1
|
Söderberg Veibäck G, Malmgren L, Asp M, Ventorp F, Suneson K, Grudet C, Westrin Å, Lindqvist D. Inflammatory depression is associated with selective glomerular hypofiltration. J Affect Disord 2024; 356:80-87. [PMID: 38574872 DOI: 10.1016/j.jad.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Systemic low-grade inflammation may be a pathophysiological mechanism in a subtype of depression. In this study we investigate a novel candidate mechanism of inflammatory depression - Selective Glomerular Hypofiltration Syndromes (SGHS) - which are characterized by a reduced estimated glomerular filtration rate (eGFR) based on cystatin C (cysC) relative to eGFR based on creatinine (crea). SGHS have been associated with increased blood levels of pro-inflammatory markers, but have never been investigated in a sample of depressed individuals. METHOD The prevalence of SGHS was compared between 313 patients with difficult-to-treat depression and 73 controls. Since there is no single established eGFRcysC/eGFRcrea-ratio cut-off to define SGHS, several cut-offs were investigated in relation to a depression diagnosis, inflammation, and symptom severity. Plasma inflammatory markers tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), interleukin (IL)-6, IL-8, and IL-10 were available from 276 depressed patients. We examined mediation effects of IL-6 on the relationship between SGHS and depression. RESULTS Depressed patients were more likely to have SGHS compared to controls defining SGHS as either eGFRcysC/eGFRcrea-ratio < 0.9 (33.2 % vs 20.5 %, p = 0.035) or < 0.8 (15.7 % vs 5.5 %, p = 0.023). Lower eGFRcysC/eGFRcrea-ratio was associated with higher levels of inflammatory markers in depressed patients. IL-6 partly mediated the relationship between SGHS and depression. CONCLUSION This is the first study to demonstrate a link between SGHS and inflammatory depression. If replicated in independent and longitudinal cohorts, this may prove to be a relevant pathophysiological mechanism in some cases of depression that could be targeted in future intervention and prevention studies.
Collapse
Affiliation(s)
- Gustav Söderberg Veibäck
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden; Department of Gastroenterology and Nutrition, Department of Clinical Sciences Skåne University Hospital, Malmö, Sweden
| | - Linnea Malmgren
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden; Department of Geriatrics, Skåne University Hospital, Malmö, Sweden
| | - Marie Asp
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | - Filip Ventorp
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | - Klara Suneson
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatric Clinic Malmö, Region Skåne, Malmö, Sweden
| | - Cécile Grudet
- Clinical addiction research unit, Faculty of Medicine, Department of Clinical Sciences, Lund University, Sweden
| | - Åsa Westrin
- Unit for Clinical Suicide Research, Department of Clinical Sciences Lund, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden
| | - Daniel Lindqvist
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden.
| |
Collapse
|
2
|
Heo GY, Koh HB, Jung CY, Park JT, Han SH, Yoo TH, Kang SW, Kim HW. Difference Between Estimated GFR Based on Cystatin C Versus Creatinine and Incident Atrial Fibrillation: A Cohort Study of the UK Biobank. Am J Kidney Dis 2024; 83:729-738.e1. [PMID: 38171411 DOI: 10.1053/j.ajkd.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE & OBJECTIVE The difference between cystatin C-based and creatinine-based estimated glomerular filtration rate (eGFRdiff) has been suggested to reflect factors distinct from kidney function that are associated with cardiovascular risk. However, the association between eGFRdiff and atrial fibrillation (AF) risk has not been extensively evaluated. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Using data from the UK Biobank, this study included 363,494 participants with measured serum creatinine and cystatin C levels and without a prior diagnosis of AF or a history of related procedures. EXPOSURE Estimated GFRdiff, calculated as cystatin C-based eGFR minus creatinine-based eGFR. Estimated GFRdiff was also categorized as negative (<-15mL/min/1.73m2), midrange (-15 to 15mL/min/1.73m2), or positive (≥15mL/min/1.73m2). OUTCOME Incident AF. ANALYTICAL APPROACH Subdistribution hazard models were fit, treating death that occurred before development of AF as a competing event. RESULTS During the median follow-up period of 11.7 years, incident AF occurred in 18,994 (5.2%) participants. In the multivariable-adjusted model, participants with a negative eGFRdiff had a higher risk of incident AF (subdistribution HR [SHR], 1.25 [95% CI, 1.20-1.30]), whereas participants with a positive eGFRdiff had a lower risk of AF (SHR, 0.81 [95% CI, 0.77-0.87]) compared with those with a midrange eGFRdiff. When eGFRdiff was treated as a continuous variable in the adjusted model, every 10mL/min/1.73m2 higher eGFRdiff was associated with a 0.90-fold decrease in the risk of incident AF. LIMITATIONS A single measurement of baseline serum creatinine and cystatin C levels. CONCLUSIONS The difference between cystatin C- and creatinine-based eGFRs was associated with the risk of AF development. A higher eGFRdiff was associated with a lower risk of AF. These findings may have implications for the management of patients at risk of incident AF. PLAIN-LANGUAGE SUMMARY The difference between cystatin C-based estimated glomerular filtration rate (eGFR) and creatinine-based eGFR has recently gained attention as a potential indicator of cardiovascular outcomes influenced by factors other than kidney function. This study investigated the association between the differences in 2 eGFRs (cystatin C-based eGFR minus creatinine-based eGFR) and incident atrial fibrillation (AF) among>340,000 participants from the UK Biobank Study. Compared with those with a near zero eGFR difference, participants with a negative eGFR difference had a higher risk of AF, while those with a positive eGFR difference had a lower risk. These findings suggest that measuring eGFR differences may help identify individuals at a higher risk of developing AF.
Collapse
Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Byung Koh
- Division of Nephrology, International Saint Mary's Hospital, Catholic Kwandong University, Gangneung, South Korea
| | - Chan-Young Jung
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea; Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea.
| |
Collapse
|
3
|
He D, Gao B, Wang J, Yang C, Zhao MH, Zhang L. The Difference Between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate and Risk of Diabetic Microvascular Complications Among Adults With Diabetes: A Population-Based Cohort Study. Diabetes Care 2024; 47:873-880. [PMID: 38470988 PMCID: PMC11043223 DOI: 10.2337/dc23-2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The impact of the difference between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff) on diabetic microvascular complications (DMCs) remains unknown. We investigated the associations of eGFRdiff with overall DMCs and subtypes, including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). RESEARCH DESIGN AND METHODS This prospective cohort study included 25,825 participants with diabetes free of DMCs at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based calculations. Incidence of DMCs was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with overall DMCs and subtypes. RESULTS During a median follow-up of 13.6 years, DMCs developed in 5,753 participants, including 2,752 cases of DR, 3,203 of DKD, and 1,149 of DN. Each SD decrease of eGFRabdiff was associated with a 28% higher risk of overall DMCs, 14% higher risk of DR, 56% higher risk of DKD, and 29% higher risk of DN. For each 10% decrease in eGFRrediff, the corresponding hazard ratios (95% CIs) were 1.16 (1.14, 1.18) for overall DMCs, 1.08 (1.05, 1.11) for DR, 1.29 (1.26, 1.33) for DKD, and 1.17 (1.12, 1.22) for DN. The magnitude of associations was not materially altered in any of the sensitivity analyses. CONCLUSIONS Large eGFRdiff was independently associated with risk of DMCs and its subtypes. Our findings suggested monitoring eGFRdiff in the diabetes population has potential benefit for identification of high-risk patients.
Collapse
Affiliation(s)
- Daijun He
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
- National Institute of Health Data Science at Peking University, Beijing, China
| |
Collapse
|
4
|
Månsson T, Rosso A, Ellström K, Abul-Kasim K, Elmståhl S. Chronic kidney disease and its association with cerebral small vessel disease in the general older hypertensive population. BMC Nephrol 2024; 25:93. [PMID: 38481159 PMCID: PMC10936027 DOI: 10.1186/s12882-024-03528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Cerebral small vessel disease can be identified using magnetic resonance imaging, and includes white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and brain atrophy. Cerebral small vessel disease and chronic kidney disease share many risk factors, including hypertension. This study aims to explore an association between chronic kidney disease and cerebral small vessel disease, and also to explore the role of hypertension in this relationship. METHODS With a cross sectional study design, data from 390 older adults was retrieved from the general population study Good Aging in Skåne. Chronic kidney disease was defined as glomerular filtration rate < 60 ml/min/1,73m2. Associations between chronic kidney disease and magnetic resonance imaging markers of cerebral small vessel disease were explored using logistic regression models adjusted for age and sex. In a secondary analysis, the same calculations were performed with the study sample stratified based on hypertension status. RESULTS In the whole group, adjusted for age and sex, chronic kidney disease was not associated with any markers of cerebral small vessel disease. After stratification by hypertension status and adjusted for age and sex, we observed that chronic kidney disease was associated with cerebral microbleeds (OR 1.93, CI 1.04-3.59, p-value 0.037), as well as with cortical atrophy (OR 2.45, CI 1.34-4.48, p-value 0.004) only in the hypertensive group. In the non-hypertensive group, no associations were observed. CONCLUSIONS In this exploratory cross-sectional study, we observed that chronic kidney disease was associated with markers of cerebral small vessel disease only in the hypertensive subgroup of a general population of older adults. This might indicate that hypertension is an important link between chronic kidney disease and cerebral small vessel disease. Further studies investigating the relationship between CKD, CSVD, and hypertension are warranted.
Collapse
Affiliation(s)
- Tomas Månsson
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University and Skåne University Hospital, Jan Waldenströms gata 35, pl 13, 205 02, Malmö, Sweden.
| | - Aldana Rosso
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University and Skåne University Hospital, Jan Waldenströms gata 35, pl 13, 205 02, Malmö, Sweden
| | - Katarina Ellström
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University and Skåne University Hospital, Jan Waldenströms gata 35, pl 13, 205 02, Malmö, Sweden
| | - Kasim Abul-Kasim
- Department of Clinical Sciences in Lund, Division of Diagnostic Radiology, Lund University, 221 85, Lund, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University and Skåne University Hospital, Jan Waldenströms gata 35, pl 13, 205 02, Malmö, Sweden
| |
Collapse
|
5
|
Zhang LW, Luo MQ, Zeng JL, You ZB, Chen LC, Chen JH, Lin KY, Guo YS. The Association of Intraindividual Difference Between Cystatin- and Creatinine-Based Estimated GFR and Contrast-Associated Acute Kidney Injury. Clin Interv Aging 2024; 19:411-420. [PMID: 38476830 PMCID: PMC10929563 DOI: 10.2147/cia.s447042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI). Patients and Methods From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m2. Results Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between -15 and 15 mL/min/1.73 m2. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (-15 to 15 mL/min/1.73 m2), the negative-eGFRdiff group (less than -15 mL/min/1.73 m2) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57-4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19-3.95, P < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19-4.63, P < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr. Conclusion There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.
Collapse
Affiliation(s)
- Li-Wei Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
| | - Man-Qing Luo
- Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ji-Lang Zeng
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
| | - Zhe-Bin You
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
- Department of Geriatric Medicine, Fujian Key Laboratory of Geriatrics, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, Fujian, 350001, People’s Republic of China
| | - Li-Chuan Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
| | - Jun-Han Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
| | - Kai-Yang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
| | - Yan-Song Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China
- Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China
| |
Collapse
|
6
|
Shen R, Xu Z, Lin L, Shen J, Hu W, Lv L, Wei T. Association between adequate dietary protein and all-cause and cardiovascular mortality in patients with selective glomerular hypofiltration syndrome. Food Funct 2024; 15:2433-2442. [PMID: 38363105 DOI: 10.1039/d3fo03212d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Aims: To determine the impact of dietary protein intake and protein sources on all-cause and cardiovascular mortality of selective glomerular hypofiltration syndrome (SGHS) patients. Methods: This study recruited participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. Cox proportional hazard models and competing risk models were employed to investigate the effects of dietary protein intake and protein sources on all-cause and cardiovascular mortality in SGHS patients. Additionally, Cox regression models utilizing restricted cubic splines (RCS) were used to explore potential non-linear associations. Results: Over a median follow-up period of 204 months, 20.71% (449/2168) participants died, with 5.40% (117/2168) experiencing cardiovascular mortality. In the fully adjusted model, participants with the highest dietary protein intake (Q4, ≥107.13 g d-1) exhibited a 40% reduced risk of all-cause mortality (HR: 0.60, 95% CI: 0.39 to 0.94) and an 88% reduced risk of cardiovascular mortality (HR: 0.12, 95% CI: 0.04 to 0.35) compared to those with the lowest dietary protein intake (Q1, < 57.93 g d-1). Notably, non-red meat protein sources were found to reduce the risk of all-cause and cardiovascular mortality, whereas no significant association was observed with red meat consumption. Conclusion: Adequate dietary protein intake has been linked to a decreased risk of all-cause and cardiovascular mortality in individuals with selective glomerular hypofiltration syndromes. This protective effect seems to be primarily associated with protein obtained from non-red meat sources.
Collapse
Affiliation(s)
- Ruming Shen
- Lishui Hospital, Zhejiang University School of Medicine, Lishui, China.
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Zhongjiao Xu
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Li Lin
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Jiayi Shen
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Wuming Hu
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Lingchun Lv
- Lishui Hospital, Zhejiang University School of Medicine, Lishui, China.
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Tiemin Wei
- Lishui Hospital, Zhejiang University School of Medicine, Lishui, China.
- Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| |
Collapse
|
7
|
Christensson A, Lundgren S, Johansson M, Nilsson PM, Engström G, Laucyte-Cibulskiene A. Aortic Stiffness Can be Predicted From Different eGFR Formulas With Long Follow-Up in the Malmö Diet Cancer Study. Angiology 2024:33197241232719. [PMID: 38334715 DOI: 10.1177/00033197241232719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
We studied the impact of estimated glomerular filtration rate (eGFR) based on either creatinine or cystatin C, or in combination, on vascular aging (aortic stiffness) and central hemodynamics (central systolic blood pressure) in a Swedish urban population with median 17 years of follow-up. Participants (n = 5049) from the population-based Malmö Diet and Cancer Study that underwent baseline examination and later participated in the prospective cardiovascular arm were selected. Of these, 2064 with measured carotid-femoral pulse wave velocity (cfPWV) and central blood pressure at follow-up were enrolled. eGFR was calculated using cystatin C (eGFRCYS) and creatinine (eGFRCR) equations: Caucasian, Asian, pediatric, and adult cohorts (CAPA), the Lund-Malmö revised (LMrev), and the European Kidney Function Consortium (EKFC) equations. Lower adjusted eGFRCR, but not eGFRCYS, were independently associated with higher cfPWV (P < .001, respectively). eGFR <60 mL/min/1.73 m2 determined higher cfPWV except when using the EKFC equation. Conversely, CAPA/LMrev and CAPA/EKFC ratios were not associated with aortic stiffness. Lower eGFRCR is associated with higher future aortic stiffness independently of age, sex, heart rate, mean blood pressure, body mass index, and antihypertensive treatment. The ratio of eGFRCYS and eGFRCR equations could not predict aortic stiffness at all.
Collapse
Affiliation(s)
- Anders Christensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Nephrology, Skane University Hospital, Malmö, Sweden
| | - Simon Lundgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Nephrology, Skane University Hospital, Malmö, Sweden
| | - Madeleine Johansson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Agne Laucyte-Cibulskiene
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Nephrology, Skane University Hospital, Malmö, Sweden
| |
Collapse
|
8
|
Nyman U, Leander P, Liss P, Sterner G, Brismar T. Absolute and relative GFR and contrast medium dose/GFR ratio: cornerstones when predicting the risk of acute kidney injury. Eur Radiol 2024; 34:612-621. [PMID: 37540321 PMCID: PMC10791854 DOI: 10.1007/s00330-023-09962-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 08/05/2023]
Abstract
Glomerular filtration rate (GFR) is considered the best overall index of kidney function in health and disease and its use is recommended to evaluate the risk of iodine contrast medium-induced acute kidney injury (CI-AKI) either as a single parameter or as a ratio between the total contrast medium dose (gram iodine) and GFR. GFR may be expressed in absolute terms (mL/min) or adjusted/indexed to body surface area, relative GFR (mL/min/1.73 m2). Absolute and relative GFR have been used interchangeably to evaluate the risk of CI-AKI, which may be confusing and a potential source of errors. Relative GFR should be used to assess the GFR category of renal function as a sign of the degree of kidney damage and sensitivity for CI-AKI. Absolute GFR represents the excretion capacity of the individual and may be used to calculate the gram-iodine/absolute GFR ratio, an index of systemic drug exposure (amount of contrast medium in the body) that relates to toxicity. It has been found to be an independent predictor of AKI following percutaneous coronary angiography and interventions but has not yet been fully validated for computed tomography (CT). Prospective studies are warranted to evaluate the optimal gram-iodine/absolute GFR ratio to predict AKI at various stages of renal function at CT. Only GFR estimation (eGFR) equations based on standardized creatinine and/or cystatin C assays should be used. eGFRcystatin C/eGFRcreatinine ratio < 0.6 indicating selective glomerular hypofiltration syndrome may have a stronger predictive power for postcontrast AKI than creatinine-based eGFR. CLINICAL RELEVANCE STATEMENT: Once the degree of kidney damage is established by estimating relative GFR (mL/min/1.73 m2), contrast dose in relation to renal excretion capacity [gram-iodine/absolute GFR (mL/min)] may be the best index to evaluate the risk of contrast-induced kidney injury. KEY POINTS: • Relative glomerular filtration rate (GFR; mL/min/1.73 m2) should be used to assess the GFR category as a sign of the degree of kidney damage and sensitivity to contrast medium-induced acute kidney injury (CI-AKI). • Absolute GFR (mL/min) is the individual's actual excretion capacity and the contrast-dose/absolute GFR ratio is a measure of systemic exposure (amount of contrast medium in the body), relates to toxicity and should be expressed in gram-iodine/absolute GFR (mL/min). • Prospective studies are warranted to evaluate the optimal contrast medium dose/GFR ratio predicting the risk of CI-AKI at CT and intra-arterial examinations.
Collapse
Affiliation(s)
- Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, University of Lund, Malmö, Sweden.
| | - Peter Leander
- Department of Translational Medicine, Division of Medical Radiology, University of Lund, Malmö, Sweden
| | - Per Liss
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Gunnar Sterner
- Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Torkel Brismar
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute/Karolinska University Hospital, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| |
Collapse
|
9
|
Quiroga B, Ortiz A, Díez J. Selective glomerular hypofiltration syndrome. Nephrol Dial Transplant 2023; 39:10-17. [PMID: 37407284 DOI: 10.1093/ndt/gfad145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
The estimated glomerular filtration rate (eGFR) provides insight into cardiovascular disease (CVD) risk stratification and proactive management. Accumulating evidence suggests that combining eGFR calculated from serum cystatin C (eGFRcys) and from serum creatinine (eGFRcrea) improves CVD risk stratification over eGFRcrea alone. The term selective glomerular hypofiltration syndrome (SGHS) or shrunken pore syndrome has been proposed to define an eGFRcys:eGFRcrea ratio <1, which is hypothesized to result from a reduced glomerular filtration of 5- to 30-kDa molecules as compared with smaller molecules. SGHS may be identified in people with normal or reduced measured GFR, but the prevalence depends on the cut-off value of the eGFRcys:eGFRcrea ratio used, which is not yet standardized. SGHS is strongly associated with increased CVD and mortality risks and it may offer an opportunity to expand our understanding of the mechanisms linking GFR disorders with CVD risk (e.g. an altered plasma proteome), which may guide treatment decisions. However, muscle wasting may also contribute to a reduced eGFRcys:eGFRcrea ratio and there are open questions regarding the pathophysiology of a reduced eGFRcys:eGFRcrea ratio, the reference cut-off values of the ratio to define the syndrome and its clinical implications. We now critically review the SGHS concept, its pathophysiological basis and links to CVD and the potential consequences for clinical practice and propose a research agenda.
Collapse
Affiliation(s)
- Borja Quiroga
- IIS-La Princesa, Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Alberto Ortiz
- Division of Nephrology IIS-Fundacion Jimenez Diaz, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- RICORS2040, Carlos III Institute of Health, Madrid, Spain
| | - Javier Díez
- Center of Applied Medical Research and School of Medicine, University of Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de la Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
| |
Collapse
|
10
|
Grubb AO, Magnusson M, Christensson A. Etiologic and Diagnostic Implications of Morbidity and Mortality Associations When Cystatin C-Based Estimated GFR Is Lower Than Creatinine-Based Estimated GFR. Am J Kidney Dis 2023; 82:509-511. [PMID: 37737748 DOI: 10.1053/j.ajkd.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Anders O Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| |
Collapse
|
11
|
Wang Y, Adingwupu OM, Shlipak MG, Doria A, Estrella MM, Froissart M, Gudnason V, Grubb A, Kalil R, Mauer M, Rossing P, Seegmiller J, Coresh J, Levey AS, Inker LA. Discordance Between Creatinine-Based and Cystatin C-Based Estimated GFR: Interpretation According to Performance Compared to Measured GFR. Kidney Med 2023; 5:100710. [PMID: 37753251 PMCID: PMC10518599 DOI: 10.1016/j.xkme.2023.100710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Rationale & Objective Use of cystatin C in addition to creatinine to estimate glomerular filtration rate (estimated glomerular filtration rate based on cystatin C [eGFRcys] and estimated glomerular filtration rate based on creatinine [eGFRcr], respectively) is increasing. When eGFRcr and eGFRcys are discordant, it is not known which is more accurate, leading to uncertainty in clinical decision making. Study Design Cross-sectional analysis. Setting & Participants Four thousand fifty participants with measured glomerular filtration rate (mGFR) from 12 studies in North America and Europe. Exposures Serum creatinine and serum cystatin C. Outcomes Performance of creatinine-based and cystatin C-based glomerular filtration rate estimating equations compared to mGFR. Analytical Approach We evaluated the accuracy of eGFRcr, eGFRcys, and the combination (eGFRcr-cys) compared to mGFR according to the magnitude of the difference between eGFRcr and eGFRcys (eGFRdiff). We used CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations to estimate glomerular filtration rate. eGFRdiff was defined as eGFRcys minus eGFRcr and categorized as less than -15, -15 to <15, and ≥15 mL/min/1.73 m2 (negative, concordant, and positive groups, respectively). We compared bias (median of mGFR minus eGFR) and the percentage of eGFR within 30% of mGFR. Results Thirty percent of participants had discordant eGFRdiff (21.0% and 9.6% negative and positive eGFRdiffs, respectively). In the concordant eGFRdiff group, all equations displayed similar accuracy. In the negative eGFRdiff groups, eGFRcr had a large overestimation of mGFR (-13.4 [-14.5 to -12.2] mL/min/1.73 m2) and eGFRcys had a large underestimation (9.9 [9.1-11.2] mL/min/1.73m2), with opposite results in the positive eGFRdiff group. In both negative and positive eGFRdiff groups, eGFRcr-cys was more accurate than either eGFRcr or eGFRcys. These results were largely consistent across age, sex, race, and body mass index. Limitations Few participants with major comorbid conditions. Conclusions Discordant eGFRcr and eGFRcys are common. eGFR using the combination of creatinine and cystatin C provides the most accurate estimates among persons with discordant eGFRcr or eGFRcys.
Collapse
Affiliation(s)
- Yeli Wang
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affair Medical Center and University of California, San Francisco, CA
| | - Alessandro Doria
- Section on Genetics & Epidemiology, Joslin Diabetes Center, and the Department of Medicine, Harvard Medical School, Boston, MA
| | - Michelle M. Estrella
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care System and University of California, San Francisco, CA
| | - Marc Froissart
- Clinical Trial Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, and the Icelandic Heart Association, Kopavogur, Iceland
| | - Anders Grubb
- Department of Clinical Chemistry and Pharmacology, Institute of Laboratory Medicine, Lund University, Sweden
| | - Roberto Kalil
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Michael Mauer
- Divisions of Pediatric and Adult Nephrology, University of Minnesota, Minneapolis, MN
| | - Peter Rossing
- Steno Diabetes Center Copenhagen and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesse Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Josef Coresh
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | |
Collapse
|
12
|
Malmgren L, Öberg C, den Bakker E, Leion F, Siódmiak J, Åkesson A, Lindström V, Herou E, Dardashti A, Xhakollari L, Grubb G, Strevens H, Abrahamson M, Helmersson-Karlqvist J, Magnusson M, Björk J, Nyman U, Ärnlöv J, Ridefelt P, Åkerfeldt T, Hansson M, Sjöström A, Mårtensson J, Itoh Y, Grubb D, Tenstad O, Hansson LO, Olafsson I, Campos AJ, Risch M, Risch L, Larsson A, Nordin G, Pottel H, Christensson A, Bjursten H, Bökenkamp A, Grubb A. The complexity of kidney disease and diagnosing it - cystatin C, selective glomerular hypofiltration syndromes and proteome regulation. J Intern Med 2023; 293:293-308. [PMID: 36385445 PMCID: PMC10107454 DOI: 10.1111/joim.13589] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Estimation of kidney function is often part of daily clinical practice, mostly done by using the endogenous glomerular filtration rate (GFR)-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by the identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, are characterized by a selective reduction in the glomerular filtration of 5-30 kDa molecules, such as cystatin C, compared to the filtration of small molecules <1 kDa dominating the glomerular filtrate, for example water, urea and creatinine. At least two types of such disorders, shrunken or elongated pore syndrome, are possible according to the pore model for glomerular filtration. Selective glomerular hypofiltration syndromes are prevalent in investigated populations, and patients with these syndromes often display normal measured GFR or creatinine-based GFR-estimates. The syndromes are characterized by proteomic changes promoting the development of atherosclerosis, indicating antibodies and specific receptor-blocking substances as possible new treatment modalities. Presently, the KDIGO guidelines for diagnosing kidney disorders do not recommend cystatin C as a general marker of kidney function and will therefore not allow the identification of a considerable number of patients with selective glomerular hypofiltration syndromes. Furthermore, as cystatin C is uninfluenced by muscle mass, diet or variations in tubular secretion and cystatin C-based GFR-estimation equations do not require controversial race or sex terms, it is obvious that cystatin C should be a part of future KDIGO guidelines.
Collapse
Affiliation(s)
- Linnea Malmgren
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden.,Department of Geriatrics, Skåne University Hospital, Malmö, Sweden
| | - Carl Öberg
- Department of Clinical Sciences Lund, Division of Nephrology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Emil den Bakker
- Department of Pediatrics, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Felicia Leion
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Joanna Siódmiak
- Department of Laboratory Medicine, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum (Nicolaus Copernicus University in Torun), Bydgoszcz, Poland
| | - Anna Åkesson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Veronica Lindström
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Herou
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alain Dardashti
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Liana Xhakollari
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Gabriel Grubb
- Department of Radiology, Skåne University Hospital, Lund, Sweden
| | - Helena Strevens
- Department of Clinical Sciences Lund, Department of Obstetrics and Gynaecology, Lund University, Lund, Sweden
| | - Magnus Abrahamson
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Hypertension in Africa Research Team (HART), North West University, Potchefstroom, South Africa
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, University of Lund, Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society (NVS), Family Medicine and Primary Care Unit, Karolinska Institute, Huddinge, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Peter Ridefelt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
| | - Torbjörn Åkerfeldt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Hansson
- Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden
| | - Anna Sjöström
- Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Yoshihisa Itoh
- Clinical Laboratory, Eiju General Hospital, Life Extension Research Institute, Tokyo, Japan
| | - David Grubb
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Olav Tenstad
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Lars-Olov Hansson
- Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland
| | - Araceli Jarquin Campos
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Martin Risch
- Central Laboratory, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,University Institute of Clinical Chemistry, University Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden
| | | | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
13
|
Zhang L, Luo M, Xie X, You Z, Zeng J, Lin M, Chen L, Lin K, Guo Y. Shrunken Pore Syndrome: A New and More Powerful Phenotype of Renal Dysfunction Than Chronic Kidney Disease for Predicting Contrast-Associated Acute Kidney Injury. J Am Heart Assoc 2022; 12:e027980. [PMID: 36565177 PMCID: PMC9973563 DOI: 10.1161/jaha.122.027980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Shrunken pore syndrome (SPS) as a novel phenotype of renal dysfunction is characterized by a difference in renal filtration between cystatin C and creatinine. The manifestation of SPS was defined as a cystatin C-based estimated glomerular filtration rate (eGFR) <60% of the creatinine-based eGFR. SPS has been shown to be associated with the progression and adverse prognosis of various cardiovascular and renal diseases. However, the predictive value of SPS for contrast-associated acute kidney injury (CA-AKI) and long-term outcomes in patients undergoing percutaneous coronary intervention remains unclear. Methods and Results We retrospectively observed 5050 consenting patients from January 2012 to December 2018. Serum cystatin C and creatinine were measured and applied to corresponding 2012 and 2021 Chronic Kidney Disease Epidemiology Collaboration equations, respectively, to calculate the eGFR. Chronic kidney disease (CKD) was defined as a creatinine-based eGFR <60 mL/min per 1.73 m2 without dialysis. CA-AKI was defined as an increase in serum creatinine ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. Overall, 649 (12.85%) patients had SPS, and 324 (6.42%) patients developed CA-AKI. Multivariate logistic regression analysis indicated that SPS was significantly associated with CA-AKI after adjusting for potential confounding factors (odds ratio [OR], 4.17 [95% CI, 3.17-5.46]; P<0.001). Receiver operating characteristic analysis indicated that the cystatin C-based eGFR:creatinine-based eGFR ratio had a better performance and stronger predictive power for CA-AKI than creatinine-based eGFR (area under the curve: 0.707 versus 0.562; P<0.001). Multivariate logistic analysis revealed that compared with those without CKD and SPS simultaneously, patients with CKD and non-SPS (OR, 1.70 [95% CI, 1.11-2.55]; P=0.012), non-CKD and SPS (OR, 4.02 [95% CI, 2.98-5.39]; P<0.001), and CKD and SPS (OR, 8.62 [95% CI, 4.67-15.7]; P<0.001) had an increased risk of CA-AKI. Patients with both SPS and CKD presented the highest risk of long-term mortality compared with those without both (hazard ratio, 2.30 [95% CI, 1.38-3.86]; P=0.002). Conclusions SPS is a new and more powerful phenotype of renal dysfunction for predicting CA-AKI than CKD and will bring new insights for an accurate clinical assessment of the risk of CA-AKI.
Collapse
Affiliation(s)
- Li‐Wei Zhang
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Man‐Qing Luo
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Xian‐Wei Xie
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Zhe‐Bin You
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
- Fujian Key Laboratory of Geriatrics, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for GeriatricsFujian Medical UniversityFuzhouChina
| | - Ji‐Lang Zeng
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Mao‐Qing Lin
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Li‐Chuan Chen
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Kai‐Yang Lin
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Yan‐Song Guo
- Department of CardiologyShengli Clinical Medical College of Fujian Medical University, Fujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| |
Collapse
|
14
|
Linné E, Elfström A, Åkesson A, Fisher J, Grubb A, Pettilä V, Vaara ST, Linder A, Bentzer P. Cystatin C and derived measures of renal function as risk factors for mortality and acute kidney injury in sepsis - A post-hoc analysis of the FINNAKI cohort. J Crit Care 2022; 72:154148. [PMID: 36108348 DOI: 10.1016/j.jcrc.2022.154148] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis. MATERIALS AND METHODS Post-hoc analysis of sepsis patients in the FINNAKI-cohort (n = 802). Primary outcome was 90-day mortality. We measured plasma cystatin C and creatinine at intensive care unit (ICU) admission and estimated glomerular filtration rates (eGFRcys, eGFRcrea) and shrunken pore syndrome (SPS; defined as eGFRcys/eGFRcrea ratio < 0.7). Associations were assessed using Cox- or logistic regression. RESULTS Increased cystatin C and decreased eGFRcys were associated with mortality in unadjusted analyses and in analyses adjusted for illness severity and creatinine. Hazard ratios (HRs) in unadjusted analyses were 3.30 (95% CI; 2.12-5.13, p < 0.001) and 3.26 (95% CI; 2.12-5.02, p < 0.001) respectively. SPS was associated with mortality in an unadjusted- (HR 1.78, 95% CI; 1.33-2.37, p < 0.001) and in an adjusted analysis (HR 1.54, 95% CI; 1.07-2.22, p = 0.021). All cystatin C-derived measures were associated with mortality also after adjustment for AKI development. Cystatin C was associated with AKI in unadjusted analyses but not in analyses adjusted for creatinine. CONCLUSION Cystatin C and derived measures of kidney function at ICU admission are associated with an increased 90-day mortality. Increased AKI incidence does not fully explain this association.
Collapse
Affiliation(s)
- Erik Linné
- Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
| | - Alma Elfström
- Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Jane Fisher
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Infection Medicine, Lund, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi T Vaara
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Adam Linder
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Infection Medicine, Lund, Sweden
| | - Peter Bentzer
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund, Sweden
| |
Collapse
|
15
|
Herou E, Grubb A, Dardashti A, Nozohoor S, Zindovic I, Ederoth P, Bjursten H. Reduced renal elimination of larger molecules is a strong predictor for mortality. Sci Rep 2022; 12:17517. [PMID: 36266435 PMCID: PMC9584920 DOI: 10.1038/s41598-022-22433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/14/2022] [Indexed: 01/12/2023] Open
Abstract
Renal dysfunction is a major risk factor for premature death and has been studied extensively. A new renal syndrome, shrunken pore syndrome (SPS), confers higher mortality in all studied populations. SPS is a condition in which cystatin C-based estimation of glomerular filtration rate (eGFRcystatin C) is ≥ 60% than creatinine-based estimation of glomerular filtration rate (eGFRcreatinine). We aimed to study the impact of SPS on mortality in a cohort of patients with follow up of up to 10 years. This was a retrospective single centre cohort study. We enrolled 3993 consecutive patients undergoing elective cardiac surgery. Outcome was evaluated using Kaplan Meier analysis and multivariable Cox regression. 1-, 5- and 10-year survival for patients with SPS was 90%, 59% and 45%, and without SPS 98%, 88% and 80% (p < 0.001). SPS was found to be an independent predictor for mortality with an HR of 1.96 (95% CI 1.63-2.36). SPS negatively affected survival regardless of pre-operative renal function. SPS is an independent predictor for mortality after elective cardiac surgery, equal to or greater than risk factors such as diabetes, impaired left ventricular function or renal dysfunction. SPS affected mortality even in patients with normal eGFR.Clinical registration number: ClinicalTrials.gov, ID NCT04141072.
Collapse
Affiliation(s)
- Erik Herou
- grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Skåne University Hospital, 221 85 Lund, Sweden
| | - Anders Grubb
- grid.411843.b0000 0004 0623 9987Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden
| | - Alain Dardashti
- grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Skåne University Hospital, 221 85 Lund, Sweden
| | - Shahab Nozohoor
- grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Skåne University Hospital, 221 85 Lund, Sweden
| | - Igor Zindovic
- grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Skåne University Hospital, 221 85 Lund, Sweden
| | - Per Ederoth
- grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Skåne University Hospital, 221 85 Lund, Sweden
| | - Henrik Bjursten
- grid.411843.b0000 0004 0623 9987Department of Cardiothoracic Surgery, Skåne University Hospital, 221 85 Lund, Sweden
| |
Collapse
|
16
|
Laucyte-Cibulskiene A, Nilsson PM, Engström G, Christensson A. Increased fat mass index is associated with decreased glomerular filtration rate estimated from cystatin C. Data from Malmö Diet and Cancer cohort. PLoS One 2022; 17:e0271638. [PMID: 35862349 PMCID: PMC9302820 DOI: 10.1371/journal.pone.0271638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background This study aims to describe associations of obesity and CKD in a Swedish urban population. The impact of fat mass, from bioimpedance analysis, on eGFR based on cystatin C and/or creatinine is studied. Methods 5049 participants from Malmö Diet and Cancer Study the cardiovascular arm (MDCS‐CV) with available body mass composition (single frequency bioimpedance analysis) and cystatin C measured at baseline were selected. Body mass index (kg/m2) was used to define overweight/obesity. eGFR was calculated using cystatin C (eGFRCYS) and creatinine (eGFRCR) equations: Chronic Kidney Disease Epidemiology Collaboration 2012 (CKD-EPICR, CKD-EPICYS, CKD-EPICR-CYS), eGFRCYS based on Caucasian, Asian, pediatric, and adult cohorts (CAPA), the Lund-Malmö revised equation (LMrev), and Modified Full Age Spectrum creatinine-based equation (EKFCCR). Two different fat mass index (FMI) z-scores were calculated: FMI z-scoreLarsson and FMI z-scoreLee. Results Lower eGFRCYS and eGFRCR-CYS following multiple adjustments were prevalent in overweight/obese subjects. Increase in FMI z-scoreLarsson or FMI z-scoreLee was related to decrease in predicted CAPA, CKD-EPICYS, CKD-EPICR-CYS and CAPA-LMrev equation. Conclusion eGFRCYS, in contrast to combined eGFRCR-CYS and eGFRCR, demonstrate the strongest association between FMI and kidney function.
Collapse
Affiliation(s)
- Agne Laucyte-Cibulskiene
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
- Department of Nephrology, Lund University, Skane University Hospital, Malmö, Sweden
- * E-mail:
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
- Department of Nephrology, Lund University, Skane University Hospital, Malmö, Sweden
| |
Collapse
|
17
|
Shrunken Pore Syndrome Is Associated with Renal Function Decline in Female Patients with Kidney Diseases. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2177991. [PMID: 35845935 PMCID: PMC9283046 DOI: 10.1155/2022/2177991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022]
Abstract
Background Shrunken pore syndrome (SPS) represents selective impairment of kidney filtration of low-molecular-weight molecules between 1 and 30 kDa and has been related to outcomes including morbidity, mortality, and cardiovascular events. However, the prevalence and kidney outcomes of SPS have not been investigated in patients with IgA nephropathy (IgAN) and membranous nephropathy (MN). Methods We retrospectively collected information of 536 patients including 414 with IgAN and 122 with MN. SPS was mainly defined by cystatin C-based eGFR < 70% of creatinine-based eGFR using the CAPA-LM equation pairs, while CKD-EPI equations were also employed in sensitivity analyses. Prevalence rate of SPS and its association with end-stage renal disease (ESRD) or severe eGFR decline (≥50% eGFR reduction or doubling of baseline creatinine) were investigated. Results 44% (8%) patients were identified as possessing SPS using the CAPA-LM definition. ESRD happened in 24 patients during the average follow-up period of 27.7 months. Despite dramatic increase of incidence rate of ESRD for SPS, significant hazard ratio (HR) only existed in IgAN patients after multivariable adjustment (HR: 8.35, 95% CI: 2.10~33.26), but lost significance in sensitivity analyses. 36 patients were determined as having experienced severe eGFR decline after excluding transient creatinine fluctuation. SPS was associated with severe eGFR decline by Kaplan-Meier survival analyses in the overall population as well as the IgAN, MN, male, and female subpopulations, which remained significant in multivariable adjustments in all groups except IgAN. However, only in female patients the association between SPS and eGFR decline remained significant in all the sensitivity analyses. Conclusions SPS was independently associated with eGFR decline in female patients with IgAN and MN.
Collapse
|
18
|
Hansson E, Wegman DH, Wesseling C, Glaser J, Schlader ZJ, Wijkström J, Jakobsson K. Markers of kidney tubular and interstitial injury and function among sugarcane workers with cross-harvest serum creatinine elevation. Occup Environ Med 2022; 79:396-402. [PMID: 34972693 PMCID: PMC9120403 DOI: 10.1136/oemed-2021-107989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/08/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Serum creatinine (SCr) is a routine marker of kidney injury but also increases with dehydration and muscular work. This study was to elucidate whether increase in SCr is associated with more specific markers of kidney tubular and interstitial injury and function, during prolonged heat stress among workers at high risk of chronic kidney disease of non-traditional origin (CKDnt). METHODS Urine monocyte chemoattractant protein-1 (MCP-1), kidney injury molecule-1 (KIM-1), calbindin, glutathione S-transferase-π (GST-π), clusterin, interleukin 18 and albumin, fractional excretion of potassium (FEK), blood haemoglobin, serum potassium, ferritin and erythropoietin were measured before and after harvest in a sample of 30 workers with a ≥0.3 mg/dL SCr increase across harvest (cases), and 53 workers with stable SCr (controls). RESULTS Urine MCP-1 (p for differential cross-harvest trend <0.001), KIM-1 (p=0.002), calbindin (p=0.02), GST-π (p=0.04), albumin (p=0.001) and FEK (p<0.001) increased in cases, whereas blood haemoglobin (p<0.001) and serum erythropoietin (p<0.001) decreased. CONCLUSION Several markers of tubular and interstitial injury and function changed as SCr increased across a harvest season, supporting the use of SCr as an indicator of kidney injury in physically active workers regularly exposed to heat stress. Repeated injury similar to that described here, and continued work under strenuous and hot conditions with similarly elevated injury markers is likely to worsen and possibly initiate CKDnt.
Collapse
Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - David H Wegman
- La Isla Network, Washington, DC, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Catharina Wesseling
- La Isla Network, Washington, DC, USA
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Jakobsson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
19
|
Updated Pathways in Cardiorenal Continuum after Kidney Transplantation. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains one of the leading causes for increased morbidity and mortality in chronic kidney disease (CKD). Kidney transplantation is the preferred treatment option for CKD G5. Improved perioperative and postoperative care, personalized immunosuppressive regimes, and refined matching procedures of kidney transplants improves cardiovascular health in the early posttransplant period. However, the long-term burden of CVD is considerable. Previously underrecognized, the role of the complement system alongside innate immunity, inflammaging, structural changes in the glomerular filtration barrier and early vascular ageing also seem to play an important role in the posttransplant management. This review provides up-to-date knowledge on these pathways that may influence the cardiovascular and renal continuum and identifies potential targets for future therapies. Arterial destiffening strategies and the applicability of sodium-glucose cotransporter 2 inhibitors and their role in cardiovascular health after kidney transplantation are also addressed.
Collapse
|
20
|
Andersson A, Hansson E, Ekström U, Grubb A, Abrahamson M, Jakobsson K, Xu Y. Large difference but high correlation between creatinine and cystatin C estimated glomerular filtration rate in Mesoamerican sugarcane cutters. Occup Environ Med 2022; 79:497-502. [PMID: 35354651 PMCID: PMC9209661 DOI: 10.1136/oemed-2021-107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the relationship between creatinine and cystatin C based estimated glomerular filtration rate (eGFR) in actively working sugarcane cutters. METHODS This cohort study included 458 sugarcane cutters from Nicaragua and El Salvador. Serum samples were taken before and at end of harvest seasons and analysed for creatinine and cystatin C. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were used to calculate eGFRs based on creatinine (eGFRcr), cystatin C (eGFRcys) and both creatinine and cystatin C (eGFRcrcys) at each time point. Bland-Altman plots and paired t-tests were used to compare the difference between eGFRcr and eGFRcys, and the difference in eGFRs between before and at end of the harvest seasons. RESULTS The mean eGFRcr was higher than eGFRcys in both cohorts; absolute difference 22 mL/min/1.73 m2 (95% CI 21 to 23) in Nicaragua and 13 mL/min/1.73 m2 (95% CI 11 to 15) in El Salvador. Correlations between eGFRcr and eGFRcys were high, with r=0.69, 0.77 and 0.67 in Nicaragua at pre-harvest, end-harvest and cross-harvest, and r=0.89, 0.89 and 0.49 in El Salvador. CONCLUSIONS Creatinine increases among heat-stressed workers reflect reduced glomerular filtration as estimated using eGFRcys, a marker independent of muscle mass and metabolism. The discrepancy between eGFRcr and eGFRcys may indicate reduced glomerular filtration of larger molecules and/or systemic bias in CKD-EPI performance in this population.
Collapse
Affiliation(s)
- Axel Andersson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden .,La Isla Network, Washington, District of Columbia, USA
| | - Erik Hansson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,La Isla Network, Washington, District of Columbia, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anders Grubb
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Kristina Jakobsson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yiyi Xu
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| |
Collapse
|
21
|
Laham G, Ponti JP, Soler Pujol G. Assessing Renal Function for Kidney Donation. How Low Is Too Low? Front Med (Lausanne) 2022; 8:784435. [PMID: 35186970 PMCID: PMC8847393 DOI: 10.3389/fmed.2021.784435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Kidney transplantation (KT) is the treatment of choice for patients with end-stage kidney disease (ESKD) with decreased morbi-mortality, improved life quality, and reduced cost. However, the shortage of organs from deceased donors led to an increase in KT from living donors. Some stipulate that living donors have a higher risk of ESKD after donation compared with healthy non-donors. The reason for this is not clear. It is possible that ESKD is due to the nephrectomy-related reduction in glomerular filtration rate (GFR), followed by an age-related decline that may be more rapid in related donors. It is essential to assess donors properly to avoid rejecting suitable ones and not accepting those with a higher risk of ESKD. GFR is a central aspect of the evaluation of potential donors since there is an association between low GFR and ESKD. The methods for assessing GFR are in continuous debate, and the kidney function thresholds for accepting a donor may vary according to the guidelines. While direct measurements of GFR (mGFR) provide the most accurate evaluation of kidney function, guidelines do not systematically use this measurement as a reference. Also, some studies have shown that the GFR decreases with age and may vary with gender and race, therefore, the lower limit of GFR in patients eligible to donate may vary based on these demographic factors. Finally, it is known that CrCl overestimates mGFR while eGFR underestimates it, therefore, another way to have a reliable GFR could be the combination of two measurement methods.
Collapse
Affiliation(s)
- Gustavo Laham
- Internal Medicine Department, Nephrology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | | | | |
Collapse
|
22
|
Zhou C, Chen Y, He X, Xue D. The value of cystatin C in predicting perioperative and long-term prognosis of renal transplantation. Scand J Clin Lab Invest 2022; 82:1-5. [PMID: 35012404 DOI: 10.1080/00365513.2021.1989714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate the value of cystatin C (Cys C) in predicting the perioperative and long-term prognosis of renal transplantation (RT). The clinical data of 198 RT recipients were collected. Blood samples were obtained daily until 7 d after transplantation and then discharge day to determine the serum levels of Cys C. The receiver-operating characteristic (ROC) analysis and the area under the curve (AUC) were used to determine the diagnostic accuracy of Cys C for delayed graft function (DGF). The presence of shrunken pore syndrome (SPS) with a cystatin C-based estimate of glomerular filtration rate less than 70% of a creatinine-based estimate, was also evaluated as a prognostic factor for the development of DGF. The serum Cys C levels of patients with DGF were higher than those of the non-DGF group. Cys C showed a higher AUC (0.928) in the ROC analysis than did sCr (0.862). Compared to the non-SPS group, there were more patients diagnosed with SPS in the DGF group (p < .05). The follow-up data showed that patients diagnosed with SPS had higher levels of sCr and Cys C compared to other patients, suggesting a poor long-term prognosis. Our findings suggest that Cys C is a sensitive indicator of renal function during the perioperative period. Cys C at a concentration of 4.9 mg/L had the highest sum of sensitivity and specificity for prediction of DGF, with a sensitivity of 0.889 and a specificity of 0.8. SPS is associated with the development of DGF and the poor long-term prognosis of RT.
Collapse
Affiliation(s)
- Cuixing Zhou
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yimeng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| |
Collapse
|
23
|
Ishigo T, Yano T, Katano S, Takada R, Aigami T, Nakano K, Kondo F, Kouzu H, Ohori K, Nakata H, Nonoyama M, Kitagawa M, Kimyo T, Fukudo M, Miura T. Utility of a Score for Predicting Glomerular Filtration Rate Overestimation in Patients with Cardiovascular and Renal Diseases and Their Risk Factors. Intern Med 2022; 61:167-175. [PMID: 35034932 PMCID: PMC8851179 DOI: 10.2169/internalmedicine.7388-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective We recently reported a novel score for the detection of glomerular filtration rate (GFR) overestimation using a creatinine-based equation. We examined the utility of this score in patients with cardiovascular/renal diseases and diabetes mellitus. Methods We enrolled 1,425 patients (65±15 years old; 37% women) who were admitted to our hospital for the management of cardiovascular and renal diseases and their risk factors. Overestimation of the GFR (OE) was defined as a creatinine-based GFR (eGFRcre) ≥120% of the cystatin C-based estimated GFR. The OE score was calculated as the sum of the scores for the body weight, hemoglobin concentration, and blood urea nitrogen (BUN)/serum creatinine (Scr), totaling 1 point if the body weight was <63.0 kg in men or <42.0 kg in women, 1 point if the hemoglobin concentration was <12.4 g/dL in men or <11.0 g/dL in women, and 1 point if the BUN/Scr was >26.5. Results The proportion of patients with OE was 14.2%. The score predicted OE with a sensitivity of 70.8% and a specificity of 99.6%, and the sensitivity was increased in patients ≥75 years old (88.3%) and decreased in diabetics (58.6%). When patients were divided into subgroups by the total score, the frequencies of OE were 8% (59/754), 14% (72/502), 38% (58/151), and 72% (13/18) in patients with scores of 0, 1, 2, and 3, respectively. Conclusion The OE score is useful for detecting elderly cases of cardiovascular and renal diseases in which eGFRcre overestimates the GFR, although its utility is limited in diabetics.
Collapse
Affiliation(s)
- Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Japan
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital, Japan
| | - Ryo Takada
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Tomohiro Aigami
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Keita Nakano
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Fuki Kondo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Japan
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Japan
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Japan
| | - Hiromasa Nakata
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Masatoshi Nonoyama
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Manabu Kitagawa
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Tomoko Kimyo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Masahide Fukudo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Japan
| |
Collapse
|
24
|
Mickelsson M, Söderström E, Stefansson K, Andersson J, Söderberg S, Hultdin J. Smoking tobacco is associated with renal hyperfiltration. Scand J Clin Lab Invest 2021; 81:622-628. [PMID: 34669529 DOI: 10.1080/00365513.2021.1989713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Tobacco consumption is a renal risk factor, but the effects on the estimated glomerular filtration rate (eGFR) remain unclear. We aimed to evaluate the possible impact of using tobacco products (smoking and snus) on eGFR based on creatinine or cystatin C. We used a first cohort with 949 participants and a second cohort with 995 participants; none had pre-existing renal disease. All subjects donated a blood sample and completed a questionnaire, including questions about tobacco use. To assess the effect on eGFR, hierarchical multiple linear regression models were used. Active smoking associated independently with a higher eGFRcreatinine in all subjects (p < 0.001; β = 0.11). Further analyses stratified for sex, showed similar findings for men (p < 0.001; β = 0.14) and for women (p = 0.026; β = 0.10). eGFRcystatin C was significantly associated with active smoking in all subjects (p = 0.040; β = -0.05), but no association was seen after stratification for sex. Snus did not associate with eGFR. In conclusion, smoking associated significantly with a higher eGFRcreatinine. The mechanism may be renal hyperfiltration of smaller molecules such as creatinine. This is probably caused by substances from smoked tobacco other than nicotine, as no effect was seen for snus.
Collapse
Affiliation(s)
- Malin Mickelsson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Elisabet Söderström
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Kristina Stefansson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| |
Collapse
|
25
|
Kim H, Park JT, Lee J, Jung JY, Lee KB, Kim YH, Yoo TH, Kang SW, Choi KH, Oh KH, Ahn C, Han SH. The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease. Atherosclerosis 2021; 335:53-61. [PMID: 34571286 DOI: 10.1016/j.atherosclerosis.2021.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD). METHODS This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60-89; G3: 30-59; G4: 15-29; G5: <15 mL/min/1.73 m2 without kidney replacement therapy). The difference in eGFR (eGFRdiff) was calculated by subtracting the cystatin C-based eGFR (eGFRcys) from the creatinine-based eGFR (eGFRcreat). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death. RESULTS During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFRdiff tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28-3.51) than the lowest tertile when adjusted for eGFRcreat, eGFRcys, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03-1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFRdiff was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01-1.05). CONCLUSIONS A large positive difference between eGFRcreat and eGFRcys was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFRdiff.
Collapse
Affiliation(s)
- Hyoungnae Kim
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Jung Tak Park
- Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, Seoul, South Korea
| | - Joongyub Lee
- Prevention and Management Center, Inha University Hospital, Incheon, South Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Yeong-Hoon Kim
- Department of Internal Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Tae-Hyun Yoo
- Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, Seoul, South Korea
| | - Shin-Wook Kang
- Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, Seoul, South Korea
| | - Kyu Hun Choi
- Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, Seoul, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Hyeok Han
- Yonsei University, Institute of Kidney Disease Research, College of Medicine, Department of Internal Medicine, Seoul, South Korea.
| | | |
Collapse
|
26
|
Grubb A. Glomerular filtration and shrunken pore syndrome in children and adults. Acta Paediatr 2021; 110:2503-2508. [PMID: 33742469 DOI: 10.1111/apa.15846] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/10/2023]
Abstract
A major function of the kidney is to, by glomerular filtration, maintain the overall steady-state of 5-30 kDa proteins, many of which are signalling molecules. This function of the kidney has been overlooked, since predominantly low-molecular-mass substances <1 kDa have been used to measure or estimate glomerular filtration rate (GFR). The use of cystatin C (13 kDa) as a marker of GFR has allowed the discovery that the filtration of 5-30 kDa molecules can be selectively impaired defining the shrunken pore syndrome. The discovery, pathophysiology, morbidity (mainly cardiovascular manifestations) and mortality of this syndrome are described.
Collapse
Affiliation(s)
- Anders Grubb
- Department of Clinical Chemistry University Hospital Lund Sweden
| |
Collapse
|
27
|
Xhakollari L, Grubb A, Jujic A, Bachus E, Nilsson PM, Leosdottir M, Christensson A, Magnusson M. The Shrunken pore syndrome is associated with poor prognosis and lower quality of life in heart failure patients: the HARVEST-Malmö study. ESC Heart Fail 2021; 8:3577-3586. [PMID: 34382359 PMCID: PMC8497365 DOI: 10.1002/ehf2.13485] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Aims This study aimed to investigate the association between the ‘Shrunken pore syndrome’ (SPS) and risk of death, 30 day rehospitalization, and health‐related quality of life (QoL) in heart failure (HF) patients. SPS is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatin C/eGFRcreatinine ratio. Methods and results A total of 373 patients hospitalized for HF [mean age 74.8 (±12.1) years; 118 (31.6%) women] were retrieved from the HeARt and brain failure inVESTigation trial (HARVEST‐Malmö). Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) formulas were used for estimation of glomerular filtration rate (eGFR). Presence of SPS was defined as eGFRcystatin C ≤ 60% of eGFRcreatinine. In Cox regression multivariate models, associations between SPS, risk of death (median follow‐up time 1.8 years), and risk of 30 day rehospitalization were studied. Associations between SPS and impaired QoL were studied using multivariate logistic regressions. In multivariate models, SPS was associated with all‐cause mortality [124 events; hazard ratio (HR) 1.99; 95% confidence interval (95% CI) 1.23–3.21; P = 0.005] and with 30 day rehospitalization (70 events; HR 1.82; CI 95% 1.04–3.18; P = 0.036). Analyses of QoL, based on a Kansas City Cardiomyopathy Questionnaire overall score < 50, revealed that SPS was associated with higher risk of low health‐related QoL (odds ratios 2.15; CI 95% 1.03–4.49; P = 0.042). Conclusions The results of this observational study show for the first time an association between SPS and poor prognosis in HF. Further studies are needed to confirm the results in HF cohorts and experimental settings to identify pathophysiological mechanisms.
Collapse
Affiliation(s)
- Liana Xhakollari
- Department of Nephrology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, Malmö, SE 205 02, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Margret Leosdottir
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, Malmö, SE 205 02, Sweden
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, Malmö, SE 205 02, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| |
Collapse
|
28
|
Söderström E, Blind R, Wennberg P, Andersson J, Söderberg S, Nilsson TK, Hultdin J. Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk of a future first-ever myocardial infarction in women. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:438-445. [PMID: 34237228 DOI: 10.1080/00365513.2021.1941235] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Impaired renal function is associated both with the development of cardiovascular disease and its prognosis. A new syndrome called 'Shrunken Pore Syndrome' has been suggested, as the estimated glomerular filtration rate for cystatin C (eGFRcystatin C) is affected earlier due to differences in molecular size compared to eGFRcreatinine. The aim was to investigate if a lower eGFRcystatin C/eGFRcreatinine ratio in a prospective setting increases the risk of later developing a first-ever myocardial infarction (MI) independently of other cardiovascular risk factors. We used a nested case-referent study design within the Northern Sweden Health and Disease Study, and 545 subjects (29.0% women) were identified who prospectively developed a first-ever MI, and their 1054 matched referents. For women, but not for men, one standard deviation (SD) increase of ln z-scores of eGFRcystatin C/eGFRcreatinine ratio was associated with a lower risk of a future MI: odds ratio [95% confidence interval] 0.58 [0.34-0.99], adjusted for apolipoprotein B/A1 ratio, CRP, homocysteine, systolic blood pressure, body mass index, and diabetes. Furthermore, a high eGFRcreatinine associated independently with an increased risk of future MI in men only: OR 1.25 [1.05-1.48]. Thus, for women, a lower eGFRcystatin C/eGFRcreatinine ratio is associated with a higher risk of having a future first-ever MI, and it may be a valuable, easily implemented biomarker for risk of cardiovascular disease.
Collapse
Affiliation(s)
- Elisabet Söderström
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Ravna Blind
- Department of Medical Biosciences, Clinical Chemistry, Norrbotten County Council, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Torbjörn K Nilsson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| |
Collapse
|
29
|
Mavrogeorgis E, Mischak H, Beige J, Latosinska A, Siwy J. Understanding glomerular diseases through proteomics. Expert Rev Proteomics 2021; 18:137-157. [PMID: 33779448 DOI: 10.1080/14789450.2021.1908893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Chronic kidney disease is avery common and complex chronic disease. Uncovering the pathological patterns of CKD on the molecular level of bio-fluids and tissue appears to be both vital and promising for a more favorable outcome. We reviewed recently discovered proteomics biomarkers for CKD to provide new insight into disease pathology. AREAS COVERED We review the application of proteome analysis in the context of CKD with various etiologies within the last 5 years. Proteins and peptides associated with CKD as derived from multiple sources (urine, blood and tissue) are reported along with their various biological pathways. EXPERT OPINION A systematic and theoretical comprehension of the CKD pathology is essential for its successful management. The underlying complexity of the disease further requires specific conditions for reliable and interpretable results. In this context, clinical proteomics has resulted in first encouraging findings in CKD. A more complete understanding of the biological pathways related to the disease, based on the scope of a holistic proteomic approach, could improve substantially the management of CKD, especially when in conjunction with the current trend of personalized medicine.
Collapse
Affiliation(s)
| | - H Mischak
- Mosaiques Diagnostics GmbH, Hannover, Germany.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J Beige
- Division of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany.,Department of Internal Medicine 2 (Nephrology, Rheumatology, Endocrinology), Martin-Luther-University Halle, Wittenberg, Germany
| | | | - J Siwy
- Mosaiques Diagnostics GmbH, Hannover, Germany
| |
Collapse
|
30
|
Xhakollari L, Jujic A, Molvin J, Nilsson P, Holm H, Bachus E, Leosdottir M, Grubb A, Christensson A, Magnusson M. Proteins linked to atherosclerosis and cell proliferation are associated with the shrunken pore syndrome in heart failure patients: Shrunken pore syndrome and proteomic associations. Proteomics Clin Appl 2021; 15:e2000089. [PMID: 33682349 DOI: 10.1002/prca.202000089] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE The "Shrunken pore syndrome" (SPS) is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatinC /eGFRcreatinine -ratio. Studies have demonstrated a high risk for cardiovascular morbidity and mortality for patients with SPS. In this discovery study, we explored associations between SPS and proteins implicated in cardiovascular disease and inflammation in patients with heart failure. EXPERIMENTAL DESIGN Plasma samples from 300 individuals in HARVEST-Malmö trial hospitalized for the diagnosis of heart failure (mean age 74.9 ± 11.5 years; 30.0% female), were analyzed with a proximity extension assay consisting of 92 proteins. A Bonferroni-corrected p-value of 0.05/92 = 5.4 × 10-4 was considered significant in the initial age and sex-adjusted analyses. Presence of SPS was defined as eGFRcystatinC ≤ 60% of eGFRcreatinine . RESULTS SPS presented with significant associations (p < 5.4 × 10-4 ) in age and sex-adjusted logistic regressions with elevated levels of six proteins; scavenger receptor cysteine rich type 1 protein M130, tumor necrosis factor receptor 1, tumor necrosis factor receptor 2, osteoprotegerin, interleukin-2 receptor subunit alpha, and tyrosine-protein kinase receptor UFO. All proteins remained associated (p < 0.05) with SPS after multivariate adjustments. CONCLUSIONS AND CLINICAL RELEVANCE In heart failure patients, SPS was associated with proteins linked to atherosclerosis and cell proliferation.
Collapse
Affiliation(s)
- Liana Xhakollari
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Skane University Hospital, Department of Cardiology, Lund University, Malmö, Sweden
| | - John Molvin
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Skane University Hospital, Department of Cardiology, Lund University, Malmö, Sweden
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Skane University Hospital, Department of Cardiology, Lund University, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Margret Leosdottir
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Skane University Hospital, Department of Cardiology, Lund University, Malmö, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Skane University Hospital, Department of Cardiology, Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.,Hypertension in Africa Research Team, North-West University Potchefstroom, Potchefstroom, South Africa
| |
Collapse
|
31
|
Hoenle A, Haase KJ, Maus S, Hofmann M, Orth M. Avoiding insufficient therapies and overdosing with co-reporting eGFRs (estimated glomerular filtration rate) for personalized drug therapy and improved outcomes - a simulation of the financial benefits. EJIFCC 2021; 32:41-51. [PMID: 33753973 PMCID: PMC7941064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patients with impaired renal function are at high risk for morbidity and mortality. Chronic kidney disease (CKD) even in the early stages can be associated with significant side effects of drug therapy, longer length of stay, and high costs. Correct assessment of renal function in the hospital is important to detect CKD, to avoid further damage to the kidneys, and to optimize pharmacological therapy. Current protocols for renal function testing in drug dosing are only creatinine based, are not robust enough, and can wrongly classify certain patients. Goal of our simulation study is to optimize noninvasive renal function estimates and to allow for optimal dosing of pharmacological treatment without further renal damage. Co-reporting of creatinine- and of cystatin C-derived estimated glomerular filtration rates (eGFR) allows a personalized approach for patients with large discrepancies in eGFR and it enabled us in detecting patients at high risk for side effects due to incorrect drug dosing. This approach might be highly effective for patients as well as for clinicians. In addition, we simulated the efficiency by estimating savings for the hospital administration and the payor with a benefit cost ratio of 58 to 1.
Collapse
Affiliation(s)
- Adrian Hoenle
- Vinzenz von Paul Kliniken gGmbH, Institut für Laboratoriumsmedizin, Stuttgart, Germany, Medizinische Fakultät Mannheim, Ruprecht Karls Universität, Mannheim, Germany,Vinzenz von Paul Kliniken gGmbH, HNO-Klinik, Stuttgart, Germany
| | | | - Sebastian Maus
- Vinzenz von Paul Kliniken gGmbH, Klinik für Nephrologie, Stuttgart, Germany
| | - Manfred Hofmann
- Vinzenz von Paul Kliniken gGmbH, Klinik für Gynäkologie und Geburtshilfe, Stuttgart, Germany
| | - Matthias Orth
- Vinzenz von Paul Kliniken gGmbH, Institut für Laboratoriumsmedizin, Stuttgart, Germany,Corresponding author: Priv.-Doz. Dr. med. Matthias Orth Institut für Laboratoriumsmedizin Vinzenz von Paul Kliniken gGmbH Postfach 103163 DE-70027 Stuttgart Germany E-mail:
| |
Collapse
|
32
|
H. Jonsson M, Åkesson A, Hommel A, Grubb A, Bentzer P. Markers of renal function at admission and mortality in hip fracture patients - a single center prospective observational study. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:201-207. [DOI: 10.1080/00365513.2021.1884892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Magnus H. Jonsson
- Department of Anaesthesia and Intensive Care Medicine, Ystad Hospital, Ystad, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden - Forum South, Skåne University Hospital Lund, Lund, Sweden
| | - Ami Hommel
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Anders Grubb
- Laboratory Medicine, Department of Clinical Chemistry and Pharmacology, Lund University Hospital, Lund, Sweden
| | - Peter Bentzer
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| |
Collapse
|
33
|
Yoshii I, Nishiyama S. The impact of shrunken pore syndrome in patient with rheumatic diseases on bone mineral metabolism. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 81:72-81. [DOI: 10.1080/00365513.2020.1858492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ichiro Yoshii
- Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, Shimanto-City, Kochi Prefecture, Japan
| | - Susumu Nishiyama
- Department of Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Prefecture, Japan
| |
Collapse
|
34
|
Jin S, Xu J, Shen G, Gu P. Predictive value of circulating cystatin C level in patients with acute coronary syndrome: a meta-analysis. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 81:1-7. [PMID: 33207943 DOI: 10.1080/00365513.2020.1846212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Circulating cystatin C level has been identified as a predictor of adverse outcomes in patients with coronary artery disease (CAD). This meta-analysis aimed to investigate the value of circulating cystatin C level for predicting adverse outcomes in patients with acute coronary syndrome (ACS). We comprehensively searched articles indexed in Pubmed and Embase databases from their inceptions to 30 November 2019. All available observational studies that investigated the association between circulating cystatin C level and major adverse cardiovascular events [MACE] (including death, heart failure, re-infarction, target vascular revascularization, angina and stroke) or all-cause mortality in patients with ACS were included. The prognostic value was expressed by pooling the multivariable-adjusted hazard risk (HR) with 95% confidence interval (CI) for the highest versus the lowest category of cystatin C level. Eleven eligible studies (12 articles) with 4600 ACS patients were identified. Meta-analysis indicated that the highest versus lowest category of cystatin C level was associated with higher risk of MACE (HR 2.28; 95% CI 1.92-2.71) and all-cause mortality (HR 2.89; 95% CI 1.43-5.83) after adjustment for estimated glomerular filtration rate (eGFR) or creatinine. Subgroup analysis by subtypes of patients, study design, follow-up duration and cutoff level of cystatin C further confirmed the value of cystatin C level for predicting MACE. Elevated circulating cystatin C level at baseline is strongly and independently associated with an increased risk of MACE and all-cause mortality in patients with ACS. Determination of circulating cystatin C level has potential to improve risk stratification of ACS patients.
Collapse
Affiliation(s)
- Song Jin
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Jian Xu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Gan Shen
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Pengying Gu
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| |
Collapse
|
35
|
Hansson M, Gustafsson R, Jacquet C, Chebaane N, Satchell S, Thunberg T, Ahlm C, Fors Connolly AM. Cystatin C and α-1-Microglobulin Predict Severe Acute Kidney Injury in Patients with Hemorrhagic Fever with Renal Syndrome. Pathogens 2020; 9:pathogens9080666. [PMID: 32824680 PMCID: PMC7460112 DOI: 10.3390/pathogens9080666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/29/2022] Open
Abstract
Puumala orthohantavirus causes hemorrhagic fever with renal syndrome (HFRS) characterized by acute kidney injury (AKI), an abrupt decrease in renal function. Creatinine is routinely used to detect and quantify AKI; however, early AKI may not be reflected in increased creatinine levels. Therefore, kidney injury markers that can predict AKI are needed. The potential of the kidney injury markers urea, cystatin C, α1-microglobulin (A1M) and neutrophil gelatinase-associated lipocalin (NGAL) to detect early AKI during HFRS was studied by quantifying the levels of these markers in consecutively obtained plasma (P) and urine samples (U) for 44 HFRS patients. P-cystatin C and U-A1M levels were significantly increased during early HFRS compared to follow-up. In a receiver operating characteristic (ROC) curve analysis, P-cystatin C, U-A1M and P-urea predicted severe AKI with area under the curve 0.72, 0.73 and 0.71, respectively, whereas the traditional kidney injury biomarkers creatinine and U-albumin did not predict AKI. Nearly half of the HFRS patients (41%) fulfilled the criteria for shrunken pore syndrome, which was associated with the level of inflammation as measured by P-CRP. P-cystatin C and U-A1M are more sensitive and earlier markers compared to creatinine in predicting kidney injury during HFRS.
Collapse
Affiliation(s)
- Magnus Hansson
- Clinical Chemistry, Karolinska University Hospital, 17176 Stockholm, Sweden;
- Department of Laboratory Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Rasmus Gustafsson
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Chloé Jacquet
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
- Molecular Infection Medicine Sweden (MIMS), Umeå University, 90187 Umeå, Sweden
| | - Nedia Chebaane
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
| | - Simon Satchell
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol BS1 3NY, UK;
| | - Therese Thunberg
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
| | - Anne-Marie Fors Connolly
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
- Molecular Infection Medicine Sweden (MIMS), Umeå University, 90187 Umeå, Sweden
- Correspondence:
| |
Collapse
|
36
|
Ishigo T, Katano S, Yano T, Kouzu H, Ohori K, Nakata H, Nonoyama M, Inoue T, Takamura Y, Nagaoka R, Kondo F, Nakano K, Takada R, Kitagawa M, Kimyo T, Miura T. Overestimation of glomerular filtration rate by creatinine-based equation in heart failure patients is predicted by a novel scoring system. Geriatr Gerontol Int 2020; 20:752-758. [PMID: 32558258 DOI: 10.1111/ggi.13959] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/02/2020] [Accepted: 05/16/2020] [Indexed: 01/02/2023]
Abstract
AIMS Creatinine-based estimated glomerular filtration rate (eGFRcre) has been shown to overestimate the glomerular filtration rate (GFR) when it is compared with cystatin C-based estimated GFR (eGFRcys) in older people. We investigated clinical determinants of GFR overestimation by eGFRcre and developed a score for prediction of GFR overestimation (OE) in heart failure patients. METHODS We retrospectively examined 244 Japanese heart failure patients (aged 72.2 ± 13.1 years; 48% women) who had no known extrarenal factors that affect serum cystatin C concentration. eGFR OE by eGFRcre was defined as eGFRcre being ≥120% of cystatin C-based eGFR. RESULTS The proportion of heart failure patients with OE was 14.3%. Patients with OE were older, had lower body weight and total skeletal muscle mass than those in patients without OE. Laboratory examinations showed that hemoglobin concentration was lower, and the ratio of blood urea nitrogen-to-creatinine was higher in patients with OE than in patients without OE. In multivariate regression analysis, body weight (<63.0 kg in men and <42.0 kg in women), hemoglobin level (<12.4 g/dL in men and <11.0 g/dL in women) and ratio of blood urea nitrogen-to-creatinine (>26.5) in addition to skeletal muscle mass were independently associated with OE. A score calculated by using cut-off levels of body weight, hemoglobin concentration and ratio of blood urea nitrogen-to-creatinine predicted OE with a sensitivity of 97.1% and a specificity of 98.1%. CONCLUSION Overestimation of GFR by eGFRcre is predictable by a novel scoring system, which might be useful for the detection of patients who require cystatin C-based eGFR measurement for accurate assessment of renal function. Geriatr Gerontol Int 2020; 20: 752-758.
Collapse
Affiliation(s)
- Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hiromasa Nakata
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Masatoshi Nonoyama
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Takuya Inoue
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yuhei Takamura
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Fuki Kondo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Keita Nakano
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryo Takada
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Manabu Kitagawa
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Tomoko Kimyo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
37
|
Grubb A. Shrunken pore syndrome - a common kidney disorder with high mortality. Diagnosis, prevalence, pathophysiology and treatment options. Clin Biochem 2020; 83:12-20. [PMID: 32544475 DOI: 10.1016/j.clinbiochem.2020.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
Invasive studies show that the glomerular sieving coefficients for 5-30 kDa plasma proteins in the human kidney may be selectively reduced compared to those for small molecules < 0.9 kDa, commonly used to measure glomerular filtration rate (GFR). Identification of this pathophysiological state, called shrunken pore syndrome (SPS), can easily and non-invasively be done by comparing estimations of GFR using cystatin C (13.3 kDa) and creatinine (0.113 kDa). SPS is present if the estimate of GFR using cystatin C is lower than 60 or 70% of the estimate using creatinine in the absence of non-renal influences on cystatin C or creatinine. All studies of SPS show that the 3- or 5-year mortality is strongly increased and high hazard ratios for mortality associated with SPS have been observed for many different patient cohorts, including cohorts with normal measured GFR, no albuminuria and no diagnosis. The prevalence of SPS in the cohorts so far investigated is between 0.2 and 36%. Proteome studies of SPS demonstrate that the high mortality associated with the syndrome might be caused by the accumulation of 10-30 kDa signalling proteins promoting development of atherosclerosis and thus suggesting use of monoclonal antibodies to reduce the levels of the most detrimental signalling proteins as a treatment option. The KDIGO recommendations for classification of chronic kidney disease (CKD) comprise determination, or estimation, of GFR and analysis of albuminuria and therefore cannot identify a large fraction of the patients with SPS. The high prevalence and mortality of SPS and the possible treatment options strongly suggest that the KDIGO recommendations should be expanded to include determination of cystatin C to be able to identify all patients with SPS.
Collapse
Affiliation(s)
- Anders Grubb
- Department of Clinical Chemistry and Pharmacology, Institute of Laboratory Medicine, Lund University, S-22185 Lund, Sweden.
| |
Collapse
|
38
|
Åkesson A, Lindström V, Nyman U, Jonsson M, Abrahamson M, Christensson A, Björk J, Grubb A. Shrunken pore syndrome and mortality: a cohort study of patients with measured GFR and known comorbidities. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:412-422. [DOI: 10.1080/00365513.2020.1759139] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Anna Åkesson
- Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Sweden
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Veronica Lindström
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Magnus Jonsson
- Department of Clinical Chemistry, Skåne University Hospital, Malmö, Sweden
| | | | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Jonas Björk
- Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Sweden
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
39
|
den Bakker E, Gemke RJ, van Wijk JA, Hubeek I, Stoffel-Wagner B, Bökenkamp A. Evidence for shrunken pore syndrome in children. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:32-38. [DOI: 10.1080/00365513.2019.1692231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Emil den Bakker
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Reinoud Jbj Gemke
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joanna Ae van Wijk
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Isabelle Hubeek
- Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Birgit Stoffel-Wagner
- Department of Clinical Chemistry and Clinical Pharmacology, University Clinics, Bonn, Germany
| | - Arend Bökenkamp
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
40
|
eGFR, cystatin C and creatinine in shrunken pore syndrome. Clin Chim Acta 2019; 498:1-5. [DOI: 10.1016/j.cca.2019.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 12/14/2022]
|
41
|
Ljungberg J, Johansson B, Bergdahl IA, Holmgren A, Näslund U, Hultdin J, Söderberg S. Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:524-530. [DOI: 10.1080/00365513.2019.1664761] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Johan Ljungberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | | | - Anders Holmgren
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| |
Collapse
|