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Narasaki Y, Siu MK, Nguyen M, Kalantar-Zadeh K, Rhee CM. Personalized nutritional management in the transition from non-dialysis dependent chronic kidney disease to dialysis. Kidney Res Clin Pract 2024:j.krcp.23.142. [PMID: 38738275 DOI: 10.23876/j.krcp.23.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/10/2023] [Indexed: 05/14/2024] Open
Abstract
Dialysis has been the dominant treatment regimen in end-stage kidney disease as a means to remove uremic waste products and to maintain electrolyte, acid base, and fluid balance. However, given that dialysis may not always provide a survival benefit nor improved quality of life in certain subpopulations, there is growing recognition of the need for conservative and preservative management as an alternative treatment strategy for advanced chronic kidney disease (CKD). Personalized nutritional management tailored to patient's sociodemographics, social needs, psychological status, health literacy level, and preferences is a key component of conservative and preservative care, as well as in the management of patients transitioning from non-dialysis dependent CKD to dialysis. In this review, we discuss the nutritional and metabolic alterations that ensue in CKD; the rationale for low-protein diets in the conservative and preservative management of advanced CKD; the role of plant-based diets in kidney health; emerging data on dietary potassium and sodium intake on CKD outcomes; and the practical implementation of dietary interventions in advanced kidney disease.
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Affiliation(s)
- Yoko Narasaki
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA, USA
| | - Man Kit Siu
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA, USA
| | - Matthew Nguyen
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA, USA
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA, USA
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Sohn SY, Inoue K, Bashir MT, Currier JW, Neverova NV, Ebrahimi R, Rhee CM, Lee ML, Leung AM. Thyroid Dysfunction Risk After Iodinated Contrast Media Administration: A Prospective Longitudinal Cohort Analysis. J Clin Endocrinol Metab 2024:dgae304. [PMID: 38700099 DOI: 10.1210/clinem/dgae304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/05/2024] [Accepted: 05/01/2024] [Indexed: 05/05/2024]
Abstract
CONTEXT Iodinated contrast media (ICM) is a common source of excess iodine in medical settings, given the common use of iodinated radiologic procedures. OBJECTIVE To determine the long-term risks of thyroid dysfunction following iodinated contrast administration in a prospective study. DESIGN, SETTING, PARTICIPANTS A longitudinal cohort study was conducted of patients in the U.S. Veterans Affairs medical system who received ICM. MAIN OUTCOME MEASURES Serum thyroid function, thyroid antibody, and inflammatory markers were measured at baseline. Thyroid function tests were repeated at 1 month, 3 months, and every 6 months thereafter until 36 months. Risk of thyroid dysfunction and longitudinal changes in thyroid hormone levels were assessed using mixed effect models. RESULTS There were 122 participants (median age, 70.0 [IQR 62.2-74.0] years; 98.4% male). At baseline, six subjects had subclinical thyroid dysfunction prior to ICM receipt. During median follow-up of 18 months, iodine-induced thyroid dysfunction was observed in 11.5% (14/122); six (4.9%) developed hyperthyroidism (including one with overt hyperthyroidism) and eight (6.6%) subclinical hypothyroidism. At last follow-up, ten of 20 subjects with thyroid dysfunction (14 new-onset cases and six with preexisting thyroid dysfunction) had persistent subclinical hyperthyroidism or hypothyroidism. There were also subtle changes in thyroid hormones observed longitudinally within the reference ranges in the overall cohort. CONCLUSIONS There is a rare long-term risk of an excess iodine load on thyroid dysfunction even among individuals from an overall iodine-sufficient region, supporting the need for targeted monitoring following iodinated contrast administration.
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Affiliation(s)
- Seo Young Sohn
- Division of Endocrinology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Hakubi Center, Kyoto University, Kyoto, Japan
| | - Muhammad T Bashir
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
| | - Jesse W Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
- Division of Cardiology, Department of Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Natalia V Neverova
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
- Division of Cardiology, Department of Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Ramin Ebrahimi
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
- Division of Cardiology, Department of Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Connie M Rhee
- Division of Nephrology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
- Division of Nephrology, Department of Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Martin L Lee
- Veterans Affairs Health Services Research & Development Center for the Study of Health Care Innovation, Implementation, and Policy; VA Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, U.S.A
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, U.S.A
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Chang LL, Rhee CM, Kalantar-Zadeh K, Woodrow G. Dietary Protein Restriction in Patients with Chronic Kidney Disease. N Engl J Med 2024; 390:86-89. [PMID: 38169496 DOI: 10.1056/nejmclde2304134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
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You AS, Kalantar-Zadeh K, Brent GA, Narasaki Y, Daza A, Sim JJ, Kovesdy CP, Nguyen DV, Rhee CM. Impact of Thyroid Status on Incident Kidney Dysfunction and Chronic Kidney Disease Progression in a Nationally Representative Cohort. Mayo Clin Proc 2024; 99:39-56. [PMID: 38176833 PMCID: PMC10795379 DOI: 10.1016/j.mayocp.2023.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/12/2023] [Accepted: 08/29/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To examine the relationship between thyroid status and incident kidney dysfunction/chronic kidney disease (CKD) progression. PATIENTS AND METHODS We examined incident thyroid status, ascertained by serum thyrotropin (TSH) levels measured from January 1, 2007, through December 31, 2018, among 4,152,830 patients from the Optum Labs Data Warehouse, containing deidentified retrospective administrative claims data from a large national health insurance plan and electronic health record data from a nationwide network of provider groups. Associations of thyroid status, categorized as hypothyroidism, euthyroidism, or hyperthyroidism (TSH levels >5.0, 0.5-5.0, and <0.5 mIU/L, respectively), with the composite end point of incident kidney dysfunction in patients without baseline kidney dysfunction and CKD progression in those with baseline CKD were examined using Cox models. RESULTS Patients with hypothyroidism and hyperthyroidism had higher risk of incident kidney dysfunction/CKD progression in expanded case-mix analyses (reference: euthyroidism): adjusted hazard ratios (aHRs) (95% CIs) were 1.37 (1.34 to 1.40) and 1.42 (1.39 to 1.45), respectively. Incrementally higher TSH levels in the upper reference range and TSH ranges for subclinical, mild overt, and overt hypothyroidism (≥3.0-5.0, >5.0-10.0, >10.0-20.0, and >20.0 mIU/L, respectively) were associated with increasingly higher risk of the composite end point (reference: TSH level, 0.5 to <3.0 mIU/L): aHRs (95% CIs) were 1.10 (1.09 to 1.11), 1.37 (1.34 to 1.40), 1.70 (1.59 to 1.83), and 1.70 (1.50 to 1.93), respectively. Incrementally lower TSH levels in the subclinical (<0.5 mIU/L) and overt (<0.1 mIU/L) hyperthyroid ranges were also associated with the composite end point: aHRs (95% CIs) were 1.44 (1.41 to 1.47) and 1.48 (1.39 to 1.59), respectively. CONCLUSION In a national cohort, TSH levels in the upper reference range or higher (≥3.0 mIU/L) and below the reference range (<0.5 mIU/L) were associated with incident kidney dysfunction/CKD progression.
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Affiliation(s)
- Amy S You
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA; Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA; Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Gregory A Brent
- Division of Endocrinology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Yoko Narasaki
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA; Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Andrea Daza
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA; Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Southern California, Los Angeles, CA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN; Memphis Veterans Affairs Medical Center, Memphis, TN
| | - Danh V Nguyen
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA; Division of General Internal Medicine, University of California Irvine, Orange, CA
| | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA; Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA.
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Narasaki Y, Kalantar-Zadeh K, Rhee CM, Brunori G, Zarantonello D. Vegetarian Nutrition in Chronic Kidney Disease. Nutrients 2023; 16:66. [PMID: 38201898 PMCID: PMC10780746 DOI: 10.3390/nu16010066] [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: 11/11/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
There is rising interest globally with respect to the health implications of vegetarian or plant-based diets. A growing body of evidence has demonstrated that higher consumption of plant-based foods and the nutrients found in vegetarian and plant-based diets are associated with numerous health benefits, including improved blood pressure, glycemic control, lipid levels, body mass index, and acid-base parameters. Furthermore, there has been increasing recognition that vegetarian and plant-based diets may have potential salutary benefits in preventing the development and progression of chronic kidney disease (CKD). While increasing evidence shows that vegetarian and plant-based diets have nephroprotective effects, there remains some degree of uncertainty about their nutritional adequacy and safety in CKD (with respect to protein-energy wasting, hyperkalemia, etc.). In this review, we focus on the potential roles of and existing data on the efficacy/effectiveness and safety of various vegetarian and plant-based diets in CKD, as well as their practical application in CKD management.
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Affiliation(s)
- Yoko Narasaki
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA 90822, USA
| | - Kamyar Kalantar-Zadeh
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA 90822, USA
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
| | - Connie M. Rhee
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Nephrology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Giuliano Brunori
- Department of Nephrology, Santa Chiara Hospital, APSS, 31822 Trento, Italy
- CISMed, University of Trento, 38122 Trento, Italy
| | - Diana Zarantonello
- Department of Nephrology, Santa Chiara Hospital, APSS, 31822 Trento, Italy
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Shrestha P, Paul S, Sumida K, Thomas F, Surbhi S, Naser AM, Streja E, Rhee CM, Kalantar-Zadeh K, Kovesdy CP. Association of iron therapy with incidence of chronic kidney disease. Eur J Haematol 2023; 111:872-880. [PMID: 37668586 DOI: 10.1111/ejh.14091] [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: 05/04/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE We investigated the association of oral iron replacement with the incidence of chronic kidney disease (CKD) in a population with normal kidney function to study the effects of iron replacement on the development of new onset CKD. METHODS In a national cohort of US Veterans with no pre-existing CKD, we identified 33 894 incident new users of oral iron replacement and a comparable group of 112 780 patients who did not receive any iron replacement during 2004-2018. We examined the association of oral iron replacement versus no iron replacement with the incidence of eGFR <60 mL/min/1.73 m2 and the incidence of urine albumin creatinine ratio (UACR) ≥30 mg/g in competing risk regressions and in Cox models. We used propensity score weighing to account for differences in key baseline characteristics associated with the use of oral iron replacement. RESULTS In the cohort of 146 674 patients, a total of 18 547 (13%) patients experienced incident eGFR <60 mL/min/1.73 m2 , and 16 117 patients (11%) experienced new onset UACR ≥30 mg/g. Oral iron replacement was associated with significantly higher risk of incident eGFR <60 mL/min/1.73 m2 (subhazard ratio, 95% confidence interval [CI]: 1.3 [1.22-1.38], p < .001) and incident albuminuria (subhazard ratio, 95% CI: 1.14 [1.07-1.22], p < .001). CONCLUSION Oral iron replacement is associated with higher risk of new onset CKD. The long-term kidney safety of oral iron replacement should be tested in clinical trials.
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Affiliation(s)
- Prabin Shrestha
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Shejuti Paul
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Keiichi Sumida
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Satya Surbhi
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Abu Mohd Naser
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, University of California-Irvine, Orange, California, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, University of California-Irvine, Orange, California, USA
- Long Beach VA Medical Center, Long Beach, California, USA
| | - Kamyar Kalantar-Zadeh
- Long Beach VA Medical Center, Long Beach, California, USA
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, Habor-UCLA Medical Center and the Lundquist Institute, Torrance, California, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
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Kang DH, Streja E, You AS, Lee Y, Narasaki Y, Torres S, Novoa-Vargas A, Kovesdy CP, Kalantar-Zadeh K, Rhee CM. Hypoglycemia and Mortality Risk in Incident Hemodialysis Patients. J Ren Nutr 2023:S1051-2276(23)00151-6. [PMID: 37918644 DOI: 10.1053/j.jrn.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/14/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Hypoglycemia is a frequent occurrence in chronic kidney disease patients due to alterations in glucose and insulin metabolism. However, there are sparse data examining the predictors and clinical implications of hypoglycemia including mortality risk among incident hemodialysis patients. DESIGN AND METHODS Among 58,304 incident hemodialysis patients receiving care from a large national dialysis organization over 2007-2011, we examined clinical characteristics associated with risk of hypoglycemia, defined as a blood glucose concentration <70 mg/dL, in the first year of dialysis using expanded case-mix + laboratory logistic regression models. We then examined the association between hypoglycemia during the first year of dialysis with all-cause mortality using expanded case-mix + laboratory Cox models. RESULTS In the first year of dialysis, hypoglycemia was observed among 16.8% of diabetic and 6.9% of nondiabetic incident hemodialysis patients. In adjusted logistic regression models, clinical characteristics associated with hypoglycemia included younger age, female sex, African-American race, presence of a central venous catheter, lower residual renal function, and longer dialysis session length. In the overall cohort, patients who experienced hypoglycemia had a higher risk of all-cause mortality risk (reference: absence of hypoglycemia): adjusted hazard ratio (95% confidence interval) 1.08 (1.04, 1.13). In stratified analyses, hypoglycemia was also associated with higher mortality risk in the diabetic and nondiabetic subgroups: adjusted hazard ratios (95% confidence interval's) 1.08 (1.04-1.13), and 1.17 (0.94-1.45), respectively. CONCLUSIONS Hypoglycemia was a frequent occurrence among both diabetic and nondiabetic hemodialysis patients and was associated with a higher mortality risk. Further studies are needed to identify approaches that reduce hypoglycemia risk in the hemodialysis population.
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Affiliation(s)
- Duk-Hee Kang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, South Korea
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Amy S You
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Yongkyu Lee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Division, Department of Internal Medicine, NHIS Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Yoko Narasaki
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Silvina Torres
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Alejandra Novoa-Vargas
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California.
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Paul S, Shrestha P, Sumida K, Thomas F, Surbhi S, Naser AM, Streja E, Rhee CM, Kalantar-Zadeh K, Kovesdy CP. Association of oral iron replacement therapy with kidney failure and mortality in CKD patients. Clin Kidney J 2023; 16:2082-2090. [PMID: 37915900 PMCID: PMC10616436 DOI: 10.1093/ckj/sfad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 11/03/2023] Open
Abstract
Background Oral iron is the predominant route of iron replacement (IRT) but its benefits and safety are unclear in patients with chronic kidney disease (CKD). Methods We examined the association of oral IRT vs no IRT with end-stage kidney disease (ESKD) and mortality in a national cohort of US Veterans. We identified 17 413 incident new users of oral IRT with estimated glomerular filtration rates <60 mL/min/1.73 m2 and 32 530 controls who did not receive any IRT during 2004-18. We used propensity score-overlap weighting to account for differences in key baseline characteristics associated with the use of oral IRT. We examined associations using competing risk regression and Cox models. Results In the cohort of 49 943 patients, 1616 (3.2%) patients experienced ESKD and 28 711 (57%) patients died during a median follow-up of 1.9 years. Oral IRT was not associated with ESKD [subhazard ratio (HR) (95% confidence interval, CI) 1.00 (0.84-1.19), P = .9] and was associated with higher risk of all-cause mortality [HR (95% CI) 1.06 (1.01-1.11), P = .01]. There was significant heterogeneity of treatment effect for mortality, with oral IRT associated with higher mortality in the subgroups of patients without congestive heart failure (CHF), anemia or iron deficiency. In patient with blood hemoglobin <10 g/dL oral IRT was associated with significantly lower mortality. Conclusion Oral IRT was associated with lower mortality only in patients with anemia. In patients without anemia, iron deficiency or CHF, the risk-benefit ratio of oral IRT should be further examined.
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Affiliation(s)
- Shejuti Paul
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Prabin Shrestha
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fridtjof Thomas
- Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satya Surbhi
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Abu Mohd Naser
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN, USA
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California-Irvine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California-Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California-Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
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Lo R, Narasaki Y, Lei S, Rhee CM. Management of traditional risk factors for the development and progression of chronic kidney disease. Clin Kidney J 2023; 16:1737-1750. [PMID: 37915906 PMCID: PMC10616454 DOI: 10.1093/ckj/sfad101] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 11/03/2023] Open
Abstract
Chronic kidney disease (CKD) and its downstream complications (i.e. cardiovascular) are a major source of morbidity worldwide. Additionally, deaths due to CKD or CKD-attributable cardiovascular disease account for a sizeable proportion of global mortality. However, the advent of new pharmacotherapies, diagnostic tools, and global initiatives are directing greater attention to kidney health in the public health agenda, including the implementation of effective strategies that (i) prevent kidney disease, (ii) provide early CKD detection, and (iii) ameliorate CKD progression and its related complications. In this Review, we discuss major risk factors for incident CKD and CKD progression categorized across cardiovascular (i.e. hypertension, dyslipidemia, cardiorenal syndrome), endocrine (i.e. diabetes mellitus, hypothyroidism, testosterone), lifestyle (i.e. obesity, dietary factors, smoking), and genetic/environmental (i.e. CKDu/Mesoamerican nephropathy, APOL1, herbal nephropathy) domains, as well as scope, mechanistic underpinnings, and management.
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Affiliation(s)
- Robin Lo
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Sean Lei
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
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Rhee CM, Wang AYM, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, Ko GJ, Piccoli GB, Garibotto G, Brunori G, Sumida K, Lambert K, Moore LW, Han SH, Narasaki Y, Kalantar-Zadeh K. Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis. J Ren Nutr 2023; 33:S56-S66. [PMID: 37394104 PMCID: PMC10756934 DOI: 10.1053/j.jrn.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.
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Affiliation(s)
- Connie M Rhee
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California.
| | - Angela Yee-Moon Wang
- University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Diana Zarantonello
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | | | | | - Giuliano Brunori
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Keiichi Sumida
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoko Narasaki
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
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Rhee CM, You AS, Narasaki Y, Brent GA, Sim JJ, Kovesdy CP, Kalantar-Zadeh K, Nguyen DV. Development and Validation of a Prediction Model for Incident Hypothyroidism in a National Chronic Kidney Disease Cohort. J Clin Endocrinol Metab 2023; 108:e1374-e1383. [PMID: 37186674 PMCID: PMC11009786 DOI: 10.1210/clinem/dgad261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Hypothyroidism is a common yet under-recognized condition in patients with chronic kidney disease (CKD), which may lead to end-organ complications if left untreated. OBJECTIVE We developed a prediction tool to identify CKD patients at risk for incident hypothyroidism. METHODS Among 15 642 patients with stages 4 to 5 CKD without evidence of pre-existing thyroid disease, we developed and validated a risk prediction tool for the development of incident hypothyroidism (defined as thyrotropin [TSH] > 5.0 mIU/L) using the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees as well as electronic health record data. Patients were divided into a two-thirds development set and a one-third validation set. Prediction models were developed using Cox models to estimate probability of incident hypothyroidism. RESULTS There were 1650 (11%) cases of incident hypothyroidism during a median follow-up of 3.4 years. Characteristics associated with hypothyroidism included older age, White race, higher body mass index, low serum albumin, higher baseline TSH, hypertension, congestive heart failure, exposure to iodinated contrast via angiogram or computed tomography scan, and amiodarone use. Model discrimination was good with similar C-statistics in the development and validation datasets: 0.77 (95% CI 0.75-0.78) and 0.76 (95% CI 0.74-0.78), respectively. Model goodness-of-fit tests showed adequate fit in the overall cohort (P = .47) as well as in a subcohort of patients with stage 5 CKD (P = .33). CONCLUSION In a national cohort of CKD patients, we developed a clinical prediction tool identifying those at risk for incident hypothyroidism to inform prioritized screening, monitoring, and treatment in this population.
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Affiliation(s)
- Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Amy S You
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Yoko Narasaki
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Gregory A Brent
- Division of Endocrinology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - John J Sim
- Division of Nephrology, Kaiser Permanente Southern California, Los Angeles, CA 90027, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN 38104, USA
- Section of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN 38104, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
- Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Danh V Nguyen
- Division of General Internal Medicine and Primary Care, University of California Irvine, Orange, CA 92868, USA
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Okazaki M, Obi Y, Shafi T, Rhee CM, Kovesdy CP, Kalantar-Zadeh K. Residual Kidney Function and Cause-Specific Mortality Among Incident Hemodialysis Patients. Kidney Int Rep 2023; 8:1989-2000. [PMID: 37849997 PMCID: PMC10577493 DOI: 10.1016/j.ekir.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction The survival benefit of residual kidney function (RKF) in patients on hemodialysis is presumably due to enhanced fluid management and solute clearance. However, data are lacking on the association of renal urea clearance (CLurea) with specific causes of death. Methods We conducted a longitudinal cohort study of 39,623 adults initiating thrice-weekly in-center hemodialysis from 2007 to 2011 and had data on renal CLurea and urine volume. Multivariable cause-specific proportional hazards model was used to examine the associations between baseline RKF and cause-specific mortality, including sudden cardiac death (SCD), non-SCD cardiovascular death (CVD), and non-CVD. Restricted cubic splines were fitted for change in RKF over 6 months after initiating hemodialysis. Results Among 39,623 patients with data on baseline renal CLurea and urine volume, there was a significant trend toward a higher mortality risk across lower RKF levels, irrespective of cause of death in a case-mix adjustment model (Ptrend < 0.05). Adjustment for ultrafiltration rate (UFR) slightly attenuated the association between low renal CLurea and high cause-specific mortality, whereas adjustment for highest potassium did not have substantial effect. Among 12,169 patients with data on change in RKF, a 6-month decline in renal CLurea showed graded associations with SCD, non-SCD CVD, and non-CVD risk, whereas the graded associations between faster 6-month decline in urine output and higher death risk were clear only for SCD and non-CVD. Conclusion Lower RKF and loss of RKF were associated with higher cause-specific mortality among patients initiating thrice-weekly in-center hemodialysis.
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Affiliation(s)
- Masaki Okazaki
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitsugu Obi
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Tariq Shafi
- Division of Nephrology, Houston Methodist Hospital, Houston, Texas, USA
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
- Los Angeles County Harbor-UCLA Medical Center, and The Lundquist Institute, Torrance, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
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14
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Xu Y, Derakhshan A, Hysaj O, Wildisen L, Ittermann T, Pingitore A, Abolhassani N, Medici M, Kiemeney LALM, Riksen NP, Dullaart RPF, Trompet S, Dörr M, Brown SJ, Schmidt B, Führer-Sakel D, Vanderpump MPJ, Muendlein A, Drexel H, Fink HA, Ikram MK, Kavousi M, Rhee CM, Bensenor IM, Azizi F, Hankey GJ, Iacoviello M, Imaizumi M, Ceresini G, Ferrucci L, Sgarbi JA, Bauer DC, Wareham N, Boelaert K, Bakker SJL, Jukema JW, Vaes B, Iervasi G, Yeap BB, Westendorp RGJ, Korevaar TIM, Völzke H, Razvi S, Gussekloo J, Walsh JP, Cappola AR, Rodondi N, Peeters RP, Chaker L. The optimal healthy ranges of thyroid function defined by the risk of cardiovascular disease and mortality: systematic review and individual participant data meta-analysis. Lancet Diabetes Endocrinol 2023; 11:743-754. [PMID: 37696273 PMCID: PMC10866328 DOI: 10.1016/s2213-8587(23)00227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Reference intervals of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are statistically defined by the 2·5-97·5th percentiles, without accounting for potential risk of clinical outcomes. We aimed to define the optimal healthy ranges of TSH and FT4 based on the risk of cardiovascular disease and mortality. METHODS This systematic review and individual participant data (IPD) meta-analysis identified eligible prospective cohorts through the Thyroid Studies Collaboration, supplemented with a systematic search via Embase, MEDLINE (Ovid), Web of science, the Cochrane Central Register of Controlled Trials, and Google Scholar from Jan 1, 2011, to Feb 12, 2017 with an updated search to Oct 13, 2022 (cohorts found in the second search were not included in the IPD). We included cohorts that collected TSH or FT4, and cardiovascular outcomes or mortality for adults (aged ≥18 years). We excluded cohorts that included solely pregnant women, individuals with overt thyroid diseases, and individuals with cardiovascular disease. We contacted the study investigators of eligible cohorts to provide IPD on demographics, TSH, FT4, thyroid peroxidase antibodies, history of cardiovascular disease and risk factors, medication use, cardiovascular disease events, cardiovascular disease mortality, and all-cause mortality. The primary outcome was a composite outcome including cardiovascular disease events (coronary heart disease, stroke, and heart failure) and all-cause mortality. Secondary outcomes were the separate assessment of cardiovascular disease events, all-cause mortality, and cardiovascular disease mortality. We performed one-step (cohort-stratified Cox models) and two-step (random-effects models) meta-analyses adjusting for age, sex, smoking, systolic blood pressure, diabetes, and total cholesterol. The study was registered with PROSPERO, CRD42017057576. FINDINGS We identified 3935 studies, of which 53 cohorts fulfilled the inclusion criteria and 26 cohorts agreed to participate. We included IPD on 134 346 participants with a median age of 59 years (range 18-106) at baseline. There was a J-shaped association of FT4 with the composite outcome and secondary outcomes, with the 20th (median 13·5 pmol/L [IQR 11·2-13·9]) to 40th percentiles (median 14·8 pmol/L [12·3-15·0]) conveying the lowest risk. Compared with the 20-40th percentiles, the age-adjusted and sex-adjusted hazard ratio (HR) for FT4 in the 80-100th percentiles was 1·20 (95% CI 1·11-1·31) for the composite outcome, 1·34 (1·20-1·49) for all-cause mortality, 1·57 (1·31-1·89) for cardiovascular disease mortality, and 1·22 (1·11-1·33) for cardiovascular disease events. In individuals aged 70 years and older, the 10-year absolute risk of composite outcome increased over 5% for women with FT4 greater than the 85th percentile (median 17·6 pmol/L [IQR 15·0-18·3]), and men with FT4 greater than the 75th percentile (16·7 pmol/L [14·0-17·4]). Non-linear associations were identified for TSH, with the 60th (median 1·90 mIU/L [IQR 1·68-2·25]) to 80th percentiles (2·90 mIU/L [2·41-3·32]) associated with the lowest risk of cardiovascular disease and mortality. Compared with the 60-80th percentiles, the age-adjusted and sex-adjusted HR of TSH in the 0-20th percentiles was 1·07 (95% CI 1·02-1·12) for the composite outcome, 1·09 (1·05-1·14) for all-cause mortality, and 1·07 (0·99-1·16) for cardiovascular disease mortality. INTERPRETATION There was a J-shaped association of FT4 with cardiovascular disease and mortality. Low concentrations of TSH were associated with a higher risk of all-cause mortality and cardiovascular disease mortality. The 20-40th percentiles of FT4 and the 60-80th percentiles of TSH could represent the optimal healthy ranges of thyroid function based on the risk of cardiovascular disease and mortality, with more than 5% increase of 10-year composite risk identified for FT4 greater than the 85th percentile in women and men older than 70 years. We propose a feasible approach to establish the optimal healthy ranges of thyroid function, allowing for better identification of individuals with a higher risk of thyroid-related outcomes. FUNDING None.
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Affiliation(s)
- Yanning Xu
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ola Hysaj
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Lea Wildisen
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Till Ittermann
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | | | | | - Marco Medici
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lambertus A L M Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | - Marcus Dörr
- German Centre for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Healthcare System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Isabela M Bensenor
- Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Graeme J Hankey
- The University of Western Australia, Perth, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Massimo Iacoviello
- Cardiology Unit, Cardiothoracic Department, University Polyclinic Hospital of Bari, Bari, Italy
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
| | - Graziano Ceresini
- Department of Medicine and Surgery, Unit of Internal Medicine and Onco-Endocrinology, University Hospital of Parma, Parma, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - José A Sgarbi
- Division of Endocrinology and Metabolism, Faculdade de Medicina de Marília, Marília, Brazil
| | - Douglas C Bauer
- Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Nick Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, the Netherlands; Netherlands Heart Institute, Utrecht, Netherlands
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Giorgio Iervasi
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Bu B Yeap
- The University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Henry Völzke
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Salman Razvi
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; The University of Western Australia, Perth, WA, Australia
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Nicolas Rodondi
- Institute of Primary Health Care, University of Bern, Bern, Switzerland; Department of General Internal Medicine, Inselspital, University of Bern, Switzerland
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.
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15
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You AS, Norris KC, Kataoka-Yahiro M, Davis J, Page V, Hayashida G, Narasaki Y, Cheng SF, Ng R, Wong LL, Lee LY, Kalantar-Zadeh K, Rhee CM. Racial Disparities in End-Stage Kidney Disease Outcomes among Asians and Native Hawaiians and Other Pacific Islanders across Geographic Residence. Am J Nephrol 2023; 55:115-126. [PMID: 37725913 DOI: 10.1159/000534052] [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: 06/04/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION While Asian and Native Hawaiian and other Pacific Islander (NHOPI) patients have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asian and NHOPI individuals, we compared their ESKD outcomes based on residence in the mainland USA versus Hawaii/Pacific Islands (PIs). MATERIALS AND METHODS Using United States Renal Data System data, we examined the impact of geographic residence in the mainland versus Hawaii/PIs on race-mortality associations among incident ESKD patients transitioning to dialysis over January 1, 2000-December 31, 2016 using Cox regression. We examined likelihood of post-dialysis kidney transplantation using Cox models and cumulative incidence curves. RESULTS Compared with White patients in the mainland, Asian and NHOPI patients in the mainland had lower mortality: adjusted HRs (95% CIs) 0.67 (0.66-0.67) and 0.72 (0.70-0.73), respectively. When examining Asian and NHOPI patients in Hawaii/PIs, survival benefit was attenuated in Asian and diminished to the null in NHOPI patients (ref: mainland White patients). Cumulative incidence curves comparing Asian, NHOPI, and White patients showed Asian and NHOPI patients in the mainland had the highest likelihood of transplantation, whereas NHOPI and Asian patients in Hawaii/PIs had the lowest likelihood. CONCLUSION In the mainland, Asian and NHOPI patients had lower mortality versus White patients, whereas in Hawaii/PIs, this survival benefit was diminished in Asian and mitigated in NHOPI patients. NHOPI and Asian patients in Hawaii/PIs had less transplantation versus those in the mainland. Further research is needed to uncover factors contributing to differential ESKD outcomes among Asian and NHOPI patients across geographic residence.
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Affiliation(s)
- Amy S You
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | - Keith C Norris
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Merle Kataoka-Yahiro
- Department of Nursing, Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Victoria Page
- National Kidney Foundation-Hawaii, Honolulu, Hawaii, USA
| | - Glen Hayashida
- National Kidney Foundation-Hawaii, Honolulu, Hawaii, USA
| | - Yoko Narasaki
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | - Shiuh Feng Cheng
- Department of Medicine, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Roland Ng
- Department of Medicine, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Linda L Wong
- Department of Surgery, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Surgery, Queens Medical Center, Honolulu, Hawaii, USA
| | - Lung-Yi Lee
- Department of Surgery, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Surgery, Queens Medical Center, Honolulu, Hawaii, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
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16
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Yeung AM, Huang J, Pandey A, Hashim IA, Kerr D, Pop-Busui R, Rhee CM, Shah VN, Bally L, Bayes-Genis A, Bee YM, Bergenstal R, Butler J, Fleming GA, Gilbert G, Greene SJ, Kosiborod MN, Leiter LA, Mankovsky B, Martens TW, Mathieu C, Mohan V, Patel KV, Peters A, Rhee EJ, Rosano GMC, Sacks DB, Sandoval Y, Seley JJ, Schnell O, Umpierrez G, Waki K, Wright EE, Wu AHB, Klonoff DC. Biomarkers for the Diagnosis of Heart Failure in People with Diabetes: A Consensus Report from Diabetes Technology Society. Prog Cardiovasc Dis 2023; 79:65-79. [PMID: 37178991 DOI: 10.1016/j.pcad.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
Diabetes Technology Society assembled a panel of clinician experts in diabetology, cardiology, clinical chemistry, nephrology, and primary care to review the current evidence on biomarker screening of people with diabetes (PWD) for heart failure (HF), who are, by definition, at risk for HF (Stage A HF). This consensus report reviews features of HF in PWD from the perspectives of 1) epidemiology, 2) classification of stages, 3) pathophysiology, 4) biomarkers for diagnosing, 5) biomarker assays, 6) diagnostic accuracy of biomarkers, 7) benefits of biomarker screening, 8) consensus recommendations for biomarker screening, 9) stratification of Stage B HF, 10) echocardiographic screening, 11) management of Stage A and Stage B HF, and 12) future directions. The Diabetes Technology Society panel recommends 1) biomarker screening with one of two circulating natriuretic peptides (B-type natriuretic peptide or N-terminal prohormone of B-type natriuretic peptide), 2) beginning screening five years following diagnosis of type 1 diabetes (T1D) and at the diagnosis of type 2 diabetes (T2D), 3) beginning routine screening no earlier than at age 30 years for T1D (irrespective of age of diagnosis) and at any age for T2D, 4) screening annually, and 5) testing any time of day. The panel also recommends that an abnormal biomarker test defines asymptomatic preclinical HF (Stage B HF). This diagnosis requires follow-up using transthoracic echocardiography for classification into one of four subcategories of Stage B HF, corresponding to risk of progression to symptomatic clinical HF (Stage C HF). These recommendations will allow identification and management of Stage A and Stage B HF in PWD to prevent progression to Stage C HF or advanced HF (Stage D HF).
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Affiliation(s)
- Andrea M Yeung
- Diabetes Technology Society, Burlingame, CA, United States of America
| | - Jingtong Huang
- Diabetes Technology Society, Burlingame, CA, United States of America
| | - Ambarish Pandey
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Ibrahim A Hashim
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - David Kerr
- Diabetes Technology Society, Burlingame, CA, United States of America
| | | | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, United States of America
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Lia Bally
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias I Pujol, CIBERCV, Universitat Autonoma Barcelona, Spain
| | | | - Richard Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX and University of Mississippi, Jackson, MS, United States of America
| | | | - Gregory Gilbert
- Mills-Peninsula Medical Center, Burlingame, CA, United States of America
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States of America
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Thomas W Martens
- International Diabetes Center and Park Nicollet Clinic, Minneapolis, MN, United States of America
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Anne Peters
- University of Southern California Keck School of Medicine, Los Angeles, CA, United States of America
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - David B Sacks
- National Institutes of Health, Bethesda, MD, United States of America
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | | | - Oliver Schnell
- Forschergruppe Diabetes e.V., Munich-, Neuherberg, Germany
| | | | - Kayo Waki
- The University of Tokyo, Tokyo, Japan
| | - Eugene E Wright
- Charlotte Area Health Education Center, Charlotte, NC, United States of America
| | - Alan H B Wu
- University of California, San Francisco, San Francisco, CA, United States of America
| | - David C Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, United States of America.
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17
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Qian Q, Nguyen DV, Telesca D, Kurum E, Rhee CM, Banerjee S, Li Y, Senturk D. Multivariate spatiotemporal functional principal component analysis for modeling hospitalization and mortality rates in the dialysis population. Biostatistics 2023:kxad013. [PMID: 37337346 DOI: 10.1093/biostatistics/kxad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Abstract
Dialysis patients experience frequent hospitalizations and a higher mortality rate compared to other Medicare populations, in whom hospitalizations are a major contributor to morbidity, mortality, and healthcare costs. Patients also typically remain on dialysis for the duration of their lives or until kidney transplantation. Hence, there is growing interest in studying the spatiotemporal trends in the correlated outcomes of hospitalization and mortality among dialysis patients as a function of time starting from transition to dialysis across the United States Utilizing national data from the United States Renal Data System (USRDS), we propose a novel multivariate spatiotemporal functional principal component analysis model to study the joint spatiotemporal patterns of hospitalization and mortality rates among dialysis patients. The proposal is based on a multivariate Karhunen-Loéve expansion that describes leading directions of variation across time and induces spatial correlations among region-specific scores. An efficient estimation procedure is proposed using only univariate principal components decompositions and a Markov Chain Monte Carlo framework for targeting the spatial correlations. The finite sample performance of the proposed method is studied through simulations. Novel applications to the USRDS data highlight hot spots across the United States with higher hospitalization and/or mortality rates and time periods of elevated risk.
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Affiliation(s)
- Qi Qian
- Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
| | - Danh V Nguyen
- Department of Medicine, University of California, Irvine, CA 92868, USA
| | - Donatello Telesca
- Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
| | - Esra Kurum
- Department of Statistics, University of California, Riverside, CA 92521, USA
| | - Connie M Rhee
- Department of Medicine, University of California, Irvine, CA 92868, USA
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California School of Medicine, Irvine, CA 92868, USA
| | - Sudipto Banerjee
- Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
| | - Yihao Li
- Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
| | - Damla Senturk
- Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
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18
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Ayus JC, Kalantar-Zadeh K, Tantisattamo E, Rhee CM, Negri AL. Is hyponatremia a novel marker of inflammation in patients with COVID 19? Nephrol Dial Transplant 2023:7181490. [PMID: 37245062 DOI: 10.1093/ndt/gfad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Juan C Ayus
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
| | - Ekamol Tantisattamo
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
| | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
| | - Armando Luis Negri
- Nephrology Section, Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina
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19
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Rhee CM, You AS, Page V, Hayashida G, Kataoka-Yahiro M, Davis J, Wong LL, Narasaki Y, Kalantar-Zadeh K. Racial and Ethnic Differences in Chronic Kidney Disease and Its Risk Factors among Asian-Americans and Pacific Islanders in Hawaii. Nephron Clin Pract 2023; 147:373-382. [PMID: 36603561 PMCID: PMC10272063 DOI: 10.1159/000527990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Several studies suggest that Asian-American and Native Hawaiian and Other Pacific Islander (NHOPI) racial/ethnic groups have a heightened risk of chronic kidney disease (CKD), but provide limited inference due to the aggregation of these groups into a single racial/ethnic category. We thus examined the association of granularly defined racial/ethnic groups with specific CKD indicators among a diverse group of participants from the National Kidney Foundation of Hawaii's Kidney Early Detection Screening (KEDS) Program. METHODS Among 1,243 participants enrolled in 19 KEDS screening events over 2006-2009, we examined the association between Asian-American and NHOPI groups and specific CKD indicators, defined as self-reported CKD, microalbuminuria, and macroalbuminuria, using multivariable logistic regression. We then examined associations of race/ethnicity with various CKD risk factors. RESULTS The most predominant racial/ethnic groups were White (22.0%), Multiracial (18.9%), Japanese (19.2%), Filipino (13.4%), NHOPI (8.4%), and Chinese (4.5%) participants. NHOPI and Chinese participants had a higher risk of microalbuminuria (adjusted ORs [aORs] [95% CIs] 2.48 [1.25-4.91] and 2.37 [1.07-5.27], respectively), while point estimates for all other minority groups suggested higher risk (reference: Whites). NHOPI participants also had a higher risk of macroalbuminuria and self-reported CKD. While most minorities had a higher risk of diabetes and hypertension, NHOPI and Multiracial participants had a higher risk of obesity, whereas the East Asian groups had a lower risk. CONCLUSIONS In this community-based cohort, compared with Whites, Asian-Americans had a higher risk of early CKD indicators, whereas NHOPIs had a higher risk of more severe CKD indicators. Further studies are needed to elucidate the distinct pathways leading to CKD across diverse racial/ethnic groups in Hawaii.
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Affiliation(s)
- Connie M. Rhee
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA
| | - Amy S. You
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA
| | - Victoria Page
- National Kidney Foundation - Hawaii Chapter, Honolulu, HI
| | - Glen Hayashida
- National Kidney Foundation - Hawaii Chapter, Honolulu, HI
| | - Merle Kataoka-Yahiro
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI
| | - James Davis
- Office of Statistics and Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
| | - Linda L. Wong
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Department of Surgery, Queen’s Medical Center, Honolulu, HI
| | - Yoko Narasaki
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
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20
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Heo GY, Kim HJ, Kalantar D, Jung CY, Kim HW, Park JT, Chang TI, Yoo TH, Kang SW, Rhee CM, Kalantar-Zadeh K, Han SH. Association between Fiber Intake and Risk of Incident Chronic Kidney Disease: The UK Biobank Study. J Nutr Health Aging 2023; 27:1018-1027. [PMID: 37997724 DOI: 10.1007/s12603-023-1998-6] [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: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Dietary fiber intake is associated with a lower risk of diabetes, cardiovascular disease, and cancer. However, it is unknown whether dietary fiber has a beneficial effect on preventing the development of chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Using the UK Biobank prospective cohort, 110,412 participants who completed at least one dietary questionnaire and had an estimated glomerular filtration rate ≥60 mL/min/1.73 m2, urinary albumin-to-creatinine ratio <30 mg/g, and no history of CKD were included. The primary exposure was total dietary fiber density, calculated by dividing the absolute amount of daily total fiber intake by total energy intake (g/1,000 kcal). We separately examined soluble and insoluble fiber densities as additional predictors. The primary outcome was incident CKD based on diagnosis codes. RESULTS A total of 3,507 (3.2%) participants developed incident CKD during a median follow-up of 9.9 years. In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for incident CKD were 0.85 (0.77-0.94), 0.78 (0.70-0.86), and 0.76 (0.68-0.86), respectively, for the second, third, and highest quartiles of dietary fiber density (reference: lowest quartile). In a continuous model, the aHR for each +∆1.0g/1,000 kcal increase in dietary fiber density was 0.97 (95% CI, 0.95-0.99). This pattern of associations was similar for both soluble and insoluble fiber densities and did not differ across subgroups of sex, age, body mass index, hypertension, diabetes, smoking, and inflammation. CONCLUSION Increased fiber intake was associated with a lower risk of CKD in this large well-characterized cohort.
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Affiliation(s)
- G Y Heo
- Seung Hyeok Han, MD, Ph.D. Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, Phone: 82-2-2228-1984; Fax: 82-2-393-6884; E-mail: , (https://orcid.org/0000-0001-7923-5635)
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21
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Rhee CM, Zhou M, Woznick R, Mullon C, Anger MS, Ficociello LH. A real-world analysis of the influence of age on maintenance hemodialysis patients: managing serum phosphorus with sucroferric oxyhydroxide as part of routine clinical care. Int Urol Nephrol 2023; 55:377-387. [PMID: 35953565 PMCID: PMC9859895 DOI: 10.1007/s11255-022-03327-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Despite the growing number of elderly hemodialysis patients, the influence of age on nutritional parameters, serum phosphorus (sP), and use of phosphate-binder (PB) medications has not been well characterized. We aimed to describe age-related differences in patient characteristics in a large, real-world cohort of maintenance hemodialysis patients, and to examine the impact of age on sP management with sucroferric oxyhydroxide (SO). METHODS We retrospectively analyzed de-identified data from 2017 adult, in-center hemodialysis patients who switched from another PB to SO monotherapy as part of routine clinical care. Changes in baseline PB pill burden, sP levels, and nutritional and dialytic clearance parameters were assessed across varying age groups through 6 months. RESULTS At baseline, older patients had lower mean sP, serum albumin, and pre-dialysis weights compared with younger patients. Prescription of SO was associated with a 62% increase in the proportion of patients achieving sP ≤ 5.5 mg/dl and a 42% reduction in daily pill burden. The proportion of patients achieving sP ≤ 5.5 mg/dl after transitioning to SO increased by 113, 96, 68, 77, 61, 37 and 40% among those aged 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥ 80 years, respectively. CONCLUSIONS Older patients had worse nutritional parameters, lower pill burden, and lower sP at baseline versus younger counterparts. Prescription of SO was associated with improved sP control and reduced pill burden across all ages.
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Affiliation(s)
- Connie M. Rhee
- grid.266093.80000 0001 0668 7243Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA USA
| | - Meijiao Zhou
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
| | | | - Claudy Mullon
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
| | - Michael S. Anger
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
| | - Linda H. Ficociello
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
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22
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Kürüm E, Nguyen DV, Banerjee S, Li Y, Rhee CM, Şentürk D. A Bayesian multilevel time-varying framework for joint modeling of hospitalization and survival in patients on dialysis. Stat Med 2022; 41:5597-5611. [PMID: 36181392 PMCID: PMC9931182 DOI: 10.1002/sim.9582] [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: 03/01/2022] [Revised: 07/02/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Over 782 000 individuals in the United States have end-stage kidney disease with about 72% of patients on dialysis, a life-sustaining treatment. Dialysis patients experience high mortality and frequent hospitalizations, at about twice per year. These poor outcomes are exacerbated at key time periods, such as the fragile period after transition to dialysis. In order to study the time-varying effects of modifiable patient and dialysis facility risk factors on hospitalization and mortality, we propose a novel Bayesian multilevel time-varying joint model. Efficient estimation and inference is achieved within the Bayesian framework using Markov chain Monte Carlo, where multilevel (patient- and dialysis facility-level) varying coefficient functions are targeted via Bayesian P-splines. Applications to the United States Renal Data System, a national database which contains data on nearly all patients on dialysis in the United States, highlight significant time-varying effects of patient- and facility-level risk factors on hospitalization risk and mortality. Finite sample performance of the proposed methodology is studied through simulations.
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Affiliation(s)
- Esra Kürüm
- Department of Statistics, University of California, Riverside, CA, USA
| | - Danh V. Nguyen
- Department of Medicine, University of California Irvine, CA, USA
| | - Sudipto Banerjee
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Yihao Li
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Connie M. Rhee
- Department of Medicine, University of California Irvine, CA, USA
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, CA, USA
| | - Damla Şentürk
- Department of Biostatistics, University of California, Los Angeles, CA, USA
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23
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de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, Rosas SE, Rossing P, Bakris G. Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care 2022; 45:3075-3090. [PMID: 36189689 PMCID: PMC9870667 DOI: 10.2337/dci22-0027] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 02/05/2023]
Abstract
People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical trials support new approaches to treat diabetes and CKD. The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management. A joint group of ADA and KDIGO representatives reviewed and developed a series of consensus statements to guide clinical care from the ADA and KDIGO guidelines. The published guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management. Recommendations include comprehensive care in which pharmacotherapy that is proven to improve kidney and cardiovascular outcomes is layered on a foundation of healthy lifestyle. Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD.
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Affiliation(s)
- Ian H. de Boer
- Kidney Research Institute, University of Washington, Seattle, WA
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | | | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | | | - Sylvia E. Rosas
- Joslin Diabetes Center and Harvard Medical School, Boston, MA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Demark
- University of Copenhagen, Copenhagen, Denmark
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24
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de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, Rosas SE, Rossing P, Bakris G. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2022; 102:974-989. [PMID: 36202661 DOI: 10.1016/j.kint.2022.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022]
Abstract
People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical trials support new approaches to treat diabetes and CKD. The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management. A joint group of ADA and KDIGO representatives reviewed and developed a series of consensus statements to guide clinical care from the ADA and KDIGO guidelines. The published guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management. Recommendations include comprehensive care in which pharmacotherapy that is proven to improve kidney and cardiovascular outcomes is layered on a foundation of healthy lifestyle. Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD.
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Affiliation(s)
- Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, Washington, USA.
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Tami Sadusky
- University of Washington, Seattle, Washington, USA
| | | | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Connie M Rhee
- University of California, Irvine, Orange, California, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Demark; University of Copenhagen, Copenhagen, Denmark
| | - George Bakris
- University of Chicago Medicine, Chicago, Illinois, USA
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25
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Narasaki Y, You AS, Malik S, Moore LW, Bross R, Cervantes MK, Daza A, Kovesdy CP, Nguyen DV, Kalantar-Zadeh K, Rhee CM. Dietary potassium intake, kidney function, and survival in a nationally representative cohort. Am J Clin Nutr 2022; 116:1123-1134. [PMID: 36026516 PMCID: PMC9535513 DOI: 10.1093/ajcn/nqac215] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/17/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In healthy adults, higher dietary potassium intake is recommended given that potassium-rich foods are major sources of micronutrients, antioxidants, and fiber. Yet among patients with advanced kidney dysfunction, guidelines recommend dietary potassium restriction given concerns about hyperkalemia leading to malignant arrhythmias and mortality. OBJECTIVES Given sparse data informing these recommendations, we examined associations of dietary potassium intake with mortality in a nationally representative cohort of adults from the NHANES. METHODS We examined associations between daily dietary potassium intake scaled to energy intake (mg/1000 kcal), ascertained by 24-h dietary recall, and all-cause mortality among 37,893 continuous NHANES (1999-2014) participants stratified according to impaired and normal kidney function (estimated glomerular filtration rates <60 and ≥60 mL · min-1 · 1.73 m-2, respectively) using multivariable Cox models. We also examined the impact of the interplay between dietary potassium, source of potassium intake (animal- compared with plant-based sources), and coexisting macronutrient and mineral consumption upon mortality. RESULTS Among participants with impaired and normal kidney function, the lowest tertile of dietary potassium scaled to energy intake was associated with higher mortality (ref: highest tertile) [adjusted HR (aHR): 1.18; 95% CI: 1.02, 1.38 and aHR: 1.17; 95% CI: 1.06, 1.28, respectively]. Compared with high potassium intake from plant-dominant sources, participants with low potassium intake from animal-dominant sources had higher mortality irrespective of kidney function. Among participants with impaired kidney function, pairings of low potassium intake with high protein, low fiber, or high phosphorus consumption were each associated with higher death risk. CONCLUSIONS Lower dietary potassium scaled to energy intake was associated with higher mortality, irrespective of kidney function. There was also a synergistic relation of higher potassium intake, plant-based sources, and macronutrient/mineral consumption with survival. Further studies are needed to elucidate pathways linking potassium intake and coexisting dietary factors with survival in populations with and without chronic kidney disease.
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Affiliation(s)
- Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Health Center, Long Beach, CA, USA
| | - Amy S You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Health Center, Long Beach, CA, USA
| | - Shaista Malik
- Division of Cardiology, University of California Irvine, Orange, CA, USA
| | - Linda W Moore
- Department of Surgery and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - Rachelle Bross
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mackenzie K Cervantes
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Andrea Daza
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Health Center, Long Beach, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Danh V Nguyen
- Division of General Internal Medicine, University of California Irvine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Health Center, Long Beach, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Long Beach Health Center, Long Beach, CA, USA
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Lo RH, Kalantar-Zadeh K, You AS, Ayus JC, Streja E, Park C, Sohn P, Nakata T, Narasaki Y, Brunelli SM, Kovesdy CP, Nguyen DV, Rhee CM. Dysnatremia and risk of bloodstream infection in dialysis patients. Clin Kidney J 2022; 15:2322-2330. [PMID: 36381361 PMCID: PMC9664572 DOI: 10.1093/ckj/sfac197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background Emerging data suggest that sodium disarrays including hyponatremia are potential risk factors for infection ensuing from impairments in host immunity, which may be exacerbated by coexisting conditions (i.e. mucosal membrane and cellular edema leading to breakdown of microbial barrier function). While dysnatremia and infection-related mortality are common in dialysis patients, little is known about the association between serum sodium levels and the risk of bloodstream infection in this population. Methods Among 823 dialysis patients from the national Biospecimen Registry Grant Program who underwent serum sodium testing over the period January 2008–December 2014, we examined the relationship between baseline serum sodium levels and subsequent rate of bloodstream infection. Bloodstream infection events were directly ascertained using laboratory blood culture data. Associations between serum sodium level and the incidence of bloodstream infection were estimated using expanded case mix–adjusted Poisson regression models. Results In the overall cohort, ∼10% of all patients experienced one or more bloodstream infection events during the follow-up period. Patients with both lower sodium levels <134 mEq/l and higher sodium levels ≥140 mEq/l had higher incident rate ratios (IRRs) of bloodstream infection in expanded case mix analyses (reference 136–<138 mEq/l), with adjusted IRRs of 2.30 [95% confidence interval (CI) 1.19–4.44], 0.77 (95% CI 0.32–1.84), 1.39 (95% CI 0.78–2.47), 1.88 (95% CI 1.08–3.28) and 1.96 (95% CI 1.08–3.55) for sodium levels <134, 134–<136, 138–<140, 140–<142 and ≥142 Eq/l, respectively. Conclusions Both lower and higher baseline serum sodium levels were associated with a higher rate of subsequent bloodstream infections in dialysis patients. Further studies are needed to determine whether correction of dysnatremia ameliorates infection risk in this population.
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Affiliation(s)
- Robin H Lo
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
- Tibor Rubin Long Beach Veterans Affairs Medical Center , Long Beach, CA , USA
| | - Amy S You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
| | - Juan Carlos Ayus
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
- Renal Consultants , Houston, TX , USA
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
- Tibor Rubin Long Beach Veterans Affairs Medical Center , Long Beach, CA , USA
| | - Christina Park
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
- University of Washington School of Public Health , Seattle, WA , USA
| | - Peter Sohn
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
| | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
| | - Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
| | | | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center , Memphis, TN , USA
- Nephrology Section, Memphis Veterans Affairs Medical Center , Memphis, TN , USA
| | - Danh V Nguyen
- Division of General Internal Medicine, University of California Irvine , Orange, CA , USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine , Orange, CA , USA
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Rhee CM, Edwards D, Ahdoot RS, Burton JO, Conway PT, Fishbane S, Gallego D, Gallieni M, Gedney N, Hayashida G, Ingelfinger J, Kataoka-Yahiro M, Knight R, Kopple JD, Kumarsawami L, Lockwood MB, Murea M, Page V, Sanchez JE, Szepietowski JC, Lui SF, Kalantar-Zadeh K. Living Well With Kidney Disease and Effective Symptom Management: Consensus Conference Proceedings. Kidney Int Rep 2022; 7:1951-1963. [PMID: 36090498 PMCID: PMC9459054 DOI: 10.1016/j.ekir.2022.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) confers a high burden of uremic symptoms that may be underrecognized, underdiagnosed, and undertreated. Unpleasant symptoms, such as CKD-associated pruritus and emotional/psychological distress, often occur within symptom clusters, and treating 1 symptom may potentially alleviate other symptoms in that cluster. The Living Well with Kidney Disease and Effective Symptom Management Consensus Conference convened health experts and leaders of kidney advocacy groups and kidney networks worldwide to discuss the effects of unpleasant symptoms related to CKD on the health and well-being of those affected, and to consider strategies for optimal symptom management. Optimizing symptom management is a cornerstone of conservative and preservative management which aim to prevent or delay dialysis initiation. In persons with kidney dysfunction requiring dialysis (KDRD), incremental transition to dialysis and home dialysis modalities offer personalized approaches. KDRD is proposed as the preferred term given the negative connotations of "failure" as a kidney descriptor, and the success stories in CKD journeys. Engaging persons with CKD to identify and prioritize their personal values and individual needs must be central to ensure their active participation in CKD management, including KDRD. Person-centered communication and care are required to ensure diversity, equity, and inclusion; education/awareness that considers the health literacy of persons with CKD; and shared decision-making among the person with CKD, care partners, and providers. By putting the needs of people with CKD, including effective symptom management, at the center of their treatment, CKD can be optimally treated in a way that aligns with their goals.
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Affiliation(s)
- Connie M. Rhee
- Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | - Dawn Edwards
- Forum of ESRD Networks Kidney Patient Advisory Council, New York, New York, USA
| | - Rebecca S. Ahdoot
- Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | | | - Paul T. Conway
- American Association of Kidney Patients, Washington, USA
| | - Steven Fishbane
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell Health, Great Neck, New York, New York, USA
| | | | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | | | - Glen Hayashida
- National Kidney Foundation of Hawaii, Honolulu, Hawaii, USA
| | | | - Merle Kataoka-Yahiro
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of Nursing, Honolulu, Hawaii, USA
| | - Richard Knight
- American Association of Kidney Patients, Washington, USA
| | | | | | - Mark B. Lockwood
- Department of Biobehavioral Nursing Science, University of Illinois at Chicago, College of Nursing, Chicago, Illinois, USA
| | - Mariana Murea
- Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Victoria Page
- National Kidney Foundation of Hawaii, Honolulu, Hawaii, USA
| | | | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
| | - Siu-Fai Lui
- Hong Kong Kidney Foundation, Hong Kong, China
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA,Tibor Rubin Veterans Affairs Long Beach Health Care Center, Long Beach, California, USA,Correspondence: Kamyar Kalantar-Zadeh, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, 333 City Boulevard West. Orange, California 92868, USA.
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Hassan W, Shrestha P, Sumida K, Thomas F, Sweeney PL, Potukuchi PK, Rhee CM, Streja E, Kalantar-Zadeh K, Kovesdy CP. Association of Uric Acid-Lowering Therapy With Incident Chronic Kidney Disease. JAMA Netw Open 2022; 5:e2215878. [PMID: 35657621 PMCID: PMC9166229 DOI: 10.1001/jamanetworkopen.2022.15878] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Uric acid is a waste metabolite produced from the breakdown of purines, and elevated serum uric acid levels are associated with higher risk of hypertension, cardiovascular disease, and mortality and progression of chronic kidney disease (CKD). Treatment of hyperuricemia in patients with preexisting CKD has not been shown to improve kidney outcomes, but the associations of uric acid-lowering therapies with the development of new-onset kidney disease in patients with estimated glomerular filtration rate (eGFR) within reference range and no albuminuria is unclear. OBJECTIVE To examine the association of initiating uric acid-lowering therapy with the incidence of CKD. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients with eGFR of 60 mL/min/1.73 m2 or greater and no albuminuria treated at US Department of Veterans Affairs health care facilities from 2004 to 2019. Clinical trial emulation methods, including propensity score weighting, were used to minimize confounding. Data were analyzed from 2020 to 2022. EXPOSURE Newly started uric acid-lowering therapy. MAIN OUTCOMES AND MEASURES The main outcomes were incidences of eGFR less than 60 mL/min/1.73 m2, new-onset albuminuria, and end-stage kidney disease. RESULTS A total of 269 651 patients were assessed (mean [SD] age, 57.4 [12.5] years; 252 171 [94%] men). Among these, 29 501 patients (10.9%) started uric acid-lowering therapy, and 240 150 patients (89.1%) did not. Baseline characteristics, including serum uric acid level, were similar among treated and untreated patients after propensity score weighting. In the overall cohort, uric acid-lowering therapy was associated with higher risk of both incident eGFR less than 60 mL/min/1.73 m2 (weighted subhazard ratio [SHR], 1.15 [95% CI, 1.10-1.20; P < .001) and incident albuminuria (SHR, 1.05 [95% CI, 1.01-1.09; P < .001) but was not associated with the risk of end-stage kidney disease (SHR, 0.96 [95% CI, 0.62-1.50]; P = .87). In subgroup analyses, the association of uric acid-lowering therapy with worse kidney outcomes was limited to patients with baseline serum uric acid levels of 8 mg/dL or less. CONCLUSIONS AND RELEVANCE These findings suggest that in patients with kidney function within reference range, uric acid-lowering therapy was not associated with beneficial kidney outcomes and may be associated with potential harm in patients with less severely elevated serum uric acid levels.
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Affiliation(s)
- Waleed Hassan
- Department of Medicine, North Mississippi Medical Center, Tupelo
- Division of Nephrology, University of Tennessee Health Science Center, Memphis
| | - Prabin Shrestha
- Division of Nephrology, University of Tennessee Health Science Center, Memphis
| | - Keiichi Sumida
- Division of Nephrology, University of Tennessee Health Science Center, Memphis
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Patrick L. Sweeney
- John W. Demming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California–Irvine, Orange
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California–Irvine, Orange
- Long Beach VA Medical Center, Long Beach, California
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California–Irvine, Orange
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
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Narasaki Y, Rhee CM, Kalantar-Zadeh K. Going Nuts to Protect Kidneys and to Live Longer with Kidney Disease. Am J Nephrol 2022; 53:423-426. [PMID: 35609551 DOI: 10.1159/000524383] [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: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Yoko Narasaki
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, California, USA,
- Tibor Rubin Veterans Long Beach Healthcare System, Long Beach, California, USA,
| | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, California, USA
- Tibor Rubin Veterans Long Beach Healthcare System, Long Beach, California, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, California, USA
- Tibor Rubin Veterans Long Beach Healthcare System, Long Beach, California, USA
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Soohoo M, Obi Y, Rivara MB, Adams SV, Lau WL, Rhee CM, Kovesdy CP, Kalantar-Zadeh K, Arah OA, Mehrotra R, Streja E. Comparative Effectiveness of Dialysis Modality on Laboratory Parameters of Mineral Metabolism. Am J Nephrol 2022; 53:157-168. [PMID: 35226895 PMCID: PMC9116596 DOI: 10.1159/000521508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chronic kidney disease-mineral and bone disorders (CKD-MBD) are prevalent in patients undergoing maintenance dialysis. Yet, there are limited and mixed evidence on the effects of different dialysis modalities involving longer treatment times or higher frequencies on CKD-MBD markers. METHODS This cohort study used data from 132,523 incident dialysis patients treated with any of the following modalities: conventional thrice-weekly in-center hemodialysis, nocturnal in-center hemodialysis (NICHD), home hemodialysis (HHD), or peritoneal dialysis (PD) from 2007 to 2011. We used marginal structural models fitted with inverse probability weights to adjust for fixed and time-varying confounding and informative censoring. We estimated the average effects of treatments with different dialysis modalities on time-varying serum concentrations of CKD-MBD markers: albumin-corrected calcium, phosphate, parathyroid hormone (PTH), and alkaline phosphatase (ALP) using pooled linear regression. RESULTS Most of the cohort were exclusively treated with conventional in-center hemodialysis, while few were ever treated with NICHD or HHD. At the baseline, PD patients had the lowest mean and median values of PTH, while NICHD patients had the highest median values. During follow-up, compared to hemodialysis patients, patients treated with NICHD had lower mean serum PTH (19.8 pg/mL [95% confidence interval: 2.8, 36.8] lower), whereas PD and HHD patients had higher mean PTH (39.7 pg/mL [31.6, 47.8] and 51.2 pg/mL [33.0, 69.3] higher, respectively). Compared to hemodialysis patients, phosphate levels were lower for patients treated with NICHD (0.44 mg/dL [0.37, 0.52] lower), PD (0.15 mg/dL [0.12, 0.19] lower), or HHD (0.33 mg/dL [0.27, 0.40] lower). There were no clinically meaningful associations between dialysis modalities and concentrations of calcium or ALP. CONCLUSION In incident dialysis patients, compared to treatment with conventional in-center hemodialysis, treatments with other dialysis modalities with longer treatment times or higher frequency were associated with different patterns of serum phosphate and PTH. Given the recent growth in the use of dialysis modalities other than hemodialysis, the associations between the treatment and the CKD-MBD markers warrant additional study.
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Affiliation(s)
- Melissa Soohoo
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Yoshitsugu Obi
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Matthew B. Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Scott V. Adams
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Wei Ling Lau
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA
| | - Connie M. Rhee
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA
| | - Csaba P. Kovesdy
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Onyebuchi A. Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
- Department of Statistics, College of Letters and Science, University of California, Los Angeles (UCLA), Los Angeles, California, USA
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
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Bhandari SK, Zhou H, Shaw SF, Shi J, Tilluckdharry NS, Rhee CM, Jacobsen SJ, Sim JJ. Causes of Death in End-Stage Kidney Disease: Comparison between the United States Renal Data System and a Large Integrated Health Care System. Am J Nephrol 2022; 53:32-40. [PMID: 35016183 DOI: 10.1159/000520466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/09/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Using a large diverse population of incident end-stage kidney disease (ESKD) patients from an integrated health system, we sought to evaluate the concordance of causes of death (CODs) between the underlying COD from the United States Renal Data System (USRDS) registry and CODs obtained from Kaiser Permanente Southern California (KPSC). METHODS A retrospective cohort study was performed among incident ESKD patients who had mortality records and CODs reported in both KPSC and USRDS databases between January 1, 2007, and December 31, 2016. Underlying CODs reported by the KPSC were compared to the CODs reported by USRDS. Overall and subcategory-specific COD agreements were assessed using Cohen's weighted kappa statistic (95% CI). Proportions of positive and negative agreement were also determined. RESULTS Among 4,188 ESKD patient deaths, 4,118 patients had CODs recorded in both KPSC and USRDS. The most common KPSC CODs were circulatory system diseases (35.7%), endocrine/nutritional/metabolic diseases (24.2%), genitourinary diseases (12.9%), and neoplasms (9.6%). Most common USRDS CODs were cardiac disease (46.9%), withdrawal from dialysis (12.6%), and infection (10.1%). Of 2,593 records with causes listed NOT as "Other," 453 (17.4%) had no agreement in CODs between the USRDS and the underlying, secondary, tertiary, or quaternary causes recorded by KPSC. In comparing CODs recorded within KPSC to the USRDS, Cohen's weighted kappa (95% CI) was 0.20 (0.18-0.22) with overall agreement of 36.4%. CONCLUSION Among an incident ESKD population with mortality records, we found that there was only fair or slight agreement between CODs reported between the USRDS registry and KPSC, a large integrated health care system.
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Affiliation(s)
- Simran K Bhandari
- Department of Internal Medicine, Kaiser Permanente Downey Medical Center, Los Angeles, California, USA
- Department of Clinical Science, Kaiser Permanente Bernard J Tyson Kaiser School of Medicine, Pasadena, California, USA
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Sally F Shaw
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jiaxiao Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Natasha S Tilluckdharry
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Connie M Rhee
- Division of Nephrology, University of California Irvine Medical Center, Orange, California, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - John J Sim
- Department of Clinical Science, Kaiser Permanente Bernard J Tyson Kaiser School of Medicine, Pasadena, California, USA
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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Kalantar-Zadeh K, Lockwood MB, Rhee CM, Tantisattamo E, Andreoli S, Balducci A, Laffin P, Harris T, Knight R, Kumaraswami L, Liakopoulos V, Lui SF, Kumar S, Ng M, Saadi G, Ulasi I, Tong A, Li PKT. Patient-centred approaches for the management of unpleasant symptoms in kidney disease. Nat Rev Nephrol 2022; 18:185-198. [PMID: 34980890 DOI: 10.1038/s41581-021-00518-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/22/2022]
Abstract
Patients with chronic kidney disease (CKD) frequently experience unpleasant symptoms. These can be gastrointestinal (constipation, nausea, vomiting and diarrhoea), psychological (anxiety and sadness), neurological (lightheadedness, headache and numbness), cardiopulmonary (shortness of breath and oedema), dermatological (pruritus and dry skin), painful (muscle cramps, chest pain and abdominal pain) or involve sexual dysfunction, sleep disorders and fatigue. These symptoms often occur in clusters, with one of them as the lead symptom and others as secondary symptoms. Uraemic toxins (also called uremic toxins) are often considered to be the main cause of CKD-associated symptom burden, but treatment of uraemia by dialysis often fails to resolve them and can engender additional symptoms. Indeed, symptoms can be exacerbated by comorbid conditions, pharmacotherapies, lifestyle and dietary regimens, kidney replacement therapy and ageing. Patients with kidney disease, including those who depend on dialysis or transplantation, should feel actively supported in their symptom management through the identification and targeting of unpleasant symptoms via a tailored palliative care approach. Such an approach may help minimize the burden and consequences of kidney disease, and lead to improved patient outcomes including health-related quality of life and better life participation.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico. .,Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA.
| | - Mark B Lockwood
- Department of Behavioral Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Ekamol Tantisattamo
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Sharon Andreoli
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | | | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Siu-Fai Lui
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico.,Hong Kong Kidney Foundation, Hong Kong, China
| | | | - Maggie Ng
- The International Federation of Kidney Foundation - World Kidney Alliance (IFKF-WKA), Mexico City, Mexico.,Hong Kong Kidney Foundation, Hong Kong, China
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol & Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
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Rhee CM, Budoff M, Brent G, You AS, Stenvinkel P, Novoa A, Flores F, Hamal S, Dailing C, Kinninger A, Nakata T, Kovesdy CP, Nguyen DV, Kalantar-Zadeh K. Serum Thyrotropin Elevation and Coronary Artery Calcification in Hemodialysis Patients. Cardiorenal Med 2022; 12:106-116. [PMID: 35551382 PMCID: PMC9452456 DOI: 10.1159/000525037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/03/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Hypothyroidism is highly prevalent in end-stage kidney disease patients, and emerging data show that lower circulating thyroid hormone levels lead to downregulation of vascular calcification inhibitors and coronary artery calcification (CAC) in this population. To date, no studies have examined the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with CAC risk in hemodialysis patients. METHODS In secondary analyses of patients from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients trial, we examined serum TSH levels and CAC risk assessed by cardiac computed tomography scans collected within a 90-day period. We evaluated the relationship between serum TSH with CAC Volume (VS) and Agatston score (AS) (defined as >100 mm3 and >100 Houndsfield Units, respectively) using multivariable logistic regression. RESULTS Among 104 patients who met eligibility criteria, higher TSH levels in the highest tertile were associated with moderately elevated CAC VS and AS in case-mix-adjusted analyses (ref: lowest tertile): adjusted ORs (95% CIs) 4.26 (1.18, 15.40) and 5.53 (1.44, 21.30), respectively. TSH levels >3.0 mIU/L (ref: ≤3.0 mIU/L) were also associated with moderately elevated CAC VS and AS. In secondary analyses, point estimates of incrementally lower direct free thyroxine levels trended toward elevated CAC VS and AS, although associations did not achieve statistical significance. CONCLUSIONS In hemodialysis patients, higher serum TSH was associated with elevated CAC VS and AS. Further studies are needed to determine if thyroid hormone supplementation can attenuate CAC burden in this population.
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Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Matthew Budoff
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Gregory Brent
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA,Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Amy S. You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Fred Flores
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Sajad Hamal
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | | | - April Kinninger
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA,Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
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Kalantar-Zadeh K, Rhee CM, Joshi S, Brown-Tortorici A, Kramer HM. Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes. Curr Opin Nephrol Hypertens 2022; 31:26-35. [PMID: 34750331 DOI: 10.1097/mnh.0000000000000761] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Nearly half of all Americans with chronic kidney disease (CKD) also have type-2-diabetes (T2D). Whereas traditional and emerging pharmacotherapies are increasingly frequently used for the management of CKD in diabetes (CKD/DM), the role of integrated or multimodal interventions including the potentially synergistic and additive effect of diet and lifestyle modifications in addition to pharmacotherapy has not been well examined, in sharp contrast to the well-known integrated approaches to heart disease. RECENT FINDINGS Low-carbohydrate low-fat diets are often recommended in T2D, whereas low-protein diets (LPD) are recommended by guidelines for nondiabetic CKD with increasing emphasis on plant-based protein sources. High-protein diets with greater animal protein lead to glomerular hyperfiltration, especially in patients with T2D, and faster decline in renal function. Guidelines provide differing recommendations regarding the amount (low vs high) and source (plant vs animal) of dietary protein intake (DPI) in CKD/DM. Some such as KDIGO recommend 0.8 g/kg/day based on insufficient evidence for DPI restriction in CKD/DM, whereas KDOQI and ISRNM recommend a DPI of 0.6 to <0.8 g/kg/day. A patient-centered plant-focused LPD for the nutritional management of CKD/DM (PLAFOND), a type of PLADO diet comprising DPI of 0.6 to <0.8 g/kg/day with >50% plant-based sources, high dietary fiber, low glycemic index, and 25-35 Cal/kg/day energy, can be implemented by renal dietitians under Medical Nutrition Therapy. SUMMARY Potential risks vs benefits of high vs low protein intake in CKD/DM is unknown, for which expert recommendations remain opinion based. Randomized controlled studies are needed to examine safety, acceptability and efficacy of PLAFOND.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- University of California Irvine (UCI), Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, Orange
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, California
| | - Connie M Rhee
- University of California Irvine (UCI), Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, Orange
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Amanda Brown-Tortorici
- University of California Irvine (UCI), Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, Orange
| | - Holly M Kramer
- Loyola University Medical Center and Hines VA Medical Center, Hines, Illinois, USA
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Beshay M, Rhee CM, Kalantar-Zadeh K. Novel monitoring of renal function and medication levels in saliva and capillary blood of patients with kidney disease. Curr Opin Nephrol Hypertens 2022; 31:100-108. [PMID: 34772839 PMCID: PMC8684380 DOI: 10.1097/mnh.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Serum creatinine, urea, and cystatin C are the main biomarkers used to estimate glomerular filtration rates in persons with and without chronic kidney disease (CKD). Frequent measurements of these assays are needed to identify patients with earlier stages of CKD, detect episodes of acute kidney injury (AKI), and monitor for CKD progression. However, the cumbersome, time-consuming nature of conventional laboratory-based kidney function assays limit more frequent monitoring and greater patient self-management. RECENT FINDINGS Noninvasive salivary assessments of creatinine, cystatin C, and urea make it feasible to conduct frequent monitoring of kidney function in point-of-care settings, as well as in nonclinical-care settings such as at home. Additionally, fingerstick sampling can offer an alternative route of blood testing that is suitable for home-based assessments. In this review, we provide an overview of emerging data on various salivary vs. fingerstick blood assessment methods for kidney function; their accuracy in comparison to 'gold-standard' laboratory-based methods; and their respective strengths and limitations in the clinical setting. SUMMARY A practical, cost-effective, minimally invasive, multimarker assessment platform has the potential to circumvent the limitation of conventional laboratory blood-based testing approaches, and thereby address a major unmet need in the management of CKD patients.
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Affiliation(s)
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA
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Abstract
PURPOSE OF REVIEW Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia. RECENT FINDINGS Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk. SUMMARY Given the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.
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Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Katherine R. Tuttle
- Providence Health Care, Spokane, Washington
- Nephrology Division and Kidney Research Institute, University of Washington, Seattle, Washington
- Institute of Translational Health Sciences, University of Washington, Seattle, Washington
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You AS, Budoff M, Zeb I, Ahmadi N, Novoa A, Flores F, Hamal S, Kinninger A, Dailing C, Nakata T, Kovesdy CP, Nguyen DV, Brent GA, Kalantar-Zadeh K, Rhee CM. Elevated serum thyrotropin levels and endothelial dysfunction in a prospective hemodialysis cohort. Hemodial Int 2022; 26:57-65. [PMID: 34231302 PMCID: PMC10753993 DOI: 10.1111/hdi.12964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Thyroid dysfunction is a highly prevalent yet under-recognized complication in hemodialysis patients. In the general population, hypothyroidism has been associated with endothelial dysfunction due to impaired vasodilator synthesis and activity. Little is known about the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with endothelial function in hemodialysis patients. METHODS In a secondary analysis of 99 patients from the Anti-inflammatory and anti-oxidative nutrition in hypoalbuminemic dialysis patients (AIONID) trial, we examined measurements of serum TSH and endothelial function ascertained by fingertip digital thermal monitoring (DTM), a novel method used to measure micro-vascular reactivity, collected within a 90-day period. DTM was used to measure changes in fingertip temperature during and after an ischemic stimulus (blood pressure cuff occlusion) as an indicator of changes in blood flow, and two DTM indices were assessed, namely adjusted (a) Temperature Rebound (TR), defined as the maximum temperature rebound post-cuff deflation, and adjusted (b) Area Under the Temperature Curve (TMP-AUC), defined as area under the curve between the maximum and minimum temperatures. We examined the relationship between serum TSH with impaired TR (separately) and TMP-AUC (both defined as less than the median level of observed values) using multivariable logistic regression. FINDINGS In unadjusted and case-mix analyses, higher serum TSH levels (defined as the three highest quartiles) were associated with lower (worse) TR (ref: lowest TSH quartile): ORs (95% CI) 2.64 (1.01-6.88) and 2.85 (1.08-7.57), respectively. In unadjusted and case-mix analyses, higher TSH levels were associated with lower (worse) TMP-AUC: ORs (95% CI) 2.64 (1.01-6.88) and 2.79 (1.06-7.38), respectively. DISCUSSION In HD patients, higher serum TSH levels were associated with worse micro-vascular reactivity measured by DTM. Further studies are needed to determine if thyroid hormone supplementation improves endothelial function in hemodialysis patients with lower levels of thyroid function.
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Affiliation(s)
- Amy S. You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| | - Matthew Budoff
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | - Irfan Zeb
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Naser Ahmadi
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| | - Ferdinand Flores
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | - Sajad Hamal
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | - April Kinninger
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | | | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | - Gregory A. Brent
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
| | - Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
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Otobe Y, Rhee CM, Nguyen M, Kalantar-Zadeh K, Kopple JD. Current status of the assessment of sarcopenia, frailty, physical performance and functional status in chronic kidney disease patients. Curr Opin Nephrol Hypertens 2022; 31:109-128. [PMID: 34772840 PMCID: PMC8688315 DOI: 10.1097/mnh.0000000000000763] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Low physical function, frailty, and sarcopenia are common complications of chronic kidney disease (CKD). In this article, we review the epidemiology and pathogenesis of low physical function, as well as its associations with adverse outcomes in CKD patients. Additionally, we present various traditional and novel methods for assessment of physical function in CKD patients. RECENT FINDINGS In nondialysis dependent (NDD) and dialysis-dependent CKD patients, the prevalence of low physical function, frailty, and sarcopenia are substantially higher than in the general population. The potential mechanisms of low physical function, frailty, and sarcopenia in CKD patients are due to various factors including underlying kidney disease, co-existing comorbidities, and certain therapeutic interventions utilized in CKD. Increasing evidence has also uncovered the ill effects of impaired physical function on clinical outcomes in CKD patients. SUMMARY Routine assessment of physical function is an under-utilized yet important component in the management of CKD patients. Future studies are needed to determine how prescription of exercise and increased daily physical activity can be tailored to optimize the health and well-being of NDD and dialysis-dependent CKD patients in pursuit of successful aging.
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Affiliation(s)
- Yuhei Otobe
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Matthew Nguyen
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
| | - Joel D. Kopple
- UCLA Fielding School of Public Health, Los Angeles, CA
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Li Y, Nguyen DV, Kürüm E, Rhee CM, Banerjee S, Şentürk D. Multilevel Varying Coefficient Spatiotemporal Model. Stat (Int Stat Inst) 2021; 11. [DOI: 10.1002/sta4.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yihao Li
- Department of Biostatistics University of California Los Angeles CA USA
| | - Danh V. Nguyen
- Department of Medicine University of California Irvine Orange CA USA
| | - Esra Kürüm
- Department of Statistics University of California Riverside CA USA
| | - Connie M. Rhee
- Department of Medicine University of California Irvine Orange CA USA
- Harold Simmons Center for Chronic Disease Research and Epidemiology University of California Irvine School of Medicine Orange CA USA
| | - Sudipto Banerjee
- Department of Biostatistics University of California Los Angeles CA USA
| | - Damla Şentürk
- Department of Biostatistics University of California Los Angeles CA USA
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Estes JP, Şentürk D, Kürüm E, Rhee CM, Nguyen DV. Fixed Effects High-Dimensional Profiling Models in Low Information Context. Int J Stats Med Res 2021; 10:118-131. [PMID: 35465259 PMCID: PMC9033160 DOI: 10.6000/1929-6029.2021.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Profiling or evaluation of health care providers, including hospitals or dialysis facilities, involves the application of hierarchical regression models to compare each provider’s performance with respect to a patient outcome, such as unplanned 30-day hospital readmission. This is achieved by comparing a specific provider’s estimate of unplanned readmission rate, adjusted for patient case-mix, to a normative standard, typically defined as an “average” national readmission rate across all providers. Profiling is of national importance in the United States because the Centers for Medicare and Medicaid Services (CMS) policy for payment to providers is dependent on providers’ performance, which is part of a national strategy to improve delivery and quality of patient care. Novel high dimensional fixed effects (FE) models have been proposed for profiling dialysis facilities and are more focused towards inference on the tail of the distribution of provider outcomes, which is well-suited for the objective of identifying sub-standard (“extreme”) performance. However, the extent to which estimation and inference procedures for FE profiling models are effective when the outcome is sparse and/or when there are relatively few patients within a provider, referred to as the “low information” context, have not been examined. This scenario is common in practice when the patient outcome of interest is cause-specific 30-day readmissions, such as 30-day readmission due to infections in patients on dialysis, which is only about ~ 8% compared to the > 30% for all-cause 30-day readmission. Thus, we examine the feasibility and effectiveness of profiling models under the low information context in simulation studies and propose a novel correction method to FE profiling models to better handle sparse outcome data.
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Affiliation(s)
| | - Damla Şentürk
- Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
| | - Esra Kürüm
- Department of Statistics, University of California, Riverside, CA 92521, USA
| | - Connie M. Rhee
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Danh V. Nguyen
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
- Address correspondence to this author at the Department of Medicine, University of California Irvine, 333 City Blvd. West, City Tower, Suite 400, Orange, CA 92868, USA;
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Marroquin MV, Sy J, Kleine CE, Oveyssi J, Hsiung JT, Park C, Soohoo M, Kovesdy CP, Rhee CM, Streja E, Kalantar-Zadeh K, Tantisattamo E. Association of Pre-ESKD Hyponatremia with Post-ESKD Outcomes among Incident ESKD Patients. Nephrol Dial Transplant 2021; 37:358-365. [PMID: 34390572 DOI: 10.1093/ndt/gfab203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hyponatremia is one of the most common electrolyte disturbances in advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients and has been shown to be associated with higher mortality risk. However, the relationship between hyponatremia during late-stage CKD and the risk of poor outcomes after ESKD transition is unknown. METHODS We conducted a retrospective cohort study including 32,257 US veterans transitioning to ESKD from October 1, 2007 to March 30, 2015. We evaluated adjusted associations between the 3-month averaged pre-transition to ESKD serum sodium and all-cause mortality. Secondary outcomes included cardiovascular (CV) mortality, infection-related mortalities, and hospitalization rate. RESULTS Cohort mean±SD serum sodium was 139 ± 3 mEq/L, mean age was 67 ± 11 years, 98% were male, and 32% were African American. Over a median follow-up of 702 days (296, 1301) there were 17,162 deaths. Compared to the reference of 135-<144 mEq/L, the lowest serum sodium group (<130 mEq/L) had a 54% higher all-cause mortality risk (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.34, 1.76) in the fully adjusted model. Associations were similar for CV and infection-related mortality, and hospitalization outcomes. CONCLUSIONS Hyponatremia prior to ESKD transition is associated with higher risk of all-cause, CV, and infection-related mortalities and hospitalization rates after ESKD transition. Future studies evaluating management of pre-ESKD hyponatremia may be indicated to improve patient outcomes for those transitioning to ESKD.
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Affiliation(s)
- Maria V Marroquin
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - John Sy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Justin Oveyssi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA.,Tibor Rubin VA Medical Center, Long Beach, CA, USA.,Fielding School of Public Health at UCLA, Los Angeles, CA, USA
| | - Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
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Narasaki Y, Park E, You AS, Daza A, Peralta RA, Guerrero Y, Novoa A, Amin AN, Nguyen DV, Price D, Kalantar-Zadeh K, Rhee CM. Continuous glucose monitoring in an end-stage renal disease patient with diabetes receiving hemodialysis. Semin Dial 2021; 34:388-393. [PMID: 34378258 DOI: 10.1111/sdi.13009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 12/29/2022]
Abstract
Diabetes is the leading cause of end-stage renal disease (ESRD) and contributes to heightened morbidity and mortality in dialysis patients. Given that ESRD patients are susceptible to hypoglycemia and hyperglycemia via multiple pathways, adequate glycemic monitoring and control is a cornerstone in diabetic kidney disease management. In ESRD, existing glycemic metrics such as glycated hemoglobin, self-monitored blood glucose, fructosamine, and glycated albumin have limitations in accuracy, convenience, and accessibility. In contrast, continuous glucose monitoring (CGM) provides automated, less invasive glucose measurements and more comprehensive glycemic data versus conventional metrics. Here, we report a 48-year-old male with ESRD due to diabetes receiving thrice-weekly hemodialysis who experienced decreased patient-burden, greater glucose monitoring adherence, improved glycemic parameters, and reduction in hypoglycemia after transitioning to CGM. Through this case, we discuss how CGM is a practical, convenient patient-centered tool that may improve metabolic outcomes and quality of life in ESRD patients with diabetes.
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Affiliation(s)
- Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Elisa Park
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Amy S You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Andrea Daza
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Rene Amel Peralta
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Yalitzi Guerrero
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Alpesh N Amin
- Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | - Danh V Nguyen
- Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | | | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
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43
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Narasaki Y, Okuda Y, Kalantar SS, You AS, Novoa A, Nguyen T, Streja E, Nakata T, Colman S, Kalantar-Zadeh K, Nguyen DV, Rhee CM. Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort. J Ren Nutr 2021; 31:411-420. [PMID: 33121888 PMCID: PMC8614638 DOI: 10.1053/j.jrn.2020.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 06/15/2019] [Revised: 04/11/2020] [Accepted: 05/03/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Among hemodialysis patients, clinical practice guidelines recommend dietary potassium restriction given concerns about potential hyperkalemia leading to malignant arrhythmias and mortality. However, there are sparse data informing recommendations for dietary potassium intake in this population. We thus sought to examine the relationship between dietary potassium intake and death risk in a prospective cohort of hemodialysis patients. DESIGN AND METHODS Among 415 hemodialysis patients from the prospective "Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease" cohort recruited across 16 outpatient dialysis clinics, information regarding dietary potassium intake was obtained using Food Frequency Questionnaires administered over October 2011 to March 2015. We first examined associations of baseline dietary potassium intake categorized as tertiles with mortality risk using Cox regression. We then examined clinical characteristics associated with low dietary potassium intake (defined as the lowest tertile) using logistic regression. RESULTS In expanded case-mix Cox analyses, patients whose dietary potassium intake was in the lowest tertile had higher mortality (ref: highest tertile) (adjusted hazard ratio 1.74, 95% confidence interval 1.14-2.66). These associations had even greater magnitude of risk following adjustment for laboratory and nutritional covariates (adjusted hazard ratio 2.65, 95% confidence interval 1.40-5.04). In expanded case-mix restricted cubic spline analyses, there was a monotonic increase in mortality risk with incrementally lower dietary potassium intake. In expanded case-mix logistic regression models, female sex; higher serum bicarbonate; and lower dietary energy, protein, and fiber intake were associated with low dietary potassium intake. CONCLUSIONS In a prospective cohort of hemodialysis patients, lower dietary potassium intake was associated with higher mortality risk. These findings suggest that excessive dietary potassium restriction may be deleterious in hemodialysis patients, and further studies are needed to determine the optimal dietary potassium intake in this population.
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Affiliation(s)
- Yoko Narasaki
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; Department of Clinical Nutrition and Food Management, Tokushima University Graduate School of Nutrition and Biosciences, Tokushima, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yusuke Okuda
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
| | - Sara S Kalantar
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; University of California, Berkeley, Berkeley, California
| | - Amy S You
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
| | - Alejandra Novoa
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
| | - Theresa Nguyen
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
| | - Elani Streja
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Tracy Nakata
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
| | | | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Danh V Nguyen
- Division of General Internal Medicine, University of California, Irvine, Orange, California
| | - Connie M Rhee
- Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California.
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44
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Sohn P, Narasaki Y, Rhee CM. Intradialytic hypotension: is timing everything? Kidney Int 2021; 99:1269-1272. [PMID: 34023027 DOI: 10.1016/j.kint.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intradialytic hypotension (IDH) is a major complication of hemodialysis, leading to myocardial stunning, cerebral hypoperfusion, gut ischemia, loss of residual kidney function, high symptom burden, and death. This study by Keane et al. provides new data on the incidence of IDH over well-defined time intervals during the hemodialysis treatment session, clinical parameters associated with the timing of IDH onset, and whether timing of IDH impacts survival in a nationally representative hemodialysis cohort.
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Affiliation(s)
- Peter Sohn
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Yoko Narasaki
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA.
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Kimura H, Kalantar-Zadeh K, Rhee CM, Streja E, Sy J. Polypharmacy and Frailty among Hemodialysis Patients. Nephron Clin Pract 2021; 145:624-632. [PMID: 34139698 DOI: 10.1159/000516532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Both polypharmacy and frailty are highly prevalent among the patients on hemodialysis and associated with adverse outcomes; however, little is known about the association between them. METHODS We examined 337 patients enrolled in the ACTIVE/ADIPOSE dialysis cohort study between 2009 and 2011. The number of prescribed medications and frailty were assessed at baseline, 12, and 24 months. Frailty was defined based upon the Fried's frailty phenotype. We used logistic regression with generalized estimating equations to model the association of the number of medications and frailty at baseline and over time. A competing-risk regression analysis was also used to assess the association between the number of medications and incidence of frailty. RESULTS The mean number of medications was 10 ± 5, and 94 patients (28%) were frail at baseline. Patients taking >11 medications showed higher odds for frailty than the patients taking fewer than 8 medications (OR 1.54, 95% CI 1.05-2.26). During the 2-year of follow-up, 87 patients developed frailty among those who were nonfrail at baseline. Compared with the patients taking fewer than 8 medications, the incidence of frailty was approximately 2-fold in those taking >11 medications (sub-distribution hazard ratio 2.15, 95% CI 1.32-3.48). CONCLUSIONS Using a higher number of medications was associated with frailty and the incidence of frailty among hemodialysis patients. Minimizing polypharmacy may reduce the incidence and prevalence of frailty among dialysis patients.
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Affiliation(s)
- Hiroshi Kimura
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA,
| | - Connie M Rhee
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
| | - John Sy
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.,Division of Nephrology, Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA
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46
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Rhee CM, Kalantar-Zadeh K, Moore LW. Medical Nutrition Therapy for Diabetic Kidney Disease. J Ren Nutr 2021; 31:229-232. [PMID: 33990265 DOI: 10.1053/j.jrn.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Connie M Rhee
- University of California Irvine, Orange, California.
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47
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Bhandari SK, Adams AL, Li BH, Rhee CM, Sundar S, Krasa H, Danforth KN, Kanter MH, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ. Sub-acute hyponatraemia more than chronic hyponatraemia is associated with serious falls and hip fractures. Intern Med J 2021; 50:1100-1108. [PMID: 31707754 DOI: 10.1111/imj.14684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Falls and hip fractures among older people are associated with high morbidity and mortality. Hyponatraemia may be a risk for falls/hip fractures, but the effect of hyponatraemia duration is not well understood. AIMS To evaluate individuals with periods of sub-acute and chronic hyponatraemia on subsequent risk for serious falls and/or hip fractures. METHODS Retrospective cohort study in the period 1 January 1998 to 14 June 2016 within an integrated health system of individuals aged ≥55 years with ≥2 outpatient serum sodium measurements. Hyponatraemia was defined as sodium <135 mEq/L with sub-acute (<30 days) and chronic (≥30 days) analysed as a time-dependent exposure. Multivariable Cox proportional-hazards modelling was used to estimate hazard ratios (HR) for serious falls/hip fractures based on sodium category. RESULTS Among 1 062 647 individuals totalling 9 762 305 sodium measurements, 96 096 serious falls/hip fracture events occurred. Incidence (per-1000-person-years) of serious falls/hip fractures were 11.5, 27.9 and 19.8 for normonatraemia, sub-acute and chronic hyponatraemia. Any hyponatraemia duration compared to normonatraemia had a serious falls/hip fractures HR (95%CI) of 1.18 (1.15, 1.22), with sub-acute and chronic hyponatraemia having HR of 1.38 (1.33, 1.42) and 0.91 (0.87, 0.95), respectively. Examined separately, the serious falls HR was 1.37 (1.32, 1.42) and 0.92 (0.88, 0.96) in sub-acute and chronic hyponatraemia, respectively. Hip fracture HR were 1.52 (1.42, 1.62) and 1.00 (0.92, 1.08) for sub-acute and chronic hyponatraemia, respectively, compared to normonatraemia. CONCLUSIONS Our findings suggest that early/sub-acute hyponatraemia appears more vulnerable and associated with serious falls/hip fractures. Whether hyponatraemia is a marker of frailty or a modifiable risk factor for falls remains to be determined.
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Affiliation(s)
- Simran K Bhandari
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Annette L Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bonnie H Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Connie M Rhee
- Otsuka Pharmaceuticals Development & Commercialization, Inc., San Francisco, California, USA
| | - Shirin Sundar
- Division of Nephrology and Hypertension, UC Irvine Medical Center, Irvine, California, USA
| | - Holly Krasa
- Division of Nephrology and Hypertension, UC Irvine Medical Center, Irvine, California, USA
| | - Kim N Danforth
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Michael H Kanter
- Department of Clinical Science, Kaiser Permanente School of Medicine, Pasadena, California, USA
| | - Kamyar Kalantar-Zadeh
- Otsuka Pharmaceuticals Development & Commercialization, Inc., San Francisco, California, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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48
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Li Y, Nguyen DV, Banerjee S, Rhee CM, Kalantar-Zadeh K, Kürüm E, Şentürk D. Multilevel modeling of spatially nested functional data: Spatiotemporal patterns of hospitalization rates in the US dialysis population. Stat Med 2021; 40:3937-3952. [PMID: 33902165 DOI: 10.1002/sim.9007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/15/2021] [Accepted: 04/08/2021] [Indexed: 11/12/2022]
Abstract
End-stage renal disease patients on dialysis experience frequent hospitalizations. In addition to known temporal patterns of hospitalizations over the life span on dialysis, where poor outcomes are typically exacerbated during the first year on dialysis, variations in hospitalizations among dialysis facilities across the US contribute to spatial variation. Utilizing national data from the United States Renal Data System (USRDS), we propose a novel multilevel spatiotemporal functional model to study spatiotemporal patterns of hospitalization rates among dialysis facilities. Hospitalization rates of dialysis facilities are considered as spatially nested functional data (FD) with longitudinal hospitalizations nested in dialysis facilities and dialysis facilities nested in geographic regions. A multilevel Karhunen-Loéve expansion is utilized to model the two-level (facility and region) FD, where spatial correlations are induced among region-specific principal component scores accounting for regional variation. A new efficient algorithm based on functional principal component analysis and Markov Chain Monte Carlo is proposed for estimation and inference. We report a novel application using USRDS data to characterize spatiotemporal patterns of hospitalization rates for over 400 health service areas across the US and over the posttransition time on dialysis. Finite sample performance of the proposed method is studied through simulations.
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Affiliation(s)
- Yihao Li
- Department of Biostatistics, University of California, Los Angeles, California
| | - Danh V Nguyen
- Department of Medicine, UC Irvine School of Medicine, Orange, California
| | - Sudipto Banerjee
- Department of Biostatistics, University of California, Los Angeles, California
| | - Connie M Rhee
- Department of Medicine, UC Irvine School of Medicine, Orange, California
| | | | - Esra Kürüm
- Department of Statistics, University of California, Riverside, California
| | - Damla Şentürk
- Department of Biostatistics, University of California, Los Angeles, California
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49
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Tantisattamo E, Murray V, Obi Y, Park C, Catabay CJ, Lee Y, Wenziger C, Hsiung JT, Soohoo M, Kleine CE, Rhee CM, Kraut J, Kovesdy CP, Kalantar-Zadeh K, Streja E. Association of Pre-ESRD Serum Bicarbonate with Post-ESRD Mortality in Patients with Incident ESRD. Am J Nephrol 2021; 52:304-317. [PMID: 33895727 DOI: 10.1159/000513855] [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: 10/05/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serum bicarbonate or total carbon dioxide (CO2) concentrations decline as chronic kidney disease (CKD) progresses and rise after dialysis initiation. While metabolic acidosis accelerates the progression of CKD and is associated with higher mortality among patients with end stage renal disease (ESRD), there are scarce data on the association of CO2 concentrations before ESRD transition with post-ESRD mortality. METHODS A historical cohort from the Transition of Care in CKD (TC-CKD) study includes 85,505 veterans who transitioned to ESRD from October 1, 2007, through March 31, 2014. After 1,958 patients without follow-up data, 3 patients with missing date of birth, and 50,889 patients without CO2 6 months prior to ESRD transition were excluded, the study population includes 32,655 patients. Associations between CO2 concentrations averaged over the last 6 months and its rate of decline during the 12 months prior to ESRD transition and post-ESRD all-cause, cardiovascular (CV), and non-CV mortality were examined by using hierarchical adjustment with Cox regression models. RESULTS The cohort was on average 68 ± 11 years old and included 29% Black veterans. Baseline concentrations of CO2 were 23 ± 4 mEq/L, and median (interquartile range) change in CO2 were -1.8 [-3.4, -0.2] mEq/L/year. High (≥28 mEq/L) and low (<18 mEq/L) CO2 concentrations showed higher adjusted mortality risk while there was no clear trend in the middle range. Consistent associations were observed irrespective of sodium bicarbonate use. There was also a U-shaped association between the change in CO2 and all-cause, CV, and non-CV mortality with the lowest risk approximately at -2.0 and 0.0 mEq/L/year among sodium bicarbonate nonusers and users, respectively, and the highest mortality was among patients with decline in CO2 >4 mEq/L/year. CONCLUSION Both high and low pre-ESRD CO2 levels (≥28 and <18 mEq/L) during 6 months prior to dialysis transition and rate of CO2 decline >4 mEq/L/year during 1 year before dialysis initiation were associated with greater post-ESRD all-cause, CV, and non-CV mortality. Further studies are needed to determine the optimal management of CO2 in patients with advanced CKD stages transitioning to ESRD.
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Affiliation(s)
- Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Victoria Murray
- Fielding School of Public Health at UCLA, Los Angeles, California, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Christina J Catabay
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Yuji Lee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Cachet Wenziger
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
- Fielding School of Public Health at UCLA, Los Angeles, California, USA
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Jeffrey Kraut
- Fielding School of Public Health at UCLA, Los Angeles, California, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
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50
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Ryu SY, Kleine CE, Hsiung JT, Park C, Rhee CM, Moradi H, Hanna R, Kalantar-Zadeh K, Streja E. Association of lactate dehydrogenase with mortality in incident hemodialysis patients. Nephrol Dial Transplant 2021; 36:704-712. [PMID: 33367881 DOI: 10.1093/ndt/gfaa277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Lactate dehydrogenase (LDH) plays a role in the glucose metabolism of the human body. Higher LDH levels have been linked to mortality in various cancer types; however, the relationship between LDH and survival in incident hemodialysis (HD) patients has not yet been examined. We hypothesized that higher LDH level is associated with higher death risk in these patients. METHODS We examined the association of baseline and time-varying serum LDH with all-cause, cardiovascular and infection-related mortality among 109 632 adult incident HD patients receiving care from a large dialysis organization in the USA during January 2007 to December 2011. Baseline and time-varying survival models were adjusted for demographic variables and available clinical and laboratory surrogates of malnutrition-inflammation complex syndrome. RESULTS There was a linear association between baseline serum LDH levels and all-cause, cardiovascular and infection-related mortality in both baseline and time-varying models, except for time-varying infection-related mortality. Adjustment for markers of inflammation and malnutrition attenuated the association in all models. In fully adjusted models, baseline LDH levels ≥360 U/L were associated with the highest risk of all-cause mortality (hazard ratios = 1.19, 95% confidence interval 1.14-1.25). In time-varying models, LDH >280 U/L was associated with higher death risk in all three hierarchical models for all-cause and cardiovascular mortality. CONCLUSIONS Higher LDH level >280 U/L was incrementally associated with higher all-cause and cardiovascular mortality in incident dialysis patients, whereas LDH <240 U/L was associated with better survival. These findings suggest that the assessment of metabolic functions and monitoring for comorbidities may confer survival benefit to dialysis patients.
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Affiliation(s)
- Soh Young Ryu
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Ramy Hanna
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, CA, USA
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