1
|
Full KM, Shi H, Lipworth L, Dauer LT, Mumma MT, Xiao Q. Associations of Long-term Sleep Duration Trajectories with Overall and Cause-Specific Mortality Among Middle-to-older Aged Black and White Adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.23.24307845. [PMID: 38826310 PMCID: PMC11142262 DOI: 10.1101/2024.05.23.24307845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Both short and long sleep durations are adversely associated with numerous chronic conditions, including cardiovascular disease (CVD), diabetes, hypertension, and mortality. The American Academy of Sleep Medicine recommends adults in the United States sleep at least 7 hours and less than 9 hours per night to maintain optimal health. It remains unclear how sleep duration trajectories over time are associated with mortality. Methods This observational cohort study includes 46,928 Black and White adults (mean age: 53 ± 9 years) who enrolled in the Southern Community Cohort Study between 2002-2009 and completed a follow-up survey in 2008-2013. Participants were categorized into nine sleep duration trajectory categories based on the reported average sleep duration between study enrollment and at follow-up. Participant vital status and date and cause of death were ascertained via linkage to the National Death Index through 2022. Cox regression analysis was performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between sleep duration trajectory and all-cause and cause-specific mortality (CVD, cancer, and neurodegenerative disease) after adjustment for sociodemographic characteristics, health behaviors, and clinical factors. Results During a median 12.6 years of follow-up, we documented 13,579 deaths, including 4,135 from CVD, 3,067 from cancer, and 544 from neurodegenerative diseases. Compared to the optimal sleep duration trajectory (maintaining 7-9 hours), all sub-optimal trajectories were associated with significant 6 to 33% greater risk of all-cause mortality in fully adjusted models. Compared to the optimal sleep trajectory, three of the sub-optimal trajectories were associated with increased CVD mortality, with HRs ranging from 1.20 to 1.34. The short-long trajectory was associated with the greatest risk of all-cause mortality (HR:1.33; 95%CI: 1.21, 1.46) and the long-short trajectory was associated with the greatest CVD mortality risk (HR:1.34; 95%CI: 1.10, 1.65). The healthy-long trajectory was associated with the greatest risk of cancer mortality (HR: 1.19; 95%CI:1.00, 1.41). None of the sub-optimal trajectories was associated with neurodegenerative disease mortality. Conclusions Suboptimal sleep duration trajectories were associated with increased risk of all-cause mortality as well as CVD mortality. Findings highlight the importance of maintaining healthy sleep duration throughout midlife to reduce mortality risk.
Collapse
|
2
|
Li R, Prastein DJ, Choi BG. Socioeconomic disparity in transcatheter and surgical aortic valve replacement: a population study of National Inpatient Sample from 2015 to 2020. Sci Rep 2024; 14:11762. [PMID: 38783030 PMCID: PMC11116551 DOI: 10.1038/s41598-024-62797-3] [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: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS). This study conducted a population-based analysis to assess the influence of SES on valve replacement outcomes. Patients with AS undergoing TAVR or SAVR were identified in National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients living in neighborhoods of income at the lowest and highest quartiles. Of 613,785 AS patients, 9.77% underwent TAVR and 10.13% had SAVR. These rates decline with lower neighborhood income levels, with TAVR/SAVR ratio also declining in lower-income areas. Excluding concomitant procedures, 58,064 patients received isolated TAVR (12,355 low-income and 15,212 high-income) and 43,694 underwent isolated SAVR (10,029 low-income and 10,811 high-income). Low-income patients, in both TAVR and SAVR, were younger but had more comorbid burden. For isolated TAVR, outcomes were similar across income groups. However, for isolated SAVR, low-income patients experienced higher in-hospital mortality (aOR = 1.44, p < 0.01), pulmonary (aOR = 1.13, p = 0.01), and renal complications (aOR = 1.14, p < 0.01). They also had more transfers, longer waits for operations, and extended hospital stays. Lower-income communities had reduced access to TAVR and SAVR, with TAVR accessibility being particularly limited. When given access to TAVR, patients from lower-income neighborhoods had mostly comparable outcomes. However, patients from low-income communities faced worse outcomes in SAVR, possibly due to delays in treatment. Ensuring equitable specialized healthcare resources including expanding TAVR access in economically disadvantaged communities is crucial.
Collapse
Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
| | - Deyanira J Prastein
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Brian G Choi
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| |
Collapse
|
3
|
Abdallah N, Mohamoud A, Linzer M, Johnson D, Abdallah M, Karim R. Relationships between socioeconomic status and cardiovascular outcomes in patients with complete heart block. Heart Rhythm 2024:S1547-5271(24)02567-0. [PMID: 38759917 DOI: 10.1016/j.hrthm.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Literature illustrates an association between adverse outcomes and lower socioeconomic status (SES) in patients with critical cardiovascular presentations; however. limited data exist on complete heart block (CHB) outcomes in the context of SES. OBJECTIVES The purpose of this study was to assess the association of SES (using zip code income quartiles) with the outcomes of CHB cases. METHODS We queried the 2016-2019 Nationwide Inpatient Sample and identified CHB as the primary diagnosis. We compared in-hospital outcomes based on zip code mean income quartiles (≤2 [< $59,000] vs ≥3). The primary outcome was mortality. Secondary outcomes included total and early permanent pacemaker (PPM) and temporary pacemaker (TPM) use, cardiogenic shock, palliative care involvement, mechanical ventilation use, length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. RESULTS Of 150,265 CHB hospitalizations, 76,635 (51%) involved patients with a lower income quartile. Lower quartiles were associated with lower odds of early PPM use (adjusted odds ratio [aOR] 0.86; 95% confidence interval [CI] 0.81-0.90) and higher odds of in-hospital mortality (aOR 1.23; 95% CI 1.05-1.46), total TPM use (aOR 1.08; 95% CI 1.02-1.14), palliative care (aOR 1.2; 95% CI 1.02-1.43), mechanical ventilation use (aOR 1.11; 95% CI 1.01-1.23), cardiogenic shock (aOR 1.15; 95% CI 1.01-1.31), and longer LOS (4 days vs 3.6 days; P <.001) compared to patients in higher quartiles. CONCLUSION Patients with lower income admitted for CHB were less likely to receive an early PPM and had higher adverse outcomes compared to patients with higher income.
Collapse
Affiliation(s)
- Nadhem Abdallah
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota.
| | | | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | | | | | - Rehan Karim
- Cardiology Division, Hennepin Healthcare, Minneapolis, Minnesota
| |
Collapse
|
4
|
Lee P, Kouba J, Jimenez EY, Kramer H. Medical Nutrition Therapy for Chronic Kidney Disease: Low Access and Utilization. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:508-516. [PMID: 38453267 DOI: 10.1053/j.akdh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024]
Abstract
CKD affects approximately half of US adults aged 65 years and older and accounts for almost 1 out of every 4 dollars of total Medicare fee-for-service spending. Efforts to prevent or slow CKD progression are urgently needed to reduce the incidence of kidney failure and reduce health care expenditures. Current CKD care guidelines recommend medical nutrition therapy (MNT), a personalized, evidence-based application of the Nutrition Care Process (assessment, intervention, diagnosis, and monitoring and evaluation) provided by registered dietitian nutritionists (RDNs) to help slow CKD progression, improve quality of life, and delay kidney failure. MNT is covered by Medicare Part B and most private insurances with no cost sharing. Despite recommendations that patients with CKD receive MNT and insurance coverage for MNT, utilization remains low. This article demonstrates low utilization of MNT and inadequate numbers of RDNs and RDNs who are board certified in renal nutrition relative to the estimated number of Medicare eligible adults with self-reported diagnosed CKD by state, with noted disparities across states. We discuss interventions to increase MNT utilization, such as improving MNT reimbursement, augmenting accessibility of RDNs via telenutrition services and increasing health care provider promotion of MNT and referral to MNT to optimize CKD outcomes.
Collapse
Affiliation(s)
- Promise Lee
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Joanne Kouba
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM and Academy of Nutrition and Dietetics, Chicago, IL
| | - Holly Kramer
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
| |
Collapse
|
5
|
Pell J, Nagata S, Menon MC. Nonpodocyte Roles of APOL1 Variants: An Evolving Paradigm. KIDNEY360 2023; 4:e1325-e1331. [PMID: 37461136 PMCID: PMC10550003 DOI: 10.34067/kid.0000000000000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Since the seminal discovery of the trypanolytic, exonic variants in apolipoprotein L1 (APOL1) and their association with kidney disease in individuals of recent African ancestry, a wide body of research has emerged offering key insights into the mechanisms of disease. Importantly, the podocyte has become a focal point for our understanding of how risk genotype leads to disease, with activation of putative signaling pathways within the podocyte identified as playing a causal role in podocytopathy, FSGS, and progressive renal failure. However, the complete mechanism of genotype-to-phenotype progression remains incompletely understood in APOL1-risk individuals. An emerging body of evidence reports more than podocyte-intrinsic expression of APOL1 risk variants is needed for disease to manifest. This article reviews the seminal data and reports which placed the podocyte at the center of our understanding of APOL1-FSGS, as well as the evident shortcomings of this podocentric paradigm. We examine existing evidence for environmental and genetic factors that may influence disease, drawing from both clinical data and APOL1's fundamental role as an immune response gene. We also review the current body of data for APOL1's impact on nonpodocyte cells, including endothelial cells, the placenta, and immune cells in both a transplant and native setting. Finally, we discuss the implications of these emerging data and how the paradigm of disease might evolve as a result.
Collapse
Affiliation(s)
- John Pell
- Department of Medicine , Yale University, New Haven , Connecticut
| | | | | |
Collapse
|
6
|
Davis RA, Branagan T, Schneck CD, Schold JD, Thant T, Kaplan B. Lithium and the living kidney donor: Science or stigma? Am J Transplant 2023; 23:1300-1306. [PMID: 37236400 DOI: 10.1016/j.ajt.2023.05.022] [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: 04/29/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Nearly 10 000 people are removed from the kidney transplant waiting list each year either due to becoming too ill for transplant or due to death. Live donor kidney transplant (LDKT) provides superior outcomes and survival benefit relative to deceased donor transplant, but the number of LDKT has decreased over the past few years. Therefore, it is of paramount importance that transplant centers employ evaluation processes that safely maximize LDKT. Decisions about donor candidacy should be based on the best available data, rather than on processes prone to bias. Here, we examine the common practice of declining potential donors based solely on treatment with lithium. We conclude that the risk of end-stage renal disease related to lithium treatment is comparable to other generally accepted risks in LDKT. We present this viewpoint to specifically challenge the carte blanche exclusion of individuals taking lithium and highlight the importance of using the best available data relevant to any risk factor, rather than relying on biases, when evaluating potential living kidney donors.
Collapse
Affiliation(s)
- Rachel A Davis
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA.
| | - Tyler Branagan
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Thida Thant
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Bruce Kaplan
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education, Aurora, Colorado, USA; Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
7
|
Hundemer GL, Ravani P, Sood MM, Zimmerman D, Molnar AO, Moorman D, Oliver MJ, White C, Hiremath S, Akbari A. Social determinants of health and the transition from advanced chronic kidney disease to kidney failure. Nephrol Dial Transplant 2023; 38:1682-1690. [PMID: 36316015 PMCID: PMC10310519 DOI: 10.1093/ndt/gfac302] [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: 07/31/2022] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The transition from chronic kidney disease (CKD) to kidney failure is a vulnerable time for patients, with suboptimal transitions associated with increased morbidity and mortality. Whether social determinants of health are associated with suboptimal transitions is not well understood. METHODS This retrospective cohort study included 1070 patients with advanced CKD who were referred to the Ottawa Hospital Multi-Care Kidney Clinic and developed kidney failure (dialysis or kidney transplantation) between 2010 and 2021. Social determinant information, including education level, employment status and marital status, was collected under routine clinic protocol. Outcomes surrounding suboptimal transition included inpatient (versus outpatient) dialysis starts, pre-emptive (versus delayed) access creation and pre-emptive kidney transplantation. We examined the association between social determinants of health and suboptimal transition outcomes using multivariable logistic regression. RESULTS The mean age and estimated glomerular filtration rate were 63 years and 18 ml/min/1.73 m2, respectively. Not having a high school degree was associated with higher odds for an inpatient dialysis start compared with having a college degree {odds ratio [OR] 1.71 [95% confidence interval (CI) 1.09-2.69]}. Unemployment was associated with higher odds for an inpatient dialysis start [OR 1.85 (95% CI 1.18-2.92)], lower odds for pre-emptive access creation [OR 0.53 (95% CI 0.34-0.82)] and lower odds for pre-emptive kidney transplantation [OR 0.48 (95% CI 0.24-0.96)] compared with active employment. Being single was associated with higher odds for an inpatient dialysis start [OR 1.44 (95% CI 1.07-1.93)] and lower odds for pre-emptive access creation [OR 0.67 (95% CI 0.50-0.89)] compared with being married. CONCLUSIONS Social determinants of health, including education, employment and marital status, are associated with suboptimal transitions from CKD to kidney failure.
Collapse
Affiliation(s)
- Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Pietro Ravani
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Danielle Moorman
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Christine White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
8
|
Shimada S, Hoffmann BR, Yang C, Kurth T, Greene AS, Liang M, Dash RK, Cowley AW. Metabolic Responses of Normal Rat Kidneys to a High Salt Intake. FUNCTION 2023; 4:zqad031. [PMID: 37575482 PMCID: PMC10413938 DOI: 10.1093/function/zqad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 08/15/2023] Open
Abstract
In this study, novel methods were developed, which allowed continuous (24/7) measurement of arterial blood pressure and renal blood flow in freely moving rats and the intermittent collection of arterial and renal venous blood to estimate kidney metabolic fluxes of O2 and metabolites. Specifically, the study determined the effects of a high salt (HS; 4.0% NaCl) diet upon whole kidney O2 consumption and arterial and renal venous plasma metabolomic profiles of normal Sprague-Dawley rats. A separate group of rats was studied to determine changes in the cortex and outer medulla tissue metabolomic and mRNAseq profiles before and following the switch from a 0.4% to 4.0% NaCl diet. In addition, targeted mRNA expression analysis of cortical segments was performed. Significant changes in the metabolomic and transcriptomic profiles occurred with feeding of the HS diet. A progressive increase of kidney O2 consumption was found despite a reduction in expression of most of the mRNA encoding enzymes of TCA cycle. A novel finding was the increased expression of glycolysis-related genes in Cx and isolated proximal tubular segments in response to an HS diet, consistent with increased release of pyruvate and lactate from the kidney to the renal venous blood. Data suggests that aerobic glycolysis (eg, Warburg effect) may contribute to energy production under these circumstances. The study provides evidence that kidney metabolism responds to an HS diet enabling enhanced energy production while protecting from oxidative stress and injury. Metabolomic and transcriptomic analysis of kidneys of Sprague-Dawley rats fed a high salt diet.
Collapse
Affiliation(s)
- Satoshi Shimada
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Brian R Hoffmann
- Mass Spectrometry and Protein Chemistry, Protein Sciences, The Jackson Laboratory, Bar Harbor, ME 04609, USA
| | - Chun Yang
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Theresa Kurth
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Andrew S Greene
- Mass Spectrometry and Protein Chemistry, Protein Sciences, The Jackson Laboratory, Bar Harbor, ME 04609, USA
| | - Mingyu Liang
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ranjan K Dash
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin and Marquette University, Milwaukee, WI 53226, USA
| | - Allen W Cowley
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| |
Collapse
|
9
|
Kirksey L, Sorour AA, Duson S, Osman MF, Downing LJ, Ayman A, Rowe V. Racial Diversity and Black Vascular Surgeons in Vascular Surgery Workforce. J Vasc Surg 2023; 77:1322-1329. [PMID: 36791895 DOI: 10.1016/j.jvs.2023.01.211] [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: 07/26/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The precise number of actively practicing vascular surgeons who self-identify as Black and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data has been collected and maintained at the societal or national board level. Vascular Surgery Societal reports suggest that less than 2% of vascular surgeons identify as Black. Blacks make up 13.4% of the American population yet for disorders such as peripheral arterial disease and end stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age adjusted basis. Significant body of research showed that clinical outcomes like medication adherence, shared decision making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black vascular surgeons. METHODS A cross sectional survey was conducted via a questionnaire sent to all participants of a Society of Black Vascular Surgeons (SBVS) that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics and professional society engagement. RESULTS Fifty-nine percent of the SBVS members completed the survey. Males compromised 81% of the responding vascular surgeons. The majority (62%) of respondents are involved in academic practice. Less than 25% percent of the total medical staff was Black in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%) and American Indian and Alaskan Natives (0.4%). Forty three percent of respondents have a current active membership in the Society of Vascular Surgery and 24% have regional society membership. Fifty-eight percent of respondents reported that they experienced workplace event that they felt were racially or ethically driven in the 12 months prior to the survey. CONCLUSION This survey describes an underrepresented in medicine (URM) vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty, and to develop benchmark goals of race composition that mirrors our society at large. In this group of Black vascular surgeons, their patients were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.
Collapse
Affiliation(s)
- Levester Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Walter W. Buckley Endowed Chair, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH.
| | - Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sira Duson
- University of Maryland School of Medicine, Department of Vascular Surgery, Baltimore, MD
| | - Mohamed F Osman
- University of Toledo, Department of Vascular Surgery, Toledo, OH
| | | | - Ahmad Ayman
- University of Toledo, Department of Vascular Surgery, Toledo, OH
| | - Vincent Rowe
- Carilion New River Valley Medical Center, Carilion Clinic, VA
| |
Collapse
|
10
|
Shimada S, Hoffmann BR, Yang C, Kurth T, Greene AS, Liang M, Dash RK, Cowley AW. Metabolic responses of normal rat kidneys to a high salt intake. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.18.524636. [PMID: 36711564 PMCID: PMC9882299 DOI: 10.1101/2023.01.18.524636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the present study, novel methods were developed which allowed continuous (24/7) measurement of blood pressure (BP) and renal blood flow (RBF) in freely moving rats and the intermittent collection of arterial and renal venous blood to estimate kidney metabolic fluxes of O 2 and metabolites. The study determined the effects of a high salt (HS) diet upon whole kidney O 2 consumption and the metabolomic profiles of normal Sprague Dawley (SD) rats. A separate group of rats was studied to determine changes in the cortex (Cx) and outer medulla (OM) tissue metabolomic and mRNAseq profiles before and following the switch from a 0.4% to a 4.0% NaCl diet. Significant changes in the metabolomic and transcriptomic profiles occurred with feeding of the HS diet. A progressive increase of kidney O 2 consumption was found despite a reduction in expression of most of the mRNA encoding enzymes of TCA cycle. Increased glycolysis was evident with the elevation of mRNA expression encoding key glycolytic enzymes and release of pyruvate and lactate from the kidney in the renal venous blood. Glycolytic production of NADH is used in either the production of lactate or oxidized via the malate aspartate shuttle. Aerobic glycolysis (e.g., Warburg-effect) may account for the needed increase in cellular energy. The study provides evidence that kidney metabolism responds to a HS diet enabling enhanced energy production while protecting from oxidate stress and injury.
Collapse
|
11
|
Levinsohn J, Li S, Ha E, Susztak K. Combing Genome-Wide Association Studies and Single-Cell Analysis to Elucidate the Mechanisms of Kidney Disease: Proceedings of the Henry Shavelle Professorship. GLOMERULAR DISEASES 2023; 3:258-265. [PMID: 38033715 PMCID: PMC10686632 DOI: 10.1159/000534678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023]
Abstract
Background Kidney diseases pose a significant global health burden; there is an urgent need to deepen our understanding of their underlying mechanisms. Summary This review focuses on new innovative approaches that merge genome-wide association studies (GWAS) and single-cell omics (including transcriptomics) in kidney disease research. We begin by detailing how GWAS has identified numerous genetic risk factors, offering valuable insight into disease susceptibility. Then, we explore the application of scRNA-seq, highlighting its ability to unravel how genetic variants influence cellular phenotypes. Through a synthesis of recent studies, we illuminate the synergy between these two powerful methodologies, demonstrating their potential in elucidating the complex etiology of kidney diseases. Moreover, we discuss how this integrative approach could pave the way for precise diagnostics and personalized treatments. Key Message This review underscores the transformative potential of combining GWAS and scRNA-seq in the journey toward a deeper understanding of kidney diseases.
Collapse
Affiliation(s)
- Jonathan Levinsohn
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Penn/CHOP Kidney Innovation Center, Philadelphia, PA, USA
| | - Shen Li
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Penn/CHOP Kidney Innovation Center, Philadelphia, PA, USA
| | - Eunji Ha
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Penn/CHOP Kidney Innovation Center, Philadelphia, PA, USA
| | - Katalin Susztak
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Penn/CHOP Kidney Innovation Center, Philadelphia, PA, USA
| |
Collapse
|
12
|
Serum Cystatin-C is linked to increased prevalence of diabetes and higher risk of mortality in diverse middle-aged and older adults. PLoS One 2022; 17:e0270289. [PMID: 36094936 PMCID: PMC9467319 DOI: 10.1371/journal.pone.0270289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/06/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Type 2 Diabetes Mellitus (henceforth diabetes) affects roughly 35 million individuals in the US and is a major risk factor for cardiovascular and kidney disease. Serum Cystatin-C is used to monitor renal function and detect kidney damage. Recent research has focused on linking Cystatin-C to cardiovascular risk and disease, but most findings focus on small sample sizes and generalize poorly to diverse populations, thus limiting epidemiological inferences. The aim of this manuscript is to study the association between Cystatin-C, diabetes, and mortality and test for possible sex or racial/ethnic background modifications in these relationships. Methods We analyzed 8-years of biennial panel data from Health and Retirement Study participants 50-years and older who self-identified as White (unweighted N (uN) = 5,595), Black (uN = 867), or Latino (uN = 565) for a total of uN = 7,027 individuals. We modeled diabetes and death over 8-years as function of baseline Cystatin-C (log transformed) adjusting for covariates and tested modifications in associations by race/ethnic background and sex. Results Mean log Cystatin-C at visit 1 was 0.03±0.32 standard deviation. A 10% increase in Cystatin-C levels was associated with 13% increased relative risk of diabetes at baseline (11% and 9% by years 4 and 8). A 10% increase in Cystatin-C was highly associated with increased relative risk of death (28% and 31% by years 4 and 8). These associations were present even after adjusting for possible confounders and were not modified by sex or racial/ethnic background. Conclusion Despite differential risks for diabetes and mortality by racial/ethnic groups, Cystatin-C was equally predictive of these outcomes across groups. Cystatin-C dysregulations could be used as a risk indicator for diabetes and as a warning sign for accelerated risk of mortality.
Collapse
|
13
|
van den Berg P, Ruppert M, Mesic E, Snelder N, Seelmann A, Heinig R, Joseph A, Garmann D, Lippert J, Eissing T. Finerenone Dose-Exposure-Response for the Primary Kidney Outcome in FIDELIO-DKD Phase III: Population Pharmacokinetic and Time-to-Event Analysis. Clin Pharmacokinet 2022; 61:439-450. [PMID: 34773606 PMCID: PMC8891099 DOI: 10.1007/s40262-021-01082-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Finerenone is a nonsteroidal selective mineralocorticoid receptor antagonist that recently demonstrated efficacy in delaying chronic kidney disease progression and reducing cardiovascular events in patients with chronic kidney disease and type 2 diabetes in FIDELIO-DKD, where 5734 patients were randomized 1:1 to receive either titrated finerenone doses of 10 or 20 mg once daily or placebo, with a median follow-up of 2.6 years. METHODS Nonlinear mixed-effects population pharmacokinetic models were used to analyze the pharmacokinetics in FIDELIO-DKD, sparsely sampled in all subjects receiving finerenone. Post-hoc model parameter estimates together with dosing histories allowed the computation of individual exposures used in subsequent parametric time-to-event analyses of the primary kidney outcome. RESULTS The population pharmacokinetic model adequately captured the typical pharmacokinetics of finerenone and its variability. Either covariate effects or multivariate forward-simulations in subgroups of interest were contained within the equivalence range of 80-125% around typical exposure. The exposure-response relationship was characterized by a maximum effect model estimating a low half-maximal effect concentration at 0.166 µg/L and a maximal hazard decrease at 36.1%. Prognostic factors for the treatment-independent chronic kidney disease progression risk included a low estimated glomerular filtration rate and a high urine-to-creatinine ratio increasing the risk, while concomitant sodium-glucose transport protein 2 inhibitor use decreased the risk. Importantly, no sodium-glucose transport protein 2 inhibitor co-medication-related modification of the finerenone treatment effect per se could be identified. CONCLUSIONS None of the tested pharmacokinetic covariates had clinical relevance in FIDELIO-DKD. Finerenone effects on kidney outcomes approached saturation towards 20 mg once daily and sodium-glucose transport protein 2 inhibitor use provided additive benefits.
Collapse
Affiliation(s)
- Paul van den Berg
- Leiden Experts on Advanced Pharmacokinetics and Pharmacodynamics (LAP&P), Leiden, The Netherlands
| | - Martijn Ruppert
- Leiden Experts on Advanced Pharmacokinetics and Pharmacodynamics (LAP&P), Leiden, The Netherlands
| | - Emir Mesic
- Leiden Experts on Advanced Pharmacokinetics and Pharmacodynamics (LAP&P), Leiden, The Netherlands
| | - Nelleke Snelder
- Leiden Experts on Advanced Pharmacokinetics and Pharmacodynamics (LAP&P), Leiden, The Netherlands
| | - Andreas Seelmann
- Pharmacometrics, Pharmaceuticals R&D, Bayer AG, Leverkusen, Germany
| | - Roland Heinig
- Clinical Pharmacology, Pharmaceuticals R&D, Bayer AG, Wuppertal, Germany
| | - Amer Joseph
- Clinical Development, Pharmaceuticals R&D, Bayer AG, Berlin, Germany
| | - Dirk Garmann
- Pharmacometrics, Pharmaceuticals R&D, Bayer AG, Leverkusen, Germany
| | - Joerg Lippert
- Pharmacometrics, Pharmaceuticals R&D, Bayer AG, Leverkusen, Germany
| | - Thomas Eissing
- Pharmacometrics, Pharmaceuticals R&D, Bayer AG, Leverkusen, Germany.
| |
Collapse
|
14
|
Merae Alshahrani M. A glance at the emerging diagnostic biomarkers in the most prevalent genitourinary cancers. Saudi J Biol Sci 2022; 29:2072-2084. [PMID: 35531253 PMCID: PMC9073037 DOI: 10.1016/j.sjbs.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022] Open
Abstract
Genitourinary cancers comprise of a heterogenous group of cancers of which renal cell carcinoma, urothelial bladder carcinoma, and prostate adenocarcinoma are the most commonly encountered subtypes. A lot of research is ongoing using various strategies for exploration of novel biomarkers for genitourinary cancers. These biomarkers would not reduce the need for invasive diagnostic techniques but also could be used for early and accurate diagnosis to improve the clinical management required for the disease. Moreover, selecting the appropriate treatment regimen for the responsive patients based on these biomarkers would reduce the treatment toxicity as well as cost. Biomarkers identified using various advanced techniques like next generation sequencing and proteomics, which have been classified as immunological biomarkers, tissue-specific biomarkers and liquid biomarkers. Immunological biomarkers include markers of immunological pathways such as CTLA4, PD-1/PDl-1, tissue biomarkers include tissue specific molecules such as PSA antigen and liquid biomarkers include biomarkers detectable in urine, circulating cells etc. The purpose of this review is to provide a brief introduction to the most prevalent genitourinary malignancies, including bladder, kidney, and prostate cancers along with a major focus on the novel diagnostic biomarkers and the importance of targeting them prior to genitourinary cancers treatment. Understanding these biomarkers and their potential in diagnosis of genitourinary cancer would not help in early and accurate diagnosis as mentioned above but may also lead towards a personalized approach for better diagnosis, prognosis and specified treatment approach for an individual.
Collapse
|
15
|
Arambegedara D, Jayasinghe S, Udagama P. Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:4893-4910. [PMID: 34799798 PMCID: PMC8604553 DOI: 10.1007/s11356-021-17316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 05/08/2023]
Abstract
Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.
Collapse
Affiliation(s)
- Dinushi Arambegedara
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 8, Sri Lanka
| | - Preethi Udagama
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka.
| |
Collapse
|
16
|
Debele GR, Hajure M, Wolde HF, Yenit MK. Incidence and Predictors of Chronic Kidney Disease among Diabetes Mellitus Patients: A Retrospective Follow-Up Study at a Tertiary Health-Care Setting of Ethiopia. Diabetes Metab Syndr Obes 2021; 14:4381-4390. [PMID: 34737594 PMCID: PMC8560326 DOI: 10.2147/dmso.s335572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is one of the most common microvascular complications of diabetes mellitus (DM) and it is a major health burden worldwide. Despite the increasing trend of microvascular complications in developing countries, there is limited evidence on predictors of CKD among diabetic patients in Ethiopia. Therefore, this study was aimed to assess the incidence and predictors of CKD among DM patients. METHODS A retrospective follow-up study was conducted among type 1 and type 2 DM patients in Southwest Ethiopia. A total of 437 newly-diagnosed diabetes patients were selected using a simple random sampling technique. Data were extracted from patients' medical records. Cox proportional hazard model was fitted and a 95% confidence interval was used to select significant variables. RESULTS Overall, 15.56% of patients developed CKD, with an incidence rate of 2.29 per 1,000 person-month (PM) (95% CI=1.79-2.93). Female sex (AHR=0.51, 95% CI=0.27-0.94) was found to be a protective factor of CKD, while positive proteinuria (AHR=2.85, 95% CI=1.48-5.55), having hypertension (HTN) (AHR=2.31, 95% CI=1.03-5.56), and high-density lipoprotein cholesterol (HDL-C) <40 mg/dL (AHR=3.19, 95% CI=1.73-5.98) were significant predictors of CKD. CONCLUSION CKD among DM patients continues to be a significant public health problem in health-care settings of Ethiopia. The current study found being female was protective, while positive proteinuria, HTN, and HDL-C <40 mg/dL were risk factors for CKD. We recommend health professionals to give more attention to DM patients with the identified risk factors.
Collapse
Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
17
|
Barzegar N, Tohidi M, Ghodssi-Ghassemabadi R, Amiri P, Azizi F, Hadaegh F. Impact of educational level on incident chronic kidney disease during 13 years of follow-up: a prospective cohort study. Public Health 2021; 195:98-104. [PMID: 34077890 DOI: 10.1016/j.puhe.2021.04.006] [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: 11/18/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the association between educational level and chronic kidney disease (CKD) among the Iranian population. STUDY DESIGN This is a prospective cohort study conducted in the framework of the Tehran Lipid and Glucose Study. METHODS A total of 8173 Iranians (men = 3659) aged ≥20 years were included in the study. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. The association between educational status and CKD was explored using multivariate Cox proportional regression analyses, adjusted for age, gender, current smoking, marital status, body mass index, waist circumference, baseline eGFR, diabetes, hypertension, physical activity, history of cardiovascular diseases and dyslipidaemia. RESULTS During a median follow-up of 13.14 years, 2609 cases of incident CKD were identified; the corresponding incidence rate was 26.35 (range 25.39-27.34) per 1000 person-years. Compared to low educational level, middle and high educational levels showed lower risks for incident CKD in the crude model [hazard ratio (HR) 0.37 (95% confidence interval {CI} 0.34-0.40) and HR 0.40 (95% CI 0.35-0.45), respectively]; however, these HRs changed direction after further adjustment for age and gender [HR 1.26 (95% CI 1.14-1.39) and HR 1.40 (95% CI 1.22-1.61), respectively]. The increased risk of incident CKD for those at higher educational levels remained significant in the fully adjusted model. In addition, results from the gender stratified analyses were in the same direction as those found among the whole study population (P-value for interaction of gender and education >0.8). CONCLUSIONS Higher educational levels were associated with incident CKD during more than a decade of follow-up; this finding may be attributed to unhealthy lifestyle behaviours among this population group.
Collapse
Affiliation(s)
- N Barzegar
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - R Ghodssi-Ghassemabadi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - P Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Cornelissen A, Fuller DT, Fernandez R, Zhao X, Kutys R, Binns-Roemer E, Delsante M, Sakamoto A, Paek KH, Sato Y, Kawakami R, Mori M, Kawai K, Yoshida T, Latt KZ, Miller CL, de Vries PS, Kolodgie FD, Virmani R, Shin MK, Hoek M, Heymann J, Kopp JB, Rosenberg AZ, Davis HR, Guo L, Finn AV. APOL1 Genetic Variants Are Associated With Increased Risk of Coronary Atherosclerotic Plaque Rupture in the Black Population. Arterioscler Thromb Vasc Biol 2021; 41:2201-2214. [PMID: 34039022 DOI: 10.1161/atvbaha.120.315788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Anne Cornelissen
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.).,Department of Cardiology, University Hospital RWTH Aachen, Germany (A.C.)
| | - Daniela T Fuller
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Raquel Fernandez
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Xiaoqing Zhao
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Robert Kutys
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Elizabeth Binns-Roemer
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD (E.B.-R.)
| | - Marco Delsante
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (M.D., T.Y., K.Z.L., J.H., J.B.K., A.Z.R.).,Dipartimento di Medicina e Chirurgia Università di Parma, UO Nefrologia, Azienda Ospedaliera-Universitaria, Italy (M.D.)
| | - Atsushi Sakamoto
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Ka Hyun Paek
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | | | - Rika Kawakami
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Masayuki Mori
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Kenji Kawai
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Teruhiko Yoshida
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (M.D., T.Y., K.Z.L., J.H., J.B.K., A.Z.R.)
| | - Khun Zaw Latt
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (M.D., T.Y., K.Z.L., J.H., J.B.K., A.Z.R.)
| | - Clint L Miller
- Department of Public Health Sciences, Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville (C.L.M.)
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (P.S.d.V.)
| | - Frank D Kolodgie
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | | | | | | | - Jurgen Heymann
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (M.D., T.Y., K.Z.L., J.H., J.B.K., A.Z.R.)
| | - Jeffrey B Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (M.D., T.Y., K.Z.L., J.H., J.B.K., A.Z.R.)
| | - Avi Z Rosenberg
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (M.D., T.Y., K.Z.L., J.H., J.B.K., A.Z.R.).,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (A.Z.R.)
| | - Harry R Davis
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Liang Guo
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.)
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD (A.C., D.T.F., R.F., X.Z., R. Kutys, A.S, K.H.P., Y.S., R. Kawakami, M.M., K.K., F.D.K., R.V., H.R.D., L.G., A.V.F.).,School of Medicine, University of Maryland School of Medicine, Baltimore (A.V.F.)
| |
Collapse
|
19
|
Yusuf AA, Govender MA, Brandenburg JT, Winkler CA. Kidney disease and APOL1. Hum Mol Genet 2021; 30:R129-R137. [PMID: 33744923 PMCID: PMC8117447 DOI: 10.1093/hmg/ddab024] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Aminu Abba Yusuf
- Department of Haematology, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Melanie A Govender
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean-Tristan Brandenburg
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl A Winkler
- Molecular Genetic Epidemiology Section, Basic Research Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, MD 21701, USA
| |
Collapse
|
20
|
Vitamin D Receptor and Vitamin D Binding Protein Gene Polymorphisms Are Associated with Renal Allograft Outcome. Nutrients 2021; 13:nu13041101. [PMID: 33801744 PMCID: PMC8067077 DOI: 10.3390/nu13041101] [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: 01/16/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Vitamin D deficiency has adverse effects on renal allograft outcomes, and polymorphisms of genes encoding vitamin D-binding protein (VDBP) and vitamin D receptor (VDR) are defined to play a role in these conditions. The goal of the current investigation was to evaluate the connection between those polymorphisms with acute rejection, viral infection history, and recipients’ vitamin D status. In this study, 115 kidney transplant recipients and 100 healthy individuals were included. VDR polymorphisms including FokI (rs2228570), Apal (rs7975232), BsmI (rs1544410), as well as VDBP (rs7040) polymorphisms were studied using high resolution melting (PCR-HRM) analysis among the studied groups. The frequency of G allele in Apal rs7975232 polymorphism in the kidney transplant recipients was 0.63 times lower than healthy individuals (p = 0.026). Further, the G allele frequency in VDBP rs7040 polymorphism was significantly lower in patients with allograft rejection (p = 0.002). Considering the incidence of viral infection, significant differences were identified between the frequencies of VDR FokI (OR = 2.035; 95% CI 1.06–2.89, p = 0.030) and VDBP rs7040 (OR = 0.40; 95% CI 0.24–0.67, p < 0.001) T alleles in the studied groups. Moreover, the VDBP rs7040 GG genotype distribution was low in the recipients with a history of viral infection (p = 0.004). VDR (FokI) and VDBP (rs7040) alleles and their genotype distribution are significantly associated with allograft outcomes including allograft rejection and viral infection in the studied population.
Collapse
|
21
|
Ozieh MN, Garacci E, Walker RJ, Palatnik A, Egede LE. The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease. BMC Nephrol 2021; 22:76. [PMID: 33639878 PMCID: PMC7916298 DOI: 10.1186/s12882-021-02277-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A growing body of evidence supports the potential role of social determinants of health on health outcomes. However, few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes. METHODS We analyzed data from National Health and Nutrition Examination Surveys (2005-2014) for 1376 adults age 20 and older (representing 7,579,967 U.S. adults) with CKD and diabetes. The primary outcome was all-cause mortality. CKD was based on estimated glomerular filtration rate and albuminuria. Diabetes was based on self-report or Hemoglobin A1c of ≥6.5%. Social determinants of health measures included family income to poverty ratio level, depression based on PHQ-9 score and food insecurity based on Food Security Survey Module. A dichotomous social determinant measure (absence vs presence of ≥1 adverse social determinants) and a cumulative social determinant score ranging from 0 to 3 was constructed based on all three measures. Cox proportional models were used to estimate the association between social determinants of health factors and mortality while controlling for covariates. RESULTS Cumulative and dichotomous social determinants of health score were significantly associated with mortality after adjusting for demographics, lifestyle variables, glycemic control and comorbidities (HR = 1.41, 95%CI 1.18-1.68 and HR = 1.41, 95%CI 1.08-1.84, respectively). When investigating social determinants of health variables separately, after adjusting for covariates, depression (HR = 1.52, 95%CI 1.10-1.83) was significantly and independently associated with mortality, however, poverty and food insecurity were not statistically significant. CONCLUSIONS Specific social determinants of health factors such as depression increase mortality in adults with chronic kidney disease and diabetes. Our findings suggest that interventions are needed to address adverse determinants of health in this population.
Collapse
Affiliation(s)
- Mukoso N Ozieh
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
22
|
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: 109] [Impact Index Per Article: 36.3] [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.
Collapse
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
| |
Collapse
|
23
|
Chen TK, Coresh J, Daya N, Ballew SH, Tin A, Crews DC, Grams ME. Race, APOL1 Risk Variants, and Clinical Outcomes among Older Adults: The ARIC Study. J Am Geriatr Soc 2021; 69:155-163. [PMID: 32894582 PMCID: PMC7855571 DOI: 10.1111/jgs.16797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES APOL1 high-risk genotypes confer an increased risk for kidney disease, but their clinical significance among older adults remains unclear. We aimed to determine whether APOL1 genotype status (high risk = 2 risk alleles; low risk = 0-1 risk alleles) and self-reported race (Black; White) are associated with number of hospitalizations, incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality among older adults participating in a community-based cohort study. DESIGN Observational longitudinal cohort study. SETTING The Atherosclerosis Risk in Communities (ARIC) study. PARTICIPANTS Community-dwelling older adults (mean age = 75.8 years; range = 66-90 years). RESULTS Among 5,564 ARIC participants (78.2% White, 19.1% APOL1 low-risk Black, and 2.7% APOL1 high-risk Black), the proportion with creatinine and cystatin C-based estimated glomerular filtration rate (eGFRCrCys ) below 60 mL/min/1.73 m2 at baseline was 40.6%, 34.8%, and 43.2%, respectively. Over a mean follow-up of 5.1 years, APOL1 high-risk Blacks had a 2.67-fold higher risk for ESRD compared with low-risk Blacks (95% confidence interval [CI] = 1.05-6.79) in models adjusted for age and sex. This association was no longer significant upon further adjustment for baseline eGFRCrCys and albuminuria (hazard ratio [HR] = 1.08; 95% CI = .39-2.96). Rate of hospitalizations and risks of mortality and incident CKD did not differ significantly by APOL1 genotype status. Compared with Whites, Blacks had 1.85-fold and 3.45-fold higher risks for incident CKD and ESRD, respectively, in models adjusted for age, sex, eGFRCrCys , and albuminuria. These associations persisted after additional adjustments for clinical/socioeconomic factors and APOL1 genotype (incident CKD: HR = 1.38; 95% CI = 1.06-1.81; ESRD: HR = 3.20; 95% CI = 1.16-8.86). CONCLUSION Among older Black adults, APOL1 high-risk genotypes were associated with lower kidney function and therefore higher risk of ESRD. Racial disparities in incident kidney disease persisted in older age and were not fully explained by APOL1.
Collapse
Affiliation(s)
- Teresa K. Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Natalie Daya
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana H. Ballew
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrienne Tin
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Morgan E. Grams
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
24
|
Borrelli S, Chiodini P, Caranci N, Provenzano M, Andreucci M, Simeon V, Panico S, De Stefano T, De Nicola L, Minutolo R, Conte G, Garofalo C. Area Deprivation and Risk of Death and CKD Progression: Long-Term Cohort Study in Patients under Unrestricted Nephrology Care. Nephron Clin Pract 2020; 144:488-497. [PMID: 32818942 DOI: 10.1159/000509351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Area deprivation index (ADI) associates with prognosis in non-dialysis CKD. However, no study has evaluated this association in CKD patients under unrestricted nephrology care. METHODS We performed a long-term prospective study to assess the role of deprivation in CKD progression and mortality in stage 1-4 CKD patients under regular nephrology care, living in Naples (Italy). We used ADI calculated at census block levels, standardized to mean values of whole population in Naples, and linked to patients by georeference method. After 12 months of "goal-oriented" nephrology treatment, we compared the risk of death or composite renal outcomes (end-stage kidney disease or doubling of serum creatinine) in the tertiles of standardized ADI. Estimated glomerular filtration rate (eGFR) decline was evaluated by mixed effects model for repeated eGFR measurements. RESULTS We enrolled 715 consecutive patients (age: 64 ± 15 years; 59.1% males; eGFR: 49 ± 22 mL/min/1.73 m2). Most (75.2%) were at the lowest national ADI quintile. At referral, demographic, clinical, and therapeutic features were similar across ADI tertiles; after 12 months, treatment intensification allowed better control of hypertension, proteinuria, hypercholesterolaemia, and anaemia with no difference across ADI tertiles. During the subsequent long-term follow-up (10.5 years [interquartile range 8.2-12.6]), 166 renal events and 249 deaths were registered. ADI independently associated with all-cause death (p for trend = 0.020) and non-cardiovascular (CV) mortality (p for trend = 0.045), while CV mortality did not differ (p for trend = 0.252). Risk of composite renal outcomes was similar across ADI tertiles (p for trend = 0.467). The same held true for eGFR decline (p for trend = 0.675). CONCLUSIONS In CKD patients under regular nephrology care, ADI is not associated with CKD progression, while it is associated with all-cause death due to an excess of non-CV mortality.
Collapse
Affiliation(s)
- Silvio Borrelli
- Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Michele Provenzano
- Division of Nephrology, Department of Health Sciences, "Magna Grecia" University, Catanzaro, Italy
| | - Michele Andreucci
- Division of Nephrology, Department of Health Sciences, "Magna Grecia" University, Catanzaro, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Toni De Stefano
- Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca De Nicola
- Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Minutolo
- Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Conte
- Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Garofalo
- Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
25
|
Bajaj A, Ihegword A, Qiu C, Small AM, Wei WQ, Bastarache L, Feng Q, Kember RL, Risman M, Bloom RD, Birtwell DL, Williams H, Shaffer CM, Chen J, Center RG, Denny JC, Rader DJ, Stein CM, Damrauer SM, Susztak K. Phenome-wide association analysis suggests the APOL1 linked disease spectrum primarily drives kidney-specific pathways. Kidney Int 2020; 97:1032-1041. [PMID: 32247630 DOI: 10.1016/j.kint.2020.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 01/13/2023]
Abstract
The relationship between commonly occurring genetic variants (G1 and G2) in the APOL1 gene in African Americans and different disease traits, such as kidney disease, cardiovascular disease, and pre-eclampsia, remains the subject of controversy. Here we took a genotype-first approach, a phenome-wide association study, to define the spectrum of phenotypes associated with APOL1 high-risk variants in 1,837 African American participants of Penn Medicine Biobank and 4,742 African American participants of Vanderbilt BioVU. In the Penn Medicine Biobank, outpatient creatinine measurement-based estimated glomerular filtration rate and multivariable regression models were used to evaluate the association between high-risk APOL1 status and renal outcomes. In meta-analysis of both cohorts, the strongest phenome-wide association study associations were for the high-risk APOL1 variants and diagnoses codes were highly significant for "kidney dialysis" (odds ratio 3.75) and "end stage kidney disease" (odds ratio 3.42). A number of phenotypes were associated with APOL1 high-risk genotypes in an analysis adjusted only for demographic variables. However, no associations were detected with non-renal phenotypes after controlling for chronic/end stage kidney disease status. Using calculated estimated glomerular filtration rate -based phenotype analysis in the Penn Medicine Biobank, APOL1 high-risk status was associated with prevalent chronic/end stage kidney disease /kidney transplant (odds ratio 2.27, 95% confidence interval 1.67-3.08). In high-risk participants, the estimated glomerular filtration rate was 15.4 mL/min/1.73m2; significantly lower than in low-risk participants. Thus, although APOL1 high-risk variants are associated with a range of phenotypes, the risks for other associated phenotypes appear much lower and in our dataset are driven by a primary effect on renal disease.
Collapse
Affiliation(s)
- Archna Bajaj
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Ihegword
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chengxiang Qiu
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aeron M Small
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - QiPing Feng
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachel L Kember
- Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; VISN 4 Mental Illness Research, Education, and Clinical Center, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Marjorie Risman
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy D Bloom
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David L Birtwell
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heather Williams
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian M Shaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jinbo Chen
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Joshua C Denny
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel J Rader
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Michael Stein
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Scott M Damrauer
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Surgery, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
| | - Katalin Susztak
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
26
|
Choi HS, Han KD, Oh TR, Kim CS, Bae EH, Ma SK, Kim SW. Smoking and risk of incident end-stage kidney disease in general population: A Nationwide Population-based Cohort Study from Korea. Sci Rep 2019; 9:19511. [PMID: 31862942 PMCID: PMC6925223 DOI: 10.1038/s41598-019-56113-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/08/2019] [Indexed: 11/09/2022] Open
Abstract
We analyzed data from the Korean National Health Insurance Service (NHIS) to investigate whether smoking increases the risk of end-stage kidney disease (ESKD). This retrospective nationwide population-based cohort study included the data of 23,232,091 participants who underwent at least one health examination between 2009 and 2012. Smoking status was recorded at baseline. The incidence of ESKD was identified via ICD-10 codes and special medical aid codes from the Korean National Health Insurance Service database till December 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between smoking and ESKD incidence. Overall, 24.6% of participants were current smokers; 13.5% and 61.9%, were ex- and non-smokers, respectively. Overall, 45,143 cases of ESKD developed during the follow-up period. Current smokers (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.35-1.43) and ex-smokers (HR, 1.09; 95% CI, 1.06-1.12) demonstrated a significant increase in the adjusted risk of ESKD compared to non-smokers. The risk of ESKD was directly proportional to the smoking duration, number of cigarettes smoked daily, and pack-years. In conclusion, smoking is associated with a greater risk of ESKD in the general Korean population; the risk increases with an increase in the smoking duration, number of cigarettes smoked daily, and pack-years.
Collapse
Affiliation(s)
- Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 61469, Korea
| | - Kyung-Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 61469, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 61469, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 61469, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 61469, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 61469, Korea.
| |
Collapse
|
27
|
Norris KC, Duru OK, Alicic RZ, Daratha KB, Nicholas SB, McPherson SM, Bell DS, Shen JI, Jones CR, Moin T, Waterman AD, Neumiller JJ, Vargas RB, Bui AAT, Mangione CM, Tuttle KR. Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD. BMC Nephrol 2019; 20:416. [PMID: 31747918 PMCID: PMC6868861 DOI: 10.1186/s12882-019-1558-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD.
Collapse
Affiliation(s)
- Keith C Norris
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA.
- UCLA Department of Medicine, Division of General Internal Medicine, 1100 Glendon Ave. Suite 900, Los Angeles, CA, 90024, USA.
| | - O Kenrik Duru
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Radica Z Alicic
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kenn B Daratha
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Sterling M McPherson
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Douglas S Bell
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Jenny I Shen
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Cami R Jones
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Tannaz Moin
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- VA Greater Los Angeles, Los Angeles, USA
| | - Amy D Waterman
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Joshua J Neumiller
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, USA
| | - Roberto B Vargas
- Charles R. Drew University of Medicine and Science, Los Angeles, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Alex A T Bui
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Carol M Mangione
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Katherine R Tuttle
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
28
|
Meghani SH, Rosa WE, Chittams J, Vallerand AH, Bao T, Mao JJ. Both Race and Insurance Type Independently Predict the Selection of Oral Opioids Prescribed to Cancer Outpatients. Pain Manag Nurs 2019; 21:65-71. [PMID: 31501079 DOI: 10.1016/j.pmn.2019.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research suggests that racial disparities in patients' reported analgesic adverse effects are partially mediated by the type of opioid prescribed to African Americans despite the presence of certain comorbidities, such as renal disease. AIMS We aimed to identify independent predictors of the type of opioid prescribed to cancer outpatients and determine if race and chronic kidney disease independently predict prescription type, adjusting for relevant sociodemographic and clinical confounders. DESIGN We conducted a secondary analysis of a 3-month observational study. SETTING Outpatient oncology clinics of an academic medical center. PARTICIPANTS/SUBJECTS Patients were older than 18 years of age, self-identified as African American or White, and had an analgesic prescription for cancer pain. METHODS Cancer patients (N = 241) were recruited from outpatient oncology clinics within a large mid-Atlantic healthcare system. RESULTS Consistent with published literature, most patients (75.5%) were prescribed either morphine or oxycodone preparations as oral opioid therapy for cancer pain. When compared with Whites, African Americans were significantly more likely to be prescribed morphine (33% vs 14%) and less likely to be prescribed oxycodone (38% vs 64%) (p < .001). The estimated odds for African Americans to receive morphine were 2.573 times that for Whites (95% confidence interval 1.077-6.134) after controlling for insurance type, income, and pain levels. In addition, the presence of private health insurance was negatively associated with the prescription of morphine and positively associated with prescription of oxycodone in separate multivariable models. The presence of chronic kidney disease did not predict type of analgesic prescribed. CONCLUSIONS Both race and insurance type independently predict type of opioid selection for cancer outpatients. Larger clinical studies are needed to fully understand the sources and clinical consequences of racial differences in opioid selection for cancer pain.
Collapse
Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; NewCourtland Center for Transitions and Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - William E Rosa
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Chittams
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ting Bao
- Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jun J Mao
- Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
29
|
Bock F, Stewart TG, Robinson-Cohen C, Morse J, Kabagambe EK, Cavanaugh KL, Birdwell KA, Hung AM, Abdel-Kader K, Siew ED, Akwo EA, Blot WJ, Ikizler TA, Lipworth L. Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study. BMC Nephrol 2019; 20:308. [PMID: 31390993 PMCID: PMC6686512 DOI: 10.1186/s12882-019-1502-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 07/29/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function. METHODS We conducted a case-cohort study of incident ESRD cases (n = 737) with stored blood and a probability sampled subcohort (n = 4238) and calculated estimated glomerular filtration rate (eGFR) from serum creatinine. 86% of participants were enrolled from community health centers in medically underserved areas and 14% from the general population in 12 states in the southeastern United States. Incident ESRD after entry into the cohort was ascertained by linkage of the cohort with the US Renal Data System (USRDS). RESULTS Median (25th, 75th percentile) eGFR at baseline was 63.3 (36.0, 98.2) ml/min/1.73m2 for ESRD cases and 103.2 (86.0, 117.9) for subcohort. Black ESRD cases had higher median (25th, 75th) eGFR [63.3 (35.9, 95.9)] compared to whites [59.1 (39.4, 99.2)]. In multivariable Cox models accounting for sampling weights, baseline eGFR was a strong predictor of ESRD risk, and an interaction with race was detected (P = 0.029). The higher ESRD risk among blacks relative to whites persisted (hazard ratio: 2.58; 95% confidence interval: 1.65, 4.03) after adjustment for eGFR. CONCLUSION In this predominantly lower SES cohort, the racial disparity in ESRD risk is not explained by differences in baseline kidney function.
Collapse
Affiliation(s)
- Fabian Bock
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Thomas G. Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Cassianne Robinson-Cohen
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jennifer Morse
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Edmond K. Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Ste 600, Nashville, TN 37203 USA
| | - Kerri L. Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kelly A. Birdwell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Adriana M. Hung
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Elvis A. Akwo
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Ste 600, Nashville, TN 37203 USA
| | - T. Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Ste 600, Nashville, TN 37203 USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN USA
| |
Collapse
|
30
|
Bilgel F. Spatial distribution of inequalities in end-stage renal disease in the United States. Spat Spatiotemporal Epidemiol 2019; 30:100282. [DOI: 10.1016/j.sste.2019.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/15/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
|
31
|
Akwo EA, Kabagambe EK, Harrell FE, Blot WJ, Bachmann JM, Wang TJ, Gupta DK, Lipworth L. Neighborhood Deprivation Predicts Heart Failure Risk in a Low-Income Population of Blacks and Whites in the Southeastern United States. Circ Cardiovasc Qual Outcomes 2019; 11:e004052. [PMID: 29317456 DOI: 10.1161/circoutcomes.117.004052] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent data suggest that neighborhood socioeconomic environment predicts heart failure (HF) hospital readmissions. We investigated whether neighborhood deprivation predicts risk of incident HF beyond individual socioeconomic status in a low-income population. METHODS AND RESULTS Participants were 27 078 whites and blacks recruited during 2002 to 2009 in the SCCS (Southern Community Cohort Study), who had no history of HF and were using Centers for Medicare or Medicaid Services. Incident HF diagnoses through December 31, 2010, were ascertained using International Classification of Diseases, Ninth Revision, codes 428.x via linkage with Centers for Medicare or Medicaid Services research files. Participant residential information was geocoded and census tract determined by a spatial join to the US Census Bureau TIGER/Line Shapefiles. The neighborhood deprivation index was constructed using principal components analysis based on census tract-level socioeconomic variables. Cox models with Huber-White cluster sandwich estimator of variance were used to investigate the association between neighborhood deprivation index and HF risk. The study sample was predominantly middle aged (mean, 55.5 years), black (69%), female (63%), low income (70% earned <$15 000/y), and >50% of participants lived in the most deprived neighborhoods (third neighborhood deprivation index tertile). Over median follow-up of 5.2 years, 4300 participants were diagnosed with HF. After adjustment for demographic, lifestyle, and clinical factors, a 1 interquartile increase in neighborhood deprivation index was associated with a 12% increase in risk of HF (hazard ratio, 1.12; 95% confidence interval, 1.07-1.18), and 4.8% of the variance in HF risk (intraclass correlation coefficient, 4.8; 95% confidence interval, 3.6-6.4) was explained by neighborhood deprivation. CONCLUSIONS In this low-income population, scant neighborhood resources compound the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors. Improvements in community resources may be a significant axis for curbing the burden of HF.
Collapse
Affiliation(s)
- Elvis A Akwo
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Edmond K Kabagambe
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Frank E Harrell
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - William J Blot
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Justin M Bachmann
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Thomas J Wang
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Deepak K Gupta
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Loren Lipworth
- From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN.
| |
Collapse
|
32
|
Pike M, Stewart TG, Morse J, Ormsby P, Siew ED, Hung A, Abdel-Kader K, Ikizler TA, Lipworth L, Robinson-Cohen C. APOL1, Acid Load, and CKD Progression. Kidney Int Rep 2019; 4:946-954. [PMID: 31317117 PMCID: PMC6611987 DOI: 10.1016/j.ekir.2019.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION High dietary acid load and metabolic acidosis are associated with an accelerated decline in kidney function and may contribute to the observed heterogeneity in end-stage renal disease (ESRD) risk according to APOL1 genotype. Our objective was to examine the associations of metabolic acidosis and dietary acid load with kidney disease progression, according to APOL1 genotype, among individuals with chronic kidney disease (CKD). METHODS We studied 1048 African American participants in the Chronic Renal Insufficiency Cohort. Metabolic acidosis was defined as blood levels of serum bicarbonate less than 22 mEq/L, and dietary acid load was quantified by potential renal acid load (PRAL) using data from the Diet Health Questionnaire. APOL1 status was defined as having 2 risk variants, consisting of either possible combination of the G1 and G2 risk alleles. We tested associations of APOL1 and dietary and metabolic acidosis with CKD progression, defined as time to ESRD or 50% decline in eGFR. RESULTS During a median follow-up period of 7 years, 379 participants had an incident CKD progression event (6.4 events per 100 person-years). After full adjustment, among participants with 2 APOL1 variants, the analysis failed to detect an association between metabolic acidosis or dietary acid load and CKD progression (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.96-1.11 per 1 mEq/L higher serum bicarbonate and an HR, 1.03; 95% CI, 0.92-1.15 per 10 mEq/L higher PRAL). Similar associations were noted among participants without the APOL1 high-risk genotype. CONCLUSION In a population at high risk of developing ESRD, metabolic acidosis and dietary acid load were not associated with CKD progression.
Collapse
Affiliation(s)
- Mindy Pike
- Division of Epidemiology, Department of Medicine, and Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas G. Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Morse
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick Ormsby
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edward D. Siew
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adriana Hung
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Khaled Abdel-Kader
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - T. Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, and Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-O’Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
33
|
Shen Y, Shi L, Nauman E, Katzmarzyk PT, Price-Haywood EG, Yin P, Bazzano AN, Nigam S, Hu G. Race and sex differences in rates of diabetic complications. J Diabetes 2019; 11:449-456. [PMID: 30315628 PMCID: PMC6462252 DOI: 10.1111/1753-0407.12869] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies on racial differences in diabetic complications are very limited. The aim of this study was to investigate the race and sex differences in diabetic complications between African Americans and Whites with type 2 diabetes (T2D) in Louisiana. METHODS A prospective cohort study was performed of 27 113 African Americans and 40 431 Whites with T2D who were 35 to 95 years of age from three healthcare systems located in south Louisiana. Four major diabetic complications were assessed: coronary heart disease (CHD), heart failure, stroke, and end-stage renal disease (ESRD). RESULTS The age- and sex-adjusted incident rates per 1000 person-years and 95% confidence intervals (CI) for CHD, heart failure, stroke, and ESRD for African Americans with diabetes were 43.1 (95% CI 41.6-44.6), 36.6 (95% CI 35.2-37.9), 29.6 (95% CI 28.4-30.8), and 38.3 (95% CI 36.9-39.7), respectively. Cox regression models showed that African American women had a higher risk than White women for heart failure (hazard ratio (HR) 1.26; 95% CI 1.18-1.34), stroke (HR 1.15; 95% CI 1.08-1.22), and ESRD (HR 1.32; 95% CI 1.24-1.40), whereas African American men had higher risks than White men for heart failure (HR 1.33; 95% CI 1.25-1.43) and ESRD (HR 1.47; 95% CI 1.37-1.57) but a lower risk of CHD (HR 0.88; 95% CI 0.83-0.94). CONCLUSIONS The incidence of major diabetic complications varied among difference race and sex groups. More race- or sex-specific studies on complications in patients with diabetes are needed to see whether incident rates are changing over time.
Collapse
Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | - Eboni G Price-Haywood
- Ochsner Health System Center for Applied Health Services Research, New Orleans, Louisiana, USA
| | - Ping Yin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| |
Collapse
|
34
|
Bajaj A, Susztak K, Damrauer SM. APOL1 and Cardiovascular Disease: A Story in Evolution. Arterioscler Thromb Vasc Biol 2019; 37:1587-1589. [PMID: 28835482 DOI: 10.1161/atvbaha.117.309756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Archna Bajaj
- From the Division of General Internal Medicine, Department of Medicine (A.B.), Renal Electrolyte and Hypertension Division, Department of Medicine (K.S.), Department of Genetics (K.S.), Division of Vascular Surgery, Department of Surgery (S.M.D.), University of Pennsylvania, Philadelphia; and Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (S.M.D.)
| | - Katalin Susztak
- From the Division of General Internal Medicine, Department of Medicine (A.B.), Renal Electrolyte and Hypertension Division, Department of Medicine (K.S.), Department of Genetics (K.S.), Division of Vascular Surgery, Department of Surgery (S.M.D.), University of Pennsylvania, Philadelphia; and Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (S.M.D.)
| | - Scott M Damrauer
- From the Division of General Internal Medicine, Department of Medicine (A.B.), Renal Electrolyte and Hypertension Division, Department of Medicine (K.S.), Department of Genetics (K.S.), Division of Vascular Surgery, Department of Surgery (S.M.D.), University of Pennsylvania, Philadelphia; and Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (S.M.D.)
| |
Collapse
|
35
|
Weldegiorgis M, Smith M, Herrington WG, Bankhead C, Woodward M. Socioeconomic disadvantage and the risk of advanced chronic kidney disease: results from a cohort study with 1.4 million participants. Nephrol Dial Transplant 2019; 35:1562-1570. [DOI: 10.1093/ndt/gfz059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Several studies have investigated the effect of socioeconomic deprivation on cardiovascular disease (CVD) and diabetes; less is known about its effect on chronic kidney disease (CKD). We aimed to measure the association between deprivation, CKD Stages 4–5 and end-stage renal disease (ESRD) in a general population sample.
Methods
This observational study examined 1 405 016 participants from the English Clinical Practice Research Datalink (2000–14), linked to hospital discharge data and death certification. Deprivation was assessed according to the participant’s postcode. Cox models were used to estimate hazard ratios (HRs) for CKD Stages 4–5 and ESRD, adjusting for age and sex, and additionally for smoking status, body mass index, diabetes, systolic blood pressure, prior CVD and estimated glomerular filtration rate (eGFR) at baseline.
Results
During 7.5 years of median follow-up, 11 490 individuals developed CKD Stages 4–5 and 1068 initiated ESRD. After adjustment for age and sex, the HRs and confidence interval (CI) comparing those in the 20% most deprived of the population to the 20% least deprived were 1.76 (95% CI 1.68–1.84) and 1.82 (95% CI 1.56–2.12) for CKD Stages 4–5 and ESRD, respectively. Further adjustment for known risk factors and eGFR substantially attenuated these HRs. Adding our results to all known cohort studies produced a pooled relative risk of 1.61 (95% CI 1.42–1.83) for ESRD, for comparisons between highest to lowest categories of deprivation.
Conclusion
Socioeconomic deprivation is independently associated with an increased hazard of CKD Stages 4–5 and ESRD, but in large part may be mediated by known risk factors.
Collapse
Affiliation(s)
- Misghina Weldegiorgis
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Margaret Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
36
|
Abstract
The purpose of this narrative review is to summarize evidence of the epidemiology of and risk factors for kidney cancer with a focus on renal cell carcinoma in adults. The etiology of kidney cancer is largely unknown and the main epidemiologic determinants are large geographic and temporal variations in incidence rates. Established risk factors include tobacco smoking, body size, and history of hypertension and chronic kidney disease. Other suspected risk factors require additional investigation, as do the underlying biologic mechanisms that are responsible for disease occurrence. Opportunities to prevent kidney cancer include targeting modifiable risk factors-for example, smoking abstinence/cessation and body weight control-as well as interventions along the diagnostic pathway to improve early diagnosis. Molecular epidemiology, including, but not limited to, metabolomics and tumor genomics, are new areas of research that promise to play important roles in identifying some of the underlying causes of kidney cancer.
Collapse
Affiliation(s)
- Ghislaine Scelo
- Ghislaine Scelo and Tricia L. Larose, International Agency for Research on Cancer, Lyon, France; and Tricia L. Larose, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tricia L. Larose
- Ghislaine Scelo and Tricia L. Larose, International Agency for Research on Cancer, Lyon, France; and Tricia L. Larose, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
37
|
Goncalves GMR, da Silva EN. Cost of chronic kidney disease attributable to diabetes from the perspective of the Brazilian Unified Health System. PLoS One 2018; 13:e0203992. [PMID: 30273345 PMCID: PMC6166929 DOI: 10.1371/journal.pone.0203992] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/02/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Diabetes is the most common cause of chronic kidney disease, with a high economic impact on health systems. OBJECTIVE To estimate the cost of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) attributable to diabetes, stratified by sex, race/skin color, and age, from the perspective of the Brazilian public health system between 2010 and 2016. METHODS Population attributable risk (PAR) was calculated from the Brazilian prevalence of diabetes and the relative risk (or odds ratio) of persons with diabetes developing CKD and ESKD as compared to non-diabetic subjects. The variables of interest were sex, race/skin color, and age. A top-down approach was used to measure the direct costs of the disease reimbursed by the Brazilian Ministry of Health, using data from outpatient and inpatient records. RESULTS The cost of CKD and ESKD attributable to diabetes in the period 2010-2016 was US$1.2 billion (US$180 million per year) and trending upward. Female sex, age 65-75, and black race/skin color contributed substantially to the costs of CKD and ESKD (US$475 million, US$63 million, and US$25 million respectively). The clinical procedures accounting for the greatest share of disease-attributable costs are hemodialysis and peritoneal dialysis. CONCLUSION Diabetes accounted for 22% of the costs of CKD and ESKD. Female sex, age 65-75 years, and black race/skin color were the variables which contributed most to disease-related expenditure. The economic burden of CKD may increase gradually in the coming years, with serious implications for the financial sustainability of the Brazilian public health system.
Collapse
Affiliation(s)
| | - Everton Nunes da Silva
- University of Brasília, Brasília, Federal District, Brazil
- National Institute os Science and Technology for health Technology Assessment (IATS)–CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
38
|
Perl J, McArthur E, Tan VS, Nash DM, Garg AX, Harel Z, Li AH, Sood MM, Ray JG, Wald R. ESRD among Immigrants to Ontario, Canada: A Population-Based Study. J Am Soc Nephrol 2018; 29:1948-1959. [PMID: 29720548 PMCID: PMC6050933 DOI: 10.1681/asn.2017101055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/03/2018] [Indexed: 12/16/2022] Open
Abstract
Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.
Collapse
Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada;
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Vivian S Tan
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
- Division of Nephrology, Department of Medicine and
| | - Danielle M Nash
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
- Division of Nephrology, Department of Medicine and
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Alvin H Li
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; and
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| |
Collapse
|
39
|
Vart P, Grams ME, Ballew SH, Woodward M, Coresh J, Matsushita K. Socioeconomic status and risk of kidney dysfunction: the Atherosclerosis Risk in Communities study. Nephrol Dial Transplant 2018; 34:1361-1368. [DOI: 10.1093/ndt/gfy142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/22/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is strong evidence of an association between socioeconomic status (SES) and end-stage renal disease (ESRD). However, the association of SES with the risk of chronic kidney disease (CKD) and the rate of change in kidney function is unclear.
Methods
A cohort of 14 086 participants with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 at baseline in the Atherosclerosis Risk in Communities study (1987–89) were studied. The association of annual household income, educational attainment and neighborhood deprivation with incident ESRD, incident CKD and change in eGFR using four measurements over ∼23 years was assessed.
Results
A total of 432 participants developed ESRD and 3510 developed CKD over a median follow-up time of ∼23 years. After adjustment for demographics and baseline eGFR, the hazard ratio (HR) for incident ESRD compared with the high-income group was 1.56 [95% confidence interval (CI) 1.22–1.99 in the medium-income group and 2.30 (95% CI 1.75–3.02) in the low-income group (P-trend < 0.001), and for CKD was 1.10 (95% CI 1.01–1.20) in the medium-income group and 1.30 (95% CI 1.17–1.44) in the low-income group (P-trend < 0.001). After full adjustments, the HR for ESRD was 1.33 (95% CI 1.03–1.70) in the medium-income group and 1.50 (95% CI 1.14–1.98) in the low-income group (P-trend = 0.003) and for CKD was 1.01 (95% CI 0.92–1.10) in the medium-income group and 1.04 (95% CI 0.93–1.16) in the low-income group (P-trend = 0.50). The eGFR decline was 5% and 15% steeper in the medium- and low-income groups, respectively, after full adjustment (P-trend < 0.001). Results were similar, with lower educational attainment and higher neighborhood deprivation being associated with adverse outcomes.
Conclusions
SES (annual household income, educational attainment or neighborhood deprivation) was associated not only with ESRD risk but also with eGFR decline, although the association with CKD appeared weaker.
Collapse
Affiliation(s)
- Priya Vart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mark Woodward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
40
|
Umeukeje EM, Wild MG, Maripuri S, Davidson T, Rutherford M, Abdel-Kader K, Lewis J, Wilkins CH, Cavanaugh K. Black Americans' Perspectives of Barriers and Facilitators of Community Screening for Kidney Disease. Clin J Am Soc Nephrol 2018; 13:551-559. [PMID: 29545381 PMCID: PMC5969459 DOI: 10.2215/cjn.07580717] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Incidence of ESKD is three times higher in black Americans than in whites, and CKD prevalence continues to rise among black Americans. Community-based kidney disease screening may increase early identification and awareness of black Americans at risk, but it is challenging to implement. This study aimed to identify participants' perspectives of community kidney disease screening. The Health Belief Model provides a theoretic framework for conceptualization of these perspectives and optimization of community kidney disease screening activities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Researchers in collaboration with the Tennessee Kidney Foundation conducted three focus groups of adults in black American churches in Nashville, Tennessee. Questions examined views on CKD information, access to care, and priorities of kidney disease health. Content analysis was used. Guided by the Health Belief Model, a priori themes were generated, and additional themes were derived from the data using an inductive approach. RESULTS Thirty-two black Americans completed the study in 2014. Participants were mostly women (79%) with a mean age of 56 years old (range, 24-78). Two major categories of barriers to kidney disease screening were identified: (1) participant factors, including limited kidney disease knowledge, spiritual/religious beliefs, emotions, and culture of the individual; and (2) logistic factors, including lack of convenience and incentives and poor advertisement. Potential facilitators of CKD screening included provision of CKD education, convenience of screening activities, and use of culturally sensitive and enhanced communication strategies. Program recommendations included partnering with trusted community members, selecting convenient locations, tailored advertising, and provision of compensation. CONCLUSIONS Findings of this study suggest that provider-delivered culturally sensitive education and stakeholder engagement are critical to increase trust, decrease fear, and maximize participation and early identification of kidney disease among black Americans considering community screening.
Collapse
Affiliation(s)
- Ebele M. Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus G. Wild
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Saugar Maripuri
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | - Khaled Abdel-Kader
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia Lewis
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kerri Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
41
|
Zeng X, Liu J, Tao S, Hong HG, Li Y, Fu P. Associations between socioeconomic status and chronic kidney disease: a meta-analysis. J Epidemiol Community Health 2018; 72:270-279. [PMID: 29437863 DOI: 10.1136/jech-2017-209815] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/22/2017] [Accepted: 01/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Socioeconomic status (SES) has long been conjectured to be associated with the incidence and progression of chronic kidney disease (CKD), but few studies have examined this quantitatively. This meta-analysis aims to fill this gap. METHODS A systematic literature review was performed using Medline and EMBASE to identify observational studies on associations between SES and incidence and progression of CKD, published between 1974 and March 2017. Individual results were meta-analysed using a random effects model, in line with Meta-analysis of Observational Studies in Epidemiology guidelines. RESULTS In total, 43 articles met our inclusion criteria. CKD prevalence was associated with several indicators of SES, particularly lower income (OR 1.34, 95% CI (1.18 to 1.53), P<0.001; I2=73.0%, P=0.05); lower education (OR 1.21, 95% CI (1.11 to 1.32), P<0.001; I2=45.20%, P=0.034); and lower combined SES (OR 2.18, 95% CI (1.64 to 2.89), P<0.001; I2=0.0%, P=0.326). Lower levels of income, occupation and combined SES were also significantly associated with progression to end-stage renal disease (risk ratio (RR) 1.24, 95% CI (1.12 to 1.37), P<0.001; I2=66.6%, P=0.006; RR 1.05, 95% CI (1.01 to 1.09), P=0.012; I2=0.0%, P=0.796; and RR 1.39, 95% CI (1.09 to 1.79), P=0.009; I2=74.2%, P=0.009). Subgroup analyses generally confirmed these results, except in a few cases, such as an inverse association related to particular socioeconomic backgrounds and where results were adjusted by more disease-related risk factors. CONCLUSION Lower income was most closely associated with prevalence and progression of CKD, and lower education was significantly associated with its prevalence. Evidence for other indicators was inconclusive.
Collapse
Affiliation(s)
- Xiaoxi Zeng
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, Sichuan University, Chengdu, China
| | - Jing Liu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Sibei Tao
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Hyokyoung G Hong
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ping Fu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, Sichuan University, Chengdu, China
| |
Collapse
|
42
|
Vart P, van Zon SKR, Gansevoort RT, Bültmann U, Reijneveld SA. SES, Chronic Kidney Disease, and Race in the U.S.: A Systematic Review and Meta-analysis. Am J Prev Med 2017; 53:730-739. [PMID: 28869090 DOI: 10.1016/j.amepre.2017.06.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/05/2017] [Accepted: 07/11/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT The risk of chronic kidney disease (CKD) in the U.S. is higher in individuals with low SES than in those with high SES. However, differences in these risks between African Americans and whites are unclear. EVIDENCE ACQUISITION Studies published through August 30, 2016 in Medline and EMBASE were searched. From the seven studies (1,775,267 participants) that met inclusion criteria, association estimates were pooled by race in meta-analysis. The ratio of association estimates and the corresponding 95% CIs for African Americans and whites were also pooled in meta-analysis. Additionally, meta-regression analysis was used to explore whether race is related to the strength of SES-CKD association. The analysis was conducted in September 2016. EVIDENCE SYNTHESIS The risk of CKD in low-SES people was 58% higher in African Americans (relative risk=1.58, 95% CI=1.33, 1.84) and 91% higher in whites (relative risk=1.91, 95% CI=1.47, 2.35) compared with their high-SES counterparts. The relative risk of CKD in low SES (versus high SES) was lower in African Americans than in whites (relative risk ratio=0.71, 95% CI=0.65, 0.77). Results from meta-regression analyses also indicated that race is potentially related to the strength of the association between low SES and CKD (p for difference between whites and African Americans=0.001). CONCLUSIONS The risk of CKD in low SES (versus high SES) is higher in whites than in African Americans.
Collapse
Affiliation(s)
- Priya Vart
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
43
|
Harding K, Mersha TB, Webb FA, Vassalotti JA, Nicholas SB. Current State and Future Trends to Optimize the Care of African Americans with End-Stage Renal Disease. Am J Nephrol 2017; 46:156-164. [PMID: 28787724 DOI: 10.1159/000479479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic kidney disease is a progressive disease, which terminates in end-stage renal diseases (ESRD) that requires either dialysis or kidney transplantation for the patient to survive. There is an alarming trend in the disparities of ESRD in African Americans (AAs). Currently, AAs represent more than 30% of incident ESRD cases, yet they constitute 15% of the overall US population. Despite the reductions in mortality, increases in access to patient-centered home dialysis and preemptive kidney transplantation for the overall US ESRD population over the last decade, disparities in the care of AAs with ESRD remain largely unaffected. SUMMARY This review discusses patient-, community-, and practitioner-related factors that contribute to disparities in ESRD care for AAs. In particular, the review addresses issues related to end-of-life support, the importance of Apolipoprotein-1 gene variants, and the advent of pharmacogenomics toward achieving precision care. The need for accessible clinical intelligence for the ESRD population is discussed. Several interventions and a call to action to address the disparities are presented. Key Messages: Significant disparities in ESRD care exist for AAs. Strategies to enhance patient engagement, education, accountable partnerships, and clinical intelligence may reduce these disparities.
Collapse
|
44
|
Koye DN, Shaw JE, Reid CM, Atkins RC, Reutens AT, Magliano DJ. Incidence of chronic kidney disease among people with diabetes: a systematic review of observational studies. Diabet Med 2017; 34:887-901. [PMID: 28164387 DOI: 10.1111/dme.13324] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 12/26/2022]
Abstract
AIMS The aim was to systematically review published articles that reported the incidence of chronic kidney disease among people with diabetes. METHODS A systematic literature search was performed using MEDLINE, Embase and CINAHL databases. The titles and abstracts of all publications identified by the search were reviewed and 10 047 studies were retrieved. RESULTS A total of 71 studies from 30 different countries with sample sizes ranging from 505 to 211 132 met the inclusion criteria. The annual incidence of microalbuminuria and albuminuria ranged from 1.3% to 3.8% for Type 1 diabetes. For Type 2 diabetes and studies combining both diabetes types, the range was from 3.8% to 12.7%, with four of six studies reporting annual rates between 7.4% and 8.6%. In studies reporting the incidence of eGFR < 60 ml/min/1.73 m2 using the Modification of Diet on Renal Disease (MDRD) equation, apart from one study which reported an annual incidence of 8.9%, the annual incidence ranged from 1.9% to 4.3%. The annual incidence of end-stage renal disease ranged from 0.04% to 1.8%. CONCLUSIONS The annual incidence of microalbuminuria and albuminuria is ~ 2-3% in Type 1 diabetes, and ~ 8% in Type 2 diabetes or mixed diabetes type. The incidence of developing eGFR < 60 ml/min/1.73 m2 is ~ 2-4% per year. Despite the wide variation in methods and study design, within a particular category of kidney disease, there was only modest variation in incidence rates. These findings may be useful in clinical settings to help understand the risk of developing kidney disease among those with diabetes.
Collapse
Affiliation(s)
- D N Koye
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - J E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - C M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - R C Atkins
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A T Reutens
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
45
|
Banerjee T, Crews DC, Wesson DE, Dharmarajan S, Saran R, Ríos Burrows N, Saydah S, Powe NR. Food Insecurity, CKD, and Subsequent ESRD in US Adults. Am J Kidney Dis 2017; 70:38-47. [PMID: 28215947 PMCID: PMC5765854 DOI: 10.1053/j.ajkd.2016.10.035] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Poor access to food among low-income adults has been recognized as a risk factor for chronic kidney disease (CKD), but there are no data for the impact of food insecurity on progression to end-stage renal disease (ESRD). We hypothesized that food insecurity would be independently associated with risk for ESRD among persons with and without earlier stages of CKD. STUDY DESIGN Longitudinal cohort study. SETTING & PARTICIPANTS 2,320 adults (aged ≥ 20 years) with CKD and 10,448 adults with no CKD enrolled in NHANES III (1988-1994) with household income ≤ 400% of the federal poverty level linked to the Medicare ESRD Registry for a median follow-up of 12 years. PREDICTOR Food insecurity, defined as an affirmative response to the food-insecurity screening question. OUTCOME Development of ESRD. MEASUREMENTS Demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. Dietary acid load was estimated from 24-hour dietary recall. We used a Fine-Gray competing-risk model to estimate the relative hazard (RH) for ESRD associated with food insecurity after adjusting for covariates. RESULTS 4.5% of adults with CKD were food insecure. Food-insecure individuals were more likely to be younger and have diabetes (29.9%), hypertension (73.9%), or albuminuria (90.4%) as compared with their counterparts (P<0.05). Median dietary acid load in the food-secure versus food-insecure group was 51.2 mEq/d versus 55.6 mEq/d, respectively (P=0.05). Food-insecure adults were more likely to develop ESRD (RH, 1.38; 95% CI, 1.08-3.10) compared with food-secure adults after adjustment for demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. In the non-CKD group, 5.7% were food insecure. We did not find a significant association between food insecurity and ESRD (RH, 0.77; 95% CI, 0.40-1.49). LIMITATIONS Use of single 24-hour diet recall; lack of laboratory follow-up data and measure of changes in food insecurity over time; follow-up of cohort ended 10 years ago. CONCLUSIONS Among adults with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.
Collapse
Affiliation(s)
- Tanushree Banerjee
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Donald E Wesson
- Texas A&M College of Medicine and Scott and White Healthcare, Temple, TX
| | - Sai Dharmarajan
- Kidney Epidemiology & Cost Center, University of Michigan, Ann Arbor, MI
| | - Rajiv Saran
- Kidney Epidemiology & Cost Center, University of Michigan, Ann Arbor, MI; Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease and Control and Prevention, Atlanta, GA
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease and Control and Prevention, Atlanta, GA
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA
| |
Collapse
|
46
|
Terrier B, Dechartres A, Deligny C, Godmer P, Charles P, Hayem G, Dunogué B, de Bandt M, Cohen P, Puéchal X, Jeunne CL, Arfi S, Mouthon L, Guillevin L. Granulomatosis with polyangiitis according to geographic origin and ethnicity: clinical-biological presentation and outcome in a French population. Rheumatology (Oxford) 2017; 56:445-450. [PMID: 27940591 DOI: 10.1093/rheumatology/kew423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Indexed: 11/15/2022] Open
Abstract
Objectives Granulomatosis with polyangiitis (GPA) mainly affects white Europeans, but rarely GPA may also affect non-Europeans. This study aimed to describe GPA clinical-biological presentation and outcome in black sub-Saharan Africans and Afro-Caribbeans and in North Africans. Methods Among 914 GPA patients included in the French Vasculitis Study Group database, geographic origin and ethnicity were known for 760. Clinical-biological presentations and outcomes of white Europeans vs black sub-Saharans and Afro-Caribbeans and vs North Africans were analysed. Results Among the 760 patients, 689 (91%) were white Europeans, 33 (4.3%) were North Africans and 22 (2.9%) were sub-Saharans (n = 8) or Afro-Caribbeans (French West Indies, n = 14). Black sub-Saharans and Afro-Caribbeans, compared with white Europeans, were significantly younger at GPA diagnosis (P = 0.003), had more frequent central nervous system involvement (P = 0.02), subglottic stenosis (P = 0.002) and pachymeningitis (P = 0.009), and tended to have more frequent chondritis and retroorbital tumour. Median serum creatinine levels and Birmingham Vasculitis Activity Score were significantly lower in sub-Saharans and Afro-Caribbeans (P = 0.002 and P = 0.003, respectively). In contrast, in comparison with white Europeans, North Africans had only less frequent arthralgias (P = 0.004). Time to relapse was shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans [adjusted HR = 1.96 (95% CI: 1.09, 3.51) (P = 0.02)], and did not differ for North Africans. In contrast, overall survival was not significantly different according to ethnicity. Conclusion Our findings indicated different GPA clinical presentations in white Europeans and sub-Saharans and Afro-Caribbeans, with black patients having more frequent severe granulomatous manifestations. In addition, time to relapse was significantly shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans.
Collapse
Affiliation(s)
- Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP).,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
| | - Agnès Dechartres
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité.,Centre de Recherche Epidémiologie et Statistique, INSERM U1153.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP
| | | | - Pascal Godmer
- Department of Internal Medicine, Centre Hospitalier Bretagne-Atlantique, Vannes
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris
| | - Gilles Hayem
- Department of Rheumatology, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt
| | - Bertrand Dunogué
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP).,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
| | | | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP)
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP)
| | - Claire Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP)
| | - Serge Arfi
- Department of Internal Medicine, CHU, Fort de France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP).,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP).,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
| |
Collapse
|
47
|
Akwo EA, Kabagambe EK, Wang TJ, Harrell FE, Blot WJ, Mumma M, Gupta DK, Lipworth L. Heart Failure Incidence and Mortality in the Southern Community Cohort Study. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003553. [PMID: 28255010 DOI: 10.1161/circheartfailure.116.003553] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/30/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a paucity of data on heart failure (HF) incidence among low-income and minority populations. Our objective was to investigate HF incidence and post-HF survival by race and sex among low-income adults in the southeastern United States. METHODS AND RESULTS Participants were 27 078 white and black men and women enrolled during 2002 to 2009 in the SCCS (Southern Community Cohort Study) who had no history of HF and were receiving Centers for Medicare and Medicaid Services. Incident HF diagnoses through December 31, 2010 were ascertained using International Classification of Diseases 9th Revision codes 428.x via linkage with Centers for Medicare and Medicaid Services research files. Most participants were black (68.8%), women (62.6%), and earned <$15 000/y (69.7%); mean age was 55.5 (10.4) years. Risk factors for HF were common: hypertension (62.5%), diabetes mellitus (26.5%), myocardial infarction (8.6%), and obesity (44.8%). Over a median follow-up of 5.2 years, 4341 participants were diagnosed with HF. The age-standardized incidence rates were 34.8, 37.3, 34.9, and 35.6 /1000 person-years in white women, white men, black men, and black women, respectively, remarkably higher than previously reported. Among HF cases, 952 deaths occurred over a median follow-up of 2.3 years. Men had lower survival; hazard ratios and 95% confidence intervals were 1.63 (1.27-2.08), 1.38 (1.11-1.72), and 0.90 (0.73-1.12) for white men, black men, and black women compared with white women. CONCLUSIONS In this low-income population, HF incidence was higher for all race-sex groups than previously reported in other cohorts. The SCCS is a unique resource to investigate determinants of HF risk in a segment of the population underrepresented in other existing cohorts.
Collapse
Affiliation(s)
- Elvis A Akwo
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Edmond K Kabagambe
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Thomas J Wang
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Frank E Harrell
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - William J Blot
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Michael Mumma
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Deepak K Gupta
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Loren Lipworth
- From the Division of Epidemiology (E.A.A., E.K.K., W.J.B., L.L.), Division of Cardiovascular Medicine (T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., T.J.W., F.E.H., D.K.G., L.L.), Department of Medicine, and Department of Biostatistics (F.E.H.), Vanderbilt University School of Medicine, Nashville, TN; and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN (M.M.).
| |
Collapse
|
48
|
Xia J, Wang L, Ma Z, Zhong L, Wang Y, Gao Y, He L, Su X. Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies. Nephrol Dial Transplant 2017; 32:475-487. [DOI: 10.1093/ndt/gfw452] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/23/2016] [Indexed: 12/15/2022] Open
|
49
|
Beckerman P, Bi-Karchin J, Park ASD, Qiu C, Dummer PD, Soomro I, Boustany-Kari CM, Pullen SS, Miner JH, Hu CAA, Rohacs T, Inoue K, Ishibe S, Saleem MA, Palmer MB, Cuervo AM, Kopp JB, Susztak K. Transgenic expression of human APOL1 risk variants in podocytes induces kidney disease in mice. Nat Med 2017; 23:429-438. [PMID: 28218918 DOI: 10.1038/nm.4287] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023]
Abstract
African Americans have a heightened risk of developing chronic and end-stage kidney disease, an association that is largely attributed to two common genetic variants, termed G1 and G2, in the APOL1 gene. Direct evidence demonstrating that these APOL1 risk alleles are pathogenic is still lacking because the APOL1 gene is present in only some primates and humans; thus it has been challenging to demonstrate experimental proof of causality of these risk alleles for renal disease. Here we generated mice with podocyte-specific inducible expression of the APOL1 reference allele (termed G0) or each of the risk-conferring alleles (G1 or G2). We show that mice with podocyte-specific expression of either APOL1 risk allele, but not of the G0 allele, develop functional (albuminuria and azotemia), structural (foot-process effacement and glomerulosclerosis) and molecular (gene-expression) changes that closely resemble human kidney disease. Disease development was cell-type specific and likely reversible, and the severity correlated with the level of expression of the risk allele. We further found that expression of the risk-variant APOL1 alleles interferes with endosomal trafficking and blocks autophagic flux, which ultimately leads to inflammatory-mediated podocyte death and glomerular scarring. In summary, this is the first demonstration that the expression of APOL1 risk alleles is causal for altered podocyte function and glomerular disease in vivo.
Collapse
Affiliation(s)
- Pazit Beckerman
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Bi-Karchin
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ae Seo Deok Park
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chengxiang Qiu
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick D Dummer
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Irfana Soomro
- Division of Nephrology, New York University, New York, New York, USA
| | - Carine M Boustany-Kari
- Department of Cardiometabolic Diseases Research, Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut, USA
| | - Steven S Pullen
- Department of Cardiometabolic Diseases Research, Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut, USA
| | - Jeffrey H Miner
- Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chien-An A Hu
- Department of Biochemistry and Molecular Biology, University of New Mexico School of Medicine and Health Sciences Center, Albuquerque, New Mexico, USA
| | - Tibor Rohacs
- Department of Pharmacology, Physiology &Neuroscience, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Kazunori Inoue
- Division of Nephrology, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Shuta Ishibe
- Division of Nephrology, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Moin A Saleem
- Bristol Renal and Children's Renal Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Matthew B Palmer
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ana Maria Cuervo
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, New York, New York, USA
| | - Jeffrey B Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Katalin Susztak
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
50
|
Malhotra R, Cavanaugh KL, Blot WJ, Ikizler TA, Lipworth L, Kabagambe EK. Higher protein intake is associated with increased risk for incident end-stage renal disease among blacks with diabetes in the Southern Community Cohort Study. Nutr Metab Cardiovasc Dis 2016; 26:1079-1087. [PMID: 27562875 PMCID: PMC5147554 DOI: 10.1016/j.numecd.2016.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Diabetes, a risk factor for end-stage renal disease (ESRD), is associated with impaired protein metabolism. We investigated whether protein intake is associated with ESRD and whether the risk is higher among blacks with diabetes. METHODS AND RESULTS We conducted a nested case-control study of ESRD within the Southern Community Cohort Study, a prospective study of low-income blacks and whites in the southeastern US (2002-2009). Through 2012, 1057 incident ESRD cases were identified by linkage with the United States Renal Data System and matched to 3198 controls by age, sex, and race. Dietary intakes were assessed from a validated food frequency questionnaire at baseline. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed from logistic regression models that included matching variables, BMI, education, income, hypertension, total energy intake, and percent energy from saturated and polyunsaturated fatty acids. Mean (±SD) daily energy intake from protein was higher among ESRD cases than controls (15.7 ± 3.3 vs. 15.1 ± 3.1%, P < 0.0001). For a 1% increase in percent energy intake from protein, the adjusted ORs (95% CIs) for ESRD were 1.06 (1.02-1.10) for blacks with diabetes, 1.02 (0.98-1.06) for blacks without diabetes, 0.99 (0.90-1.09) for whites with diabetes and 0.94 (0.84-1.06) for whites without diabetes. Protein intake in g/kg/day was also associated with ESRD (4th vs. 1st quartile OR = 1.76; 95% CI: 1.17-2.65). CONCLUSION Our results raise the possibility that among blacks with diabetes, increased dietary protein is associated with increased incidence of ESRD. Studies on how protein intake and metabolism affect ESRD are needed.
Collapse
Affiliation(s)
- R Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA
| | - K L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA
| | - W J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA; International Epidemiology Institute, Rockville, MD 20850, USA
| | - T A Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA
| | - L Lipworth
- Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - E K Kabagambe
- Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
| |
Collapse
|