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Wulczyn KE, Shafi T, Anderson A, Rincon-Choles H, Clish CB, Denburg M, Feldman HI, He J, Hsu CY, Kelly T, Kimmel PL, Mehta R, Nelson RG, Ramachandran V, Ricardo A, Shah VO, Srivastava A, Xie D, Rhee EP, Kalim S. Metabolites Associated With Uremic Symptoms in Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024:S0272-6386(24)00044-1. [PMID: 38266973 DOI: 10.1053/j.ajkd.2023.11.013] [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: 06/03/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/26/2024]
Abstract
RATIONALE & OBJECTIVE The toxins that contribute to uremic symptoms in patients with chronic kidney disease (CKD) are unknown. We sought to apply complementary statistical modeling approaches to data from untargeted plasma metabolomic profiling to identify solutes associated with uremic symptoms in patients with CKD. STUDY DESIGN Cross-sectional. SETTING & PARTICIPANTS 1,761 Chronic Renal Insufficiency Cohort (CRIC) participants with CKD not treated with dialysis. PREDICTORS Measurement of 448 known plasma metabolites. OUTCOMES The uremic symptoms of fatigue, anorexia, pruritus, nausea, paresthesia, and pain were assessed by single items on the Kidney Disease Quality of Life-36 instrument. ANALYTICAL APPROACH Multivariable adjusted linear regression, least absolute shrinkage and selection operator linear regression, and random forest models were used to identify metabolites associated with symptom severity. After adjustment for multiple comparisons, metabolites selected in at least 2 of the 3 modeling approaches were deemed "overall significant." RESULTS Participant mean estimated glomerular filtration rate was 43mL/min/1.73m2, with 44% self-identifying as female and 41% as non-Hispanic Black. The prevalence of uremic symptoms ranged from 22% to 55%. We identified 17 metabolites for which a higher level was associated with greater severity of at least one uremic symptom and 9 metabolites inversely associated with uremic symptom severity. Many of these metabolites exhibited at least a moderate correlation with estimated glomerular filtration rate (Pearson's r≥0.5), and some were also associated with the risk of developing kidney failure or death in multivariable adjusted Cox regression models. LIMITATIONS Lack of a second independent cohort for external validation of our findings. CONCLUSIONS Metabolomic profiling was used to identify multiple solutes associated with uremic symptoms in adults with CKD, but future validation and mechanistic studies are needed. PLAIN-LANGUAGE SUMMARY Individuals living with chronic kidney disease (CKD) often experience symptoms related to CKD, traditionally called uremic symptoms. It is likely that CKD results in alterations in the levels of numerous circulating substances that, in turn, cause uremic symptoms; however, the identity of these solutes is not known. In this study, we used metabolomic profiling in patients with CKD to gain insights into the pathophysiology of uremic symptoms. We identified 26 metabolites whose levels were significantly associated with at least one of the symptoms of fatigue, anorexia, itchiness, nausea, paresthesia, and pain. The results of this study lay the groundwork for future research into the biological causes of symptoms in patients with CKD.
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Affiliation(s)
- Kendra E Wulczyn
- Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts.
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Amanda Anderson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Hernan Rincon-Choles
- Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Michelle Denburg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco, School of Medicine, San Francisco, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Tanika Kelly
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Vasan Ramachandran
- Department of Epidemiology and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Public Health, Boston, Massachusetts
| | - Ana Ricardo
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dawei Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eugene P Rhee
- Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts; Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Sahir Kalim
- Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts
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Sullivan VK, Appel LJ, Anderson CAM, Tan TC, Brown J, Ricardo AC, Schrauben SJ, Hsu CY, Shah VO, Unruh M, Nelson RG, Sondheimer J, Chen J, He J, Charleston J, Rebholz CM. Changes in Diet Quality, Risk of CKD Progression, and All-Cause Mortality in the CRIC Study. Am J Kidney Dis 2023; 81:621-624. [PMID: 36455682 PMCID: PMC10228419 DOI: 10.1053/j.ajkd.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Valerie K Sullivan
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, California
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Julia Brown
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Ana C Ricardo
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Sarah J Schrauben
- Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California San Francisco, San Francisco, California; Kaiser Permanente Division of Nephrology, Oakland, California
| | - Vallabh O Shah
- Departments of Internal Medicine and Biochemistry and Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mark Unruh
- Departments of Internal Medicine and Biochemistry and Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - James Sondheimer
- Division of Nephrology and Hypertension, School of Medicine, Wayne State University, Detroit, Michigan
| | - Jing Chen
- Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kwan B, Fuhrer T, Montemayor D, Fink JC, He J, Hsu CY, Messer K, Nelson RG, Pu M, Ricardo AC, Rincon-Choles H, Shah VO, Ye H, Zhang J, Sharma K, Natarajan L. A generalized covariate-adjusted top-scoring pair algorithm with applications to diabetic kidney disease stage classification in the Chronic Renal Insufficiency Cohort (CRIC) Study. BMC Bioinformatics 2023; 24:57. [PMID: 36803209 PMCID: PMC9942303 DOI: 10.1186/s12859-023-05171-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The growing amount of high dimensional biomolecular data has spawned new statistical and computational models for risk prediction and disease classification. Yet, many of these methods do not yield biologically interpretable models, despite offering high classification accuracy. An exception, the top-scoring pair (TSP) algorithm derives parameter-free, biologically interpretable single pair decision rules that are accurate and robust in disease classification. However, standard TSP methods do not accommodate covariates that could heavily influence feature selection for the top-scoring pair. Herein, we propose a covariate-adjusted TSP method, which uses residuals from a regression of features on the covariates for identifying top scoring pairs. We conduct simulations and a data application to investigate our method, and compare it to existing classifiers, LASSO and random forests. RESULTS Our simulations found that features that were highly correlated with clinical variables had high likelihood of being selected as top scoring pairs in the standard TSP setting. However, through residualization, our covariate-adjusted TSP was able to identify new top scoring pairs, that were largely uncorrelated with clinical variables. In the data application, using patients with diabetes (n = 977) selected for metabolomic profiling in the Chronic Renal Insufficiency Cohort (CRIC) study, the standard TSP algorithm identified (valine-betaine, dimethyl-arg) as the top-scoring metabolite pair for classifying diabetic kidney disease (DKD) severity, whereas the covariate-adjusted TSP method identified the pair (pipazethate, octaethylene glycol) as top-scoring. Valine-betaine and dimethyl-arg had, respectively, ≥ 0.4 absolute correlation with urine albumin and serum creatinine, known prognosticators of DKD. Thus without covariate-adjustment the top-scoring pair largely reflected known markers of disease severity, whereas covariate-adjusted TSP uncovered features liberated from confounding, and identified independent prognostic markers of DKD severity. Furthermore, TSP-based methods achieved competitive classification accuracy in DKD to LASSO and random forests, while providing more parsimonious models. CONCLUSIONS We extended TSP-based methods to account for covariates, via a simple, easy to implement residualizing process. Our covariate-adjusted TSP method identified metabolite features, uncorrelated from clinical covariates, that discriminate DKD severity stage based on the relative ordering between two features, and thus provide insights into future studies on the order reversals in early vs advanced disease states.
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Grants
- R01 DK110541 NIDDK NIH HHS
- U24 DK060990 NIDDK NIH HHS
- R01DK118736, 1R01DK110541-01A1, U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902, U24DK060990 NIDDK NIH HHS
- National Science Foundation Graduate Research Fellowship Program
- Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute of Diabetes and Digestive and Kidney Diseases
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Affiliation(s)
- Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Tobias Fuhrer
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Daniel Montemayor
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Center for Renal Precision Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jeffery C Fink
- Department of Medicine, University of Maryland, Baltimore School of Medicine, Baltimore, MD, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute,, New Orleans, LA, USA
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Karen Messer
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Minya Pu
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Ana C Ricardo
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Hernan Rincon-Choles
- Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Vallabh O Shah
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Hongping Ye
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Center for Renal Precision Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jing Zhang
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Kumar Sharma
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Center for Renal Precision Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Loki Natarajan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA.
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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Pankratz VS, Choi EE, Qeadan F, Ghahate D, Bobelu J, Nelson RG, Faber T, Shah VO. Diabetes status modifies the efficacy of home-based kidney care for Zuni Indians in a randomized controlled trial. J Diabetes Complications 2021; 35:107753. [PMID: 33097384 PMCID: PMC7854937 DOI: 10.1016/j.jdiacomp.2020.107753] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Home-Based Kidney Care (HBKC) is a pragmatic treatment approach that addresses patient preferences and cultural barriers to healthcare. We previously reported the results of a clinical trial of HBKC vs. usual care in a cohort of Zuni Indians in New Mexico. This study investigated the potential for differential efficacy of HBKC vs. usual care according to type 2 diabetes (T2DM) status. METHODS We analyzed the data from all individuals who participated in a randomized clinical trial that compared HBKC to usual care among patients with CKD, and assessed whether the effect of the HBKC intervention affected the subset of patients with T2DM differently than those individuals without T2DM. We used linear regression models to estimate the effect of HBKC on improvement in Patient Activation Measure (PAM) total scores within the groups of participants defined by T2DM status, and to compare the effects between these two groups. We used generalized estimating equations (GEE) to account for household clustering. RESULTS The original study enrolled 63 participants into the HBKC group, and 62 into the usual care. Ninety-eight of these individuals completed the 12-month intervention, 50 in the HBKC group and 48 in the usual care group. The present study compared the intervention effect in the 56 participants with T2DM (24 participants in the HBKC group and 32 in usual care) to the intervention effect in the 42 participants without T2DM (26 participants in the HBKC group and 16 in usual care). Those with T2DM who received the HBKC intervention experienced an average increase in PAM total scores of 16.0 points (95% Confidence Interval: 8.8-23.1) more than those with T2DM who were in the usual care group. For those without T2DM, the intervention had essentially no effect, with those who received the HBKC intervention having an average PAM total scores that was 1.4 points (95% C.I.: -12.4 to 9.6) lower than those who received usual care. There was a significantly different HBKC treatment effect by T2DM status (p = 0.02). CONCLUSION This secondary analysis suggests that the effectiveness of this HBKC intervention on increasing patient activation is most notable among those CKD patients who also have T2DM.
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Affiliation(s)
- V Shane Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - E Eunice Choi
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Fares Qeadan
- Division of Public Health, Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA
| | - Donica Ghahate
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jeanette Bobelu
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Robert G Nelson
- Chronic Kidney Disease Section, Phoenix Epidemiology and Clinical Research Branch, NIDDK, NIH, Phoenix, AZ, USA
| | - Thomas Faber
- Indian Health Service, Zuni Comprehensive Care Center, NM, USA
| | - Vallabh O Shah
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
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Unruh ML, Arzhan S, Feldman HI, Looker HC, Nelson RG, Faber T, Johnson D, Son-Stone L, Pankratz VS, Myaskovsky L, Shah VO. American Indian chronic Renal insufficiency cohort study (AI-CRIC study). BMC Nephrol 2020; 21:291. [PMID: 32698776 PMCID: PMC7376925 DOI: 10.1186/s12882-020-01954-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Chronic kidney disease (CKD) is an increasing epidemic globally that is associated with adverse health outcomes including end stage kidney disease (ESKD), cardiovascular disease (CVD), and death. American Indians (AIs) have a higher prevalence of CKD than most other racial/ethnic groups, due in part to a high prevalence of type 2 diabetes. Other genetic and environmental factors not yet identified may also contribute to the disproportionate burden of CKD in AIs. Method We will establish 3 clinical centers to recruit AIs from the Southwest United States (US) to expand the Chronic Renal Insufficiency Cohort (CRIC) study. We will follow the current CRIC protocol for kidney and cardiovascular measures and outcomes, which include ambulatory monitoring of kidney function and the use of mobile health technologies for CVD sub-phenotyping, and compare the outcomes in AIs with those in other racial/ethnic groups in CRIC. Discussion AI-CRIC will identify the role of various risk factors for rapid loss of kidney function among AIs of the Southwest US. In addition, to better understand the natural history of CKD and CVD in this high-risk population, we will identify unique risk factors for CKD and CVD progression in AIs. We will also compare event rates and risk factors for kidney and cardiovascular events in AIs with the other populations represented in CRIC.
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Affiliation(s)
- Mark L Unruh
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Soraya Arzhan
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | | | | | | | | | | | | | - Vernon S Pankratz
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA.
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Aguirre LE, Colleluori G, Robbins D, Dorin R, Shah VO, Chen R, Jan IZ, Qualls C, Villareal DT, Armamento-Villareal R. Bone and body composition response to testosterone therapy vary according to polymorphisms in the CYP19A1 gene. Endocrine 2019; 65:692-706. [PMID: 31325085 PMCID: PMC8077393 DOI: 10.1007/s12020-019-02008-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/19/2019] [Accepted: 07/06/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the influence of single nucleotide polymorphisms (SNPs) of CYP19A1 on the response and susceptibility to side effects from testosterone therapy. This is a prospective, single-arm study of men with low-morning serum testosterone (<10.68 nmol/l) administered testosterone cypionate 200 mg intramuscularly every 2 weeks for 18 months. METHODS We measured areal bone mineral density (aBMD) and body composition by dual energy X-ray absorptiometry, tibial volumetric BMD and geometry by peripheral quantitative computer tomography, bone turnover markers by enzyme-linked immunosorbent assay, testosterone, and estradiol by liquid-chromatography/mass-spectroscopy, genotyping by microarray, CYP19A1 expression by quantitative polymerase chain reaction, hematocrit and prostate-specific antigen (PSA). RESULTS We enrolled 105 men (40-74-years-old). SNPs rs1062033 and rs700518 were associated with significant differences in outcomes at 18 months. The GG genotype in rs1062033 had significant increase in whole body aBMD, but had significant decrease in tibial bone size compared to the CG and CC genotypes. Body composition analysis showed that the CC genotype of rs1062033, and the AA genotype of rs700518, had significant increase in total lean and appendicular lean mass compared to CG and GG, and AG and GG, respectively. The GG genotype of rs700518 had significant increase in PSA (GG = 105.8 ± 23.3% vs. AG + AA = 53.4 ± 11.3%, p = 0.046) while hematocrit changes were comparable among genotypes. CYP19A1 expression was highest in GG genotype in both SNPs. CONCLUSIONS For the first time, we demonstrated that CYP19A1 SNPs influence response to testosterone therapy in hypogonadal men, highlighting the importance of genetic profiling in therapeutics even for common clinical conditions.
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Affiliation(s)
- Lina E Aguirre
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Georgia Colleluori
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - David Robbins
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Richard Dorin
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Vallabh O Shah
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Rui Chen
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Irum Zeb Jan
- New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Clifford Qualls
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Biomedical Research Institute of New Mexico, Albuquerque, NM, USA
| | - Dennis T Villareal
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Reina Armamento-Villareal
- Baylor College of Medicine, Houston, TX, USA.
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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Nelson RG, Pankratz VS, Ghahate DM, Bobelu J, Faber T, Shah VO. Home-Based Kidney Care, Patient Activation, and Risk Factors for CKD Progression in Zuni Indians: A Randomized, Controlled Clinical Trial. Clin J Am Soc Nephrol 2018; 13:1801-1809. [PMID: 30442864 PMCID: PMC6302341 DOI: 10.2215/cjn.06910618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/28/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The burden of CKD is greater in ethnic and racial minorities and persons living in rural communities, where access to care is limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A 12-month clinical trial was performed in 98 rural adult Zuni Indians with CKD to examine the efficacy of a home-based kidney care program. Participants were randomized by household to receive usual care or home-based care. After initial lifestyle coaching, the intervention group received frequent additional reinforcement by community health representatives about adherence to medicines, diet and exercise, self-monitoring, and coping strategies for living with stress. The primary outcome was change in patient activation score, which assesses a participant's knowledge, skill, and confidence in managing his/her own health and health care. RESULTS Of 125 randomized individuals (63 intervention and 62 usual care), 98 (78%; 50 intervention and 48 usual care) completed the 12-month study. The average patient activation score after 12 months was 8.7 (95% confidence interval, 1.9 to 15.5) points higher in the intervention group than in the usual care group after adjusting for baseline score using linear models with generalized estimating equations. Participants randomized to the intervention had 4.8 (95% confidence interval, 1.4 to 16.7) times the odds of having a final activation level of at least three ("taking action") than those in the usual care group. Body mass index declined by 1.1 kg/m2 (P=0.01), hemoglobin A1c declined by 0.7% (P=0.01), high-sensitivity C-reactive protein declined by 3.3-fold (P<0.001), and the Short-Form 12 Health Survey mental score increased by five points (P=0.002) in the intervention group relative to usual care. CONCLUSIONS A home-based intervention improves participants' activation in their own health and health care, and it may reduce risk factors for CKD in a rural disadvantaged population.
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Affiliation(s)
- Robert G. Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - V. Shane Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Donica M. Ghahate
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Jeanette Bobelu
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Thomas Faber
- Indian Health Service, Zuni Comprehensive Care Center, Zuni, New Mexico
| | - Vallabh O. Shah
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
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Lee NM, Deriy L, Petersen TR, Shah VO, Hutchens MP, Gerstein NS. Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute Kidney Injury Assayed by Urinary [TIMP-2] × [IGFBP7] in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:348-356. [PMID: 30181085 DOI: 10.1053/j.jvca.2018.07.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Administration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. DESIGN Prospective, randomized, and single-blinded trial. SETTING Single university medical center. PARTICIPANTS Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. INTERVENTIONS Subjects were randomized to receive either NS or Isolyte during the intraoperative period. MEASUREMENTS AND MAIN RESULTS The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). CONCLUSION The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.
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Affiliation(s)
- Nathan M Lee
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Timothy R Petersen
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Vallabh O Shah
- Department of Internal Medicine, Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Michael P Hutchens
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
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10
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Armamento-Villareal R, Shah VO, Aguirre LE, Meisner ALW, Qualls C, Royce ME. The rs4646 and rs12592697 Polymorphisms in CYP19A1 Are Associated with Disease Progression among Patients with Breast Cancer from Different Racial/Ethnic Backgrounds. Front Genet 2016; 7:211. [PMID: 27994616 PMCID: PMC5133243 DOI: 10.3389/fgene.2016.00211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/18/2016] [Indexed: 12/26/2022] Open
Abstract
Given the racial/ethnic disparities in breast cancer, we evaluated the association between CYP19A1 single nucleotide polymorphisms (SNPs) on disease progression in women with breast cancer from different racial/ethnic backgrounds. This is a cross-sectional analysis of data from 327 women with breast cancer in the Expanded Breast Cancer Registry program of the University of New Mexico. Stored DNA samples were analyzed for CYP19A1 SNPs using a custom designed microarray panel. Genotype-phenotype correlations were analyzed. Of the 384 SNPs, 2 were associated with clinically significant outcomes, the rs4646 and rs12592697. The T allele for the rs4646 was associated with advanced stage of the disease at the time of presentation (odds ratio [OR]:1.8, confidence intervals [CI]: 1.05–3.13, p < 0.05) and a more progressive disease (OR: 2.1 [CI: 1.1–4.0], p = 0.04). For the rs12592697, the variant T allele was more frequent in Hispanic women and associated with a more progressive disease (OR: 2.05 [CI: 1.0–4.0], p = 0.04). However, further analysis according to menopausal status showed that the association between these 2 SNPs with disease progression or the stage at diagnosis are confined only to postmenopausal women. The odds ratios of disease progression among postmenopausal women carrying the T allele for the rs4646 and rs12592697 are 3.05 (1.21, 7.74, p = 0.02) and 3.80 (1.24, 11.6, p = 0.02), respectively. Regardless, differences in disease progression among the different genotypes for both SNPs disappeared after adjustment for treatment. In summary, the rs4646 and the rs12592697 SNPs in CYP19A1 are associated with differences in disease progression in postmenopausal women. However, treatment appears to mitigate the differences in genetic risk.
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Affiliation(s)
- Reina Armamento-Villareal
- Department of Internal Medicine, Baylor College of MedicineHouston, TX, USA; Department of Internal Medicine, Michael E. DeBakey VA Medical CenterHouston, TX, USA
| | - Vallabh O Shah
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Science CenterAlbuquerque, NM, USA; New Mexico Tumor Registry, University of New Mexico Health Sciences CenterAlbuquerque, NM, USA
| | - Lina E Aguirre
- Department of Internal Medicine, New Mexico VA Health Care System Albuquerque, NM, USA
| | - Angela L W Meisner
- New Mexico Tumor Registry, University of New Mexico Health Sciences Center Albuquerque, NM, USA
| | - Clifford Qualls
- Department of Mathematics, University of New Mexico Health Science Center Albuquerque, NM, USA
| | - Melanie E Royce
- New Mexico Tumor Registry, University of New Mexico Health Sciences Center Albuquerque, NM, USA
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Abstract
OBJECTIVE Reliable identification of individuals at risk for developing diabetes is critical to instituting preventative strategies. Studies suggest that the accuracy of using hemoglobin A1c as a sole diagnostic criterion for diabetes may be variable across different ethnic groups. We postulate that there will be lack of concordance between A1c and the oral glucose tolerance test (OGTT) for diagnosing prediabetes across Hispanic and non-Hispanic white (NHW) populations. METHODS A total of 218 asymptomatic adults at risk for type 2 diabetes (T2D) were assessed with A1c and OGTT for the diagnosis of prediabetes. Glucose homeostasis status was assigned as no diabetes (A1c <5.7% [39 mmol/mol]), prediabetes (A1c 5.7 to 6.4% [46 mmol/mol]), and T2D (A1c >6.4% [46 mmol/mol]). Inclusion criteria were age >18 years and at least one of the following: a family history of diabetes, a history of gestational diabetes, Hispanic ethnicity, non-Caucasian race, or obesity. Subjects received a fasting 75-g OGTT and A1c on the same day. Bowker's test of symmetry was employed to determine agreement between the tests. RESULTS Data from 99 Hispanic patients and 79 NHW patients were analyzed. There was no concordance between A1c and OGTT for Hispanic (P = .002) or NHW individuals (P = .003) with prediabetes. CONCLUSION A1c is discordant with OGTT among Hispanic and NHW subjects for the diagnosis of prediabetes. Sole use of A1c to designate glycemic status will result in a greater prevalence of prediabetes among Hispanic and NHW New Mexicans. ABBREVIATIONS A1c = hemoglobin A1c BMI = body mass index CDC = Centers for Disease Control CI = confidence interval FPG = fasting plasma glucose NHW = non-Hispanic white OGTT = oral glucose tolerance test T2D = type 2 diabetes WHO = World Health Organization.
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Affiliation(s)
- Jenny E. Camacho
- Department of Pediatrics, University of New Mexico, MSC 10 5590, 1 University of New Mexico, Albuquerque, NM 87131
| | - Vallabh O. Shah
- Department of Molecular Biology and Biochemistry, University of New Mexico, MSC MSC08 4670, 1 University of New Mexico, Albuquerque, NM 87131
| | - Ronald Schrader
- Department of Internal Medicine/Endocrinology- 5 ACC; MSC 10 5590, 1 University of New Mexico, Albuquerque, NM 87131
| | - Craig S. Wong
- Department of Pediatrics, University of New Mexico, MSC 10 5590, 1 University of New Mexico, Albuquerque, NM 87131
| | - Mark R. Burge
- Department of Internal Medicine/Endocrinology- 5 ACC; MSC 10 5590, 1 University of New Mexico, Albuquerque, NM 87131
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Cukor D, Cohen LM, Cope EL, Ghahramani N, Hedayati SS, Hynes DM, Shah VO, Tentori F, Unruh M, Bobelu J, Cohen S, Dember LM, Faber T, Fischer MJ, Gallardo R, Germain MJ, Ghahate D, Grote N, Hartwell L, Heagerty P, Kimmel PL, Kutner N, Lawson S, Marr L, Nelson RG, Porter AC, Sandy P, Struminger BB, Subramanian L, Weisbord S, Young B, Mehrotra R. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases. Clin J Am Soc Nephrol 2016; 11:1703-1712. [PMID: 27197911 PMCID: PMC5012486 DOI: 10.2215/cjn.09780915] [Citation(s) in RCA: 50] [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] [Indexed: 11/23/2022]
Abstract
Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.
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Affiliation(s)
- Daniel Cukor
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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13
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Williams RC, Elston RC, Kumar P, Knowler WC, Abboud HE, Adler S, Bowden DW, Divers J, Freedman BI, Igo RP, Ipp E, Iyengar SK, Kimmel PL, Klag MJ, Kohn O, Langefeld CD, Leehey DJ, Nelson RG, Nicholas SB, Pahl MV, Parekh RS, Rotter JI, Schelling JR, Sedor JR, Shah VO, Smith MW, Taylor KD, Thameem F, Thornley-Brown D, Winkler CA, Guo X, Zager P, Hanson RL. Selecting SNPs informative for African, American Indian and European Ancestry: application to the Family Investigation of Nephropathy and Diabetes (FIND). BMC Genomics 2016; 17:325. [PMID: 27142425 PMCID: PMC4855449 DOI: 10.1186/s12864-016-2654-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/22/2016] [Indexed: 01/06/2023] Open
Abstract
Background The presence of population structure in a sample may confound the search for important genetic loci associated with disease. Our four samples in the Family Investigation of Nephropathy and Diabetes (FIND), European Americans, Mexican Americans, African Americans, and American Indians are part of a genome- wide association study in which population structure might be particularly important. We therefore decided to study in detail one component of this, individual genetic ancestry (IGA). From SNPs present on the Affymetrix 6.0 Human SNP array, we identified 3 sets of ancestry informative markers (AIMs), each maximized for the information in one the three contrasts among ancestral populations: Europeans (HAPMAP, CEU), Africans (HAPMAP, YRI and LWK), and Native Americans (full heritage Pima Indians). We estimate IGA and present an algorithm for their standard errors, compare IGA to principal components, emphasize the importance of balancing information in the ancestry informative markers (AIMs), and test the association of IGA with diabetic nephropathy in the combined sample. Results A fixed parental allele maximum likelihood algorithm was applied to the FIND to estimate IGA in four samples: 869 American Indians; 1385 African Americans; 1451 Mexican Americans; and 826 European Americans. When the information in the AIMs is unbalanced, the estimates are incorrect with large error. Individual genetic admixture is highly correlated with principle components for capturing population structure. It takes ~700 SNPs to reduce the average standard error of individual admixture below 0.01. When the samples are combined, the resulting population structure creates associations between IGA and diabetic nephropathy. Conclusions The identified set of AIMs, which include American Indian parental allele frequencies, may be particularly useful for estimating genetic admixture in populations from the Americas. Failure to balance information in maximum likelihood, poly-ancestry models creates biased estimates of individual admixture with large error. This also occurs when estimating IGA using the Bayesian clustering method as implemented in the program STRUCTURE. Odds ratios for the associations of IGA with disease are consistent with what is known about the incidence and prevalence of diabetic nephropathy in these populations. Electronic supplementary material The online version of this article (doi:10.1186/s12864-016-2654-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert C Williams
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, 85014, USA.
| | - Robert C Elston
- Genetic Analysis and Data Coordinating Center, Case Western Reserve University, Cleveland, OH, 44104, USA
| | - Pankaj Kumar
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, 85014, USA
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, 85014, USA
| | - Hanna E Abboud
- Division of Nephrology, The University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Sharon Adler
- Department of Nephrology, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Donald W Bowden
- Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jasmin Divers
- Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | | | - Robert P Igo
- Genetic Analysis and Data Coordinating Center, Case Western Reserve University, Cleveland, OH, 44104, USA
| | - Eli Ipp
- Department of Nephrology, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Sudha K Iyengar
- Genetic Analysis and Data Coordinating Center, Case Western Reserve University, Cleveland, OH, 44104, USA
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 20892, USA
| | - Michael J Klag
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, 21205, USA
| | - Orly Kohn
- The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | | | - David J Leehey
- Loyola University Medical Center, Chicago, IL, 60153, USA
| | - Robert G Nelson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, 85014, USA
| | - Susanne B Nicholas
- Divisions of Nephrology and Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Madeleine V Pahl
- Division of Nephrology and Hypertension, Department of Medicine, UC Irvine School of Medicine, University of California, Orange, 92868, CA, USA
| | - Rulan S Parekh
- Hospital for Sick Children, University Health Network and the University of Toronto, Ontario, M5G1X8, Canada
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Jeffrey R Schelling
- Departments of Medicine and Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, 44104, USA
| | - John R Sedor
- Departments of Medicine and Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, 44104, USA
| | - Vallabh O Shah
- The University of New Mexico, Albuquerque, NM, 87131, USA
| | - Michael W Smith
- National Human Genome Research Institute, NIH, Bethesda, MD, 20892, USA
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Farook Thameem
- Division of Nephrology, The University of Texas Health Science Center, San Antonio, TX, 78229, USA.,Department of Biochemistry, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Cheryl A Winkler
- Center for Cancer Research, National Cancer Institute, NIH, Leidos Biomedical, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Phillip Zager
- The University of New Mexico, Albuquerque, NM, 87131, USA
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, 85014, USA
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Lambeth SM, Carson T, Lowe J, Ramaraj T, Leff JW, Luo L, Bell CJ, Shah VO. Composition, Diversity and Abundance of Gut Microbiome in Prediabetes and Type 2 Diabetes. J Diabetes Obes 2015. [PMID: 26756039 DOI: 10.15436/2376-0949.15.031figurelegends] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Association between type 2 diabetes (T2DM) and compositional changes in the gut micro biota is established, however little is known about the dysbiosis in early stages of Prediabetes (preDM). The purpose of this investigation is to elucidate the characteristics of the gut micro biome in preDM and T2DM, compared to Non-Diabetic (nonDM) subjects. Forty nine subjects were recruited for this study, 15 nonDM, 20 preDM and 14 T2DM. Bacterial community composition and diversity were investigated in fecal DNA samples using Illumina sequencing of the V4 region within the 16S rRNA gene. The five most abundant phyla identified were: Bacteroidetes, Firmicutes, Proteobacteria, Verrucomicrobia, and Actinobacteria. Class Chloracido bacteria was increased in preDM compared to T2DM (p = 0.04). An unknown genus from family Pseudonocardiaceae was significantly present in preDM group compared to the others (p = 0.04). Genus Collinsella, and an unknown genus belonging to family Enterobacteriaceae were both found to be significantly increased in T2DM compared to the other groups (Collinsella, and p = 0.03, Enterobacteriaceae genus p = 0.02). PERMANOVA and Mantel tests performed did not reveal a relationship between overall composition and diagnosis group or HbA1C level. This study identified dysbiosis associated with both preDM and T2DM, specifically at the class and genus levels suggesting that earlier treatment in preDM could possibly have an impact on the intestinal micro flora transitioning to T2DM.
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Affiliation(s)
- Stacey M Lambeth
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Trechelle Carson
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Janae Lowe
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | | | | | - Li Luo
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Callum J Bell
- National Center for Genome Resources, Santa Fe, NM, 87505, USA
| | - Vallabh O Shah
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
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Lambeth SM, Carson T, Lowe J, Ramaraj T, Leff JW, Luo L, Bell CJ, Shah VO. Composition, Diversity and Abundance of Gut Microbiome in Prediabetes and Type 2 Diabetes. J Diabetes Obes 2015; 2:1-7. [PMID: 26756039 PMCID: PMC4705851 DOI: 10.15436/2376-0949.15.031] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Association between type 2 diabetes (T2DM) and compositional changes in the gut micro biota is established, however little is known about the dysbiosis in early stages of Prediabetes (preDM). The purpose of this investigation is to elucidate the characteristics of the gut micro biome in preDM and T2DM, compared to Non-Diabetic (nonDM) subjects. Forty nine subjects were recruited for this study, 15 nonDM, 20 preDM and 14 T2DM. Bacterial community composition and diversity were investigated in fecal DNA samples using Illumina sequencing of the V4 region within the 16S rRNA gene. The five most abundant phyla identified were: Bacteroidetes, Firmicutes, Proteobacteria, Verrucomicrobia, and Actinobacteria. Class Chloracido bacteria was increased in preDM compared to T2DM (p = 0.04). An unknown genus from family Pseudonocardiaceae was significantly present in preDM group compared to the others (p = 0.04). Genus Collinsella, and an unknown genus belonging to family Enterobacteriaceae were both found to be significantly increased in T2DM compared to the other groups (Collinsella, and p = 0.03, Enterobacteriaceae genus p = 0.02). PERMANOVA and Mantel tests performed did not reveal a relationship between overall composition and diagnosis group or HbA1C level. This study identified dysbiosis associated with both preDM and T2DM, specifically at the class and genus levels suggesting that earlier treatment in preDM could possibly have an impact on the intestinal micro flora transitioning to T2DM.
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Affiliation(s)
- Stacey M Lambeth
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Trechelle Carson
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Janae Lowe
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | | | | | - Li Luo
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Callum J Bell
- National Center for Genome Resources, Santa Fe, NM, 87505, USA
| | - Vallabh O Shah
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
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Iyengar SK, Sedor JR, Freedman BI, Kao WHL, Kretzler M, Keller BJ, Abboud HE, Adler SG, Best LG, Bowden DW, Burlock A, Chen YDI, Cole SA, Comeau ME, Curtis JM, Divers J, Drechsler C, Duggirala R, Elston RC, Guo X, Huang H, Hoffmann MM, Howard BV, Ipp E, Kimmel PL, Klag MJ, Knowler WC, Kohn OF, Leak TS, Leehey DJ, Li M, Malhotra A, März W, Nair V, Nelson RG, Nicholas SB, O’Brien SJ, Pahl MV, Parekh RS, Pezzolesi MG, Rasooly RS, Rotimi CN, Rotter JI, Schelling JR, Seldin MF, Shah VO, Smiles AM, Smith MW, Taylor KD, Thameem F, Thornley-Brown DP, Truitt BJ, Wanner C, Weil EJ, Winkler CA, Zager PG, Igo RP, Hanson RL, Langefeld CD. Genome-Wide Association and Trans-ethnic Meta-Analysis for Advanced Diabetic Kidney Disease: Family Investigation of Nephropathy and Diabetes (FIND). PLoS Genet 2015; 11:e1005352. [PMID: 26305897 PMCID: PMC4549309 DOI: 10.1371/journal.pgen.1005352] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 06/10/2015] [Indexed: 11/28/2022] Open
Abstract
Diabetic kidney disease (DKD) is the most common etiology of chronic kidney disease (CKD) in the industrialized world and accounts for much of the excess mortality in patients with diabetes mellitus. Approximately 45% of U.S. patients with incident end-stage kidney disease (ESKD) have DKD. Independent of glycemic control, DKD aggregates in families and has higher incidence rates in African, Mexican, and American Indian ancestral groups relative to European populations. The Family Investigation of Nephropathy and Diabetes (FIND) performed a genome-wide association study (GWAS) contrasting 6,197 unrelated individuals with advanced DKD with healthy and diabetic individuals lacking nephropathy of European American, African American, Mexican American, or American Indian ancestry. A large-scale replication and trans-ethnic meta-analysis included 7,539 additional European American, African American and American Indian DKD cases and non-nephropathy controls. Within ethnic group meta-analysis of discovery GWAS and replication set results identified genome-wide significant evidence for association between DKD and rs12523822 on chromosome 6q25.2 in American Indians (P = 5.74x10-9). The strongest signal of association in the trans-ethnic meta-analysis was with a SNP in strong linkage disequilibrium with rs12523822 (rs955333; P = 1.31x10-8), with directionally consistent results across ethnic groups. These 6q25.2 SNPs are located between the SCAF8 and CNKSR3 genes, a region with DKD relevant changes in gene expression and an eQTL with IPCEF1, a gene co-translated with CNKSR3. Several other SNPs demonstrated suggestive evidence of association with DKD, within and across populations. These data identify a novel DKD susceptibility locus with consistent directions of effect across diverse ancestral groups and provide insight into the genetic architecture of DKD. Type 2 diabetes is the most common cause of severe kidney disease worldwide and diabetic kidney disease (DKD) associates with premature death. Individuals of non-European ancestry have the highest burden of type 2 DKD; hence understanding the causes of DKD remains critical to reducing health disparities. Family studies demonstrate that genes regulate the onset and progression of DKD; however, identifying these genes has proven to be challenging. The Family Investigation of Diabetes and Nephropathy consortium (FIND) recruited a large multi-ethnic collection of individuals with type 2 diabetes with and without kidney disease in order to detect genes associated with DKD. FIND discovered and replicated a DKD-associated genetic locus on human chromosome 6q25.2 (rs955333) between the SCAF8 and CNKSR genes. Findings were supported by significantly different expression of genes in this region from kidney tissue of subjects with, versus without DKD. The present findings identify a novel kidney disease susceptibility locus in individuals with type 2 diabetes which is consistent across subjects of differing ancestries. In addition, FIND results provide a rich catalogue of genetic variation in DKD patients for future research on the genetic architecture regulating this common and devastating disease.
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Affiliation(s)
- Sudha K. Iyengar
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail: (SKI); (JRS); (BIF)
| | - John R. Sedor
- Departments of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Departments of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail: (SKI); (JRS); (BIF)
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
- * E-mail: (SKI); (JRS); (BIF)
| | - W. H. Linda Kao
- Department of Epidemiology and Medicine, John Hopkins University, Baltimore, Maryland, United States of America
| | - Matthias Kretzler
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Benjamin J. Keller
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Hanna E. Abboud
- Department of Medicine/Nephrology, The University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Sharon G. Adler
- Department of Medicine, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Lyle G. Best
- Missouri Breaks Industries Research, Timber Lake, South Dakota, United States of America
| | - Donald W. Bowden
- Department of Biochemistry, Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Allison Burlock
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Shelley A. Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Mary E. Comeau
- Center for Public Health Genomics and Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, United States of America
| | - Jeffrey M. Curtis
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Jasmin Divers
- Center for Public Health Genomics and Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, United States of America
| | - Christiane Drechsler
- University Hospital Würzburg, Renal Division and Comprehensive Heart Failure Center, Würzburg, Germany
| | - Ravi Duggirala
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Robert C. Elston
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Huateng Huang
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Barbara V. Howard
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
| | - Eli Ipp
- Department of Medicine, Section of Diabetes and Metabolism, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Paul L. Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States of America
| | - Michael J. Klag
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - William C. Knowler
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Orly F. Kohn
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Tennille S. Leak
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David J. Leehey
- Department of Medicine, Loyola School of Medicine, Maywood, Illinois, United States of America
| | - Man Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alka Malhotra
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Winfried März
- Heidelberg University and Synlab Academy, University of Graz, Graz, Austria
| | - Viji Nair
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Robert G. Nelson
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Susanne B. Nicholas
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Stephen J. O’Brien
- Theodosius Dobzhansky Center for Genome Bioinformatics, St. Petersburg, Russia, and Oceanographic Center, Nova Southeastern University, Ft. Lauderdale, Florida, United States of America
| | - Madeleine V. Pahl
- Department of Medicine, University of California, Irvine, Irvine, California, United States of America
| | - Rulan S. Parekh
- Departments of Paediatrics and Medicine, Hospital for Sick Children, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Marcus G. Pezzolesi
- Department of Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rebekah S. Rasooly
- National Institute of Diabetes and Digestive Disease, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Charles N. Rotimi
- Center for Research on Genomics and Global Health, Bethesda, Maryland, United States of America
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Jeffrey R. Schelling
- Departments of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Michael F. Seldin
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Davis, California, United States of America
| | - Vallabh O. Shah
- Department of Biochemistry & Molecular Biology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Adam M. Smiles
- Joslin Diabetes Center, Section on Genetics and Epidemiology, Boston, Massachusetts, United States of America
| | - Michael W. Smith
- National Human Genome Research Institute, Rockville, Maryland, United States of America
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Farook Thameem
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States of America
| | | | - Barbara J. Truitt
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - E. Jennifer Weil
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Cheryl A. Winkler
- Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Philip G. Zager
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Robert P. Igo
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Robert L. Hanson
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Carl D. Langefeld
- The Institute for Translational Genomics and Population Sciences, Harbor-UCLA Medical Center, Torrance, California, United States of America
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VanderJagt TA, Neugebauer MH, Morgan M, Bowden DW, Shah VO. Epigenetic profiles of pre-diabetes transitioning to type 2 diabetes and nephropathy. World J Diabetes 2015; 6:1113-1121. [PMID: 26265998 PMCID: PMC4530325 DOI: 10.4239/wjd.v6.i9.1113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/04/2015] [Accepted: 07/14/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine DNA methylation profiles in a longitudinal comparison of pre-diabetes mellitus (Pre-DM) subjects who transitioned to type 2 diabetes mellitus (T2DM).
METHODS: We performed DNA methylation study in bisulphite converted DNA from Pre-DM (n = 11) at baseline and at their transition to T2DM using Illumina Infinium HumanMethylation27 BeadChip, that enables the query of 27578 individual cytosines at CpG loci throughout the genome, which are focused on the promoter regions of 14495 genes.
RESULTS: There were 694 CpG sites hypomethylated and 174 CpG sites hypermethylated in progression from Pre-DM to T2DM, representing putative genes involved in glucose and fructose metabolism, inflammation, oxidative and mitochondrial stress, and fatty acid metabolism. These results suggest that this high throughput platform is able to identify hundreds of prospective CpG sites associated with diverse genes that may reflect differences in Pre-DM compared with T2DM. In addition, there were CpG hypomethylation changes associated with a number of genes that may be associated with development of complications of diabetes, such as nephropathy. These hypomethylation changes were observed in all of the subjects.
CONCLUSION: These data suggest that some epigenomic changes that may be involved in the progression of diabetes and/or the development of complications may be apparent at the Pre-DM state or during the transition to diabetes. Hypomethylation of a number of genes related to kidney function may be an early marker for developing diabetic nephropathy.
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Garner CJ, Conn CA, Cohen D, Luo L, Castillo JJ, Shah VO, Garver WS. NAFLD Susceptibility Genes and their Association with Type 2 Diabetes and Obesity in a New Mexico Population. ACTA ACUST UNITED AC 2015; 2. [PMID: 28596988 DOI: 10.15436/2376-0494.15.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Genome-wide association studies have identified single-nucleotide polymorphisms (SNPs) that increase the risk of developing non-alcoholic fatty liver disease (NAFLD). One purpose of this study was to determine the frequencies of NAFLD susceptibility SNPs in a non-Hispanic white and Hispanic population who attended a clinic in northeast Albuquerque, NM. Another goal was to determine associations with selected indicators in this New Mexican population. METHODS This cohort study involving 168 volunteer subjects in the NM population (88 non-Hispanic whites, 63 Hispanics, 4 Native Americans, 11 Asian Americans, 2 unreported ethnicity). Eight SNPs within 6 NAFLD susceptibility genes including PNPLA3 (rs738409), LYPLAL1 (rs12137855), APOC3 (rs2854116, rs2854117), GCKR (rs780094, rs741038), FABP2 (rs1799883), PEMT (rs7946) were analyzed by genotyping using the TaqMan genotyping assay (Applied Biosystems, Foster City, CA). Statistical analyses were carried out using statistical package SAS 9.3. RESULTS The NAFLD allele frequencies were similar in non-Hispanic whites and Hispanics except for PNPLA3 (rs738409), FABP2 (rs1799883), and PEMT (rs7946). Eight SNPs in 5 NAFLD susceptibility genes were significantly associated OR marginally associated with selected indicators for NAFLD, metabolic syndrome, overweight, obesity, insulin resistance, type 2 diabetes, hypertension, dyslipidemia. No SNPs were significantly associated with the same indicator in both the non-Hispanic white and Hispanic groups. CONCLUSIONS In this population of non-Hispanic whites and Hispanics, there were only heterozygotes for the APOC3 derived alle le whereas for all other genes tested, both heterozygotes and homozygotes were found. Associations of alleles with indicators of chronic disease were different in non-Hispanic whites compared to Hispanics.
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Affiliation(s)
- Cara J Garner
- Department of Individual Family and Community Education, Nutrition and Dietetics Program, Albuquerque, New Mexico, USA
| | - Carole A Conn
- Department of Individual Family and Community Education, Nutrition and Dietetics Program, Albuquerque, New Mexico, USA
| | - Deborah Cohen
- Department of Individual Family and Community Education, Nutrition and Dietetics Program, Albuquerque, New Mexico, USA
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Joseph J Castillo
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Vallabh O Shah
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - William S Garver
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Laston SL, Voruganti VS, Haack K, Shah VO, Bobelu A, Bobelu J, Ghahate D, Harford AM, Paine SS, Tentori F, Cole SA, MacCluer JW, Comuzzie AG, Zager PG. Genetics of kidney disease and related cardiometabolic phenotypes in Zuni Indians: the Zuni Kidney Project. Front Genet 2015; 6:6. [PMID: 25688259 PMCID: PMC4311707 DOI: 10.3389/fgene.2015.00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/08/2015] [Indexed: 12/31/2022] Open
Abstract
The objective of this study is to identify genetic factors associated with chronic kidney disease (CKD) and related cardiometabolic phenotypes among participants of the Genetics of Kidney Disease in Zuni Indians study. The study was conducted as a community-based participatory research project in the Zuni Indians, a small endogamous tribe in rural New Mexico. We recruited 998 members from 28 extended multigenerational families, ascertained through probands with CKD who had at least one sibling with CKD. We used the Illumina Infinium Human1M-Duo version 3.0 BeadChips to type 1.1 million single nucleotide polymorphisms (SNPs). Prevalence estimates for CKD, hyperuricemia, diabetes, and hypertension were 24%, 30%, 17% and 34%, respectively. We found a significant (p < 1.58 × 10-7) association for a SNP in a novel gene for serum creatinine (PTPLAD2). We replicated significant associations for genes with serum uric acid (SLC2A9), triglyceride levels (APOA1, BUD13, ZNF259), and total cholesterol (PVRL2). We found novel suggestive associations (p < 1.58 × 10-6) for SNPs in genes with systolic (OLFML2B), and diastolic blood pressure (NFIA). We identified a series of genes associated with CKD and related cardiometabolic phenotypes among Zuni Indians, a population with a high prevalence of kidney disease. Illuminating genetic variations that modulate the risk for these disorders may ultimately provide a basis for novel preventive strategies and therapeutic interventions.
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Affiliation(s)
- Sandra L Laston
- South Texas Diabetes and Obesity Institute, Regional Academic Health Center, University of Texas at San Antonio Harlingen, TX, USA
| | - V Saroja Voruganti
- Department of Nutrition, University of North Carolina at Chapel Hill Kannapolis, NC, USA ; University of North Carolina Nutrition Research Institute, University of North Carolina at Chapel Hill Kannapolis, NC, USA
| | - Karin Haack
- Department of Genetics, Texas Biomedical Research Institute San Antonio, TX, USA
| | - Vallabh O Shah
- Department of Biochemistry, University of New Mexico School of Medicine Albuquerque, NM, USA
| | - Arlene Bobelu
- Department of Biochemistry, University of New Mexico School of Medicine Albuquerque, NM, USA
| | - Jeanette Bobelu
- Department of Biochemistry, University of New Mexico School of Medicine Albuquerque, NM, USA
| | - Donica Ghahate
- Department of Biochemistry, University of New Mexico School of Medicine Albuquerque, NM, USA
| | - Antonia M Harford
- Department of Biochemistry, University of New Mexico School of Medicine Albuquerque, NM, USA
| | | | | | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute San Antonio, TX, USA
| | - Jean W MacCluer
- Department of Genetics, Texas Biomedical Research Institute San Antonio, TX, USA
| | - Anthony G Comuzzie
- Department of Genetics, Texas Biomedical Research Institute San Antonio, TX, USA ; Southwest National Primate Research Center San Antonio, TX, USA
| | - Philip G Zager
- Dialysis Clinic, Inc., Albuquerque, NM USA ; Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine Albuquerque, NM, USA
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Newman S, Cheng T, Ghahate DM, Bobelu J, Sandy P, Faber T, Shah VO. Assessing knowledge and attitudes of diabetes in Zuni Indians using a culture-centered approach. PLoS One 2014; 9:e99614. [PMID: 24919064 PMCID: PMC4053347 DOI: 10.1371/journal.pone.0099614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 05/15/2014] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The Zuni Pueblo, in collaboration with the University of New Mexico, have formed the Zuni Health Initiative (ZHI) engaged in community-based participatory research to plan and implement educational interventions to reduce health disparities. We conducted the first phase of ZHI study and identified barriers to healthcare. We concluded that the burden presented by these barriers ultimately translates into a lack of patient activation and engagement in their health care including for diabetes, effectively hindering adoption of healthy behaviors. METHODS Community health representatives (CHRs) led 10 one-hour focus group sessions to elicit information on diabetes knowledge and self-management strategies at which a total of 84 people participated. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program. RESULTS The focus groups revealed that despite extensive personal or family experiences with diabetes or complications, participants identified knowledge gaps in the disease progression and disease management. However, we gained insight into how many Zunis conceptualize the etiology of diabetes, risk factors associated with diabetes, sources of knowledge and self-management practices. CONCLUSION We concluded that many of the Zuni diabetics experience significant impacts on their life when they were diagnosed with diabetes and suffered the plight of stigmatization. We further concluded that developing Zuni culture specific diabetes care should focus on family involvement with continued education.
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Affiliation(s)
- Sara Newman
- Health and Behavioral Sciences, University of Colorado, Denver, Colorado, United States of America
| | - Terri Cheng
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Donica M. Ghahate
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Jeanette Bobelu
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Phillip Sandy
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Thomas Faber
- Indian Health Services Comprehensive Center in Zuni Pueblo, Zuni, New Mexico, United States of America
| | - Vallabh O. Shah
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
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Thameem F, Igo RP, Freedman BI, Langefeld C, Hanson RL, Schelling JR, Elston RC, Duggirala R, Nicholas SB, Goddard KAB, Divers J, Guo X, Ipp E, Kimmel PL, Meoni LA, Shah VO, Smith MW, Winkler CA, Zager PG, Knowler WC, Nelson RG, Pahl MV, Parekh RS, Kao WHL, Rasooly RS, Adler SG, Abboud HE, Iyengar SK, Sedor JR. A genome-wide search for linkage of estimated glomerular filtration rate (eGFR) in the Family Investigation of Nephropathy and Diabetes (FIND). PLoS One 2013; 8:e81888. [PMID: 24358131 PMCID: PMC3866106 DOI: 10.1371/journal.pone.0081888] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 10/27/2013] [Indexed: 12/22/2022] Open
Abstract
Objective Estimated glomerular filtration rate (eGFR), a measure of kidney function, is heritable, suggesting that genes influence renal function. Genes that influence eGFR have been identified through genome-wide association studies. However, family-based linkage approaches may identify loci that explain a larger proportion of the heritability. This study used genome-wide linkage and association scans to identify quantitative trait loci (QTL) that influence eGFR. Methods Genome-wide linkage and sparse association scans of eGFR were performed in families ascertained by probands with advanced diabetic nephropathy (DN) from the multi-ethnic Family Investigation of Nephropathy and Diabetes (FIND) study. This study included 954 African Americans (AA), 781 American Indians (AI), 614 European Americans (EA) and 1,611 Mexican Americans (MA). A total of 3,960 FIND participants were genotyped for 6,000 single nucleotide polymorphisms (SNPs) using the Illumina Linkage IVb panel. GFR was estimated by the Modification of Diet in Renal Disease (MDRD) formula. Results The non-parametric linkage analysis, accounting for the effects of diabetes duration and BMI, identified the strongest evidence for linkage of eGFR on chromosome 20q11 (log of the odds [LOD] = 3.34; P = 4.4×10−5) in MA and chromosome 15q12 (LOD = 2.84; P = 1.5×10−4) in EA. In all subjects, the strongest linkage signal for eGFR was detected on chromosome 10p12 (P = 5.5×10−4) at 44 cM near marker rs1339048. A subsequent association scan in both ancestry-specific groups and the entire population identified several SNPs significantly associated with eGFR across the genome. Conclusion The present study describes the localization of QTL influencing eGFR on 20q11 in MA, 15q21 in EA and 10p12 in the combined ethnic groups participating in the FIND study. Identification of causal genes/variants influencing eGFR, within these linkage and association loci, will open new avenues for functional analyses and development of novel diagnostic markers for DN.
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Affiliation(s)
- Farook Thameem
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Robert P. Igo
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Barry I. Freedman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Carl Langefeld
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Robert L. Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Jeffrey R. Schelling
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Robert C. Elston
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Ravindranath Duggirala
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Susanne B. Nicholas
- Department of Medicine, University of California, Los Angeles, California, United States of America
| | - Katrina A. B. Goddard
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| | - Jasmin Divers
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Xiuqing Guo
- Department of Pediatrics, Harbor-University of California Los Angeles Medical Center, Torrance, California, United States of America
| | - Eli Ipp
- Department of Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, California, United States of America
| | - Paul L. Kimmel
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Lucy A. Meoni
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Vallabh O. Shah
- University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Michael W. Smith
- National Human Genome Research Institute, NIH, Bethesda, Maryland, United States of America
| | - Cheryl A. Winkler
- Center for Cancer Research, National Cancer Institute, NIH, Frederick, Maryland, United States of America
| | - Philip G. Zager
- University of New Mexico, Albuquerque, New Mexico, United States of America
| | - William C. Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Robert G. Nelson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America
| | - Madeline V. Pahl
- Department of Medicine, University of California, Irvine, California, United States of America
| | - Rulan S. Parekh
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - W. H. Linda Kao
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rebekah S. Rasooly
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sharon G. Adler
- Department of Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, California, United States of America
| | - Hanna E. Abboud
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Sudha K. Iyengar
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
| | - John R. Sedor
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
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Shah VO, Ghahate DM, Bobelu J, Sandy P, Newman S, Helitzer DL, Faber T, Zager P. Identifying barriers to healthcare to reduce health disparity in Zuni Indians using focus group conducted by community health workers. Clin Transl Sci 2013; 7:6-11. [PMID: 24528897 DOI: 10.1111/cts.12127] [Citation(s) in RCA: 19] [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] [Indexed: 11/28/2022] Open
Abstract
The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo. Community health representatives (CHRs) led 14 one-hour focus group sessions at which a total of 112 people participated posed unique questions that took into account the Zuni culture to elicit information on perceived barriers to healthcare. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program. We identified nine themes emerged regarding the barriers experienced in receiving healthcare and adhering to medical advice. These included distance; transportation; embarrassment; relating to healthcare professionals; navigating the medical system; awareness of available resources; waiting times; adhering to medication; and incentives in health promotion. In conclusion the implementation of culturally appropriate community-based health promotion programs and preventive screening techniques will improve access to healthcare and diminish health disparities.
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Affiliation(s)
- Vallabh O Shah
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Shah VO, Townsend RR, Feldman HI, Pappan KL, Kensicki E, Vander Jagt DL. Plasma metabolomic profiles in different stages of CKD. Clin J Am Soc Nephrol 2012; 8:363-70. [PMID: 23220422 DOI: 10.2215/cjn.05540512] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES CKD is a common public health problem. Identifying biomarkers adds prognostic/diagnostic value by contributing to an understanding of CKD at the molecular level and possibly defining new drug targets. Metabolomics provides a snapshot of biochemical events at a particular time in the progression of CKD. This cross-sectional metabolomics study ascertained whether plasma metabolite profiles are significantly different in CKD stages 2, 3, and 4. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS An analysis of plasma metabolites, using gas and liquid chromatography coupled to mass spectrometry, was conducted on 30 nondiabetic men ages 40-52 years, with 10 participants each in CKD stages 2, 3, and 4 based on their estimated GFR (calculated by the Modified Diet in Renal Disease formula). Participants were recruited in late 2008, and plasma samples were tested at Metabolon Inc and analyzed in 2012. RESULTS Comparison of stage 3/stage 2 identified 62 metabolites that differed (P ≤ 0.05), with 39 higher and 23 lower in stage 3 compared with stage 2; comparisons of stage 4/stage 2 identified 111 metabolites, with 66 higher and 45 lower; and comparisons of stage 4/stage 3 identified 11 metabolites, with 7 higher and 4 lower. Major differences in metabolite profiles with increasing stage of CKD were observed, including altered arginine metabolism, elevated coagulation/inflammation, impaired carboxylate anion transport, and decreased adrenal steroid hormone production. CONCLUSIONS Global metabolite profiling of plasma uncovered potential biomarkers of stages of CKD. Moreover, these biomarkers provide insight into possible pathophysiologic processes that may contribute to progression of CKD.
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Affiliation(s)
- Vallabh O Shah
- Department of Biochemistry and Molecular Biology, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
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Gupta J, Mitra N, Kanetsky PA, Devaney J, Wing MR, Reilly M, Shah VO, Balakrishnan VS, Guzman NJ, Girndt M, Periera BG, Feldman HI, Kusek JW, Joffe MM, Raj DS. Association between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC. Clin J Am Soc Nephrol 2012; 7:1938-46. [PMID: 23024164 DOI: 10.2215/cjn.03500412] [Citation(s) in RCA: 361] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Increased risk of mortality in patients with CKD has been attributed to inflammation. However, the association between kidney function, albuminuria, and biomarkers of inflammation has not been examined in a large cohort of CKD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study measured the plasma levels of IL-1β, IL-1 receptor antagonist (IL-1RA), IL-6, TNF-α, TGF-β, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, and serum albumin in 3939 participants enrolled in the Chronic Renal Insufficiency Cohort study between June 2003 and September 2008. An inflammation score was established based on plasma levels of IL-1β, IL-6, TNF-α, hs-CRP, and fibrinogen. Estimated GFR (eGFR) and serum cystatin C were used as measures of kidney function. Albuminuria was quantitated by urine albumin to creatinine ratio (UACR). RESULTS Plasma levels of IL-1β, IL-1RA, IL-6, TNF-α, hs-CRP, and fibrinogen were higher among participants with lower levels of eGFR. Inflammation score was higher among those with lower eGFR and higher UACR. In regression analysis adjusted for multiple covariates, eGFR, cystatin C, and UACR were strongly associated with fibrinogen, serum albumin, IL-6, and TNF-α. Each unit increase in eGFR, cystatin C, and UACR was associated with a -1.2% (95% confidence interval, -1.4, -1), 64.9% (56.8, 73.3) and 0.6% (0.4, 0.8) change in IL-6, respectively (P<0.001). CONCLUSIONS Biomarkers of inflammation were inversely associated with measures of kidney function and positively with albuminuria.
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Affiliation(s)
- Jayanta Gupta
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Chuang LT, Glew RH, Li CC, VanderJagt DJ, Broyles JS, Ray GM, Shah VO. Comparison of the fatty acid composition of the serum phospholipids of controls, prediabetics and adults with type 2 diabetes. ACTA ACUST UNITED AC 2012; 2:393-401. [PMID: 25414798 DOI: 10.4236/jdm.2012.24061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Although abnormalities in the fatty acid composition of serum and red cell membrane phospholipids of patients with type 2 diabetes are well-documented, lacking are studies of this issue in prediabetic individuals. MATERIALS/METHODS For this cross-sectional study, we recruited 180 subjects (30-80 years), 56 of whom were normal with regard to glucose control (HbA1c, <5.7%), 61 who had prediabetes (HbA1c, 5.7%-6.4%) and 59 who had type 2 diabetes (HbA1c, >6.5%). Serum phospholipids were isolated and analyzed for fatty acids. RESULTS Most importantly, the fatty acid compositions of the controls and prediabetic subjects were not different for 19 fatty acids. However, the fatty acid profile of the phospholipids of the patients with diabetes differed from the other two groups; the 14 to 18-carbon saturated fatty acids were decreased by 12%-26% whereas the unsaturated fatty acids 16:1n-7, 18:1n-9, 18:2n-6, 20:3n-6 and 20:4n-6 were increased by 45%-64%. Of note, the docosahexaenoic acid (DHA) status of individuals in all three study groups was remarkably low compared with international values, as indicated by DHA proportions in the 1.62%-2.07% range, and there were no differences between groups. The mean melting point of the phospholipid fatty acids of the diabetic patients (32.2°C) was significantly lower (p < 0.001) than that of the prediabetic subjects (38.1°C) and the controls (39.9°C) which were not different from each other. CONCLUSION These observations indicate that the fatty acid changes associated with type 2 diabetes follow the onset of the disease as opposed to being a causative factor of poor glucose control and insulin insensitivity.
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Affiliation(s)
- Lu-Te Chuang
- Department of Biotechnology, Yuanpei University, Hsinchu, Taiwan
| | - Robert H Glew
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, USA
| | - Chia-Chun Li
- Department of Biotechnology, Yuanpei University, Hsinchu, Taiwan
| | - Dorothy J VanderJagt
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, USA
| | - Julie S Broyles
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - Gretchen M Ray
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, USA
| | - Vallabh O Shah
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, USA
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Wilmot B, Voruganti VS, Chang YPC, Fu Y, Chen Z, Taylor HA, Wilson JG, Gipson T, Shah VO, Umans JG, Flessner MF, Hitzemann R, Shuldiner AR, Comuzzie AG, McWeeney S, Zager PG, Maccluer JW, Cole SA, Cohen DM. Heritability of serum sodium concentration: evidence for sex- and ethnic-specific effects. Physiol Genomics 2011; 44:220-8. [PMID: 22186255 DOI: 10.1152/physiolgenomics.00153.2011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Serum sodium concentration is the clinical index of systemic water balance. Although disordered water balance is common and morbid, little is known about genetic effects on serum sodium concentration at the population level. Prior studies addressed only participants of European descent and either failed to demonstrate significant heritability or showed only modest effect. We investigated heritability of serum sodium concentration in large cohorts reflecting a range of races/ethnicities, including the Framingham Heart Study (FHS, non-Hispanic Caucasian), the Heredity and Phenotype Intervention Heart Study (HAPI, Amish Caucasian), the Jackson Heart Study (JHS, African American), the Strong Heart Family Study (SHFS, American Indian), and the Genetics of Kidney Disease in Zuni Indians Study (GKDZI, American Indian). Serum sodium was transformed for the osmotic effect of glucose, and participants with markedly elevated glucose or reduced estimated glomerular filtration rate (eGFR) were excluded. Using a standard variance components method, incorporating covariates of age, glucose, and eGFR, we found heritability to be high in African American and American Indian populations and much more modest in non-Hispanic Caucasian populations. Estimates among females increased after stratification on sex and were suggestive among female participants in FHS (0.18 ± 0.12, P = 0.057) and male participants in JHS (0.24 ± 0.16, P = 0.067) and statistically significant among female participants in JHS (0.44 ± 0.09, P = 1 × 10 ⁻⁷), SHFS (0.59 ± 0.05, P = 9.4 × 10⁻⁴⁶), and GKDZI (0.46 ± 0.15, P = 1.7 × 10⁻⁴), and male participants in HAPI (0.18 ± 0.12, P = 0.03) and SHFS (0.67 ± 0.07, P = 5.4 × 10⁻²⁶). Exclusion of diuretic users increased heritability among females and was significant in all cohorts where data were available. In aggregate, these data strongly support the heritability of systemic water balance and underscore sex and ethnicity-specific effects.
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Affiliation(s)
- Beth Wilmot
- Division of Nephrology & Hypertension, Departments of Medicine, Oregon Health & Science University, Portland, OR, USA
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Igo RP, Iyengar SK, Nicholas SB, Goddard KAB, Langefeld CD, Hanson RL, Duggirala R, Divers J, Abboud H, Adler SG, Arar NH, Horvath A, Elston RC, Bowden DW, Guo X, Ipp E, Kao WHL, Kimmel PL, Knowler WC, Meoni LA, Molineros J, Nelson RG, Pahl MV, Parekh RS, Rasooly RS, Schelling JR, Shah VO, Smith MW, Winkler CA, Zager PG, Sedor JR, Freedman BI. Genomewide linkage scan for diabetic renal failure and albuminuria: the FIND study. Am J Nephrol 2011; 33:381-9. [PMID: 21454968 DOI: 10.1159/000326763] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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] [Received: 01/04/2011] [Accepted: 02/23/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetic nephropathy (DN) is a leading cause of mortality and morbidity in patients with type 1 and type 2 diabetes. The multicenter FIND consortium aims to identify genes for DN and its associated quantitative traits, e.g. the urine albumin:creatinine ratio (ACR). Herein, the results of whole-genome linkage analysis and a sparse association scan for ACR and a dichotomous DN phenotype are reported in diabetic individuals. METHODS A genomewide scan comprising more than 5,500 autosomal single nucleotide polymorphism markers (average spacing of 0.6 cM) was performed on 1,235 nuclear and extended pedigrees (3,972 diabetic participants) ascertained for DN from African-American (AA), American-Indian (AI), European-American (EA) and Mexican-American (MA) populations. RESULTS Strong evidence for linkage to DN was detected on chromosome 6p (p = 8.0 × 10(-5), LOD = 3.09) in EA families as well as suggestive evidence for linkage to chromosome 7p in AI families. Regions on chromosomes 3p in AA, 7q in EA, 16q in AA and 22q in MA displayed suggestive evidence of linkage for urine ACR. The linkage peak on chromosome 22q overlaps the MYH9/APOL1 gene region, previously implicated in AA diabetic and nondiabetic nephropathies. CONCLUSION These results strengthen the evidence for previously identified genomic regions and implicate several novel loci potentially involved in the pathogenesis of DN.
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Affiliation(s)
- Robert P Igo
- Genetic Analysis and Data Coordinating Center, Cleveland, Ohio, USA
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Shah VO, Ferguson JE, Hunsaker LA, Deck LM, Vander Jagt DL. Natural products inhibit LPS-induced activation of pro-inflammatory cytokines in peripheral blood mononuclear cells. Nat Prod Res 2010; 24:1177-88. [DOI: 10.1080/14786410903112680] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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MacCluer JW, Scavini M, Shah VO, Cole SA, Laston SL, Voruganti VS, Paine SS, Eaton AJ, Comuzzie AG, Tentori F, Pathak DR, Bobelu A, Bobelu J, Ghahate D, Waikaniwa M, Zager PG. Heritability of measures of kidney disease among Zuni Indians: the Zuni Kidney Project. Am J Kidney Dis 2010; 56:289-302. [PMID: 20646805 DOI: 10.1053/j.ajkd.2010.03.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 03/03/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND The long-term goal of the GKDZI (Genetics of Kidney Disease in Zuni Indians) Study is to identify genes, environmental factors, and genetic-environmental interactions that modulate susceptibility to renal disease and intermediate phenotypes. STUDY DESIGN A community-based participatory research approach was used to recruit family members of individuals with kidney disease. SETTING & PARTICIPANTS The study was conducted in the Zuni Indians, a small endogamous tribe located in rural New Mexico. We recruited members of extended families, ascertained through a proband with kidney disease and at least 1 sibling with kidney disease. 821 participants were recruited, comprising 7,702 relative pairs. PREDICTOR OUTCOMES & MEASUREMENTS: Urine albumin-creatinine ratio (UACR) and hematuria were determined in 3 urine samples and expressed as a true ratio. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) Study equation modified for American Indians. Probands were considered to have kidney disease if UACR was >or=0.2 in 2 or more of 3 spot urine samples or estimated GFR was decreased according to the CRIC (Chronic Renal Insufficiency Cohort) Study criteria. RESULTS Kidney disease was identified in 192 participants (23.4%). There were significant heritabilities for estimated GFR, UACR, serum creatinine, serum urea nitrogen, and uric acid and a variety of phenotypes related to obesity, diabetes, and cardiovascular disease. There were significant genetic correlations of some kidney-related phenotypes with these other phenotypes. LIMITATIONS Limitations include absence of renal biopsy, possible misclassification bias, lack of direct GFR measurements, and failure to include all possible environmental interactions. CONCLUSIONS Many phenotypes related to kidney disease showed significant heritabilities in Zuni Indians, and there were significant genetic correlations with phenotypes related to obesity, diabetes, and cardiovascular disease. The study design serves as a paradigm for the conduct of research in relatively isolated, endogamous, underserved populations.
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Affiliation(s)
- Jean W MacCluer
- Southwest Foundation for Biomedical Research, San Antonio, TX, USA
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Malhotra A, Igo RP, Thameem F, Kao WL, Abboud HE, Adler SG, Arar NH, Bowden DW, Duggirala R, Freedman BI, Goddard KA, Ipp E, Iyengar SK, Kimmel PL, Knowler WC, Kohn O, Leehey D, Meoni LA, Nelson RG, Nicholas SB, Parekh RS, Rich SS, Chen YDI, Saad MF, Scavini M, Schelling JR, Sedor JR, Shah VO, Taylor KD, Thornley-Brown D, Zager PG, Horvath A, Hanson RL. Genome-wide linkage scans for type 2 diabetes mellitus in four ethnically diverse populations-significant evidence for linkage on chromosome 4q in African Americans: the Family Investigation of Nephropathy and Diabetes Research Group. Diabetes Metab Res Rev 2009; 25:740-7. [PMID: 19795399 PMCID: PMC2783577 DOI: 10.1002/dmrr.1031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous studies have shown that in addition to environmental influences, type 2 diabetes mellitus (T2DM) has a strong genetic component. The goal of the current study is to identify regions of linkage for T2DM in ethnically diverse populations. METHODS Phenotypic and genotypic data were obtained from African American (AA; total number of individuals [N] = 1004), American Indian (AI; N = 883), European American (EA; N = 537), and Mexican American (MA; N = 1634) individuals from the Family Investigation of Nephropathy and Diabetes. Non-parametric linkage analysis, using an average of 4404 SNPs, was performed in relative pairs affected with T2DM in each ethnic group. In addition, family-based tests were performed to detect association with T2DM. RESULTS Statistically significant evidence for linkage was observed on chromosome 4q21.1 (LOD = 3.13; genome-wide p = 0.04) in AA. In addition, a total of 11 regions showed suggestive evidence for linkage (estimated at LOD > 1.71), with the highest LOD scores on chromosomes 12q21.31 (LOD = 2.02) and 22q12.3 (LOD = 2.38) in AA, 2p11.1 (LOD = 2.23) in AI, 6p12.3 (LOD = 2.77) in EA, and 13q21.1 (LOD = . 2.24) in MA. While no region overlapped across all ethnic groups, at least five loci showing LOD > 1.71 have been identified in previously published studies. CONCLUSIONS The results from this study provide evidence for the presence of genes affecting T2DM on chromosomes 4q, 12q, and 22q in AA; 6p in EA; 2p in AI; and 13q in MA. The strong evidence for linkage on chromosome 4q in AA provides important information given the paucity of diabetes genetic studies in this population.
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Affiliation(s)
- Alka Malhotra
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | | | - Farook Thameem
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Hanna E. Abboud
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sharon G. Adler
- Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Nedal H. Arar
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | | | | | - Eli Ipp
- Harbor-University of California Los Angeles Medical Center, Torrance, California
| | | | - Paul L. Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases Program Office, Bethesda, Maryland
| | - William C. Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Orly Kohn
- University of Chicago, Chicago, Illinois
| | | | | | - Robert G. Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | | | | | | | - Yii-Der I. Chen
- University of California Los Angeles, Los Angeles, California
| | | | - Marina Scavini
- University of New Mexico, Albuquerque, New Mexico
- San Raffaele Scientific Institute, Milan (Italy)
| | | | | | | | - Kent D. Taylor
- University of California Los Angeles, Los Angeles, California
| | | | | | | | - Robert L. Hanson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
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Raj DSC, Carrero JJ, Shah VO, Qureshi AR, Bárány P, Heimbürger O, Lindholm B, Ferguson J, Moseley PL, Stenvinkel P. Soluble CD14 levels, interleukin 6, and mortality among prevalent hemodialysis patients. Am J Kidney Dis 2009; 54:1072-80. [PMID: 19733948 DOI: 10.1053/j.ajkd.2009.06.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 06/23/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND CD14 is a pattern-recognition receptor that has a central immunomodulatory role in proinflammatory signaling in response to a variety of ligands, including endotoxin. CD14 protein is present in 2 forms: soluble (sCD14) and membrane bound. Here, we studied the implications of increased sCD14 levels in hemodialysis patients. We hypothesized that sCD14 level increase may link to cytokine activation and protein-energy wasting, predisposing to increased mortality risk. STUDY DESIGN Prospective observational study of prevalent hemodialysis patients. SETTING & PARTICIPANTS 211 prevalent hemodialysis patients, median age of 65 years, with 29 months of vintage dialysis time followed up for mortality for a median of 31 months. PREDICTORS Tertiles of baseline circulating sCD14 levels corresponding to less than 2.84, 2.85 to 3.62, and greater than 3.63 microg/mL. OUTCOME The major outcome of interest was all-cause mortality. MEASUREMENTS sCD14 and endotoxin, together with other markers of inflammation and protein-energy wasting. RESULTS Median sCD14 level was 3.2 microg/mL (25th to 75th percentile, 2.7 to 3.9). sCD14 level correlated positively with C-reactive protein, interleukin 6, endotoxin, and pentraxin 3 levels and negatively with serum albumin level, muscle mass, and handgrip strength. Patients with increased sCD14 levels had lower body mass index and increased prevalence of muscle atrophy. Patients within the highest sCD14 tertile had a crude morality hazard ratio of 1.94 (95% confidence interval, 1.13 to 3.32) that persisted after adjustment for multiple confounders (hazard ratio, 3.11; 95% confidence interval, 1.49 to 6.46). In patients with persistent inflammation, the presence of a concurrent sCD14 level increase gradually increased mortality risk, but this effect was less than multiplicative and failed to show a statistical interaction. LIMITATIONS Those inherent to an observational study. CONCLUSIONS sCD14 level is associated with inflammation and protein-energy wasting in hemodialysis patients. It is a strong and independent predictor of mortality that warrants further assessment in the clinical setting regarding its usefulness as a complementary prognosticator to other general inflammatory markers.
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Affiliation(s)
- Dominic S C Raj
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC, USA
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Raj DSC, Shah VO, Rambod M, Kovesdy CP, Kalantar-Zadeh K. Association of soluble endotoxin receptor CD14 and mortality among patients undergoing hemodialysis. Am J Kidney Dis 2009; 54:1062-71. [PMID: 19699018 DOI: 10.1053/j.ajkd.2009.06.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 06/22/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND CD14 is a key molecule in innate immunity that mediates cell activation and signaling in response to endotoxin and other bacterial wall-derived components. CD14 protein exists in soluble (sCD14) and membrane-bound forms. The correlates of sCD14 in persons undergoing long-term hemodialysis (HD) therapy are not known. We hypothesized that increased sCD14 levels in HD patients are associated with proinflammatory cytokine activation and increased mortality. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS 310 long-term HD patients who participated in the Nutritional and Inflammatory Evaluation in Dialysis (NIED) Study, a cohort derived from a pool of more than 3,000 HD outpatients during 5 years in 8 DaVita maintenance dialysis facilities in the South Bay Los Angeles, CA, area. PREDICTORS sCD14 levels in serum. OUTCOMES 33-month mortality. RESULTS Mean sCD14 level was 7.24 +/- 2.45 microg/mL. Tumor necrosis factor alpha level was the strongest correlate of sCD14 level (r = +0.24; P < 0.001), followed by interleukin 6 level (r = +0.18; P = 0.002), serum ferritin level (r = +0.21; P < 0.001), total iron-binding capacity (r = -0.19; P < 0.001), body mass index (r = -0.15; P = 0.008), vintage (r = +0.14; P = 0.01), low-density lipoprotein cholesterol level (r = +0.13; P = 0.03), and body fat (r = -0.11; P = 0.06). During the 33-month follow-up, 71 (23%) patients died. Multivariable Cox proportional analysis adjusted for case-mix and other nutritional and inflammatory confounders, including serum tumor necrosis factor alpha, C-reactive protein, and interleukin 6 levels, showed that compared with the lowest sCD14 tertile, sCD14 levels in the third tertile (>7.8 microg/mL) were associated with greater death risk (hazard ratio, 1.94; 95% confidence interval, 1.01 to 3.75; P = 0.04). LIMITATIONS Survivor bias in combined incident/prevalent studies. CONCLUSIONS Increased sCD14 level is related positively to markers of inflammation and negatively to nutritional status and is an independent predictor of mortality in long-term HD patients. Additional studies are needed to examine the usefulness of sCD14 level in risk stratification and the clinical decision-making process in HD patients.
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Affiliation(s)
- Dominic S C Raj
- George Washington University School of Medicine, North Washington, DC, USA
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Arar NH, Freedman BI, Adler SG, Iyengar SK, Chew EY, Davis MD, Satko SG, Bowden DW, Duggirala R, Elston RC, Guo X, Hanson RL, Igo RP, Ipp E, Kimmel PL, Knowler WC, Molineros J, Nelson RG, Pahl MV, Quade SRE, Rasooly RS, Rotter JI, Saad MF, Scavini M, Schelling JR, Sedor JR, Shah VO, Zager PG, Abboud HE. Heritability of the severity of diabetic retinopathy: the FIND-Eye study. Invest Ophthalmol Vis Sci 2008; 49:3839-45. [PMID: 18765632 DOI: 10.1167/iovs.07-1633] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Diabetic retinopathy (DR) and diabetic nephropathy (DN) are serious microvascular complications of diabetes mellitus. Correlations between severity of DR and DN and computed heritability estimates for DR were determined in a large, multiethnic sample of diabetic families. The hypothesis was that (1) the severity of DR correlates with the presence and severity of nephropathy in individuals with diabetes mellitus, and (2) the severity of DR is under significant familial influence in members of multiplex diabetic families. METHODS The Family Investigation of Nephropathy and Diabetes (FIND) was designed to evaluate the genetic basis of DN in American Indians, European Americans, African Americans, and Mexican Americans. FIND enrolled probands with advanced DN, along with their diabetic siblings who were concordant and discordant for nephropathy. These diabetic family members were invited to participate in the FIND-Eye study to determine whether inherited factors underlie susceptibility to DR and its severity. FIND-Eye participants underwent eye examinations and had fundus photographs taken. The severity of DR was graded by using the Early Treatment Diabetic Retinopathy Study Classification (ETDRS). Sib-sib correlations were calculated with the SAGE 5.0 program FCOR, to estimate heritability of retinopathy severity. RESULTS This report summarizes the results for the first 2368 diabetic subjects from 767 families enrolled in FIND-Eye; nearly 50% were Mexican American, the largest single ethnicity within FIND. The overall prevalence of DR was high; 33.4% had proliferative DR; 7.5%, 22.8%, and 9.5% had severe, moderate, and mild nonproliferative DR, respectively; 26.6% had no DR. The severity of DR was significantly associated with severity of DN, both by phenotypic category and by increasing serum creatinine concentration (chi(2) = 658.14, df = 20; P < 0.0001). The sib-sib correlation for DR severity was 0.1358 in the total sample and 0.1224 when limited to the Mexican-American sample. Broad sense heritabilities for DR were 27% overall and 24% in Mexican-American families. The polygenic heritability of liability for proliferative DR approximated 25% in this FIND-Eye sample. CONCLUSIONS These data confirm that the severity of DR parallels the presence and severity of nephropathy in individuals with diabetes mellitus. The severity of DR in members of multiplex diabetic families appears to have a significant familial connection.
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Affiliation(s)
- Nedal H Arar
- Family Investigation of Nephropathy and Diabetes (FIND) Genetic Analysis and Data Coordinating Center, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
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Degaffe GH, Vander Jagt DL, Bobelu A, Bobelu J, Neha D, Waikaniwa M, Zager P, Shah VO. Distribution of glyoxalase I polymorphism among Zuni Indians: the Zuni Kidney Project. J Diabetes Complications 2008; 22:267-72. [PMID: 18413187 PMCID: PMC2504516 DOI: 10.1016/j.jdiacomp.2007.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 11/03/2006] [Revised: 05/04/2007] [Accepted: 06/01/2007] [Indexed: 12/24/2022]
Abstract
Zuni Indians are experiencing simultaneous epidemics of type 2 diabetes mellitus (T2DM) and renal disease [Scavini, M., Stidley, C. A., Shah, V. O., Narva, A. S., Tentori, F., Kessler, D. S., et al. (2003). Prevalence of diabetes is higher among female than male Zuni Indians: Diabetes among Zuni Indians. Diabetes Care, 26 (1), 55-60; Shah, V. O., Scavini, M., Stidley, C., Tentori, F., Welty, T., Maccluer, J. W., et al. (2003). Epidemic of diabetic and nondiabetic renal disease among the Zuni Indians: The Zuni Kidney Project. Journal of the American Society of Nephrology, 14, 1320-1329]. Methylglyoxal (MG), a highly reactive, cytotoxic, cross-linking endogenous aldehyde involved in the modification of biologic macromolecules, is elevated among patients with T2DM. Glyoxalase I (Glo1) is the initial enzyme involved in the detoxification of MG. Glo1 is a dimeric enzyme with three isoforms Glo1-1, Glo2-1, and Glo2-2, resulting from a point mutation (A-->C) at position 332 of cDNA. The present study was conducted to explore the hypothesis that specific polymorphisms of the Glo1 gene are associated with diabetes and/or albuminuria in Zuni Indians. We studied four groups of Zuni Indians stratified by diabetes status and albuminuria, as assessed by the urinary albumin:creatinine ratio (UACR): Group I--normal controls; Group II--T2DM and UACR<0.03; Group III--T2DM and UACR>or=0.03; and Group IV--nondiabetic participants with UACR>or=0.03. Genomic DNA was used as template for polymerase chain reaction amplification of the Glo1 gene. Products were digested to yield 110-bp bands (homozygous, CC); 54- and 45-bp bands (homozygous, AA); or all three bands (heterozygous CA). Data on age, gender, UACR, serum creatinine, hemoglobin A1(c), serum glucose, systolic and diastolic blood pressures, and the duration of T2DM among participants in Groups II and III were analyzed using analysis of variance. A generalized linear model logistic regression analysis was used to assess the relationships between specific Glo1 polymorphisms to T2DM and UACR. All three Glo1 genotypes were present among Zuni Indians. There were no significant differences in the distributions of Glo1 genotypes among the study groups (chi-square test, P=.5590). The prevalence of Glo1 A allele was higher among diabetic participants (Groups II and III combined) than among nondiabetic participants (Groups I and IV combined) (chi-square test, P=.0233). There was an association (odds ratio=2.9; 95% confidence interval=1.3-7.2) between the Glo1 A allele and T2DM.
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Affiliation(s)
- Guenet H. Degaffe
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | - David L. Vander Jagt
- Department of Biochemistry and Molecular Biology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | | | - Jeanette Bobelu
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | - Donica Neha
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | - Mildred Waikaniwa
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | - Philip Zager
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | - Vallabh O. Shah
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
- Department of Biochemistry and Molecular Biology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
- * Address correspondence to this author: Vallabh (Raj) Shah, PhD, Department of Internal Medicine, University of New Mexico –HSC, 1 UNM MSC10-5550, Albuquerque, NM 87131-0001, 505 272-4750 –phone, 505-272-2349 –fax,
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Schelling JR, Abboud HE, Nicholas SB, Pahl MV, Sedor JR, Adler SG, Arar NH, Bowden DW, Elston RC, Freedman BI, Goddard KAB, Guo X, Hanson RL, Ipp E, Iyengar SK, Jun G, Kao WHL, Kasinath BS, Kimmel PL, Klag MJ, Knowler WC, Nelson RG, Parekh RS, Quade SR, Rich SS, Saad MF, Scavini M, Smith MW, Taylor K, Winkler CA, Zager PG, Shah VO. Genome-wide scan for estimated glomerular filtration rate in multi-ethnic diabetic populations: the Family Investigation of Nephropathy and Diabetes (FIND). Diabetes 2008; 57:235-43. [PMID: 18003762 DOI: 10.2337/db07-0313] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Diabetic nephropathy, the most common cause of end-stage renal disease, aggregates in families and specific ethnic groups. Deconstructing diabetic nephropathy into intermediate, quantitative phenotypes may increase feasibility of detecting susceptibility loci by genetic screens. Glomerular filtration rate (GFR), which characterizes diabetic nephropathy, was employed as a quantitative trait in a preliminary whole-genome scan. RESEARCH DESIGN AND METHODS Estimated GFR (eGFR) was calculated for 882 diabetic sibpairs (mean age 57 years) of African-American (25.6% of total), American Indian (8.6%), European-American (14.2%), and Mexican-American (51.6%) descent enrolled in the initial phase of the Family Investigation of Nephropathy and Diabetes (FIND). A whole-genome scan was performed using 404 microsatellite markers (average spacing 9 cM) and model-free linkage analysis. RESULTS For all ethnicities combined, strong evidence for linkage was observed on chromosomes 1q43 (P = 3.6 x 10(-3)), 7q36.1 (P = 2.1 x 10(-4)), 8q13.3 (P = 4.6 x 10(-4)), and 18q23.3 (P = 2.7 x 10(-3)). Mexican-American families, who comprised the major ethnic subpopulation in FIND, contributed to linkage on chromosomes 1q43, 2p13.3, 7q36.1, 8q13.3, and 18q23.3, whereas African-American and American-Indian families displayed linkage peaks on chromosomes 11p15.1 and 15q22.3, respectively. CONCLUSIONS We have demonstrated multiple chromosomal regions linked to eGFR in a multi-ethnic collection of families ascertained by a proband with diabetic nephropathy. Identification of genetic variants within these loci that are responsible for the linkage signals could lead to predictive tests or novel therapies for subsets of patients at risk for diabetic nephropathy.
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Affiliation(s)
- Jeffrey R Schelling
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Wolstein Research Building, Rm. 1300, 10900 Euclid Ave., Cleveland, OH 44106-7281, USA
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Abstract
BACKGROUND Mitochondria play a crucial role in the regulation of the endogenous pathways of apoptosis activated by oxidant stress. Nuclear factor-kappaB (NF-kappaB) is a central integration site for pro-inflammatory signals and oxidative stress. MATERIALS AND METHODS Peripheral blood mononuclear cells (PBMC) were isolated from eight end-stage renal disease (ESRD) patients before haemodialysis (Pre-HD) and during the last 10 min of HD (End-HD). A new polysulfone membrane (F70, Fresenius) was used for dialysis. Intracellular generation of reactive oxygen species (ROS), mitochondrial redox potential (Deltapsim) and PBMC apoptosis were determined by flow-cytometry. RESULTS Plasma levels of interleukin-6 (IL-6) (24.9+/-7.0 vs. 17.4+/-5.5 pg dL(-1), P<0.05), IL-6 soluble receptor (52.2+/-4.9 vs. 37.6+/-3.2 ng dL(-1), P<0.02) and IL-6 gp130 (405.7+/-41.0 vs. 235.1+/-38.4 ng dL(-1), P<0.02) were higher end-HD compared to pre-HD. IL-6 secretion by the isolated PBMC (24.0+/-2.3 vs. 19.3+/-3.5 pg dL(-1), P<0.02) increased end-HD. Percentage of lymphocytes exhibiting collapse of mitochondrial membrane potential (43.4+/-4.6% vs. 32.6+/-2.9%, P<0.01), apoptosis (33.4+/-7.1% vs. 23.7+/-7.7%, P<0.01), and generation of superoxide (20.7+/-5.2% vs. 12.5+/-2.9%, P<0.02) and hydrogen peroxide (51.1+/-7.8% vs.38.2+/-5.9%, P<0.04) were higher at end-HD than pre-HD. NF-kappaB activation (3144.1+/-208.1 vs. 2033.4+/-454.6 pg well(-1), P<0.02), expression of B-cell lymphoma protein-2 (6494.6+/-1461 vs. 3501.5+/-796.5 ng mL(-1), P<0.03) and heat shock protein-70 (9.81+/-1.47 vs. 6.38+/-1.0 ng mL(-1), P<0.05) increased during HD. CONCLUSIONS Intra-dialytic activation of cytokines, together with impaired mitochondrial function, promotes generation of ROS culminating in augmented PBMC apoptosis. There is concomitant activation of pathways aimed at attenuation of cell stress and apoptosis during HD.
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Affiliation(s)
- D S C Raj
- University of New Mexico Health Sciences Center, Division of Nephrology and Epidemiology, Department of Medicine, Albuquerque, New Mexico 87131-5271, USA.
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Iyengar SK, Abboud HE, Goddard KAB, Saad MF, Adler SG, Arar NH, Bowden DW, Duggirala R, Elston RC, Hanson RL, Ipp E, Kao WHL, Kimmel PL, Klag MJ, Knowler WC, Meoni LA, Nelson RG, Nicholas SB, Pahl MV, Parekh RS, Quade SRE, Rich SS, Rotter JI, Scavini M, Schelling JR, Sedor JR, Sehgal AR, Shah VO, Smith MW, Taylor KD, Winkler CA, Zager PG, Freedman BI. Genome-wide scans for diabetic nephropathy and albuminuria in multiethnic populations: the family investigation of nephropathy and diabetes (FIND). Diabetes 2007; 56:1577-85. [PMID: 17363742 DOI: 10.2337/db06-1154] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Family Investigation of Nephropathy and Diabetes (FIND) was initiated to map genes underlying susceptibility to diabetic nephropathy. A total of 11 centers participated under a single collection protocol to recruit large numbers of diabetic sibling pairs concordant and discordant for diabetic nephropathy. We report the findings from the first-phase genetic analyses in 1,227 participants from 378 pedigrees of European-American, African-American, Mexican-American, and American Indian descent recruited from eight centers. Model-free linkage analyses, using a dichotomous definition for diabetic nephropathy in 397 sibling pairs, as well as the quantitative trait urinary albumin-to-creatinine ratio (ACR), were performed using the Haseman-Elston linkage test on 404 microsatellite markers. The strongest evidence of linkage to the diabetic nephropathy trait was on chromosomes 7q21.3, 10p15.3, 14q23.1, and 18q22.3. In ACR (883 diabetic sibling pairs), the strongest linkage signals were on chromosomes 2q14.1, 7q21.1, and 15q26.3. These results confirm regions of linkage to diabetic nephropathy on chromosomes 7q, 10p, and 18q from prior reports, making it important that genes underlying these peaks be evaluated for their contribution to nephropathy susceptibility. Large family collections consisting of multiple members with diabetes and advanced nephropathy are likely to accelerate the identification of genes causing diabetic nephropathy, a life-threatening complication of diabetes.
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Affiliation(s)
- Sudha K Iyengar
- FIND-Genetic Analysis and Data Coordinating Center, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio 44106-7281, USA.
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Scavini M, Stidley CA, Paine SS, Shah VO, Tentori F, Bobelu A, Welty TK, MacCluer JW, Zager PG. The burden of chronic kidney disease among the Zuni Indians: the Zuni Kidney Project. Clin J Am Soc Nephrol 2007; 2:509-16. [PMID: 17699458 DOI: 10.2215/cjn.02780806] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 11/23/2022]
Abstract
The Zuni Indians of New Mexico are experiencing an epidemic of chronic kidney disease (CKD). The Zuni Pueblo created the Zuni Kidney Project (ZKP) to decrease the burden of CKD in the community. The aim of this study was to estimate the prevalence of CKD among Zuni Indians using National Kidney Foundation Kidney Disease Outcomes Quality Initiative criteria. The ZKP conducted a population-based, cross-sectional survey to estimate the prevalence of CKD and related risk factors among Zuni Indians aged > or =20 yr (n = 1113). GFR was estimated using equations based on serum creatinine, and urine albumin:creatinine ratio was calculated in a single spot urine sample. ESRD counts were obtained from health care providers. The age- and sex-adjusted prevalence of CKD among the Zuni Indians was >2.5-fold higher than that among the US composite population. The estimated prevalence of CKD stages 1 and 2 combined was three- to four-fold higher than that of CKD stages 3 and 4 combined. This ratio was significantly higher than that in the US composite population (1.4-fold). The prevalence of CKD stage 5 was eight-fold higher among the Zuni Indians than among the composite US population. The Zuni Indians have an expanded pool of CKD that contributes to the high burden of ESRD. The high prevalence of CKD stages 1 and 2 provides a unique opportunity to develop innovative treatment programs to reduce the burden of CKD in Zuni Pueblo.
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Affiliation(s)
- Marina Scavini
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87102, USA
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Shah VO, Dominic EA, Moseley P, Pickett G, Fleet M, Ness S, Raj DSC. Hemodialysis modulates gene expression profile in skeletal muscle. Am J Kidney Dis 2006; 48:616-28. [PMID: 16997058 DOI: 10.1053/j.ajkd.2006.05.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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] [Received: 02/23/2006] [Accepted: 05/15/2006] [Indexed: 12/27/2022]
Abstract
BACKGROUND Uremia alters diverse metabolic pathways involving multiple organ systems, including skeletal muscle. Skeletal muscle has an important role in nutrition, metabolism, oxidative stress, and inflammation. We hypothesized that hemodialysis (HD) will change the genomic fingerprinting associated with uremia and facilitate expression of a distinct set of genes. METHODS Five patients with end-stage renal disease (ESRD) were studied. Skeletal muscle biopsy specimens from the vastus lateralis were obtained before (pre-HD) and during the last 10 minutes of HD (post-HD). Oligonucleotide microarray (version 2, GeneChip arrays; Affymetrix U95A, Santa Clara, CA) was used to analyze global transcriptional modification in skeletal muscle by HD. Pre-HD data were compared with data from 3 subjects without renal failure. RESULTS In skeletal muscle of patients with ESRD, 83 genes were upregulated and 8 genes were downregulated pre-HD compared with controls. Pathway analysis linked 55 genes to 5 gene networks involved in the regulation of cell cycle, cell proliferation, cellular organization, apoptosis, and inflammation. During HD, expression of 22 genes increased and 1 (TOB1) decreased. Pathway analysis mapped 20 genes to 2 genetic networks involved in: (1) inflammation, cell proliferation, and cell signaling; and (2) apoptosis, cell function, protein synthesis, and tissue morphology. Reverse-transcription polymerase chain reaction confirmed increased expression of GADD45A, BTG2, PDE4B, and CEBPD and downregulation of TOB1 in skeletal muscle intradialysis. CONCLUSION In response to the uremic milieu, skeletal muscle goes through very active transcriptional and translational changes. HD activates a diverse, yet biologically linked, network of genes related to inflammation and apoptosis in skeletal muscle.
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Affiliation(s)
- Vallabh O Shah
- Division of Nephrology and Department of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
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Raj DSC, Dominic EA, Pai A, Osman F, Morgan M, Pickett G, Shah VO, Ferrando A, Moseley P. Skeletal muscle, cytokines, and oxidative stress in end-stage renal disease. Kidney Int 2006; 68:2338-44. [PMID: 16221238 DOI: 10.1111/j.1523-1755.2005.00695.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 12/18/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) is a state of microinflammation, with increased activation of cytokines and augmented oxidative stress. While peripheral blood mononuclear cells are an established source of reactive oxygen species and inflammatory cytokines during hemodialysis (HD), skeletal muscle is also capable of generating these biomolecules. METHODS Femoral arterio-venous (A-V) balance of interleukin-1 (IL-1), IL-6, IL-10, tumor necrosis factor-alpha (TNF-alpha), malonyldialdehyde (MDA), and carbonyl protein (CP) were measured in 17 ESRD patients and 9 healthy volunteers. ESRD patients were studied before (pre-HD) and during HD. mRNA levels of cytokines, heme oxygenase-1 (HO-1), and suppressors of cytokine signaling-2 (SOCS-2) were quantitated in the skeletal muscle by real-time polymerase chain reaction (PCR). RESULTS Arterial concentration of MDA (pmol/mL) was higher pre-HD (325.5 +/- 19.6) compared to controls (267.7 +/- 14.7), but decreased intradialysis (248.8 +/- 16.1) (P < 0.01). Dialysis clearance of MDA was 16.9 +/- 3.1 mL/min. CP concentration (nmol/mg protein) in the artery was significantly higher pre-HD (2.29 +/- 0.09) than in controls (1.92 +/- 0.05), and remained stable during HD (2.23 +/- 0.07). Plasma cytokines increased to a variable degree in the artery and vein during HD. A-V balance studies demonstrated that the MDA (17.8%) and CP (5.1%) concentrations increased significantly in the vein intradialysis. Venous concentration of IL-6 was higher than that in the artery during dialysis (16.27 +/- 2.42 vs. 11.29 +/- 2.17 pg/dL, P < 0.01). mRNA levels of IL-6 (0.028 +/- 0.02 vs. 6.69 +/- 0.21), HO-1 (0.96 +/- 0.01 vs. 5.08 +/- 1.11), and SOCS-2 (0.63 +/- 0.12 vs. 0.82 +/- 0.14) in the muscle increased during HD (P < 0.01). Immunohistochemical studies confirmed the increase in IL-6 protein in the skeletal muscle during HD. The intradialytic increase in IL-1, IL-10, and TNF-alpha gene expression was not significant. CONCLUSION Skeletal muscle may also contribute to the circulating plasma IL-6 and increased oxidative stress during HD.
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Affiliation(s)
- Dominic S C Raj
- Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, 87131, USA.
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Scavini M, Shah VO, Stidley CA, Tentori F, Paine SS, Harford AM, Narva AS, Kessler DS, Bobelu A, Albert CP, Bobelu J, Jamon E, Natachu K, Neha D, Welty TK, MacCluer JW, Zager PG. Kidney disease among the Zuni Indians: The Zuni Kidney Project. Kidney Int 2005:S126-31. [PMID: 16014090 DOI: 10.1111/j.1523-1755.2005.09721.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 11/27/2022]
Abstract
BACKGROUND There is an epidemic of kidney disease among the Zuni Indians. In collaboration with health care providers and research institutions, the Zuni Pueblo established the Zuni Kidney Project to reduce the burden of kidney disease. METHODS The Zuni Kidney Project conducted a population-based, cross-sectional survey to estimate the prevalence of albuminuria, hematuria, and related risk factors. Neighborhood household clusters served as the sampling frame. Participants completed a questionnaire, donated blood and urine samples, and had blood pressure, height, and weight measured. This survey provided the foundation for ongoing studies to identify genetic and environmental risk factors for disease susceptibility and progression. RESULTS Age and gender distributions among survey participants were similar to those in the eligible Zuni population. Prevalence of incipient albuminuria (IA) (0.03< or = urine albumin:creatinine ratio, UACR <0.3) and overt albuminuria (OA) (UACR < 0.3) were higher among diabetics [IA 34.3% (28.3, 40.4%); OA 18.6% (13.7, 23.6%)] than nondiabetics [IA 11.1% (9.3, 12.8%); OA 1.7% (1.0, 2.5%)]. Nondiabetics comprised 58.6% (52.2, 65.0%) and 30.9% (19.9, 41.9%) of participants with IA and OA, respectively. The prevalence of hematuria was higher among diabetics [> or = trace 47.0% (40.7, 53.4); > or =50 red blood cell/microL 25.8% (20.3, 31.4%)] than nondiabetics [> or = trace 31.1% (28.5, 33.7%); > or =50 red blood cell/microL 16.6% (14.5, 18.7%)]. Hypertension was associated with albuminuria among diabetic and nondiabetic participants. Hypercholesterolemia was associated with albuminuria among nondiabetic participants. Diabetes and alcohol use were associated with hematuria. CONCLUSION The high prevalences of albuminuria among nondiabetics and of hematuria among diabetics and nondiabetics are consistent with high rates of nondiabetic kidney disease among Zuni Indians with and without diabetes.
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Abstract
BACKGROUND Hemodialysis (HD) is associated with protein catabolism and augmented apoptosis. Although the effect of metabolic acidosis and inflammatory cytokines on activation of the ubiquitin-proteasome pathway and branched-chain keto acid dehydrogenase (BCKAD) is well known, the effect of HD on these pathways remains unexplored. METHODS Twelve patients with end-stage renal disease were studied before and during HD. Eight controls also were studied. Plasma levels of complement components and cytokines, interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-alpha) were measured. Messenger RNA (mRNA) levels of caspase-3, a mediator of apoptosis; ubiquitin, a marker of proteolysis; and BCKAD-E2, an enzyme regulating branched-chain amino acid oxidation, were estimated in skeletal muscle biopsy specimens by means of reverse-transcriptase polymerase chain reaction. Annexin-V expression was quantified by DNA array. Before the study, participants were placed on a 1.2-g/kg/d protein diet, and metabolic acidosis was corrected. RESULTS During HD, plasma IL-6 levels increased from 7.54 +/- 2.24 to 27.86 +/- 4.94 pg/dL (P < 0.001). Complement component, IL-1, and TNF-alpha levels did not change significantly during HD. mRNA levels of caspase-3 (0.50 +/- 0.01 versus 0.81 +/- 0.04), annexin-V (0.94 +/- 0.06 versus 1.48 +/- 0.05; P < 0.001), ubiquitin (1.10 +/- 0.03 versus 1.44 +/- 0.03), and BCKAD-E2 (0.47 +/- 0.01 versus 0.81 +/- 0.04) increased in muscle during HD compared with pre-HD values (P < 0.001). mRNA levels of ubiquitin (0.62 +/- 0.03) and BCKAD-E2 (0.58 +/- 0.02) were greater in controls than pre-HD values (P < 0.05). There were significant positive correlations between plasma IL-6 levels and expression of caspase-3, ubiquitin, and BCKAD-E2 genes. CONCLUSION HD causes activation of cytokines, which may mediate the increase in gene expression of caspase-3, ubiquitin, and BCKAD-E2 in skeletal muscles.
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Affiliation(s)
- Dominic S C Raj
- Division of Nephrology University of New Mexico, Albuquerque, NM, USA.
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Raj DSC, Dominic EA, Wolfe R, Shah VO, Bankhurst A, Zager PG, Ferrando A. Coordinated increase in albumin, fibrinogen, and muscle protein synthesis during hemodialysis: role of cytokines. Am J Physiol Endocrinol Metab 2004; 286:E658-64. [PMID: 14722024 DOI: 10.1152/ajpendo.00444.2003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Serum albumin, fibrinogen levels, and lean body mass are important predictors of outcome in end-stage renal disease (ESRD). We estimated the fractional synthesis rates of albumin (FSR-A), fibrinogen (FSR-F), and muscle protein (FSR-M) in nine ESRD patients and eight controls, using primed constant infusion of l-[ring-(13)C(6)]phenylalanine. Cytokine profile and arteriovenous balance of amino acids were also measured. ESRD patients were studied before (Pre-HD) and during hemodialysis (HD). Plasma IL-6, IL-10, and C-reactive protein increased significantly during HD. Despite a decrease in the delivery of amino acids to the leg, the outflow of the amino acids increased during HD. The net balance of amino acids became more negative during HD, indicating release from the muscle. HD increased leg muscle protein synthesis (45%) and catabolism (108%) but decreased whole body proteolysis (15%). FSR-A during HD (9.7 +/- 0.9%/day) was higher than pre-HD (6.5 +/- 0.9%/day) and controls (5.8 +/- 0.5%/day, P < 0.01). FSR-F increased during HD (19.7 +/- 2.6%/day vs. 11.8 +/- 0.6%/day, P < 0.01), but it was not significantly different from that of controls (14.4 +/- 1.4%/day). FSR-M intradialysis (1.77 +/- 0.19%/day) was higher than pre-HD (1.21 +/- 0.25%/day) and controls (1.30 +/- 0.32%/day, P < 0.001). Pre-HD FSR-A, FSR-F, and FSR-M values were comparable to those of controls. There was a significant and positive correlation between plasma IL-6 and the FSRs. Thus, in ESRD patients without metabolic acidosis, the fractional synthesis rates of albumin, fibrinogen, and muscle protein are not decreased pre-HD. However, HD increases the synthesis of albumin, fibrinogen, and muscle protein. The coordinated increase in the FSRs is facilitated by constant delivery of amino acids derived from the muscle catabolism and intradialytic increase in IL-6.
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Affiliation(s)
- Dominic S C Raj
- Division of Nephrology, ACC 5th Floor, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, Albuquerque, NM 87131, USA.
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Zager RA, Johnson ACM, Hanson SY, Shah VO. Acute tubular injury causes dysregulation of cellular cholesterol transport proteins. Am J Pathol 2003; 163:313-20. [PMID: 12819036 PMCID: PMC1868170 DOI: 10.1016/s0002-9440(10)63655-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2003] [Indexed: 11/23/2022]
Abstract
Acute renal injury causes accumulation of free and esterified cholesterol (FC, CE) in proximal tubules, mediated, at least in part, by increased cholesterol synthesis. Normally, this would trigger compensatory mechanisms such as increased efflux and decreased influx to limit or reverse the cholesterol overload state. This study sought to determine the integrity of these compensatory pathways following acute renal damage. Rhabdomyolysis-induced acute renal failure was induced in mice by glycerol injection. Normal mice served as controls. After 18 hours, BUN levels and renal cortical FC/CE content were determined. Expression of ABCA-1 and SR-B1 (cholesterol efflux proteins) were assessed by Western blot. Renal cortical LDL receptor (LDL-R; a cholesterol importer) regulation was gauged by quantifying its mRNA. To obtain proximal tubule cell-specific data, the impact of oxidant (Fe) stress on cultured HK-2 cell LDL-R, SR-B1, and ABCA-1 proteins and their mRNAs (versus controls) was assessed. Glycerol evoked marked azotemia and striking FC/CE increments (44%, 384%, respectively). Paradoxically, renal cortical SR-B1 and ABCA-1 protein reductions and LDL-R mRNA increments resulted. Fe-induced injury suppressed HK-2 cell SR-B1, ABCA-1, and their mRNAs. LDL-R protein rose with the in vitro Fe challenge. Renal tubular cell injury causes dysregulation of SR-B1, ABCA-1, and LDL-R protein expression, changes which should contribute to a cholesterol overload state. Reductions in HK-2 cell SR-B1 and ABCA-1 mRNAs and increases in renal cortical LDL-R mRNA imply that this dysregulation reflects, at least in part, altered genomic/transcriptional events.
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Affiliation(s)
- Richard A Zager
- Fred Hutchinson Cancer Research Center, the University of Washington, Seattle, Washington, USA.
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Stidley CA, Shah VO, Scavini M, Narva AS, Kessler D, Bobelu A, MacCluer JW, Welty TK, Zager PG. The Zuni kidney project: a collaborative approach to an epidemic of kidney disease. J Am Soc Nephrol 2003; 14:S139-43. [PMID: 12819319 DOI: 10.1097/01.asn.0000070151.95421.87] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 11/26/2022] Open
Abstract
There is an epidemic of renal disease among the Zuni Indians. In contrast to most other American-Indian communities, the epidemic of renal disease among the Zuni Indians reflects high rates of diabetic and nondiabetic renal disease. Almost every Zuni Indian has a relative with end-stage renal disease. This epidemic offers a unique opportunity to advance our understanding of the risk factors for the susceptibility and/or progression of renal disease. Thus, Zuni Tribal leaders formed a research partnership with the University of New Mexico Health Sciences Center, Indian Health Service, Southwest Foundation for Biomedical Research and Dialysis Clinic Inc., to establish the Zuni Kidney Project (ZKP). The ZKP conducted a population-based, cross-sectional survey of the Zuni Pueblo. Age and gender distributions among survey participants were similar to those of the eligible Zuni population. Among diabetics the prevalence (95% confidence interval) of incipient albuminuria (IA) was 32.3% (25.1, 39.5) in women and 36.1% (24.7, 47.5) in men. The prevalence of IA among nondiabetics was 9.3% (6.9, 11.7) in women and 12.2% (9.7, 14.7) in men. Among diabetics, the prevalence of overt albuminuria (OA) was 17.7% (11.9, 23.5) in women and 20.8% (11.4, 30.2) in men. Among nondiabetics, OA was present in 1.2% (0.3, 2.1) of women and 2.3% (1.1, 3.5) of men. Although IA and OA were each more common among diabetics, the majority of participants with albuminuria were nondiabetics. Hematuria was common among both diabetics and nondiabetics. Among diabetics, the crude prevalence of hematuria was similar among men and women. Among nondiabetics, however, hematuria was more common among women. Diabetes and obesity were more common among women than men. In contrast, hypertension and hypercholesterolemia were more common among men than women. The ZKP is incorporating these preliminary data into planning for the development and implementation of primary and secondary prevention programs.
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Tentori F, Stidley CA, Scavini M, Shah VO, Narva AS, Paine S, Bobelu A, Welty TK, Maccluer JW, Zager PG. Prevalence of hematuria among Zuni Indians with and without diabetes: The Zuni kidney Project. Am J Kidney Dis 2003; 41:1195-204. [PMID: 12776271 DOI: 10.1016/s0272-6386(03)00351-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Abstract
BACKGROUND There is an epidemic of kidney disease among the Zuni Indians. In contrast to other American Indian tribes, the epidemic among the Zuni Indians is attributable to diabetic and nondiabetic renal disease. METHODS The Zuni Kidney Project, established to reduce the burden of renal disease, conducted a population-based cross-sectional survey of Zuni Indians aged 5 years or older to precisely estimate the prevalence of hematuria. The survey used neighborhood household clusters as the sampling frame to maximize ascertainment and minimize bias. During the survey, we administered a questionnaire; collected blood and urine samples; and measured blood pressure, height, and weight. RESULTS Age and sex distributions in our sample (n = 1,469) were similar to those of the eligible Zuni population (n = 9,228). Prevalences of hematuria, defined as dipstick of trace or greater and 50 red blood cells/microL or greater, age- and sex-adjusted to the Zuni population aged 5 years or older, were 33.2% (95% confidence interval [CI], 30.7 to 35.6) and 17.8% (95% CI, 15.8 to 19.8), respectively. Hematuria of trace or greater was more common among females (40.6%; 95% CI, 37.0 to 44.1) than males (25.1%; 95% CI, 21.8 to 28.4). Hematuria of trace or greater was common among Zuni Indians without diabetes (females, 39.7%; 95% CI, 35.7 to 43.8; males, 22.7%; 95% CI, 19.4 to 26.1) and with diabetes (females, 47.5%; 95% CI, 39.8 to 55.2; males, 45.8%; 95% CI, 34.3 to 57.3). Diabetes and alcohol use for greater than 10 years were associated with hematuria among males, but not females. CONCLUSION The prevalence of hematuria is high among Zuni Indians with and without diabetes. These findings are consistent with the hypothesis that nondiabetic kidney disease is common among Zuni Indians with and without diabetes.
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Affiliation(s)
- Francesca Tentori
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131-5241, USA
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Shah VO, Scavini M, Stidley CA, Tentori F, Welty TK, MacCluer JW, Narva AS, Bobelu A, Albert CP, Kessler DS, Harford AM, Wong CS, Harris AA, Paine S, Zager PG. Epidemic of diabetic and nondiabetic renal disease among the Zuni Indians: the Zuni Kidney Project. J Am Soc Nephrol 2003; 14:1320-9. [PMID: 12707401 DOI: 10.1097/01.asn.0000059920.00228.a0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [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: 11/26/2022] Open
Abstract
There is an epidemic of renal disease among the Zuni Indians. The prevalence of end-stage renal disease among the Zuni Indians is 18.4-fold and 7.4-fold higher than among European Americans and American Indians/Alaskan Natives, respectively. In contrast to other American Indian tribes, nondiabetic renal disease accounts for a significant percent of the renal disease burden among the Zuni Indians. To explore this hypothesis, a community epidemiologic study of the Zuni Pueblo was conducted. A questionnaire was administered, blood and urine samples were collected, and BP, height, and weight were measured. Neighborhood household clusters were used as the sampling frame to maximize ascertainment and minimize bias. Age and gender distributions in the sample (n = 1483) were similar to those of the eligible Zuni population (n = 9228). The prevalence, age-adjusted and gender-adjusted to the Zuni population, of incipient (0.03 < or = UACR < 0.3) albuminuria (IA) (15.0% [95% confidence interval, 13.1 to 16.9%]), and overt (UACR > or = 0.3) albuminuria (OA) (4.7% [3.6 to 5.8%]) was high. The prevalence estimates for IA and OA were higher among diabetic participants (IA: 33.6% [27.6 to 39.7%]; OA: 18.7% [13.7 to 23.7%]) than nondiabetic participants (IA: 10.8% [9.0 to 12.6%]; OA: 1.8% [1.0 to 2.5%]). However, there were more nondiabetic participants; therefore, they comprised 58.0% [51.4 to 64.6%] and 30.9% [20.0 to 41.7%] of participants with IA and OA, respectively. In contrast to most other American Indian tribes, nondiabetic renal disease contributes significantly to the overall burden of renal disease among the Zuni Indians.
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Affiliation(s)
- Vallabh O Shah
- Department of Internal Medicine, Nephrology ACC5, University of New Mexico, Albuquerque, NM 87131-5271, USA
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Scavini M, Stidley CA, Shah VO, Narva AS, Tentori F, Kessler DS, Bobelu A, Albert CP, Bobelu J, Jamon E, Natachu K, Neha D, Waikaniwa M, Welty TK, MacCluer JW, Zager PG. Prevalence of diabetes is higher among female than male Zuni indians. Diabetes Care 2003; 26:55-60. [PMID: 12502658 DOI: 10.2337/diacare.26.1.55] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Test the hypothesis that diabetes and related risk factors are more common among female than male Zuni Indians. RESEARCH DESIGN AND METHODS We conducted a population-based, cross-sectional survey of the Zuni Indians aged > or =5 years. We used households within neighborhood clusters as the sampling frame. We administered a questionnaire, collected blood and urine, and measured height and weight. Self-reported diabetes was used to assess previously diagnosed diabetes. Participants without a prior history of diabetes were classified as having newly diagnosed diabetes if they had HbA(1c) >7.0% or random glucose > or =11.1 mmol/l during the survey. RESULTS The prevalence of previously diagnosed diabetes among Zuni Indians aged > or =5 years (n = 1,503) was higher among female Zuni Indians (16.7% [95% CI 14.1-19.3]) than male Zuni Indians (9.7% [7.4-12.1]) (P < 0.001). The prevalence of newly diagnosed diabetes was similar among female Zuni Indians (2.4% [1.4-3.4]) and male Zuni Indians (2.4% [1.2-3.6]). The prevalence of previously and newly diagnosed diabetes was higher among female Zuni Indians (19.1% [16.4-21.9]) than male Zuni Indians (12.2% [9.5-14.8]) (P < 0.001). The prevalence of obesity was higher among female Zuni Indians (34.3% [30.9-37.7]) than male Zuni Indians (21.5% [18.4-24.7]) (P < 0.001). Obesity was associated with diabetes among female and male Zuni Indians. Physical inactivity was more common among female Zuni Indians (44.2% [40.7-47.8]) than male Zuni Indians (35.1% [31.5-38.7]) (P < 0.001). However, physical inactivity was not associated with diabetes among either female or male Zuni Indians. Gestational diabetes was a risk factor among female Zuni Indians. CONCLUSIONS Among the Zuni Indians, the prevalence of diabetes was 57% higher among female than male members of the population. Culture, tradition, and lifestyle differences may contribute to the higher prevalence of diabetes and obesity among female Zuni Indians.
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Affiliation(s)
- Marina Scavini
- Dialysis Clinic, Inc., Albuquerque, New Mexico 87131-5271, USA.
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Johnson ACM, Yabu JM, Hanson S, Shah VO, Zager RA. Experimental glomerulopathy alters renal cortical cholesterol, SR-B1, ABCA1, and HMG CoA reductase expression. Am J Pathol 2003; 162:283-91. [PMID: 12507911 PMCID: PMC1851117 DOI: 10.1016/s0002-9440(10)63819-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2002] [Indexed: 11/16/2022]
Abstract
Previous studies indicate that acute tubular injury causes free cholesterol (FC) and cholesteryl ester (CE) accumulation within renal cortex/proximal tubules. This study assessed whether similar changes occur with glomerulopathy/nephrotic syndrome, in which high-circulating/filtered lipoprotein levels increase renal cholesterol supply. Potential adaptive changes in cholesterol synthetic/transport proteins were also assessed. Nephrotoxic serum (NTS) or passive Heymann nephritis (PHN) was induced in Sprague-Dawley rats. Renal injury (blood urea nitrogen, proteinuria) was assessed 2 and 7 days (NTS), or 10 and 30 days (PHN) later. FC and CE levels in renal cortex, isolated glomeruli, and proximal tubule segments were determined. SR-B1 (a CE influx protein), ABCA1 (a FC exporter), and HMG CoA reductase protein/mRNA levels were also assessed. FC was minimally elevated in renal cortex (0 to 15%), the majority apparently localizing to proximal tubules. More dramatic CE elevations were found ( approximately 5 to 15x), correlating with the severity of proteinuria at any single time point (r >/= 0.85). Cholesterol increments were associated with decreased SR-B1, increased ABCA1, and increased HMG CoA reductase (HMGCR) protein and its mRNA. Tubule (HK-2) cell culture data indicated that SR-B1 and ABCA1 levels are responsive to cholesterol supply. Experimental nephropathy can increase renal FC, and particularly CE, levels, most notably in proximal tubules. These changes are associated with adaptations in SR-B1 and ABCA1 expression, which are physiologically appropriate changes for a cholesterol overload state. However, HMGCR protein/mRNA increments can also result. These seem to reflect a maladaptive response, potentially contributing to a cell cholesterol overload state.
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MESH Headings
- ATP Binding Cassette Transporter 1
- ATP-Binding Cassette Transporters/metabolism
- Animals
- Blotting, Western
- CD36 Antigens/metabolism
- Cell Line
- Cholesterol/metabolism
- Cholesterol Esters/metabolism
- Disease Models, Animal
- Disease Progression
- Glomerulonephritis/metabolism
- Glomerulonephritis/pathology
- Humans
- Hydroxymethylglutaryl CoA Reductases/genetics
- Hydroxymethylglutaryl CoA Reductases/metabolism
- Kidney Cortex/metabolism
- Kidney Cortex/pathology
- Kidney Function Tests
- Kidney Tubules, Proximal/cytology
- Kidney Tubules, Proximal/metabolism
- Male
- Membrane Proteins
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptors, Immunologic
- Receptors, Lipoprotein
- Receptors, Scavenger
- Scavenger Receptors, Class B
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Affiliation(s)
- Ali C M Johnson
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
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Zager RA, Shah VO, Shah HV, Zager PG, Johnson ACM, Hanson S. The mevalonate pathway during acute tubular injury: selected determinants and consequences. Am J Pathol 2002; 161:681-92. [PMID: 12163393 PMCID: PMC1850732 DOI: 10.1016/s0002-9440(10)64224-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2002] [Indexed: 02/04/2023]
Abstract
Renal injury evokes tubular cholesterol accumulation, mediated in part by increased HMG CoA reductase (HMGCR) levels. The present study was undertaken to define potential molecular determinants of these changes and to ascertain the relative importance of increased cholesterol production versus mevalonate pathway-driven protein prenylation, on the emergence of the so-called postrenal injury "cytoresistant state." Cultured proximal tubule (HK-2) cells were subjected to Fe or ATP depletion injury, followed 1 to 24 hours later by assessments of: 1) sterol transcription factor expression (SREBP)-1 and -2); 2) HMGCR mRNA levels; and 3) Ras/Rho prenylation. HMGCR mRNA and Ras/Rho prenylation were also assessed after in vivo ischemic and Fe-mediated renal damage. Using specific inhibitors, the relative importance of protein prenylation versus terminal cholesterol synthesis on HK-2 cell susceptibility to injury was also assessed. Acute injury induced HK-2 cell SREBP disruption and reductions in HMGCR mRNA. Renal cortical HMGCR mRNA also fell in response to either in vivo ischemic or Fe-mediated oxidant damage. At 24 hours after in vitro/in vivo injury, a time of cholesterol buildup, no increase in Ras/Rho prenylation was observed. Prenylation inhibitors did not sensitize HK-2 cells to injury. Conversely, squalene synthase (terminal cholesterol synthesis) blockade sensitized HK-2 cells to both Fe and ATP depletion attack. We concluded that: 1) acute tubular cell injury can destroy SREBPs and lower HMGCR mRNA. This suggests that posttranscriptional/translational events are responsible for HMGCR enzyme and cholesterol accumulation after renal damage. 2) Injury-induced cholesterol accumulation appears dissociated from increased protein prenylation. 3) Cholesterol accumulation, per se, seems to be the dominant mechanism by which the mevalonate pathway contributes to the postrenal injury cytoresistant state.
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Affiliation(s)
- Richard A Zager
- Department of Medicine, the University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
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