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Marzinke MA, Greene DN, Bossuyt PM, Chambliss AB, Cirrincione LR, McCudden CR, Melanson SEF, Noguez JH, Patel K, Radix AE, Takwoingi Y, Winston-McPherson G, Young BA, Hoenig MP. Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review. Clin Chem 2021; 68:521-533. [DOI: 10.1093/clinchem/hvab279] [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] [Received: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Commonly used estimated glomerular filtration rate (eGFR) equations include a Black race modifier (BRM) that was incorporated during equation derivation. Race is a social construct, and a poorly characterized variable that is applied inconsistently in clinical settings. The BRM results in higher eGFR for any creatinine concentration, implying fundamental differences in creatinine production or excretion in Black individuals compared to other populations. Equations without inclusion of the BRM have the potential to detect kidney disease earlier in patients at the greatest risk of chronic kidney disease (CKD), but also has the potential to over-diagnose CKD or impact downstream clinical interventions. The purpose of this study was to use an evidence- based approach to systematically evaluate the literature relevant to the performance of the eGFR equations with and without the BRM and to examine the clinical impact of the use or removal.
Content
PubMed and Embase databases were searched for studies comparing measured GFR to eGFR in racially diverse adult populations using the Modification of Diet in Renal Disease or the 2009-Chronic Kidney Disease Epidemiology Collaboration-creatinine equations based on standardized creatinine measurements. Additionally, we searched for studies comparing clinical use of eGFR calculated with and without the BRM. 8,632 unique publications were identified; an additional 3 studies were added post-hoc. In total, 96 studies were subjected to further analysis and 44 studies were used to make a final assessment.
Summary
There is limited published evidence to support the use of a BRM in eGFR equations.
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Affiliation(s)
- Mark A Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology; University of Washington, Seattle, WA; Kaiser Permanente, Renton, WA
| | - Patrick M Bossuyt
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Christopher R McCudden
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital; University of Ottawa; Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Stacy E F Melanson
- Department of Pathology; Brigham and Women’s Hospital; Harvard Medical School, Boston, MA
| | - Jaime H Noguez
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Khushbu Patel
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY
| | - Yemisi Takwoingi
- Institute of Applied Health Research,University of Birmingham and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | | | - Bessie A Young
- Office of Healthcare Equity, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Melanie P Hoenig
- Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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Sharma A, Greene DN, Chambliss AB, Farnsworth CW, French D, Herman DS, Kavsak PA, Merrill AE, Margaret Lo SY, Lyon ME, Winston-McPherson G, Pearson LN, SoRelle JA, Waring AC, Schmidt RL. The effect of the Covid-19 shutdown on glycemic testing and control. Clin Chim Acta 2021; 519:148-152. [PMID: 33932408 PMCID: PMC8080532 DOI: 10.1016/j.cca.2021.04.018] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic caused a halt to in-person ambulatory care. We evaluated how the reduction in access to care affected HbA1c testing and patient HbA1c levels. METHODS HbA1c data from 11 institutions were extracted to compare testing volume and the percentage of abnormal results between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (Jan-June 2020, period 2). HbA1c results greater than 6.4% were categorized as abnormal. RESULTS HbA1C testing volumes decreased in March, April and May by 23, 61 and 40% relative to the corresponding months in 2019. The percentage of abnormal results increased in April, May and June (25, 23, 9%). On average, we found that the frequency of abnormal results increased by 0.31% for every 1% decrease in testing volume (p < 0.0005). CONCLUSION HbA1c testing volume for outpatients decreased by up to 70% during the early months of the pandemic. The decrease in testing was associated with an increase in abnormal HbA1c results.
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Dina N Greene
- Kaiser Permanente Washington, Renton, WA, United States
| | - Allison B Chambliss
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Deborah French
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Daniel S Herman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | | | - Lauren N Pearson
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT
| | | | | | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT.
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Wheeler SE, Peck Palmer OM, Greene DN, Park JY, Winston-McPherson G, Amukele TK, Pérez-Stable EJ. Examining Laboratory Medicine's Role in Eliminating Health Disparities. Clin Chem 2021; 66:1266-1271. [PMID: 32888006 DOI: 10.1093/clinchem/hvaa174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah E Wheeler
- Assistant Professor of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Medical Director of UPMC Mercy and UPMC Children's Hospital Automated Testing Laboratories, Associate Director of UPMC Presbyterian Clinical Immunopathology Laboratory, Pittsburgh, PA
| | - Octavia M Peck Palmer
- Associate Professor of Pathology, Critical Care Medicine and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Medical Director, UPMC Presbyterian and Shadyside Automated Testing Laboratories, Pittsburgh, PA
| | - Dina N Greene
- Technical Director, Kaiser Permanente Washington Laboratories, Portland, OR.,Clinical Associate Professor University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Jason Y Park
- Associate Professor of Pathology and the Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical School, Dallas, TX
| | | | - Timothy K Amukele
- Associate Professor of Pathology Johns Hopkins School of Medicine, Chief of Pathology Clinical Laboratories, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Eliseo J Pérez-Stable
- Director of the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD
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Greene DN, Schmidt RL, Winston-McPherson G, Rongitsch J, Imborek KL, Dickerson JA, Drees JC, Humble RM, Nisly N, Dole NJ, Dane SK, Frerichs J, Krasowski MD. Reproductive Endocrinology Reference Intervals for Transgender Men on Stable Hormone Therapy. J Appl Lab Med 2020; 6:41-50. [PMID: 33241847 DOI: 10.1093/jalm/jfaa169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/15/2020] [Accepted: 08/31/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gender-affirming therapy with testosterone is commonly prescribed to aid in the masculinization of transgender men. Sex-hormone concentrations are routinely measured, but interpretation of results can be difficult due to the lack of published reference intervals. METHODS Healthy transgender individuals who had been prescribed testosterone (n = 82) for at least a year were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Total testosterone and estradiol were measured using immunoassay and mass spectrometry; LH, FSH, SHBG, prolactin, progesterone, anti-Müllerian hormone (AMH), and dehydroepiandrosterone sulfate (DHEAS) were measured using immunoassay; free testosterone was calculated. Reference intervals (central 95%) were calculated according to Clinical Laboratory Standards Institute guidelines. RESULTS When evaluating general endocrine laboratory tests in people using masculinizing hormones, reference intervals for cisgender men can be applied for total and free testosterone and SHBG and reference intervals for cisgender women can be applied for prolactin. Reference intervals for estradiol, LH, FSH, AMH, and DHEAS differ from those used for cisgender men and cisgender women, and therefore should be interpreted using intervals specific to the transmasculine population. For testosterone and estradiol, results from immunoassays were clinically equivalent to mass spectrometry. CONCLUSION Masculinizing hormones will alter the concentrations of commonly evaluated endocrine hormones. Providers and laboratories should use appropriate reference intervals to interpret the results of these tests.
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Affiliation(s)
- Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | | | | | | | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Julia C Drees
- The Permanente Medical Group Regional Laboratories, Richmond, CA
| | - Robert M Humble
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Nicole Nisly
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Nancy J Dole
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Susan K Dane
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Janice Frerichs
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Simonson PD, Kim KH, Winston-McPherson G, Parakh RS, Yamaguchi D, Merrill AE, Dickerson JA, Greene DN. Characterization of bilirubin interference in three commonly used digoxin assays. Clin Biochem 2018; 63:102-105. [PMID: 30316751 DOI: 10.1016/j.clinbiochem.2018.10.006] [Citation(s) in RCA: 2] [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: 06/11/2018] [Revised: 10/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to the narrow therapeutic range of digoxin, determining serum/plasma digoxin concentrations is critical for assessing patients with congestive heart failure, atrial fibrillation, and certain types of arrhythmias. However, digoxin quantification by competitive immunoassays is susceptible to interferences that may alter the accuracy of its measurement in patient plasma. This study aimed to characterize the extent of bilirubin interference in three commonly used digoxin immunoassays. METHODS Digoxin concentrations were compared using the Beckman Coulter® Unicel DxI 800, the Vitros® 4600, and the Roche Cobas® 8000 in neat or digoxin-spiked icteric and non-icetric plasma samples. A mixing study was performed to demonstrate how digoxin quantification is affected by bilirubin. An equation was derived that predicts the response of the DxI 800, given known bilirubin and digoxin concentrations. RESULTS The DxI reported detectable concentrations of digoxin in high bilirubin samples with no added digoxin, while the Vitros® 4600 and Cobas® 8000 gave virtually undetectable results. Spiking digoxin into samples with elevated bilirubin concentrations resulted in a higher percent recovery for the DxI 800 when compared to the other two platforms. The mixing study also revealed an increase in the percent recovery in the DxI 800, while the Vitros® 4600 and Cobas® 8000 were comparable to the expected concentration of digoxin. CONCLUSIONS The DxI 800 is most prone to interference by bilirubin, while the Vitros® 4600 and Cobas® 8000 are relatively unaffected. Icteric samples should be interpreted with caution if digoxin quantification is needed, especially on the DxI 800 assay.
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Affiliation(s)
- Paul D Simonson
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
| | - Katie H Kim
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
| | | | - Rugvedita S Parakh
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
| | - Diane Yamaguchi
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
| | - Anna E Merrill
- Department of Pathology, University of Iowa, Iowa City, IA, United States
| | - Jane A Dickerson
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States; Department of Pathology, Seattle Children's Hospital, Seattle, WA, United States
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States.
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Jaskula-Sztul R, Eide J, Tesfazghi S, Dammalapati A, Harrison AD, Yu XM, Scheinebeck C, Winston-McPherson G, Kupcho KR, Robers MB, Hundal AK, Tang W, Chen H. Tumor-suppressor role of Notch3 in medullary thyroid carcinoma revealed by genetic and pharmacological induction. Mol Cancer Ther 2014; 14:499-512. [PMID: 25512616 DOI: 10.1158/1535-7163.mct-14-0073] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Notch1-3 are transmembrane receptors that appear to be absent in medullary thyroid cancer (MTC). Previous research has shown that induction of Notch1 has a tumor-suppressor effect in MTC cell lines, but little is known about the biologic consequences of Notch3 activation for the progression of the disease. We elucidate the role of Notch3 in MTC by genetic (doxycycline-inducible Notch3 intracellular domain) and pharmacologic [AB3, novel histone deacetylase (HDAC) inhibitor] approaches. We find that overexpression of Notch3 leads to the dose-dependent reduction of neuroendocrine tumor markers. In addition, Notch3 activity is required to suppress MTC cell proliferation, and the extent of growth repression depends on the amount of Notch3 protein expressed. Moreover, activation of Notch3 induces apoptosis. The translational significance of this finding is highlighted by our observation that MTC tumors lack active Notch3 protein and reinstitution of this isoform could be a therapeutic strategy to treat patients with MTC. We demonstrate, for the first time, that overexpression of Notch3 in MTC cells can alter malignant neuroendocrine phenotype in both in vitro and in vivo models. In addition, our study provides a strong rationale for using Notch3 as a therapeutic target to provide novel pharmacologic treatment options for MTC.
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Affiliation(s)
- Renata Jaskula-Sztul
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Jacob Eide
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Sara Tesfazghi
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Ajitha Dammalapati
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - April D Harrison
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Xiao-Min Yu
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Casi Scheinebeck
- School of Pharmacy and Department of Chemistry, University of Wisconsin, Madison, Wisconsin
| | | | | | | | - Amrit K Hundal
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Weiping Tang
- School of Pharmacy and Department of Chemistry, University of Wisconsin, Madison, Wisconsin.
| | - Herbert Chen
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin.
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Liu R, Zhang M, Winston-McPherson G, Tang W. Ring expansion of alkynyl cyclopropanes to highly substituted cyclobutenes via a N-sulfonyl-1,2,3-triazole intermediate. Chem Commun (Camb) 2012; 49:4376-8. [PMID: 22864054 DOI: 10.1039/c2cc34609e] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Regioselective ring expansion of alkynyl cyclopropanes to highly substituted cyclobutenes was developed. The reaction involves a copper-catalyzed cycloaddition of an alkyne with an arylsulfonyl azide and a silver-catalyzed carbene formation followed by ring expansion of a cyclopropyl carbene intermediate.
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Affiliation(s)
- Renhe Liu
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
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