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Li X, Wu Q, Kong Y, Lu C. Mild cognitive impairment in type 2 diabetes is associated with fibrinogen-to-albumin ratios. PeerJ 2023; 11:e15826. [PMID: 37576498 PMCID: PMC10414025 DOI: 10.7717/peerj.15826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Cognitive impairment is the main manifestation of diabetes central neuropathy. Currently, there is no effective dementia treatment; early diagnosis and treatment are particularly crucial. Inflammation index fibrinogen-to-albumin ratio (FAR) has been shown to predict complications of type 2 diabetes (diabetic kidney disease and diabetes-related arteriosclerosis), but its relationship with mild cognitive impairment (MCI) in type 2 diabetes (T2D) is undetermined. In this study, we examined the association between the FAR and mild cognitive impairment in type 2 diabetes. Methods This is a retrospective and cross-sectional study. From January 2022 to December 2022, we have retrieved 328 inpatient medical records for T2D patients hospitalized at the First Hospital of Harbin Medical University from the hospital's electronic system. Subjects' cognitive function was assessed and grouped by the MoCA scales. Subjects' demographic and various laboratory indicators were collected. Using Spearman's bivariate correlation analysis, the FAR and other clinical variables were analyzed for association strength. A multiple linear regression analysis was conducted to determine the independent relationship between FAR and MoCA scores. Multivariate logistic regression was used to analyze the independent relationship between FAR and MCI. The capacity of the FAR to detect MCI was carried using receiver operating characteristic (ROC) analysis. Results The included participants' (n = 328; 61.9% male) mean age was 52.62 ± 10.92 years. MoCA scores and MCI prevalence significantly differed (p < 0.05) between the four subgroups of FAR quartiles. The FAR and the MoCA score were significantly negatively correlated in the entire population (p < 0.05). Based on the multiple linear regression analysis, lnFAR and lnMoCA are significantly correlated (β = -0.449, t = -8.21, p < 0.05, R2 = 0.469). In multivariate logistic regression analysis, FAR and MCI were independently correlated after adjusting for covariates (OR 95% CI 34.70 [13.90-86.66]). Finally, the analysis of receptor working characteristics shows that the optimal FAR cut-off value was 0.08 (sensitivity: 95.81%, specificity: 84.47%) for detecting MCI in type 2 diabetes. Conclusion In type 2 diabetes, the FAR was positive associations with MCI and negative associations with MoCA score. The high FAR was associated with an increased risk of MCI. FAR maybe a appropriate indicator of MCI risk for type 2 diabetes.
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Affiliation(s)
- Xinyu Li
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Qian Wu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanqi Kong
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chong Lu
- Department of Neurology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
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Shinzato Y, Zamami R, Oshiro N, Nakamura T, Ishida A, Ohya Y, Kohagura K. The Association of Smoking and Hyperuricemia with Renal Arteriolosclerosis in IgA Nephropathy. Biomedicines 2023; 11:2053. [PMID: 37509692 PMCID: PMC10377274 DOI: 10.3390/biomedicines11072053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
The combination effects of smoking (SMK) and hyperuricemia (HU) on renal arteriolosclerosis in patients with IgA nephropathy remain unknown. We examined the cross-sectional association between smoking (current or former) and renal arteriolar hyalinosis and wall thickening with or without HU [uric acid (UA) level ≥ 7 and ≥5 mg/dL in men and women] in 87 patients with IgA nephropathy who underwent renal biopsy. Arteriolar hyalinosis and wall thickening were assessed by the semiquantitative grading of arterioles. The SMK/HU subgroup showed the highest indices for hyalinosis and wall thickening, followed by the non-SMK/HU, SMK/non-HU, and non-SMK/non-HU subgroups. Multiple logistic analysis showed that SMK/HU, but not SMK/non-HU, was significantly associated with an increased risk of higher-grade renal arteriolar wall thickening. However, this did not occur with hyalinosis compared to non-SMK/non-HU. The adjusted odds ratio (95% confidence interval, p value) for SMK/HU was 12.8 (1.36-119, p < 0.05) for wall thickening. An association between SMK and renal arteriolar wall thickening might be prevalent only among patients with HU and in patients with IgA nephropathy. Further prospective studies are needed to determine whether patients with HU and SMK history exhibit rapid eGFR deterioration.
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Affiliation(s)
- Yuki Shinzato
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa 903-0125, Japan
| | - Ryo Zamami
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Nanako Oshiro
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa 903-0125, Japan
| | - Takuto Nakamura
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Akio Ishida
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Yusuke Ohya
- University of the Ryukyus Hospital, Okinawa 903-0125, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa 903-0125, Japan
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Gronda EG, Vanoli E, Iacoviello M, Urbinati S, Caldarola P, Colivicchi F, Gabrielli D. Renal effects of SGLT2 inhibitors in cardiovascular patients with and without chronic kidney disease: focus on heart failure and renal outcomes. Heart Fail Rev 2023; 28:723-732. [PMID: 35098383 PMCID: PMC8801273 DOI: 10.1007/s10741-021-10211-9] [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] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
The kidney has a prominent role in maintaining glucose homeostasis by using glucose as a metabolic substrate. This occurs by generating glucose through gluconeogenesis, and by reuptaking filtered glucose through the sodium-glucose cotransporters SGLT1 and SGLT2 located in the proximal tubule. In recent studies, the administration of sodium-glucose cotransporters inhibitors demonstrated that inhibition of renal glucose reabsorption significantly reduces adverse renal events and heart failure exacerbations, in type 2 diabetic patients with and without cardiovascular damage as well as in advanced chronic kidney disease and heart failure patients with reduced ejection fraction with and without diabetes. The benefit was consistent throughout the different investigated clinical conditions, ameliorating overall patient outcome. The efficacy of sodium glucose cotransporters inhibitors was prominently linked to the limitation of renal damage as highlighted by the significant reduction on global mortality achieved in the studies investigating diabetic and not diabetic populations with advanced chronic kidney disease. Both studies were halted at the interim analysis because of unquestionable evidence of treatment benefit. In current review, we examine the role of SGLT2 and SGLT1 in the regulation of renal glucose reabsorption in health and disease and the effect of SGLT2 inhibition on clinical outcomes of populations with different cardiovascular conditions investigated with large-scale outcome trials.
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Affiliation(s)
- Edoardo G Gronda
- Dipartimento Di Medicina E Specialità Mediche, Programma Cardiorenale, Dialisi e Trapianto Renale Dell'Adulto, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico - Via Francesco Sforza, 35, U.O.C. Nefrologia, 20122, Milan, Italy.
- U.O.C. Cardiologia-UTIC, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy.
| | - Emilio Vanoli
- U.O. Cardiologia Riabilitativa Ospedale Sacra Famiglia Fatebenefratelli, Erba, Italy
- Molecular Medicine Dept, University of Pavia, Pavia, Italy
| | - Massimo Iacoviello
- Dipartimento Di Scienze Mediche E Chirurgiche, AOU Policlinico Riuniti Di Foggia, Università Degli Studi, Foggia, S.C. Cardiologia, Italy
| | | | | | | | - Domenico Gabrielli
- U.O.C. Cardiologia, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
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Structural and Functional Changes in Aging Kidneys. Int J Mol Sci 2022; 23:ijms232315435. [PMID: 36499760 PMCID: PMC9737118 DOI: 10.3390/ijms232315435] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
The renal condition is one of the crucial predictors of longevity; therefore, early diagnosis of any dysfunction plays an important role. Kidneys are highly susceptible to the aging process. Unfavorable conditions may lead to a significant disturbance of the body's homeostasis. Apart from physiological changes, there are some conditions such as hypertension, diabetes or obesity which contribute to the acceleration of the aging process. A determination of macroscopic and microscopic changes is essential for assessing the progression of aging. With age, we observe a decrease in the volume of renal parenchyma and an increase in adipose tissue in the renal sinuses. Senescence may also be manifested by the roughness of the kidney surface or simple renal cysts. The main microscopic changes are a thickening of the glomerular basement membrane, nephrosclerosis, an accumulation of extracellular matrix, and mesangial widening. The principal aspect of stopping unfavorable changes is to maintain health. Studies have shown many useful ways to mitigate renal aging. This review is focused especially on medications such as renin-angiotensin-aldosterone system blockers or resveratrol, but even eating habits and lifestyle.
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Rogula S, Gąsecka A, Mazurek T, Navarese EP, Szarpak Ł, Filipiak KJ. Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031436. [PMID: 35162472 PMCID: PMC8835601 DOI: 10.3390/ijerph19031436] [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] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/27/2022]
Abstract
The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of orally administered drugs to prevent thromboembolic events in patients with CKD who require anticoagulation: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Although VKAs remain the first-line treatment in patients with advanced CKD, treatment with VKAs is challenging due to difficulties in maintaining the appropriate anticoagulation level, tendency to accelerate vascular calcification and faster progression of CKD in patients treated with VKAs. On the other hand, the pleiotropic effect of DOACs, including vascular protection and anti-inflammatory properties along with comparable efficacy and safety of treatment with DOACs, compared to VKAs observed in preliminary reports encourages the use of DOACs in patients with CKD. This review summarizes the available data on the efficacy and safety of DOACs in patients with CKD and provides recommendations regarding the choice of the optimal drug and dosage depending on the CKD stage.
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Affiliation(s)
- Sylwester Rogula
- Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.R.); (T.M.)
| | - Aleksandra Gąsecka
- Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.R.); (T.M.)
- Correspondence:
| | - Tomasz Mazurek
- Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.R.); (T.M.)
| | - Eliano Pio Navarese
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Łukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Krzysztof J. Filipiak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland;
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Kelly JT, Su G, Zhang L, Qin X, Marshall S, González-Ortiz A, Clase CM, Campbell KL, Xu H, Carrero JJ. Modifiable Lifestyle Factors for Primary Prevention of CKD: A Systematic Review and Meta-Analysis. J Am Soc Nephrol 2021; 32:239-253. [PMID: 32868398 PMCID: PMC7894668 DOI: 10.1681/asn.2020030384] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist. METHODS To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m2). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria). RESULTS We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding. CONCLUSIONS These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.
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Affiliation(s)
- Jaimon T. Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Guobin Su
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - La Zhang
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Xindong Qin
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Skye Marshall
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia,Nutrition Research Australia, Sydney, New South Wales, Australia
| | - Ailema González-Ortiz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Catherine M. Clase
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Katrina L. Campbell
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Hong Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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7
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Go AS, Yang J, Tan TC, Cabrera CS, Stefansson BV, Greasley PJ, Ordonez JD. Contemporary rates and predictors of fast progression of chronic kidney disease in adults with and without diabetes mellitus. BMC Nephrol 2018; 19:146. [PMID: 29929484 PMCID: PMC6014002 DOI: 10.1186/s12882-018-0942-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 06/07/2018] [Indexed: 11/26/2022] Open
Abstract
Background Chronic kidney disease (CKD) is highly prevalent but identification of patients at high risk for fast CKD progression before reaching end-stage renal disease in the short-term has been challenging. Whether factors associated with fast progression vary by diabetes status is also not well understood. We examined a large community-based cohort of adults with CKD to identify predictors of fast progression during the first 2 years of follow-up in the presence or absence of diabetes mellitus. Methods Within a large integrated healthcare delivery system in northern California, we identified adults with estimated glomerular filtration rate (eGFR) 30–59 ml/min/1.73 m2 by CKD-EPI equation between 2008 and 2010 who had no previous dialysis or renal transplant, who had outpatient serum creatinine values spaced 10–14 months apart and who did not initiate renal replacement therapy, die or disenroll during the first 2 years of follow-up. Through 2012, we calculated the annual rate of change in eGFR and classified patients as fast progressors if they lost > 4 ml/min/1.73 m2 per year. We used multivariable logistic regression to identify patient characteristics that were independently associated with fast CKD progression stratified by diabetes status. Results We identified 36,195 eligible adults with eGFR 30–59 ml/min/1.73 m2 and mean age 73 years, 55% women, 11% black, 12% Asian/Pacific Islander and 36% with diabetes mellitus. During 24-month follow-up, fast progression of CKD occurred in 23.0% of patients with diabetes vs. 15.3% of patients without diabetes. Multivariable predictors of fast CKD progression that were similar by diabetes status included proteinuria, age ≥ 80 years, heart failure, anemia and higher systolic blood pressure. Age 70–79 years, prior ischemic stroke, current or former smoking and lower HDL cholesterol level were also predictive in patients without diabetes, while age 18–49 years was additionally predictive in those with diabetes. Conclusions In a large, contemporary population of adults with eGFR 30–59 ml/min/1.73 m2, accelerated progression of kidney dysfunction within 2 years affected ~ 1 in 4 patients with diabetes and ~ 1 in 7 without diabetes. Regardless of diabetes status, the strongest independent predictors of fast CKD progression included proteinuria, elevated systolic blood pressure, heart failure and anemia.
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Affiliation(s)
- Alan S Go
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA. .,Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA
| | | | | | | | - Juan D Ordonez
- Division of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Abstract
As the population worldwide ages, the epidemic of kidney disease will also increase. Anti-neutrophil cytoplasmic antibodies (ANCA) positive rapidly progressive positive glomerulonephritis (RPGN) is the most common etiology for biopsied patients among the very elderly. Its pathological features and clinical course are well described, though there is still debate about the mechanism of injury involved in individual patients. From very ancient times, the cornerstone of treatment historically has been high-dose cyclophosphamide and a lengthy course of high-dose corticosteroids. Although this regimen has diminished the immediate mortality rate of RPGN, its intermediate and long-term adverse effects are not insignificant. Attempts to minimize toxicity and improve efficacy have been made through the years to allow physicians some options for therapy. Lower cumulative cyclophosphamide regimens, shorter corticosteroid courses, and the introduction of rituximab have modified the armamentarium for treatment of ANCA positive RPGN. As progress is made in understanding the molecular pathogenesis of this disease, new targets will be found for potential therapeutic attack. The complement system is an area of active interest for all glomerular diseases at this time. Indeed, animal studies and preliminary human studies suggest that targeting the complement system can ameliorate the course of ANCA-positive RPGN. Hopefully, as the population ages, we will see more and safer therapeutic options to treat this once rapidly fatal disease.
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9
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Hybrid EANN-EA System for the Primary Estimation of Cardiometabolic Risk. J Med Syst 2016; 40:138. [DOI: 10.1007/s10916-016-0498-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
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10
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Zammit AR, Katz MJ, Derby C, Bitzer M, Lipton RB. Metabolic Syndrome and Smoking Are Associated with Future Development of Advanced Chronic Kidney Disease in Older Adults. Cardiorenal Med 2015; 6:108-15. [PMID: 26989396 DOI: 10.1159/000441624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/04/2015] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Metabolic syndrome (MetS) and smoking have been identified as risk factors for chronic kidney disease (CKD) in cross-sectional studies in various age groups, but longitudinal data on progression of CKD in older adults are limited. Our objectives were to examine whether MetS and its components and smoking predict the onset of CKD stage 3b (CKD-3b) in older adults. METHODS A subset of participants of the Einstein Aging Study who were free of diabetes, dementia, and CKD-3b at enrollment were included in this analysis. CKD-3b was defined as an estimated glomerular filtration rate <45 ml/min/1.73 m(2). Cox proportional hazards models were used in these analyses. RESULTS In total, 413 ≥70-year-old individuals were eligible for this study. 65.4% were female and 26.6% were black. 22.3% of the participants had MetS at baseline, 4.4% were active smokers, and 6.1% developed CKD-3b over a mean of 4 years of follow-up. MetS and smoking independently predicted incident CKD in our fully adjusted model (hazard ratio 3.65, 95% CI 1.20-10.60, p = 0.022; hazard ratio 29.69, 95% CI 4.47-197.23, p = 0.000). CONCLUSION MetS and smoking are associated with an increased incidence of CKD-3b. These risk factors are modifiable, easily identified and prevented through better health care practice and early diagnosis.
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Affiliation(s)
- Andrea R Zammit
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA
| | - Mindy J Katz
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA
| | - Carol Derby
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA
| | - Markus Bitzer
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich., USA
| | - Richard B Lipton
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA; Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, N.Y., USA
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Kupusinac A, Stokić E, Lečić D, Tomić-Naglić D, Srdić-Galić B. Gender-, Age-, and BMI-Specific Threshold Values of Sagittal Abdominal Diameter Obtained by Artificial Neural Networks. J Med Biol Eng 2015. [DOI: 10.1007/s40846-015-0090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Buja A, Vinelli A, Lion C, Scafato E, Baldo V. Is Moderate Alcohol Consumption a Risk Factor for Kidney Function Decline? A Systematic Review of Observational Studies. J Ren Nutr 2014; 24:224-35. [DOI: 10.1053/j.jrn.2014.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 11/11/2022] Open
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13
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Yamaguchi M, Ando M, Yamamoto R, Akiyama S, Kato S, Katsuno T, Kosugi T, Sato W, Tsuboi N, Yasuda Y, Mizuno M, Ito Y, Matsuo S, Maruyama S. Smoking is a risk factor for the progression of idiopathic membranous nephropathy. PLoS One 2014; 9:e100835. [PMID: 24964146 PMCID: PMC4071015 DOI: 10.1371/journal.pone.0100835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
Background Multiple studies have shown cigarette smoking to be a risk factor for chronic kidney disease. However, it is unknown whether smoking similarly increases the risk for progression of membranous nephropathy. Methods This study used the Nagoya Nephrotic Syndrome Cohort Study (N-NSCS), including 171 patients with idiopathic membranous nephropathy (IMN) from 10 nephrology centers in Japan. The dose-response relationships between cigarette smoking and the outcomes were assessed by using multivariate Cox proportional hazards models adjusted for clinically relevant factors. The primary outcome was a 30% decline in the estimated glomerular filtration rate (eGFR). The secondary outcome was first complete remission (CR) of proteinuria. Results During the observation period (median, 37 months; interquartile range, 16–71 months), 37 (21.6%) patients developed a 30% decline in eGFR and 2 (1.2%) progressed to ESRD. CR occurred in 103 (60.2%) patients. Multivariate Cox proportional hazards models revealed current smoking (adjusted hazard ratio [HR], 7.81 [95% confidence interval (CI), 3.17–19.7]), female sex (adjusted HR, 3.58 [95% CI, 1.87–8.00]), older age (adjusted HR, 1.71 [95% CI, 1.13–2.62] per 10 years), the number of cigarettes smoked daily (adjusted HR, 1.61 [95% CI, 1.23–2.09] per 10 cigarettes daily), and cumulative smoking of ≥40 pack-years (adjusted HR, 5.56 [95% CI, 2.17–14.6]) to be associated with a 30% decline in eGFR. However, smoking was not associated with CR. Conclusion Smoking is a significant and dose-dependent risk factor for IMN progression. All patients with IMN who smoke should be encouraged to quit.
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Affiliation(s)
- Makoto Yamaguchi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Ryohei Yamamoto
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichi Akiyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Katsuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Waichi Sato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiichi Matsuo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
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Gagat M, Grzanka D, Izdebska M, Sroka WD, Marszałł MP, Grzanka A. Tropomyosin-1 protects endothelial cell-cell junctions against cigarette smoke extract through F-actin stabilization in EA.hy926 cell line. Acta Histochem 2014; 116:606-18. [PMID: 24369881 DOI: 10.1016/j.acthis.2013.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 01/07/2023]
Abstract
The aim of the study was to estimate the effect of cigarette smoke extract (CSE) on EA.hy926 endothelial cells in culture in the context of maintenance of cell-cell junctions through the structural stabilization of the actin cytoskeleton. In the present study, F-actin was stabilized by the overexpression of tropomyosin-1, which is known to stabilize actin filaments in muscle and non-muscle cells. Our study showed that the stabilization of F-actin significantly increased the survival of cells treated with 25% CSE. In addition, after stabilization of F-actin the migratory potential of EA.hy926 cells subjected to CSE treatment was increased. Our results also showed increased fluorescence intensity of alpha- and beta-catenin after CSE treatment in cells which had stabilized F-actin. Analysis of fluorescence intensity of Zonula occludens-1 did not reveal any significant differences when EA.hy926 cells overexpressing tropomyosin-1 were compared with those lacking overexpression. It would appear that overexpression of tropomyosin-1 preserved the structure of actin filaments in the cells treated with CSE. In conclusion, the present study demonstrates that stabilization of F-actin protects EA.hy926 cells against CSE-induced loss of both adherens and tight junctions. The data presented in this study suggest that overexpression of tropomyosin-1 stabilizes the organizational structure of actin filaments and helps preserve the endothelial barrier function under conditions of strong oxidative stress.
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Affiliation(s)
- Maciej Gagat
- Department of Histology and Embryology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Dariusz Grzanka
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Immunodermatology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Magdalena Izdebska
- Department of Histology and Embryology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Wiktor Dariusz Sroka
- Department of Medicinal Chemistry, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Michał Piotr Marszałł
- Department of Medicinal Chemistry, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Alina Grzanka
- Department of Histology and Embryology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
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15
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The aging kidney revisited: a systematic review. Ageing Res Rev 2014; 14:65-80. [PMID: 24548926 DOI: 10.1016/j.arr.2014.02.003] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 01/10/2023]
Abstract
As for the whole human body, the kidney undergoes age-related changes which translate in an inexorable and progressive decline in renal function. Renal aging is a multifactorial process where gender, race and genetic background and several key-mediators such as chronic inflammation, oxidative stress, the renin-angiotensin-aldosterone (RAAS) system, impairment in kidney repair capacities and background cardiovascular disease play a significant role. Features of the aging kidney include macroscopic and microscopic changes and important functional adaptations, none of which is pathognomonic of aging. The assessment of renal function in the framework of aging is problematic and the question whether renal aging should be considered as a physiological or pathological process remains a much debated issue. Although promising dietary and pharmacological approaches have been tested to retard aging processes or renal function decline in the elderly, proper lifestyle modifications, as those applicable to the general population, currently represent the most plausible approach to maintain kidney health.
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Bu C, Zhao Y, Ma H, Han H, Yang S, Shi D, Liu Y, Fang Z, Wang Z, Ma Q, Hu B, Yang Q, Li Y, Liu R, Nie B, Zhou Y. Protective role of statins in patients with acute coronary syndrome aged ≥ 75 years with low LDL-C who underwent percutaneous coronary intervention. Angiology 2013; 65:590-5. [PMID: 23990595 DOI: 10.1177/0003319713500379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effect of statins in patients with acute coronary syndrome (ACS) at advanced age with lower low-density lipoprotein cholesterol (LDL-C) levels undergoing percutaneous coronary intervention (PCI) remains unknown. We evaluated the effect of statins in 220 Chinese patients with ACS aged ≥ 75 years with low LDL-C undergoing PCI. Biomarkers were measured before and 6 hours after PCI, and patients were followed up for 1 year. Biomarkers in the statin group at 6 hours post-PCI were lower than controls (creatine kinase-myocardial band 14.2 ± 5.78 vs 47.3 ± 16.4 IU/L, P = .03; cardiac troponin I 0.36 ± 0.12 vs 1.33 ± 0.47 ng/mL, P = .01; and high-sensitivity C-reactive protein 7.6 ± 4.3 vs 13.6 ± 4.5 mg/L, P = .001, respectively). Significant differences were found in major adverse cardiac events at 1 year (P = .02-.01), while target lesion revascularization alone was less at 3 months between the 2 groups (P = .03). This study demonstrates that elderly patients with ACS having low LDL-C benefit from statins regardless of type, dosage, and duration of statin administration prior to PCI.
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Affiliation(s)
- Congya Bu
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Hanying Ma
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Shiwei Yang
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Zhe Fang
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Qian Ma
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Qing Yang
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Yueping Li
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Ruifang Liu
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Bin Nie
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing An zhen Hospital, Capital Medical University, Beijing, China
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Athyros VG, Katsiki N, Tziomalos K, Gossios TD, Theocharidou E, Gkaliagkousi E, Anagnostis P, Pagourelias ED, Karagiannis A, Mikhailidis DP. Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study. Arch Med Sci 2013; 9:418-26. [PMID: 23847661 PMCID: PMC3701988 DOI: 10.5114/aoms.2013.35424] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly. MATERIAL AND METHODS The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on "structured care" with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on "usual care" (n = 800) followed up by specialists or general practitioners of the patient's choice outside the hospital. RESULTS In the elderly (mean age 69 ±4 and 70 ±3 years in the "structured" and "usual care", respectively) the absolute CVD event reduction between "structured" and "usual care" was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the "structured" and "usual care", respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients. CONCLUSIONS All age groups benefited from statin treatment, but the elderly on "structured care" had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to "usual care". These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.
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Affiliation(s)
- Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas D. Gossios
- First Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Eleni Theocharidou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Eygenia Gkaliagkousi
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Efstathios D. Pagourelias
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Kupusinac A, Doroslovački R, Malbaški D, Srdić B, Stokić E. A primary estimation of the cardiometabolic risk by using artificial neural networks. Comput Biol Med 2013; 43:751-7. [PMID: 23668351 DOI: 10.1016/j.compbiomed.2013.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 03/30/2013] [Accepted: 04/01/2013] [Indexed: 10/27/2022]
Abstract
Estimation of the cardiometabolic risk (CMR) has a leading role in the early prevention of atherosclerosis and cardiovascular diseases. The CMR estimation can be separated into two parts: primary estimation (PE-CMR) that includes easily-obtained, non-invasive and low-cost diagnostic methods and secondary estimation (SE-CMR) involving complex, invasive and/or expensive diagnostic methods. This paper presents a PE-CMR solution based on artificial neural networks (ANN) as it would be of great interest to develop a procedure for PE-CMR that would save time and money by extracting the persons with potentially higher CMR and conducting complete SE-CMR tests only on them. ANN inputs are values obtained by using PE-CMR methods, i.e. primary risk factors: gender, age, waist-to-height ratio, body mass index, systolic and diastolic blood pressures. ANN output is cmr-coefficient obtained from the number of disturbances in biochemical indicators, i.e. secondary risk factors: HDL-, LDL- and total cholesterol, triglycerides, glycemia, fibrinogen and uric acid. ANN training and testing are done by dataset that includes 1281 persons. The accuracy of our solution is 82.76%.
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Affiliation(s)
- Aleksandar Kupusinac
- University of Novi Sad, Faculty of Technical Sciences, Trg Dositeja Obradovića 6, 21000 Novi Sad, Serbia.
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Noborisaka Y. Smoking and chronic kidney disease in healthy populations. Nephrourol Mon 2012; 5:655-67. [PMID: 23577327 PMCID: PMC3614318 DOI: 10.5812/numonthly.3527] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/08/2011] [Accepted: 01/09/2012] [Indexed: 11/16/2022] Open
Abstract
The objective of this review is to explore the link between smoking and the development of chronic kidney disease (CKD) in generally healthy populations without pre-existing renal dysfunction such as diabetic nephropathy. Twenty-eight epidemiological studies concerning the renal effects of smoking in the general population were collected from the MEDLINE database and were reviewed for indications of proteinuria and/or the decline of glomerular filtration rate (GFR), and evaluated on the level of evidence and the quality of the study. Sixteen of the 28 studies were cross-sectional in design. Most articles had some weakness in scope, such as the 6 articles which did not fully exclude DM patients from the subjects, the 4 that did not consider the effects of ex-smoking, and the 3 that focused on only a small number of subjects. From these cases, it is difficult to draw firm conclusions. However, proteinuria or microalbuminuria was persistently high in current smokers; as much as 5-8% or 8-15% respectively, which was up to 2 to 3-times the rate of lifelong non-smokers. On the other hand, only 5 studies broader in scope detected any decline of GFR in smokers, while 9 other studies suggested a higher GFR in smokers than in non-smokers. Two good quality studies showed an even a significantly lower risk of a decreased GFR in smokers. These paradoxical CKD markers in smokers, i.e., a higher appearance of proteinuria with a higher GFR, could be a focus for further studies to reveal the underlying reasons for smoking-induced CKD. Workplaces may be an excellent place to study this subject since the long-term changes in renal function of smokers can be observed by collecting data in the annual health check-ups mandated at places of employment.
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Affiliation(s)
- Yuka Noborisaka
- Department of Social and Environmental Medicine, School of Medicine, Kanazawa Medical University, Ishikawa, Japan
- Corresponding author: Yuka Noborisaka, Department of Social and Environmental Medicine, School of Medicine, Kanazawa Medical University, 1-1 Uchinada, Ishikawa, Japan. Tel.: +76-2188101, Fax: +76-2869723, E-mail:
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Blood pressure control in Italy: analysis of clinical data from 2005-2011 surveys on hypertension. J Hypertens 2012; 30:1065-74. [PMID: 22573073 DOI: 10.1097/hjh.0b013e3283535993] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Blood pressure (BP) control is poorly achieved in hypertensive patients, worldwide. AIM We evaluated clinic BP levels and the rate of BP control in hypertensive patients included in observational studies and clinical surveys published between 2005 and 2011 in Italy. METHODS We reviewed the medical literature to identify observational studies and clinical surveys on hypertension between January 2005 and June 2011, which clearly reported information on clinic BP levels, rates of BP control, proportions of treated and untreated patients, who were followed in different clinical settings (mostly in general practice, and also in outpatient clinics and hypertension centres). RESULTS The overall sample included 158 876 hypertensive patients (94 907 women, mean age 56.6 ± 9.6 years, BMI 27.2 ± 4.2 kg/m(2), known duration of hypertension 90.2 ± 12.4 months). In the selected studies, average SBP and DBP levels were 145.7 ± 15.9 and 87.5 ± 9.7 mmHg, respectively; BP levels were higher in patients followed in hypertension centres (n = 10 724, 6.7%; 146.5 ± 17.3/88.5 ± 10.3 mmHg) than in those followed by general practitioners (n = 148 152, 93.3%; 143.5 ± 13.9/84.8 ± 8.9 mmHg; P < 0.01). More than half of the patients were treated (n = 91 318, 57.5%); among treated hypertensive patients, only 31 727 (37.0%) had controlled BP levels. CONCLUSION The present analysis confirmed inadequate control of BP in Italy, independently of the clinical setting. Although some improvement was noted compared with a similar analysis performed between 1995 and 2005, these findings highlight the need for a more effective clinical management of hypertension.
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Inrig JK, Barnhart HX, Reddan D, Patel UD, Sapp S, Califf RM, Singh AK, Szczech LA. Effect of hemoglobin target on progression of kidney disease: a secondary analysis of the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial. Am J Kidney Dis 2012; 60:390-401. [PMID: 22537421 DOI: 10.1053/j.ajkd.2012.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 03/13/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Conflicting relationships have been described between anemia correction using erythropoiesis-stimulating agents and progression of chronic kidney disease (CKD). This study was undertaken to examine the impact of target hemoglobin level on progression of kidney disease in the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial. STUDY DESIGN Secondary analysis of a randomized controlled trial. SETTING & PARTICIPANTS 1,432 participants with CKD and anemia. INTERVENTION Participants were randomly assigned to target hemoglobin levels of 13.5 versus 11.3 g/dL with the use of epoetin alfa. OUTCOMES & MEASUREMENTS Cox regression was used to estimate HRs for progression of CKD (a composite of doubling of creatinine level, initiation of renal replacement therapy, or death). Interactions between hemoglobin target and select baseline variables (estimated glomerular filtration rate, proteinuria, diabetes, heart failure, and smoking history) also were examined. RESULTS Participants randomly assigned to higher hemoglobin targets experienced shorter time to progression of kidney disease in both univariate (HR, 1.25; 95% CI, 1.03-1.52; P = 0.02) and multivariable models (HR, 1.22; 95% CI, 1.00-1.48; P = 0.05). These differences were attributable to higher rates of renal replacement therapy and death for participants in the high hemoglobin arm. Hemoglobin target did not interact with estimated glomerular filtration rate, proteinuria, diabetes, or heart failure (P > 0.05 for all). In the multivariable model, hemoglobin target interacted with tobacco use (P = 0.04) such that the higher target had a greater risk of CKD progression for participants who currently smoked (HR, 2.50; 95% CI, 1.23-5.09; P = 0.01), which was not present for those who did not currently smoke (HR, 1.15; 95% CI, 0.93-1.41; P = 0.2). LIMITATIONS A post hoc analysis; thus, cause and effect cannot be determined. CONCLUSIONS These results suggest that a high hemoglobin target is associated with a greater risk of progression of CKD. This risk may be augmented by concurrent smoking. Further defining the mechanism of injury may provide insight into methods to optimize outcomes in anemia management.
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Affiliation(s)
- Jula K Inrig
- Renal Division, University of Texas Southwestern, Dallas, TX 75390-8523, USA.
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Abstract
Hypertension is the most-prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide. Hypertension is highly prevalent among older adults (≥65 years), and aging of the population will substantially increase the prevalence of this condition. Age-related endothelial dysfunction and increased arterial stiffness contribute to the increased prevalence of hypertension, particularly systolic hypertension, among the elderly. The incidence of some forms of secondary hypertension also increases with age, mainly owing to the use of drugs (especially NSAIDs that have pressor effects) and the presence of chronic kidney disease, obstructive sleep apnea, and renal artery stenosis. Guidelines differ in thresholds and goals for antihypertensive drug therapy in the elderly because of a paucity of high-level evidence from randomized controlled trials and inconsistencies in the definition of 'elderly'. Medical treatment of hypertension reduces cardiovascular morbidity and mortality in the elderly, and all guidelines recommend lifestyle modifications and medical treatment for elderly patients whose blood pressure exceeds prescribed thresholds and who are at moderate or high cardiovascular disease risk. In the absence of comorbidities, which constitute 'compelling indications' for the use of specific antihypertensive drugs or drug classes, no clear evidence exists to support recommendations for the use of particular antihypertensive-drug classes in older adults.
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Bomback AS, Herlitz LC, Markowitz GS. Renal biopsy in the elderly and very elderly: useful or not? Adv Chronic Kidney Dis 2012; 19:61-7. [PMID: 22449342 DOI: 10.1053/j.ackd.2011.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/02/2011] [Accepted: 09/04/2011] [Indexed: 11/11/2022]
Abstract
Longer life expectancy has led to a growing epidemic of kidney disease in the elderly (aged ≥ 65 years) and very elderly (aged ≥ 80 years). While much of the rising burden of kidney disease in these age-groups can be attributed to age-associated decline and a high prevalence of comorbidities such as hypertension and diabetes mellitus, a significant proportion of kidney disease is due to potentially reversible causes of injury in the glomerular, tubulointerstitial, and vascular compartments. A renal biopsy is crucial not only to diagnose such potentially reversible lesions but also to provide prognostic information and guide therapeutic decisions. In this review, we survey the literature on renal biopsy in the elderly and very elderly, focusing on the utility and safety of this procedure. We report the most common histopathologic findings in these age-groups and demonstrate that many of these lesions are associated with diseases that respond to appropriate therapies, regardless of age. We conclude that, in a variety of commonly encountered clinical situations, a renal biopsy is crucial for appropriate management of elderly and very elderly patients with kidney disease.
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Nagasawa Y, Yamamoto R, Rakugi H, Isaka Y. Cigarette smoking and chronic kidney diseases. Hypertens Res 2011; 35:261-5. [DOI: 10.1038/hr.2011.205] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann Forciea M, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner TJ, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Stein JH, Weitz HH, Wesley DJ. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. ACTA ACUST UNITED AC 2011; 5:259-352. [PMID: 21771565 DOI: 10.1016/j.jash.2011.06.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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Hallan SI, Orth SR. Smoking is a risk factor in the progression to kidney failure. Kidney Int 2011; 80:516-23. [DOI: 10.1038/ki.2011.157] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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27
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Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Forciea MA, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ. ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly. Circulation 2011; 123:2434-506. [PMID: 21518977 DOI: 10.1161/cir.0b013e31821daaf6] [Citation(s) in RCA: 254] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Carl J. Pepine
- American College of Cardiology Foundation Representative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Deborah J. Wesley
- ACCF Task Force on Clinical Expert Consensus Documents Representative. Authors with no symbol by their name were included to provide additional content expertise apart from organizational representation
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28
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Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann Forciea M, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol 2011; 57:2037-114. [PMID: 21524875 DOI: 10.1016/j.jacc.2011.01.008] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Affiliation(s)
- John M Starr
- Geriatric Medicine, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
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Kalil AC, Mattei J, Florescu DF, Sun J, Kalil RS. Recommendations for the assessment and reporting of multivariable logistic regression in transplantation literature. Am J Transplant 2010; 10:1686-94. [PMID: 20642690 PMCID: PMC2909008 DOI: 10.1111/j.1600-6143.2010.03141.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multivariable logistic regression is an important method to evaluate risk factors and prognosis in solid organ transplant literature. We aimed to assess the quality of this method in six major transplantation journals. Eleven analytical criteria and four documentation criteria were analyzed for each selected article that used logistic regression. A total of 106 studies (6%) out of 1,701 original articles used logistic regression analyses from January 1, 2005 to January 1, 2006. The analytical criteria and their respective reporting percentage among the six journals were: Linearity (25%); Beta coefficient (48%); Interaction tests (19%); Main estimates (98%); Ovefitting prevention (84%); Goodness-of-fit (3.8%); Multicolinearity (4.7%); Internal validation (3.8%); External validation (8.5%). The documentation criteria were reported as follows: Selection of independent variables (73%); Coding of variables (9%); Fitting procedures (49%); Statistical program (65%). No significant differences were found among different journals or between general versus subspecialty journals with respect to reporting quality. We found that the report of logistic regression is unsatisfactory in transplantation journals. Because our findings may have major consequences for the care of transplant patients and for the design of transplant clinical trials, we recommend a practical solution for the use and reporting of logistic regression in transplantation journals.
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Affiliation(s)
- Andre C. Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Jane Mattei
- Hospital Nossa Senhora da Conceicao, Porto Alegre, Brazil
| | - Diana F. Florescu
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD
| | - Roberto S. Kalil
- Nephrology Division, University of Iowa Hospitals and Clinics, Iowa City, IA
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Yamamoto R, Nagasawa Y, Shoji T, Iwatani H, Hamano T, Kawada N, Inoue K, Uehata T, Kaneko T, Okada N, Moriyama T, Horio M, Yamauchi A, Tsubakihara Y, Imai E, Rakugi H, Isaka Y. Cigarette smoking and progression of IgA nephropathy. Am J Kidney Dis 2010; 56:313-24. [PMID: 20471735 DOI: 10.1053/j.ajkd.2010.02.351] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/25/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multiple community-based cohort studies of mainly middle-aged and elderly populations have shown that cigarette smoking is a risk factor for chronic kidney disease. However, little information is available about an effect of cigarette smoking on progression of primary kidney diseases, including immunoglobulin A (IgA) nephropathy. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 971 of 1,001 patients with a diagnosis of IgA nephropathy in 3 major nephrology centers in Osaka, Japan, between 1992 and 2005 who enrolled in the Study of Outcome and Practice Pattern of IgA Nephropathy (STOP-IgAN). PREDICTORS Smoking status and number of cigarettes smoked at the time of diagnosis using kidney biopsy. Dose-dependent associations between cigarette smoking and outcomes were assessed in multivariate Cox proportional hazards models. Significantly different clinical characteristics between non-/past and current smokers were controlled for using propensity score-based adjustment, stratification, and matching. OUTCOMES 50% increase in serum creatinine level as primary outcome. A composite outcome of a 100% increase in serum creatinine level or end-stage renal disease (ESRD) and ESRD alone as secondary outcomes. RESULTS During the median 5.8 years (interquartile range, 2.6-10.2) of the observational period, 117 participants progressed to a 50% increase in serum creatinine level and 47 advanced to ESRD. Multivariate Cox proportional hazards models identified current smokers (HR, 2.03 [95% CI, 1.33-3.10] for primary outcome) and number of cigarettes at kidney biopsy (HR, 1.21 [95% CI, 1.06-1.39] per 10 cigarettes per day) as significant predictors of outcomes. Propensity score-based models confirmed these results. Tests for interaction showed that the association of current smoking with adverse outcomes was stronger in those with lower compared with higher estimated glomerular filtration rates. LIMITATION Baseline smoking status was not verified using biochemical tests. Smoking status during the observational period was unavailable. CONCLUSIONS Cigarette smoking, in a dose-dependent manner, was identified as a key prognostic factor in IgA nephropathy. Smoking cessation should be encouraged as part of the treatment for IgA nephropathy.
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Affiliation(s)
- Ryohei Yamamoto
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Schaeffner ES, van der Giet M, Gaedeke J, Tölle M, Ebert N, Kuhlmann MK, Martus P. The Berlin initiative study: the methodology of exploring kidney function in the elderly by combining a longitudinal and cross-sectional approach. Eur J Epidemiol 2010; 25:203-10. [DOI: 10.1007/s10654-010-9424-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 01/06/2010] [Indexed: 01/10/2023]
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Schlanger LE, Bailey JL, Sands JM. Geriatric Nephrology: Old or New Subspecialty. Clin Geriatr Med 2009; 25:311-24. [DOI: 10.1016/j.cger.2009.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kronborg J, Solbu M, Njølstad I, Toft I, Eriksen BO, Jenssen T. Predictors of change in estimated GFR: a population-based 7-year follow-up from the Tromso study. Nephrol Dial Transplant 2008; 23:2818-26. [PMID: 18400822 DOI: 10.1093/ndt/gfn148] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with increased cardiovascular mortality, and even mild impairment of renal function is a cardiovascular risk factor. Several studies have investigated the risk factors for the development of end-stage renal disease, but little is known about predictors of change in renal function in the general population. METHODS The present study included 2249 men and 2192 women without signs of kidney disease at baseline who were followed for 7 years from 1994 to 1995 in the Tromsø Study. Estimated glomerular filtration rate (eGFR) was calculated from the Modification of Diet in Renal Disease study equation. Gender-specific multiple linear regression analyses were used to assess predictors of change in eGFR (DeltaGFR). RESULTS Change in eGFR, measured in ml/min/1.73 m(2)/year, was associated with systolic blood pressure (SBP) [beta-value for a 10-mmHg increase in SBP, men = -0.14, 95% confidence interval (CI) = -0.18 to -0.09; women = -0.07, 95% CI = -0.11 to -0.03] and fibrinogen [beta-value for 1 SD increase in fibrinogen, men (1 SD: 0.85 g/L) = -0.12, 95% CI -0.20 to -0.03; women (1 SD: 0.80) = -0.11, 95% CI -0.20 to -0.02]. High alcohol consumption in men and high physical activity in women predicted an increase in eGFR. Higher albumin/creatinine ratio was associated with a decline in eGFR in men only. CONCLUSIONS Some risk factors for change in GFR seem to be gender specific but both high SBP and high levels of fibrinogen contribute to a more rapid decline in GFR for both men and women.
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Affiliation(s)
- Jens Kronborg
- Department of Internal Medicine, Innlandet Hospital Trust, Olav Aukrustsvej 6 N-2618, Lillehammer, Norway.
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Mitsutake R, Miura SI, Shiga Y, Kawamura A, Saku K. Is chronic kidney disease associated with coronary artery stenosis or calcification as assessed by multi-detector row computed tomography? Intern Med 2008; 47:1835-41. [PMID: 18981625 DOI: 10.2169/internalmedicine.47.1250] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The coronary artery calcification (CAC) score as determined by multi-detector row computed tomography (MDCT) is known to predict coronary artery disease (CAD). Chronic kidney disease (CKD) is also known to be a risk factor for CAD. Little is known about the relationship between CKD and the severity of coronary artery stenosis or CAC as determined by MDCT, a non-invasive method for screening. METHODS AND RESULTS The subjects included 313 consecutive patients who underwent MDCT angiography. We quantified the number of significantly stenosed vessels in coronary vessel disease (VD) and CAC score using MDCT and measured body mass index (BMI), waist circumference and blood pressure. We also analyzed plasma levels of lipid profile, hemoglobin A1c, uric acid, and creatinine. Furthermore, we calculated the estimated glomerular filtration rate (eGFR), and defined CKD as GFR <60 mL/min/1.73 m(2). eGFR levels in the 3-VD group were significantly lower than those in patients without stenosed vessels. In the two classifications that were based on the CAC score [low (L, 0-444) and high (H, >or=445)] in our previous report, the H group was significantly associated with age, number of VD, incidence of hypertension and CKD. Multivariate logistic regression analysis revealed that the high CAC score group was significantly correlated with age (p=0.0023), CKD (p=0.0109) and number of VD (p=0.0470). CONCLUSION CKD may contribute to the severity of CAD associated with the progression of CAC. Therefore, therapeutic intervention for CKD, in addition to the improvement of conventional risk factors, is needed to prevent CAD when MDCT is performed.
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Affiliation(s)
- Ryoko Mitsutake
- Department of Cardiology, Fukuoka University School of Medicine
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Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients--absence of evidence or evidence of absence? Clin J Am Soc Nephrol 2007; 3:226-36. [PMID: 18003763 DOI: 10.2215/cjn.03740907] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although it is beyond any doubt that smoking is the number one preventable cause of death in most countries, smoking as an independent progression factor in renal disease has been questioned against the background of evidence-based criteria. This is because information from large, randomized, prospective studies that investigate the effects of smoking on renal function in healthy individuals as well as in patients with primary or secondary renal disease are lacking. Since 2003, a substantial number of clinical and experimental data concerning the adverse renal effects of smoking have been published, including large, prospective, population-based, observational studies. These more recent data together with evidence from experimental studies clearly indicate that smoking is a relevant risk factor, conferring a substantial increase in risk for renal function deterioration. This review summarizes the present knowledge about the renal risks of smoking as well as the increased cardiovascular risk caused by smoking in patients with chronic kidney disease. The conclusion is that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.
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Covic A, Gusbeth-Tatomir P, Goldsmith DJA. The epidemics of cardiovascular disease in elderly patients with chronic kidney disease--two facets of the same problem. Int Urol Nephrol 2007; 38:371-9. [PMID: 16868714 DOI: 10.1007/s11255-006-0044-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2005] [Indexed: 10/24/2022]
Abstract
There is increasing evidence that even mild renal dysfunction is a novel potent cardiovascular risk factor in the general elderly population. With more severe renal impairment, cardiovascular risk increases proportionately. This issue deserves attention, as chronic kidney disease (CKD) is predominantly a disease of the elderly, and the mean age of end-stage renal disease patients entering dialysis is growing constantly. In the dialysis population, when clinically significant cardiovascular disease (CVD) (particularly congestive heart failure) is present, survival is worse. Thus, every effort should be made to identify and treat cardiovascular risk factor in the early stages of CKD. However, elderly renal patients receive less proper cardiovascular therapy compared to non-renal subjects of the same age. This review deals briefly with the most significant data published in the last decade on CVD in elderly with CKD.
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Affiliation(s)
- Adrian Covic
- Nephrology Clinic and Dialysis and Transplantation Center, C. I. PARHON University Hospital, 6600, Iasi, Romania.
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Abstract
The kidney could be the cause of essential hypertension which can also cause renal disease. High blood pressure is also very common in chronic kidney disease, and is moreover a well-known risk factor for a faster progression of kidney failure. Hypertension and kidneys are thus closely linked. Hypertension must be aggressively treated in patients suffering from chronic kidney disease, with a blood pressure goal of less than 130/80 mmHg, even lower than 125/75 mmHg when proteinuria is over 1g/day, using optimal and effective antihypertensive drugs. Among them, the blockers of the renin-angiotensin axis offer nephroprotective but also cardioprotective properties beyond their effect on blood pressure.
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Affiliation(s)
- J M Krzesinski
- Division of Nephrology/Transplantation, University of Liège, Sart Titman B35, Belgium.
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40
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Nakamura K, Okamura T, Hayakawa T, Kadowaki T, Kita Y, Ohnishi H, Saitoh S, Sakata K, Okayama A, Ueshima H. Chronic Kidney Disease is a Risk Factor for Cardiovascular Death in a Community-Based Population in Japan NIPPON DATA90. Circ J 2006; 70:954-9. [PMID: 16864924 DOI: 10.1253/circj.70.954] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) has been identified as a risk factor for cardiovascular disease (CVD). METHODS AND RESULTS The risk of cardiovascular death was evaluated in a large cohort of participants selected randomly from the overall Japanese population. Participants (mean age, 52.4 years) free of previous CVD were followed up for 10 years. Glomerular filtration rate (GFR) was estimated using the abbreviated equation developed at the Cleveland Clinic laboratory for the Modification of Diet in Renal Disease study. Of the 7,316 participants, 6.7% had CKD with a GFR<60 at baseline. Even after adjustment for other risk factors, the presence of CKD conferred an increased risk of cardiovascular death with a hazard ratio of 1.20 (95% confidence interval, 0.82-1.76). Furthermore, a negative, graded correlation between GFR and risk of cardiovascular death was observed: 1.09 (0.72-1.64) for a 60<or=GFR<90, 1.15 (0.67-1.99) for a 45<or=GFR<60, 1.23 (0.49-3.09) for a 30<or=GFR<45, 5.52 (1.62-18.75) for a 15<or=GFR<30, 9.12 (2.12-39.29) for a GFR<15, as compared with normal kidney function (GFR>or=90). The proportion of excess cardiovascular death due to CKD was 1.3%. CONCLUSION CKD was an independent risk factor for cardiovascular death in a community-dwelling Japanese population.
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Affiliation(s)
- Koshi Nakamura
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
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Fliser D. Ren sanus in corpore sano: the myth of the inexorable decline of renal function with senescence. Nephrol Dial Transplant 2005; 20:482-5. [PMID: 15735239 DOI: 10.1093/ndt/gfh710] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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