFC) equation is used to estimate GFR. This equation was developed and validated mainly in European individuals and based on a rescaled creatinine, with the rescaling factor (Q-value) defined as the median normal value of serum creatinine in a given population. The validation was limited in Non-Black Americans and absent in Black Americans. Here, our cross-sectional analysis included 12,854 participants from nine studies encompassing large numbers of both non-Black and Black Americans with measured GFR by clearance of an exogenous marker (reference method), serum creatinine, age, sex, and self-reported race available. Two strategies were considered with population-specific Q-values in Black and non-Black men and women (EKFCPS) or a race-free Q-value (EKFCRF). In the whole population, only the EKFCPS equation showed no statistical median bias (0.14, 95% confidence interval [-0.07; 0.35] mL/min/1.73m2), and the bias for the EKFCRF (0.74, [0.51; 0.94] mL/min/1.73m2) was closer to zero than that for the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI2021) equation (1.22, [0.99; 1.47]) mL/min/1.73m2]. The percentage of estimated GFR within 30% of measured GFR was similar for CKD-EPI2021 (79.2% [78.5%; 79.9%]) and EKFCRF (80.1% [79.4%; 80.7%]), but improved for the EKFCPS equation (81.1% [80.5%; 81.8%]). Thus, our EKFC equations can be used to estimate GFR in the United States incorporating either self-reported race or unknown race at the patient's discretion per hospital registration records.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Elke Schaeffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Junyan Shi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA; Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA; Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Groothof D, Shehab NBN, Post A, Gans ROB, Bakker SJL, Erler NS. Rounding creatinine, cystatin C or both: impact on discordance group assignment and GFR-estimating equation performance. Nephrol Dial Transplant 2024; 39:553-555. [PMID: 37852678 PMCID: PMC10899766 DOI: 10.1093/ndt/gfad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naser B N Shehab
- 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
| | - Reinold O B Gans
- 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
| | - 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
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Nyman U, Björk J, Delanaye P, Lahens A, Pottel H, Vidal-Petiot E, Flamant M. Rescaling creatinine makes GFR estimation equations generally applicable across populations - validation results for the Lund-Malmö equation in a French cohort of sub-Saharan ancestry. Clin Chem Lab Med 2024; 62:421-427. [PMID: 37768854 DOI: 10.1515/cclm-2023-0496] [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: 05/12/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES To make glomerular filtration rate (GFR) estimating equations applicable across populations with different creatinine generation by using rescaled serum creatinine (sCr/Q) where sCr represents the individual creatinine level and Q the average creatinine value in healthy persons of the same population. METHODS GFR measurements (mGFR, plasma clearance of 51Cr-EDTA) were conducted in 964 adult Black Europeans. We established the re-expressed Lund-Malmö revised equation (r-LMR) by replacing serum creatinine (sCr) with rescaled creatinine sCr/Q. We evaluated the r-LMR equation based on Q-values of White Europeans (r-LMRQ-white; Q-values females: 62 μmol/L, males: 80 μmol/L) and Black Europeans (r-LMRQ-Black; Q-values females: 65 μmol/L, males: 90 μmol/L), and the European Kidney Function Consortium equation (EKFCQ-White and EKFCQ-Black) regarding bias, precision (interquartile range, IQR) and accuracy (percentage of estimates within ±10 % [P10] and ±30 % [P30] of mGFR). RESULTS Median bias of r-LMRQ-White/r-LMRQ-Black/EKFCQ-White/EKFCQ-Black were -9.1/-4.5/-6.3/-0.9 mL/min/1.73 m2, IQR 14.7/14.5/14.5/15.6 mL/min/1.73 m2, P10 25.1 %/34.8 %/30.3 %/37.2 % and P30 74.2 %/84.1 %/80.6 %/83.6 %. The improvement of bias and accuracy when using proper Q-values was most pronounced in men. Similar improvements were obtained above and below mGFR 60 mL/min/1.73 m2 and at various age and BMI intervals, except for BMI<20 kg/m2 where bias increased, and accuracy decreased. CONCLUSIONS GFR estimating equations may be re-expressed to include rescaled creatinine (sCr/Q) and used across populations with different creatinine generation if population-specific average creatinine concentrations (Q-values) for healthy persons are established.
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Affiliation(s)
- Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Alexandre Lahens
- Assistance Publique-Hôpitaux de Paris, Renal Physiology Unit, Bichat Hospital Paris, France
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Emmanuelle Vidal-Petiot
- Assistance Publique-Hôpitaux de Paris, Renal Physiology Unit, Bichat Hospital Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM U1148, LVTS Paris, France
| | - Martin Flamant
- Assistance Publique-Hôpitaux de Paris, Renal Physiology Unit, Bichat Hospital Paris, France
- Université Paris Cité, INSERM U1149, Center for Research on Inflammation Paris, France
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Sotomi Y, Tamaki S, Hikoso S, Nakatani D, Okada K, Dohi T, Sunaga A, Kida H, Sato T, Matsuoka Y, Sakamoto D, Kitamura T, Komukai S, Seo M, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Ohtani T, Yasumura Y, Yamada T, Sakata Y. Pathophysiological insights into machine learning-based subphenotypes of acute heart failure with preserved ejection fraction. Heart 2024; 110:441-447. [PMID: 37827559 DOI: 10.1136/heartjnl-2023-323059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The heterogeneous pathophysiology of the diverse heart failure with preserved ejection fraction (HFpEF) phenotypes needs to be examined. We aim to assess differences in the biomarkers among the phenotypes of HFpEF and investigate its multifactorial pathophysiology. METHODS This study is a retrospective analysis of the PURSUIT-HFpEF Study (N=1231), an ongoing, prospective, multicentre observational study of acute decompensated HFpEF. In this registry, there is a predefined subcohort in which we perform multibiomarker tests (N=212). We applied the previously established machine learning-based clustering model to the subcohort with biomarker measurements to classify them into four phenotypes: phenotype 1 (n=69), phenotype 2 (n=49), phenotype 3 (n=41) and phenotype 4 (n=53). Biomarker characteristics in each phenotype were evaluated. RESULTS Phenotype 1 presented the lowest value of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C reactive protein, tumour necrosis factor-α, growth differentiation factor (GDF)-15, troponin T and cystatin C, whereas phenotype 2, which is characterised by hypertension and cardiac hypertrophy, showed the highest value of these markers. Phenotype 3 showed the second highest value of GDF-15 and cystatin C. Phenotype 4 presented a low NT-proBNP value and a relatively high GDF-15. CONCLUSIONS Distinctive characteristics of biomarkers in HFpEF phenotypes would indicate differential underlying mechanisms to be elucidated. The contribution of inflammation to the pathogenesis varied considerably among different HFpEF phenotypes. Systemic inflammation substantially contributes to the pathophysiology of the classic HFpEF phenotype with cardiac hypertrophy. TRIAL REGISTRATION NUMBER UMIN-CTR ID: UMIN000021831.
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Affiliation(s)
- Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Tamaki
- Department of Cardiology, Rinku General Medical Center, Izumisano, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuki Matsuoka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisuke Sakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | | | - Akito Nakagawa
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
- Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Medical Center, Kawanishi, Japan
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Chandler S, Viswanathan S, Sartain F, John GT. Bone broth ingestion and acute kidney injury following kidney transplant: a role for cystatin C. BMJ Case Rep 2024; 17:e256431. [PMID: 38388200 PMCID: PMC10884203 DOI: 10.1136/bcr-2023-256431] [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] [Indexed: 02/24/2024] Open
Abstract
Measurement of graft dysfunction following kidney transplant through creatinine is well known to be impacted by many different factors. We report here a clinical scenario demonstrating the importance of dual measurement of glomerular filtration rate (GFR) based on creatinine and cystatin C while also examining within-subject variability of both tests.
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Affiliation(s)
- Shaun Chandler
- The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Renal Unit, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - Shankar Viswanathan
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Felicity Sartain
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Bålsrud P, Ulven SM, Christensen JJ, Ottestad I, Holven KB. Inflammatory markers and frailty in home-dwelling elderly, a cross-sectional study. BMC Geriatr 2024; 24:175. [PMID: 38373890 PMCID: PMC10877806 DOI: 10.1186/s12877-024-04690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low-grade, chronic inflammation during ageing, ("inflammageing"), is suggested to be involved in the development of frailty in older age. However, studies on the association between frailty, using the frailty index definition, and inflammatory markers are limited. The aim of this study was to investigate the relationship between inflammatory markers and frailty index (FI) in older, home-dwelling adults. METHOD Home-dwelling men and women aged ≥ 70 years old, living in South-East Norway were recruited and included in a cross-sectional study. The FI used in the current study was developed according to Rockwood's frailty index and included 38 variables, resulting in an FI score between 0 and 1 for each participant. Circulating inflammatory markers (IL-6, CRP, IGF-1, cystatin C, cathepsin S, and glycoprotein Acetyls) were analyzed from non-fasting blood samples using ELISA. Whole-genome PBMC transcriptomics was used to study the association between FI score and inflammation. RESULTS The study population comprised 403 elderly (52% women), with a median age of 74 years and a mean BMI of 26.2 kg/m2. The mean FI score for the total group was 0.15 (range 0.005-0.56). The group was divided into a frail group (FI score ≥ 0.25) and non-frail group. After adjusting for BMI, age, sex, and smoking in the whole group, IL-6, cathepsin S, cystatin C, and Gp-acetyls remained significant associated to FI score (IL-6: 0.002, 95% CI: 0.001, 0.002, cathepsin S: 6.7e-06, 95% CI 2.44e-06, 0.00001, cystatin C: 0.004, 95% CI: 0.002, 0.006, Gp- Acetyls: 0.09, 95% CI: 0.05, 0.13, p < 0.01 for all), while CRP and IGF-1 were not (0.0003, 95% CI: -00001, 0.0007, p = 0.13, (-1.27e-06), 95% CI: (-0.0003), 0.0003, p = 0.99). There was a significant association between FI score and inflammatory markers, and FI score and monocyte-specific gene expression. CONCLUSIONS We found an association between FI score and inflammatory markers, and between FI score and monocyte-specific gene expression among elderly subjects above 70 years of age. Whether inflammation is a cause or consequence of frailty and whether the progression of frailty can be attenuated by reducing inflammation remains to be clarified.
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Affiliation(s)
- Pia Bålsrud
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jacob J Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Clinical Nutrition, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
- National Advisory Unit on FH, Oslo University Hospital, Oslo, Norway.
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Cigula Kurajica V, Vogrinc Ž, Turčić A, Galić S. Determination of cystatin C reference interval for children in Croatia. Biochem Med (Zagreb) 2024; 34:010702. [PMID: 38125620 PMCID: PMC10731735 DOI: 10.11613/bm.2024.010702] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Cystatin C is considered an early marker of kidney damage. The aim was to determine the reference interval in children since this information was not available from the test manufacturer. Materials and methods Included were children aged 0 to 18 years undergoing routine check without history of any renal disease. Cystatin C was measured by the immunoturbidimetric method, and creatinine by the enzymatic method on a Cobas c501 analyzer (Roche Diagnostics, Manheim, Germany). Reference intervals were determined according to the CLSI C28-A3 guidelines using a robust method and a nonparametric percentile method, depending on the sample size. The Schwartz's formula was applied to estimate glomerular filtration (eGFR) from cystatin C. Results The cystatin C reference interval for children aged 1-18 years (N = 204, median 8 years) was from 0.61 mg/L (90% CI: 0.53 to 0.64) to 1.08 mg/L (90% CI: 1.07 to 1.14). Differences according to sex were not found. For children aged 0-1 years (N = 29, median 5 months), the reference interval was from 0.60 mg/L (90% CI: 0.48 to 0.72) to 1.49 mg/L (90% CI: 1.36 to 1.61). The sample size was too small to test the difference according to sex. The eGFR was 76 (70-88) mL/min/1.73m2 for males and 83 (74-92) mL/min/1.73m2 for females. Conclusion The cystatin C reference intervals for Croatian pediatric population according to age were determined. The cystatin C concentrations in children reach adulthood values after the first year. The cystatin C Schwartz's formula is applicable for eGFR calculation in children.
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Affiliation(s)
- Vlasta Cigula Kurajica
- Department for Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Željka Vogrinc
- Department for Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Turčić
- Department for Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Slobodan Galić
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
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Gan Y, Cai Y, Li J, Wu J, Zhang R, Han Q, Li W, Yang Q. Development and validation of a diagnostic nomogram to evaluate tubular atrophy/interstitial fibrosis of IgA nephropathy. Int J Med Sci 2024; 21:674-680. [PMID: 38464822 PMCID: PMC10920839 DOI: 10.7150/ijms.91804] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
Background: IgA nephropathy (IgAN) is a cause of chronic kidney disease (CKD). Tubular atrophy/interstitial fibrosis is associated with IgAN prognosis. However, simple tools for predicting pathological lesions of IgAN remain limited. Our objective was to develop a tool for evaluating tubular atrophy/interstitial fibrosis in patients with IgAN. Methods: In this cross-sectional study, 410 biopsy-verified IgAN patients were included. The factors associated with the incident interstitial fibrosis or tubular atrophy in IgAN were confirmed by using logistic regression analysis. A nomogram was developed using logistic regression coefficients to evaluate tubular atrophy or interstitial fibrosis. Receiver operating characteristic curves (ROC) and calibration curves were used to determine the discriminative ability and predictive accuracy of the nomogram. Results: In this study, the IgAN patients with tubular atrophy or interstitial fibrosis were older and had a higher percentage of males, hypertension and urinary protein excretion (UPE), with high levels of serum cystatin C, serum creatinine, high-sensitivity C-reactive protein and serum C4. The eGFRcr-cys equation calculated using serum creatinine, cystatin C and UPE were considered independent influencing factors of tubular atrophy or interstitial fibrosis in patients with IgAN. Furthermore, the nomogram demonstrated good discrimination (AUC: 0.87, 95% CI 0.81 to 0.93) and calibration in the validation cohort. Conclusion: The eGFRcr-cys and UPE are associated with tubular atrophy or interstitial fibrosis in patients with IgAN. Diagnostic nomogram can predict tubular atrophy or interstitial fibrosis in IgAN.
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Affiliation(s)
| | | | | | | | | | | | | | - Qiongqiong Yang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Inker LA, Chami A, Levey AS. Do We Need a New Creatinine-Based Estimated GFR Equation for Kidney Transplant Recipients? Am J Kidney Dis 2024; 83:257-259. [PMID: 37844726 DOI: 10.1053/j.ajkd.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
| | - Ashtar Chami
- Division of Transplant Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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37
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Kim JK, Faul J, Weir DR, Crimmins EM. Dried blood spot based biomarkers in the Health and Retirement Study: 2006 to 2016. Am J Hum Biol 2024; 36:e23997. [PMID: 37803815 PMCID: PMC10873048 DOI: 10.1002/ajhb.23997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION The Health and Retirement Study (HRS) has collected biomarker data over multiple waves. Such data can help improve our understanding of health changes in individuals and the causal pathways related to health. There are, however, technical challenges to using the HRS dried blood spots (DBS) biomarker data due to changes over time in assay protocols, platforms, and laboratories. We provide technical and summary information on biological indicators collected as part of the HRS from 2006 to 2016 that should be helpful to users of the data. METHODS We describe the opportunities and challenges provided by the HRS DBS data as well as insights provided by the data. The HRS collected DBS from its nationally representative sample of respondents 51 years of age or older from 2006 to 2016. DBS-based biomarkers were collected from half the sample in 2006, 2010, and 2014, and from the other half of the sample in 2008, 2012, and 2016. These DBS specimens were used to assay total and HDL cholesterol, glycosylated hemoglobin, C-reactive protein, and cystatin C from 2006 to 2016, and Interleukin 6 was added in 2014/2016. Samples included approximately 6000 individuals at each wave, and completion rates ranged from 81% to 90%. HRS transformed DBS values into venous blood equivalents to make them more comparable to those of the whole blood-based assays collected in most other studies and to facilitate longitudinal analysis. RESULTS Distribution of changes over time by age shows that total cholesterol levels decreased for each age, while HbA1c levels increased. Cystatin C shows a clear age gradient, but a number of other markers do not. Non-Hispanic Black persons and Hispanic respondents have a higher incidence of risk levels of each biomarker except for CRP among non-Hispanic Black older persons. CONCLUSION These public-use DBS data provide analysis opportunities that can be used to improve our understanding of health change with age in both populations and among individuals.
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Affiliation(s)
- Jung Ki Kim
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Jessica Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - David R. Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Eileen M. Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Ling J, Yang X, Dong L, Jiang Y, Zou S, Hu N. Utility of cystatin C and serum creatinine-based glomerular filtration rate equations in predicting vancomycin clearance: A population pharmacokinetics analysis in elderly Chinese patients. Biopharm Drug Dispos 2024; 45:58-68. [PMID: 38319316 DOI: 10.1002/bdd.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
Renal function is an important factor affecting the pharmacokinetics of vancomycin. The renal function in elderly patients gradually decreases with age. An accurate estimated glomerular filtration rate (GFR) is essential in drug dosing. The study aimed to determine the most appropriate renal function estimation equations to describe vancomycin pharmacokinetics in elderly patients using population pharmacokinetic analysis. Data were obtained retrospectively from elderly patients aged ≥65 years who received vancomycin for infection from September 2016 to January 2022. Renal function was estimated using the Cockcroft-Gault equation (CG), Modification of Diet in Renal Disease equation (MDRD), three Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPIcys-scr , CKD-EPIscr , and CKD-EPIcys ) and two Berlin Initiative Study equations (BIS-1 and BIS-2). The CKD-EPIcys-scr and BIS-2 equations were based on cystatin C (Cys C) and serum creatinine (Scr). The others were based on Cys C or Scr. A nonlinear mixed effects model (NONMEM) was used to develop the population pharmacokinetic model. A total of 471 serum concentrations from 313 elderly patients were used to develop the population pharmacokinetic model. Weight and GFR were identified as significant covariates affecting the pharmacokinetics of vancomycin. Cys C and Scr-based GFR (CKD-EPIcys-scr and BIS-2) yielded significant improvement performance compared with the other equations in model building. The interindividual variability of CL was reduced from 49.4% to 23.6% and 49.4% to 23.7% in CKD-EPIcys-scr and BIS-2 based models, respectively. However, greater interindividual variabilities of CL (from 26.6% to 29.0%) were represented in the other five models which were based on either Cys C or Scr. The GFR estimated by EPIcys-scr and BIS-2 equations and vancomycin CL exhibited a good correlation (r = 0.834 and 0.833). In the external validation with 124 serum concentrations, the predictive performances of the CKD-EPIcys-scr and BIS-2 based models (the mean relative prediction errors were less than 1%, the mean relative absolute prediction errors were about 23%) were also superior to the other five models (the mean relative prediction errors were about 2%, the mean relative absolute prediction errors were greater than 25%) which are based on either Cys C or Scr. In this study, we determined that the equation used to estimate GFR can affect the population pharmacokinetic model fitting result. Population pharmacokinetics model with CKD-EPIcys-scr or BIS-2 can be used to optimize vancomycin dosage in elderly Chinese patients.
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Affiliation(s)
- Jing Ling
- Department of Pharmacy, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xuping Yang
- Department of Pharmacy, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Lulu Dong
- Department of Pharmacy, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yan Jiang
- Department of Pharmacy, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Sulan Zou
- Department of Pharmacy, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Nan Hu
- Department of Pharmacy, The First People's Hospital of Changzhou/The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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Pinsino A, Wu J, Mohamed A, Cela A, Yu TC, Rednor SJ, Gong MN, Moskowitz A. Estimated glomerular filtration rate among intensive care unit survivors: From the removal of race coefficient to cystatin C-based equations. J Crit Care 2024; 79:154450. [PMID: 37918130 DOI: 10.1016/j.jcrc.2023.154450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Black race coefficient used in serum creatinine (sCr)-based estimated glomerular filtration rate (eGFR) calculation may perpetuate racial disparities. Among intensive care unit (ICU) survivors, sCr overestimates kidney function due to sarcopenia. Cystatin C (cysC) is a race- and muscle mass-independent eGFR marker. We investigated the impact of removing the race coefficient from sCr-based eGFR and compared cysC- and sCr-based eGFR in ICU survivors. MATERIALS AND METHODS Among 30,920 patients from 2 institutions in the Bronx and Boston, eGFR was calculated at hospital discharge using sCr-based equations with and without race coefficient (eGFRsCr2009 and eGFRsCr2021). In a subset with available cysC between ICU admission and 1-year follow-up, sCr- and cysC-based estimates were compared. RESULTS eGFRsCr2021 was higher than eGFRsCr2009 by a median of 4 ml/min/1.73 m2 among non-Black patients and lower by a median of 8 ml/min/1.73 m2 among Black patients. Removing race coefficient reclassified 12.9% of non-Black subjects and 16.1% of Black subjects to better and worse eGFR category, respectively, and differentially impacted the prevalence of kidney dysfunction between the institutions due to differences in racial composition. Among 51 patients with available cysC (108 measurements), cysC-based estimates were lower than sCr-based estimates (median difference 9 to 16 ml/min/1.73 m2), resulting in reclassification to worse eGFR category in 34% to 53.5% of measurements. CONCLUSIONS Among ICU survivors, removal of race coefficient leads to lower eGFR in Black patients and may contribute to overestimation of kidney function in non-Black patients. While cysC is rarely used, estimates based on this marker are significantly lower than those based on sCr.
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Affiliation(s)
- Alberto Pinsino
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA; Division of Cardiology, Columbia University Irving Medical Center, NY, USA.
| | - Jianwen Wu
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Amira Mohamed
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alban Cela
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Tsai-Chin Yu
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Samuel J Rednor
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michelle Ng Gong
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Ari Moskowitz
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA
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Liao L, Shi S, Ding B, Zhang R, Tu J, Zhao Y, Guo Q, Liao Y. The relationship between serum creatinine/ cystatin C ratio and mortality in hypertensive patients. Nutr Metab Cardiovasc Dis 2024; 34:369-376. [PMID: 37949717 DOI: 10.1016/j.numecd.2023.09.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND AIMS Sarcopenia is a disease characterized by loss of skeletal muscle mass and function that is closely associated with cardiovascular disease. The serum creatinine/cystatin C (Cr/CysC) ratio has been shown to be a simplified indicator for identifying low muscle mass (LMM) or sarcopenia. The aim of this study was to investigate whether the Cr/CysC ratio helps to predict prognostic information in hypertensive patients. METHODS AND RESULTS This cohort study included 2509 patients with hypertension from the National Health and Nutrition Survey 1999-2002. To evaluate the association between Cr/CysC ratio and mortality, we used Kaplan Meier estimates to calculate cumulative survival probabilities for all-cause mortality and cardiovascular mortality, Cox regression analyses, and hazard ratio (HR) and 95% confidence interval (CI) were calculated. Over a median follow-up of 11.76 years, lower Cr/CysC ratio was associated with lower risk of all-cause mortality (per 0.1 increase, HR:0.81, 95% CI: 0.77-0.85, P < 0.001) and cardiovascular mortality (per 0.1 increase, HR:0.80, 95% CI: 0.72-0.89, P < 0.001). Compared with patients with normal muscle mass, all-cause mortality, and cardiovascular mortality HR for patients with LMM diagnosed by Cr/CysC ratio were 1.57 (95% CI: 1.36-1.82, P < 0.001) and 1.64 (95% CI: 1.12-2.42, P = 0.012), respectively. CONCLUSION We found that low muscle mass shown by lower Cr/CysC ratio was an independent risk factor for poor prognosis in hypertensive patients. We recommend routine screening of Cr/CysC ratio in hypertensive patients and early intervention for low muscle mass or sarcopenia.
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Affiliation(s)
- Lihua Liao
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350000, China
| | - Shanshan Shi
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350000, China
| | - Bo Ding
- Respiratory Department of Jinan Fourth People's Hospital, Jinan, 250000, China
| | - Rongting Zhang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350000, China
| | - Jiabin Tu
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350000, China
| | - Yukun Zhao
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350000, China
| | - Qian Guo
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China; The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350000, China
| | - Ying Liao
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
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Wang J, Zeng L, Hong C, Cui H, Wang W, Zhu H, Li Q, Li Y, Li R, He J, Zhu H, Liu L, Xiao L. Lower creatinine to cystatin C ratio is associated with an increased risk of MASLD: A cross-sectional and prospective study of 368,634 UK Biobank participants. Clin Endocrinol (Oxf) 2024; 100:116-123. [PMID: 38146598 DOI: 10.1111/cen.14990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Metabolic dysfunction-associated steatotic liver disease (MASLD) affects many populations, and screening out the high-risk populations at an early stage is a challenge. As a sarcopenia index, the relationship between creatinine to cystatin C ratio (CCR) and MASLD remains unclear. This cross-sectional, prospective study aimed to explore the relationship between CCR and MASLD. Design Firstly, explored the correlation between CCR and MASLD in cross-sectional analyses. Then excluded the population with baseeline diagnosis of MASLD and analyzed the association with baseline CCR levels and the onset of MASLD in the population with available follow-up data. Univariate and multivariate logistic regression analyses were used to calculate odds ratios (ORs) to evaluate the association between CCR levels and MASLD. PATIENTS AND MEASUREMENTS This study included 368,634 participants from the UK Biobank for cross-sectional and prospective analyses. The demographic characteristics and laboratory measurements of all participants were obtained from the UK Biobank. MASLD was diagnosed according to the multi-society consensus nomenclature. Hepatic steatosis was defined as FLI ≥60. RESULTS We grouped the study participants according to CCR tertiles. In cross-sectional analyses, participants in CCR tertile 1 had the highest MASLD risk (OR: 1.070, 95% CI: 1.053-1.088, p < .001). And the similar association was observed in the prospective analyses (CCR tertile 1 OR: 1.340, 95% CI: 1.077-1.660, p = .009; CCR tertile 2 OR: 1.217, 95% CI: 1.021-1.450, p = .029, respectively). After stratification by gender, the significant association between CCR and the onset of MASLD was only observed in males (CCR tertile 1 OR: 1.639, 95% CI: 1.160-2.317, p = .005; CCR tertile 2 OR: 1.322, 95% CI: 1.073-1.628, p = .005, respectively). CONCLUSION Our results indicated that lower CCR was significantly associated with higher risk of MASLD, based on which predictive models can be developed to screen populations at high risk of developing MASLD.
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Affiliation(s)
- Jiaren Wang
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lin Zeng
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chang Hong
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Cui
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhen Wang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongbo Zhu
- Department of Medical Oncology, Hengyang Medical School, The First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Qimei Li
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Li
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruining Li
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingzhe He
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Zhu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Liu
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lushan Xiao
- Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Yang Y, Jiao YY, Zhang Z, Di DX, Zhang DY, Jiang SM, Zhou JH, Li WG. Optimal assessment of the glomerular filtration rate in older chinese patients using the equations of the Berlin Initiative Study. Aging Clin Exp Res 2024; 36:17. [PMID: 38294586 PMCID: PMC10830815 DOI: 10.1007/s40520-023-02657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024]
Abstract
AIM To evaluate the performances of the various estimated glomerular filtration rate (eGFR) equations of the Chronic Kidney Disease Epidemiology Collaboration, the Berlin Initiative Study (BIS), and the Full Age Spectrum (FAS) in older Chinese. METHODS This study enrolled Chinese adults aged ≥ 65 years who underwent GFR measurements (via 99Tcm-DTPA renal dynamic imaging) in our hospital from 2011 to 2022. Using the measured glomerular filtration rate (mGFR) as the reference, we derived the bias, precision, accuracy, and consistency of each equation. RESULTS We enrolled 519 participants, comprising 155 with mGFR ≥ 60 mL/min/1.73 m2 and 364 with mGFR < 60 mL/min/1.73 m2. In the total patients, the BIS equation based on creatinine and cystatin C (BIScr-cys) exhibited the lowest bias [median (95% confidence interval): 1.61 (0.77-2.18)], highest precision [interquartile range 11.82 (10.32-13.70)], highest accuracy (P30: 81.12%), and best consistency (95% limit of agreement: 101.5 mL/min/1.73 m2). In the mGFR ≥ 60 mL/min/1.73 m2 subgroup, the BIScr-cys and FAS equation based on creatinine and cystatin C (FAScr-cys) performed better than the other equations; in the mGFR < 60 mL/min/1.73 m2 subgroup, all equations exhibited relatively large deviations from the mGFR. Of all eight equations, the BIScr-cys performed the best. CONCLUSIONS Although no equation was fully accurate in the mGFR < 60 mL/min/1.73 m2 subgroup, the BIScr-cys (of the eight equations) assessed the eGFRs of the entire population best. A new equation is urgently required for older Chinese and even East Asians, especially those with moderate-to-severe renal insufficiency.
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Affiliation(s)
- Yue Yang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Yuan-Yuan Jiao
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
- Department of Nephrology, Fuwai Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zheng Zhang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Ding-Xin Di
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Dan-Yang Zhang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Shi-Min Jiang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Jia-Hui Zhou
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Wen-Ge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.
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Lee S, Noh S, Lee WH. Association of obstructive sleep apnea and diurnal variation of cystatin C. BMC Nephrol 2024; 25:40. [PMID: 38287274 PMCID: PMC10823701 DOI: 10.1186/s12882-024-03472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
PURPOSE Obstructive sleep apnea is a known risk factor for the progression of chronic kidney disease. To find early signs of the progression in subjects with obstructive sleep apnea., we assessed the diurnal variation of kidney biomarkers. METHODS A prospective observational study was conducted at Kangwon National University Hospital, Chuncheon, South Korea. All participants underwent in-laboratory polysomnography and phlebotomy in the evening before the polysomnography and in the morning after the polysomnography. Kidney biomarkers, including serum creatinine, blood urea nitrogen, and serum cystatin C, were measured. Delta kidney biomarkers were calculated by subtracting the evening level of the biomarkers from the morning level. RESULTS Twenty-six of 50 participants had severe obstructive sleep apnea. Delta cystatin C was significantly correlated with apnea-hypopnea index, oxygen desaturation index, and total arousal index with coefficients of -0.314, -0.323, and -0.289, respectively. In participants without severe obstructive sleep apnea, the morning cystatin C level (0.84 ± 0.11 mg/L) was significantly higher than the evening cystatin C level (0.81 ± 0.11 mg/L) (P = 0.005). With severe obstructive sleep apnea, the cystatin C levels were not different between the morning (0.85 ± 0.11 mg/L) and the evening (0.85 ± 0.10 mg/L). CONCLUSIONS Cystatin C level was increased in the morning in participants without severe obstructive sleep apnea, but not in participants with severe obstructive sleep apnea.
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Affiliation(s)
- Seolhyun Lee
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Sungryong Noh
- Division of Pulmonary & Critical Care, Sleep Medicine, McCovern Medical School, University of Texas at Houston, Houston, TX, USA
| | - Woo Hyun Lee
- Department of Otolaryngology, Kangwon National University, Chuncheon, Korea.
- Departments of Otolaryngology, Kangwon National University Hospital, 156, Baengnyeong-Ro, Chuncheon-Si, Gangwon-Do, 24289, Republic of Korea.
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Jou-Valencia D, Volbeda M, Zijlstra JG, Kootstra-Ros JE, Moser J, van Meurs M, Koeze J. Longitudinal NGAL and cystatin C plasma profiles present a high level of heterogeneity in a mixed ICU population. BMC Nephrol 2024; 25:43. [PMID: 38287305 PMCID: PMC10826252 DOI: 10.1186/s12882-024-03477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/21/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND NGAL and Cystatin C (CysC) as biomarkers for the early detection of AKI are subject to both pathophysiological, as well as patient related heterogeneity. The aim of this study was to investigate the timeline of plasma levels of NGAL and CysC during the first seven days of ICU admission in a mixed ICU population and to relate these to AKI severity during ICU stay. Via these means we aimed to bring clarity to the previously reported heterogeneity of these renal biomarkers. METHODS Prospective Observation Cohort. Consecutive patients admitted to adult ICU at an academic hospital in the Netherlands between 18-02-2014 and 31-03-2014 were included. Urine output, serum creatinine, plasma NGAL and CysC were recorded during the first seven days of ICU admission. Biomarker expression was analyzed based on KDIGO score and time of AKI diagnosis. RESULTS 335 patients were included, 110 met KDIGO criteria for AKI. NGAL and CysC plasma levels were higher in AKI patients compared to non-AKI, high variability in individual values resulted in 56% of AKI patients having a false negative, and 32% of non-AKI patients having a false positive. Individual biomarker levels were variable, and no pattern based on KDIGO score was observed. CONCLUSIONS Plasma NGAL and CysC as biomarkers for the early AKI detection may be subject to pathophysiological, and patient related heterogeneity. Further understanding of individual biomarker profiles may help in their application amongst mixed ICU populations. TRIAL REGISTRATION The need for informed consent was waived by the Institutional Ethical Review Board of the University Medical Center Groningen (METc 2013 - 174) by Prof. dr. W.A. Kamps on May 17th 2013.
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Affiliation(s)
- Daniela Jou-Valencia
- Department of Critical Care, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713GZ, The Netherlands
| | - Meint Volbeda
- Department of Critical Care, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713GZ, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713GZ, The Netherlands
- Department of Pathology and Medical Biology, Medical Biology section, Laboratory for Endothelial Biomedicine & Vascular Drug Targeting Research, University of Groningen, UMCG, Groningen, The Netherlands
| | | | - Jill Moser
- Department of Critical Care, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713GZ, The Netherlands
- Department of Pathology and Medical Biology, Medical Biology section, Laboratory for Endothelial Biomedicine & Vascular Drug Targeting Research, University of Groningen, UMCG, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713GZ, The Netherlands
| | - Jacqueline Koeze
- Department of Critical Care, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, 9713GZ, The Netherlands.
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de Almeida GS, Toledo NDN, Matos MMM, Martin LC, Franco RJDS. Different methods for assessing glomerular filtration rate in the elderly. Rev Assoc Med Bras (1992) 2024; 70:e20221101. [PMID: 38294122 PMCID: PMC10830097 DOI: 10.1590/1806-9282.20221101] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The objective of this study was to identify the best method to replace cystatin C in the evaluation of glomerular filtration in the elderly. METHODS Individuals over 60 years of age from a primary care center were studied. Blood was collected to determine creatinine and cystatin C and 24-h urine. Three methods were compared to determine glomerular filtration: Creatinine clearance, Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine, considering as a reference the determination of glomerular filtration using the cystatin-based Chronic Kidney Disease Epidemiology Collaboration equation. The statistical methods used were linear regression, Bland-Altman curve, and receiver operating characteristic. RESULTS A total of 180 elderly people were evaluated, but 14 patients were lost from the sample, resulting in a total of 166 patients. The average age of patients was 66.9±6.1 years, and 69.8% were females. Regarding the number of patients eligible for the study, there were 12 black, 108 brown, and 46 white, 42.77% hypertensive, and 38.3% diabetic. Glomerular filtration was less than 60 mL/min in 22.28% of patients. Regarding the evaluation of the different equations, the correlation coefficient was lower for creatinine clearance and progressively higher for Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine. The Bland-Altman diagram and the receiver operating characteristic curve showed similar performance to the correlation coefficient for the different equations evaluated. CONCLUSION Collaboration Epidemiology of Chronic Kidney Disease based on creatinine presented the best performance. Creatinine debug had the worst performance, which reinforces the idea that 24-h urine collection is unnecessary in these patients.
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Affiliation(s)
| | | | | | - Luis Cuadrado Martin
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculty of Medicine – Botucatu (SP), Brazil
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Tan SH, Guan CA, Bujang MA, Lai WH, Voon PJ, Sim EUH. Identification of phenomic data in the pathogenesis of cancers of the gastrointestinal (GI) tract in the UK biobank. Sci Rep 2024; 14:1997. [PMID: 38263244 PMCID: PMC10805853 DOI: 10.1038/s41598-024-52421-9] [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: 09/13/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
Gastrointestinal (GI) cancers account for a significant incidence and mortality rates of cancers globally. Utilization of a phenomic data approach allows researchers to reveal the mechanisms and molecular pathogenesis of these conditions. We aimed to investigate the association between the phenomic features and GI cancers in a large cohort study. We included 502,369 subjects aged 37-73 years in the UK Biobank recruited since 2006, followed until the date of the first cancer diagnosis, date of death, or the end of follow-up on December 31st, 2016, whichever occurred first. Socio-demographic factors, blood chemistry, anthropometric measurements and lifestyle factors of participants collected at baseline assessment were analysed. Unvariable and multivariable logistic regression were conducted to determine the significant risk factors for the outcomes of interest, based on the odds ratio (OR) and 95% confidence intervals (CI). The analysis included a total of 441,141 participants, of which 7952 (1.8%) were incident GI cancer cases and 433,189 were healthy controls. A marker, cystatin C was associated with total and each gastrointestinal cancer (adjusted OR 2.43; 95% CI 2.23-2.64). In this cohort, compared to Asians, the Whites appeared to have a higher risk of developing gastrointestinal cancers. Several other factors were associated with distinct GI cancers. Cystatin C and race appear to be important features in GI cancers, suggesting some overlap in the molecular pathogenesis of GI cancers. Given the small proportion of Asians within the UK Biobank, the association between race and GI cancers requires further confirmation.
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Affiliation(s)
- Shirin Hui Tan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia.
- Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Malaysia.
| | - Catherina Anak Guan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Wei Hong Lai
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Edmund Ui Hang Sim
- Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Malaysia
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47
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Choi MC, Kim DG, Yim SH, Kim HJ, Kim HW, Yang J, Kim BS, Huh KH, Kim MS, Lee J. Creatinine- cystatin C ratio and death with a functioning graft in kidney transplant recipients. Sci Rep 2024; 14:1966. [PMID: 38263396 PMCID: PMC10806062 DOI: 10.1038/s41598-024-52649-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/22/2024] [Indexed: 01/25/2024] Open
Abstract
Death with a functioning graft is important cause of graft loss after kidney transplantation. However, little is known about factors predicting death with a functioning graft among kidney transplant recipients. In this study, we evaluated the association between post-transplant creatinine-cystatin C ratio and death with a functioning graft in 1592 kidney transplant recipients. We divided the patients into tertiles based on sex-specific creatinine-cystatin C ratio. Among the 1592 recipients, 39.5% were female, and 86.1% underwent living-donor kidney transplantation. The cut-off value for the lowest creatinine-cystatin C ratio tertile was 0.86 in males and 0.73 in females. The lowest tertile had a significantly lower 5-year patient survival rate and was independently associated with death with a functioning graft (adjusted hazard ratio 2.574, 95% confidence interval 1.339-4.950, P < 0.001). Infection was the most common cause of death in the lowest tertile group, accounting for 62% of deaths. A low creatinine-cystatin C ratio was significantly associated with an increased risk of death with a functioning graft after kidney transplantation.
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Affiliation(s)
- Mun Chae Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Deok Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyuk Yim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Woo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeseok Yang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beom Seok Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
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48
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Zheng X, Feng L, Xing C, Wang J, Zhao W, Zhang F. Renal impairment may indicate postoperative low vision in young patients with proliferative diabetic retinopathy undergoing vitrectomy. Front Endocrinol (Lausanne) 2024; 14:1321226. [PMID: 38274226 PMCID: PMC10808762 DOI: 10.3389/fendo.2023.1321226] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Objective To innovatively evaluate the impact of renal impairment in young work age patients with proliferative diabetic retinopathy (PDR) on their visuality after vitrectomy. Methods To find out whether it is possible to better predict the improvement of visual acuity after vitrectomy in working-age people without adding additional preoperative testing. In view of the fact that diabetic retinopathy and diabetic nephropathy are common diabetic complications of microvascular damage, it is considered whether preoperative renal function can be used as this evaluation index. This paper studies the design under this theme. This retrospective study included 306 patients (306 eyes) diagnosed with PDR and undergoing vitrectomy in our hospital from January 2016 to June 2023. Relevant baseline data were collected, including age, history of kidney disease and clinical laboratory test results. According to the International Standard Logarithmic Visual Acuity Checklist, the best corrected visual acuity was tested on the first day of admission and one month after surgery, and the difference between the two was subtracted. A difference >0 was defined as "vision improved". Patients were classified as vision-improved group (n=245) and non-improved group (n=61). The differences in baseline serum urea nitrogen, creatinine, uric acid, Cystatin C, estimated glomerular filtration rate (eGFR) and urine protein distribution between the two groups were statistically analyzed, binary regression analysis was performed for meaningful parameters, and random forest model ranked the characteristics in importance. Results 1.A higher level of serum cystatin C [1.02(0.80,1.48) mg/L vs 0.86(0.67,1.12) mg/L, P<0.001] and a lower eGFR [82.3(50.33, 115.11) ml/(min/1.73m²) vs 107.69(73.9, 126.01) ml/(min/1.73m²), P=0.002] appeared in the non-(vision-)improved group compared with the vision-improved group. 2. The occurrence of preoperation proteinuria history of nephropathy take a larger proportion in non-improved group. 3. Univariate regression analysis showed history of nephrology (OR=1.887, P=0.028), preoperative serum urea nitrogen (OR=0.939, P=0.043), cystatin C (Cys-C) concentration (OR=0.75, P=0.024), eGFR (OR=1.011, P=0.003) and proteinuria (OR=3.128, P<0.001) were influencing factors to postoperative visual acuity loss in young working age PDR patients. Excluding other confounding factors, preoperative proteinuria is an independent risk factor for postoperative vision improvement in working-age PDR populations (OR=2.722, P=0.009). 4. The accuracy of the prediction random forst model is 0.81. The model appears to be superior in terms of positive prediction. Conclusion In young work aged PDR patients undergoing vitrectomy, preoperative urine protein can be an independent indicator of postoperative visual loss. Aggressive correction of kidney injury before surgery may help improve postoperative vision in patients with PDR.
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Affiliation(s)
- Xiaorong Zheng
- Clinical Laboratory, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Lin Feng
- Diabetic Eye Disease Ward, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Chen Xing
- Fundus Imaging and Laser Therapy Department, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Junlan Wang
- Internal Medicine Department, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Wei Zhao
- Medical Records Room, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Fengmei Zhang
- Clinical Laboratory, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
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Politis MD, Gutiérrez-Avila I, Just A, Pizano-Zárate ML, Tamayo-Ortiz M, Greenberg JH, Téllez-Rojo MM, Sanders AP, Rosa MJ. Recent ambient temperature and fine particulate matter (PM 2.5) exposure is associated with urinary kidney injury biomarkers in children. Sci Total Environ 2024; 907:168119. [PMID: 37884142 PMCID: PMC10842020 DOI: 10.1016/j.scitotenv.2023.168119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Limited research has examined associations between exposure to ambient temperature, air pollution, and kidney function or injury during the preadolescent period. We examined associations between exposure to ambient temperature and particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) with preadolescent estimated glomerular filtration rate (eGFR) and urinary kidney injury biomarkers. METHODS Participants included 437 children without cardiovascular or kidney disease enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors birth cohort study in Mexico City. eGFR and urinary kidney injury biomarkers were assessed at 8-12 years. Validated satellite-based spatio-temporal models were used to estimate mean daily temperature and PM2.5 levels at each participant's residence 7- and 30-days prior to the date of visit. Linear regression and distributed lag nonlinear models (DLNM) were used to examine associations between daily mean temperature and PM2.5 exposure and kidney outcomes, adjusted for covariates. RESULTS In single linear regressions, higher seven-day average PM2.5 was associated with higher urinary alpha-1-microglobulin and eGFR. In DLNM analyses, higher temperature exposure in the seven days prior to date of visit was associated with a decrease in urinary cystatin C of -0.56 ng/mL (95 % confidence interval (CI): -1.08, -0.04) and in osteopontin of -0.08 ng/mL (95 % CI: -0.15, -0.001). PM2.5 exposure over the seven days prior to date of visit was associated with an increase in eGFR of 1.77 mL/min/1.73m2 (95 % CI: 0.55, 2.99) and urinary cystatin C of 0.19 ng/mL (95 % CI: 0.03, 0.35). CONCLUSIONS Recent exposure to ambient temperature and PM2.5 were associated with increased and decreased urinary kidney injury biomarkers that may reflect subclinical glomerular or tubular injury in children. Further research is required to assess environmental exposures and worsening subclinical kidney injury across development.
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Affiliation(s)
- Maria D Politis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Iván Gutiérrez-Avila
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Epidemiology and Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI, United States
| | - María Luisa Pizano-Zárate
- Nutrition and Bioprogramming Coordination, National Institute of Perinatology, Mexico City, Mexico; UMF 4, South Delegation of the Federal District, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Social Security Institute, Mexico City, Mexico; Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, United States
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alison P Sanders
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria José Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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50
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Law YM, Hsu C, Hingorani SR, Richards M, McMullan DM, Jefferies H, Himmelfarb J, Katz R. Randomized controlled trial of remote ischemic preconditioning in children having cardiac surgery. J Cardiothorac Surg 2024; 19:5. [PMID: 38172875 PMCID: PMC10765905 DOI: 10.1186/s13019-023-02450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Children undergoing cardiac surgery are at risk for acute kidney injury (AKI) and cardiac dysfunction. Opportunity exists in protecting end organ function with remote ischemic preconditioning. We hypothesize this intervention lessens kidney and myocardial injury. METHODS We conducted a randomized, double blind, placebo controlled trial of remote ischemic preconditioning in children undergoing cardiac surgery. Pre-specified end points are change in creatinine, estimated glomerular filtration rate, development of AKI, B-type natriuretic peptide and troponin I at 6, 12, 24, 48, 72 h post separation from bypass. RESULTS There were 45 in the treatment and 39 patients in the control group, median age of 3.5 and 3.8 years, respectively. There were no differences between groups in creatinine, cystatin C, eGFR at each time point. There was a trend for a larger rate of decrease, especially for cystatin C (p = 0.042) in the treatment group but the magnitude was small. AKI was observed in 21 (54%) of control and 16 (36%) of treatment group (p = 0.094). Adjusting for baseline creatinine, the odds ratio for AKI in treatment versus control was 0.31 (p = 0.037); adjusting for clinical characteristics, the odds ratio was 0.34 (p = 0.056). There were no differences in natriuretic peptide or troponin levels between groups. All secondary end points of clinical outcomes were not different. CONCLUSIONS There is suggestion of RIPC delivering some kidney protection in an at-risk pediatric population. Larger, higher risk population studies will be required to determine its efficacy. Trial registration and date: Clinicaltrials.gov NCT01260259; 2021.
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Affiliation(s)
- Yuk M Law
- Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
- University of Washington School of Medicine, Seattle, WA, 98115, USA.
| | - Christine Hsu
- Kaiser Permanente of Washington, Seattle, WA, 98105, USA
| | - Sangeeta R Hingorani
- Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
- University of Washington School of Medicine, Seattle, WA, 98115, USA
| | - Michael Richards
- Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
- University of Washington School of Medicine, Seattle, WA, 98115, USA
| | - David M McMullan
- Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
- University of Washington School of Medicine, Seattle, WA, 98115, USA
| | - Howard Jefferies
- Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
- University of Washington School of Medicine, Seattle, WA, 98115, USA
| | | | - Ronit Katz
- University of Washington School of Medicine, Seattle, WA, 98115, USA
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