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Gohda T, Murakoshi M, Suzuki Y, Kagimura T, Wada T, Narita I. Effect of proteinuria on the rapid kidney function decline in chronic kidney disease depends on the underlying disease: A post hoc analysis of the BRIGHTEN study. Diabetes Res Clin Pract 2024; 212:111682. [PMID: 38677368 DOI: 10.1016/j.diabres.2024.111682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
AIMS It is unclear whether the effect of proteinuria on rapid kidney function decline is equivalent among diabetic kidney disease (DKD), non-DKD with diabetes (NDKD+DM), and nephrosclerosis without diabetes (NS-DM), particularly in advanced chronic kidney disease patients. METHODS In total, 1038 chronic kidney disease patients who participated in the BRIGHTEN study were included in the present study. A linear mixed effect model was applied to estimate the annual estimated glomerular filtration rate decline in each disease group. RESULTS The prevalence of rapid decliners (rapid kidney function decline, defined as an eGFR loss of > 5 mL/min/1.73 m2/year) in the DKD group (44.6 %) was significantly higher compared with the NDKD+DM (27.9 %) and NS-DM (27.0 %) groups. By contrast, the prevalence of rapid decliners in different urine total protein to creatinine ratio (UPCR) categories (<0.5, 0.5 to < 1.0, 1.0 to < 3.5, and ≥ 3.5 g/g) were equivalent between the DKD and NS-DM groups. Moreover, the prevalence of a UPCR < 1.0 g/g in rapid decliners of the NS-DM group was more than double than in those of the DKD and NDKD+DM groups. CONCLUSIONS The risk of rapid kidney function decline in NS-DM patients with low levels of proteinuria may be greater than initially predicted.
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Affiliation(s)
- Tomohito Gohda
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Maki Murakoshi
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Tatsuo Kagimura
- Translational Research Centre for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | | | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Bielopolski D, Streja E, Steinmetz T, Rozen-Zvi B, Kalantar-Zadeh K. Novel insights in classic versus relative glomerular hyperfiltration and implications on pharmacotherapy. Curr Opin Nephrol Hypertens 2023; 32:58-66. [PMID: 36444663 DOI: 10.1097/MNH.0000000000000847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Glomerular filtration rate (GFR) assessment and its estimation (eGFR) is a long-lasting challenge in medicine and public health. Current eGFR formulae are indexed for standardized body surface area (BSA) of 1.73 m2, ignoring persons and populations wherein the ratio of BSA or metabolic rate to nephron number might be different, due to increased BSA, increased metabolic rate or reduced nephron number. These equations are based on creatinine, cystatin C or a combination of the two, which adds another confounder to eGFR assessment. Unusually high GFR values, also known as renal hyperfiltration, have not been well defined under these equations. RECENT FINDINGS Special conditions such as solitary kidney in kidney donors, high dietary protein intake, obesity and diabetes are often associated with renal hyperfiltration and amenable to errors in GFR estimation. In all hyperfiltration types, there is an increased intraglomerular pressure that can be physiologic, but its persistence over time is detrimental to glomerulus leading to progressive glomerular damage and renal fibrosis. Hyperfiltration might be underdiagnosed due to BSA standardization embedded in the formula. Hence, timely intervention is delayed. Reducing intraglomerular pressure in diabetes can be achieved by SGLT2 inhibitors or low protein diet to reverse the glomerulopathy process. SUMMARY Accurate identification of glomerular hyperfiltration as a pre-CKD condition needs accurate estimation of GFR in the above normal range should establish a threshold for timely intervention.
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Blanchfield D, O'Connor L. A participatory action research study to inform combined type 2 diabetes and chronic kidney disease care provided in the context of advanced practice nursing. J Adv Nurs 2022; 78:3427-3443. [PMID: 35855655 DOI: 10.1111/jan.15362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
AIM To outline the development, implementation and evaluation of an alternative combined type 2 diabetes and chronic kidney disease (CKD) care delivery strategy provided in the context of advanced practice nursing informed by co-created knowledge, between patients and healthcare teams to address identified gaps in care provision. DESIGN This study was informed by the theoretical underpinnings of critical theory and operationalized using a participatory action research (PAR) design. This approach enabled alignment between the theoretical underpinnings and research methodology to respond to practice-level problems and address issues related to healthcare delivery. METHODS The study was undertaken in a series of three cycles of enquiry over a 20 month period (July 2018-February 2020) in five geographically diverse specialist diabetes and nephrology centres. Data collection methods included PAR group minute consensus, retrospective chart review, discovery and focus group interviews. Thematic analysis and descriptive statistics were used to analyse the data. RESULTS Compared with international standard care outcomes, a higher proportion of patients attending combined care achieved best practice recommendations for blood pressure, Hba1c and lipid management (64.3% vs. <40%). Patients attending combined care experienced improved detection and management of CKD-related anaemia. Additionally, the combined care service experienced significantly lower levels of patient's failure to attend scheduled reviews compared with participating standard care services (0% vs. 7%-23.3%). CONCLUSIONS Best practice clinical care outcomes and patient attendance improved when a combined type 2 diabetes and CKD care delivery strategy provided in the context of advanced practice nursing was adopted. IMPACT This alternative care strategy represented a departure from standard care delivery approaches, in which care for type 2 diabetes and CKD is provided separately and led by physicians. Outcomes demonstrate improved clinical and attendance outcomes which may inform the development of future services led by advanced nurse practitioners.
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Affiliation(s)
- Denise Blanchfield
- School of Nursing & Midwifery Royal College of Surgeons Ireland, University College Dublin (UCD), Dublin, Ireland
| | - Laserina O'Connor
- School of Nursing, Midwifery and Health Systems University College Dublin (UCD), Dublin, Ireland
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Iakoubova OA, Tong CH, Rowland CM, Arellano AR, Bare LA, Fragala MS, Birse CE. Workplace Outreach Program Improves Management of Chronic Kidney Disease. J Occup Environ Med 2022; 64:482-487. [PMID: 34967765 PMCID: PMC9275843 DOI: 10.1097/jom.0000000000002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assess whether an employee outreach program improved management of chronic kidney disease (CKD). METHODS Participants with suspected CKD (eGFR <60 mL/min/1.73m 2 ) identified in employee health assessments in 2017 and 2018 were contacted by phone and offered physician consultation. Subsequent nephrologist visits at 11 months of follow up were compared between those who were (outreach group) and were not (control group) successfully contacted. RESULTS Most CKD risk factors at baseline were similar in outreach and control groups. At the end of the follow-up, outreach participants had more than 2-fold greater incidence of visiting a nephrologist compared with controls (HR = 2.3; 95% CI 1.2-4.2, P = 0.01), after adjusting for potential confounders. Conclusions: Employee outreach program increased utilization of nephrologist care.
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Affiliation(s)
- Olga A Iakoubova
- From the Department of Quest Diagnostics, San Juan Capistrano, California (Dr Iakoubova, Ms Tong, Mr Rowland, Arellano, Dr Bare, Dr Fragala, and Dr Birse)
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Akizawa T, Tanaka-Amino K, Otsuka T, Yamaguchi Y. Clinical parameters among patients in Japan with anemia and non-dialysis-dependent chronic kidney disease with and without diabetes mellitus who received roxadustat. Clin Exp Nephrol 2022; 26:843-850. [PMID: 35462610 PMCID: PMC9385792 DOI: 10.1007/s10157-022-02225-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/05/2022] [Indexed: 12/14/2022]
Abstract
Background Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for treating anemia of chronic kidney disease (CKD). This post hoc analysis of a Japanese, open-label, partially randomized, phase 3 study in patients with non-dialysis-dependent (NDD) CKD evaluated disease state–related parameters among patients with and without diabetes mellitus who received roxadustat. In the 1517-CL-0310 study (NCT02988973), roxadustat was noninferior to darbepoetin alfa for change in average hemoglobin levels at Weeks 18–24 from baseline who received roxadustat. Methods Patients enrolled in the 1517-CL-0310 study who received roxadustat were included in this post hoc analysis. Hematologic (hemoglobin, reticulocyte/erythrocyte ratio, mean corpuscular volume [MCV], and mean corpuscular hemoglobin [MCH]), iron-related (ferritin, total iron-binding capacity, transferrin, ceruloplasmin, and hepcidin), metabolic (HbA1c, glycated albumin, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), and renal (eGFR) parameters were summarized descriptively by visit through Week 52. Results Among 201 included patients, 105 (52.2%) and 96 (47.8%) were in the Diabetes and No Diabetes subgroups, respectively. There were no clinically meaningful differences through Week 52 for most hematologic, iron-related, metabolic, or renal parameters between patients in the Diabetes and No Diabetes subgroups. MCV and MCH remained lower and HbA1c and glycated albumin remained higher in patients in the Diabetes subgroup through Week 52. Both subgroups experienced a similar benefit from roxadustat in maintaining hemoglobin levels in the target range of 10–12 g/dL. Conclusion Roxadustat maintained hemoglobin levels in the target range with similar clinical parameters irrespective of diabetes mellitus presence at baseline. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-022-02225-w.
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Affiliation(s)
- Tadao Akizawa
- Department of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Keiko Tanaka-Amino
- Medical Specialty, Japan Medical Affairs, Astellas Pharma, Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Tetsuro Otsuka
- Japan-Asia Clinical Development, Astellas Pharma, Inc., Tokyo, Japan
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Weng SC, Chen CM, Chen YC, Wu MJ, Tarng DC. Trajectory of Estimated Glomerular Filtration Rate and Malnourishment Predict Mortality and Kidney Failure in Older Adults With Chronic Kidney Disease. Front Med (Lausanne) 2021; 8:760391. [PMID: 34912823 PMCID: PMC8666586 DOI: 10.3389/fmed.2021.760391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The trajectory patterns of estimated glomerular filtration rates (eGFR) in chronic kidney disease (CKD) older adults with malnourishment and their association with subsequent patient outcomes have not been elucidated. We aimed to assess the eGFR trajectory patterns for predicting patient survival and kidney failure in the elderly without or with malnourishment. Materials and Methods: Based on a prospective longitudinal cohort, CKD patients aged 65 years or older were enrolled from 2001 to 2013. Among the 3,948 patients whose eGFR trajectory patterns were analyzed, 1,872 patients were stratified by the absence or presence of malnourishment, and 765 patients were identified and categorized as having malnourishment. Four eGFR trajectory patterns [gradual decline (T0), early non-decline and then persistent decline (T1), persistent increase (T2), and low baseline and then progressive increase (T3)] were classified by utilizing a linear mixed-effect model with a quadratic term in time. The malnourishment was defined as body mass index < 22 kg/m2, serum albumin < 3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) < 98. This study assessed the effectiveness of eGFR trajectory patterns in a median follow-up of 2.27 years for predicting all-cause mortality and kidney failure. Results: The mean age was 76.9 ± 6.7 years, and a total of 82 (10.7%) patients with malnourishment and 57 (5.1%) patients without malnourishment died at the end of the study. Compared with the reference trajectory T0, the overall mortality of T1 was markedly reduced [adjusted hazard ratio (aHR) = 0.52, 95% confidence interval (CI) 0.32–0.83]. In patients with trajectory, T3 was associated with a high risk for kidney failure (aHR = 5.68, 95% CI 3.12–10.4) compared with the reference, especially higher risk in the presence of malnourishment. Patients with high GNRI values were significantly associated with a lower risk of death and kidney failure, but patients with malnourishment and concomitant alcohol consumption had a higher risk of kidney failure. Conclusions: Low baseline eGFR and progressively increasing eGFR trajectory were high risks for kidney failure in CKD patients. These findings may be attributed to multimorbidity, malnourishment, and decompensation of renal function.
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Affiliation(s)
- Shuo-Chun Weng
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chyong-Mei Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Ju Wu
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Nagano T, Yasuoka R, Tanaka M, Maruyama M, Nakazawa G, Kurita T. A proposed interval for evaluation of renal function during anticoagulation therapy using direct oral anticoagulants in patients with atrial fibrillation. J Cardiol 2021; 79:283-290. [PMID: 34756768 DOI: 10.1016/j.jjcc.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) have been used to prevent cardiogenic embolism in patients with atrial fibrillation (AF). No evidence has been established for the follow-up renal function evaluation intervals. We hypothesized that a proposed follow-up interval of renal function can be estimated by patient's baseline characteristics including creatinine clearance (CCr). METHODS We conducted a single-center retrospective study at Kindai University Hospital from May 2011 to December 2017. Patients were screened and they were enrolled if baseline CCr of ≥50 mL/min. To provide a periodical synchronization for measurements of CCr in all patients, these were evaluated at four different time points (approximately at 3, 6, 9, and 12 months). Primary endpoint was defined as a CCr value of <50 mL/min during the follow-up period. We analyzed associations between the cumulative risk for renal endpoint and baseline characteristics by the Kaplan-Meier method and the Cox proportional hazards model. RESULTS Renal endpoint was associated with age (95% CI: 0.07 to 0.21, p<0.01), body weight (95% CI: -0.09 to -0.01, p<0.01), CCr (95% CI: -0.18 to -0.07, p<0.01), and CHA2DS2-VASc score (95% CI: 0.14 to 0.63, p<0.01). Combining baseline CCr of <60 mL/min and other risk factors, acceptable intervals for 5% risk levels were 78 days (age ≥75 years old), 100 days (CHA2DS2-VASc score of> 4 points), and 90 days (body weight <60kg), respectively. Under conditions of baseline CCr of <60 mL/min, age ≥75 years old, CHA2DS2-VASc score of> 4 points, or body weight <60 kg, an increased risk of renal endpoints is 4.85, 3.29, 1.24, 2.44 fold, respectively. CONCLUSIONS We propose a risk-stratified follow-up interval for renal evaluation in patients with AF and DOACs therapy according to a combination of baseline CCr and other risk factors.
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Affiliation(s)
- Tomoya Nagano
- Kindai University Hospital Division of Cardiology, Osaka, Japan
| | - Ryobun Yasuoka
- Kindai University Hospital Division of Cardiology, Osaka, Japan
| | - Motohide Tanaka
- Kindai University Hospital Division of Cardiology, Osaka, Japan
| | | | - Gaku Nakazawa
- Kindai University Hospital Division of Cardiology, Osaka, Japan
| | - Takashi Kurita
- Kindai University Hospital Division of Cardiology, Osaka, Japan.
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Abstract
OBJECTIVES This study aimed to investigate the relationship between cardiovascular mortality in elderly Asians and decline in renal function. DESIGN A retrospective cohort study. SETTING Community-based health examination database from Taipei city. PARTICIPANTS At the beginning, the database included 315 045 health check-up visits of 97 803 elderly persons aged ≥65 years old from 2005 to 2012. After excluding missing values and outliers, there were 64 732 elderly persons with at least two visits retained for further analyses. PRIMARY OUTCOME MEASURES Kidney function indicators include estimated glomerular filtration rate (eGFR) and urine protein, and rapid decline in eGFR was defined as slope ≤ -5 mL/min/1.73 m2 per year. The endpoint outcome was defined as the cardiovascular deaths registered in the death registry encoded by the International Classification of Diseases. We applied a Cox proportional hazards model to analyse the association between renal function and cardiovascular mortality. RESULTS In this study, we found 1264 elderly persons died from cardiovascular diseases, for whom the data included 4055 previous health check-up visits. We observed significant and independent associations of eGFR <60 mL/min/1.73 m2 (HR (95% CI) of 60>eGFR≥45 and eGFR<45 in males: 2.85 (1.33 to 6.09) and 3.98 (1.84 to 8.61); in females: 3.66 (1.32 to 10.15) and 6.77 (2.41 to 18.99)), positive proteinuria (HR (95% CI) of +/-, +,++ and +++, ++++ in males: 1.51 (1.29 to 1.78) and 2.31 (1.51 to 3.53); in females: 1.93 (1.54 to 2.42) and 4.23 (2.34 to 7.65)) and rapid decline in eGFR (HR (95% CI) in males: 3.24 (2.73 to 3.85); in females: 2.83 (2.20 to 3.64) with higher risk of cardiovascular mortality. The joint effect of increased concentration of urine protein and reduced eGFR was associated with a higher risk of cardiovascular mortality. CONCLUSIONS Renal function and rapid decline in renal function are independent risk factors for cardiovascular mortality in the elderly.
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Affiliation(s)
- Ying-Jhen Huang
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Yu-Lin Hsu
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Yung-Hsin Chuang
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hugo Y-H Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Research Center of Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Ramaswamy R, Wee SN, George K, Ghosh A, Sarkar J, Burghaus R, Lippert J. CKD subpopulations defined by risk-factors: A longitudinal analysis of electronic health records. CPT Pharmacometrics Syst Pharmacol 2021; 10:1343-1356. [PMID: 34510793 PMCID: PMC8592509 DOI: 10.1002/psp4.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 12/05/2022]
Abstract
Chronic kidney disease (CKD) is a progressive disease that evades early detection and is associated with various comorbidities. Although clinical comprehension and control of these comorbidities is crucial for CKD management, complex pathophysiological interactions and feedback loops make this a formidable task. We have developed a hybrid semimechanistic modeling methodology to investigate CKD progression. The model is represented as a system of ordinary differential equations with embedded neural networks and takes into account complex disease progression pathways, feedback loops, and effects of 53 medications to generate time trajectories of eight clinical biomarkers that capture CKD progression due to various risk factors. The model was applied to real world data of US patients with CKD to map the available longitudinal information onto a set of time‐invariant patient‐specific parameters with a clear biological interpretation. These parameters describing individual patients were used to segment the cohort using a clustering approach. Model‐based simulations were conducted to investigate cluster‐specific treatment strategies. The model was able to reliably reproduce the variability in biomarkers across the cohort. The clustering procedure segmented the cohort into five subpopulations – four with enhanced sensitivity to a specific risk factor (hypertension, hyperlipidemia, hyperglycemia, or impaired kidney) and one that is largely insensitive to any of the risk factors. Simulation studies were used to identify patient‐specific strategies to restrain or prevent CKD progression through management of specific risk factors. The semimechanistic model enables identification of disease progression phenotypes using longitudinal data that aid in prioritizing treatment strategies at individual patient level.
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Affiliation(s)
| | | | | | | | | | - Rolf Burghaus
- Pharmacometrics, Bayer AG - Pharmaceuticals, Wuppertal, Germany
| | - Jörg Lippert
- Pharmacometrics, Bayer AG - Pharmaceuticals, Wuppertal, Germany
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Suzuki S, Yamashita T, Otsuka T, Arita T, Yagi N, Kishi M, Semba H, Kano H, Matsuno S, Matsuhama M, Kato Y, Uejima T, Oikawa Y, Inoue T, Yajima J. Decline of estimated glomerular filtration rate has triphasic changes according to age. Geriatr Gerontol Int 2021; 20:844-846. [PMID: 33448558 DOI: 10.1111/ggi.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/12/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikio Kishi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroaki Semba
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Minoru Matsuhama
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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Gurung RL, Dorajoo R, M Y, Liu JJ, Pek SLT, Wang J, Wang L, Sim X, Liu S, Shao YM, Ang K, Subramaniam T, Tang WE, Sum CF, Liu JJ, Lim SC. Association of Genetic Variants for Plasma LRG1 With Rapid Decline in Kidney Function in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2021; 106:2384-2394. [PMID: 33889958 DOI: 10.1210/clinem/dgab268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Elevated levels of plasma leucine-rich α-2-glycoprotein 1 (LRG1), a component of transforming growth factor beta signaling, are associated with development and progression of chronic kidney disease in patients with type 2 diabetes (T2D). However, whether this relationship is causal is uncertain. OBJECTIVES To identify genetic variants associated with plasma LRG1 levels and determine whether genetically predicted plasma LRG1 contributes to a rapid decline in kidney function (RDKF) in patients with T2D. DESIGN AND PARTICIPANTS We performed a genome-wide association study of plasma LRG1 among 3694 T2D individuals [1881 (983 Chinese, 420 Malay, and 478 Indian) discovery from Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes cohort and 1813 (Chinese) validation from Diabetic Nephropathy cohort]. One- sample Mendelian randomization analysis was performed among 1337 T2D Chinese participants with preserved glomerular filtration function [baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2)]. RDKF was defined as an eGFR decline of 3 mL/min/1.73 m2/year or greater. RESULTS We identified rs4806985 variant near LRG1 locus robustly associated with plasma LRG1 levels (meta P = 6.66 × 10-16). Among 1337 participants, 344 (26%) developed RDKF, and the rs4806985 variant was associated with higher odds of RDKF (meta odds ratio = 1.23, P = 0.030 adjusted for age and sex). Mendelian randomization analysis provided evidence for a potential causal effect of plasma LRG1 on kidney function decline in T2D (P < 0.05). CONCLUSION We demonstrate that genetically influenced plasma LRG1 increases the risk of RDKF in T2D patients, suggesting plasma LRG1 as a potential treatment target. However, further studies are warranted to elucidate underlying pathways to provide insight into diabetic kidney disease prevention.
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Affiliation(s)
- Resham Lal Gurung
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Rajkumar Dorajoo
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yiamunaa M
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Ling Wang
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Heath, Singapore, Singapore
| | - Sylvia Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yi-Ming Shao
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Wern Ee Tang
- National Healthcare Group Polyclinic, Singapore, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | - Jian-Jun Liu
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Heath, Singapore, Singapore
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
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12
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Thanachayanont T, Chanpitakkul M, Hengtrakulvenit J, Watcharakanon P, Wisansak W, Tancharoensukjit T, Kaewsringam P, Leesmidt V, Pongpirul K, Lekagul S, Tungsanga K. Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand (ESCORT-2) trials. Nephrology (Carlton) 2021; 26:333-340. [PMID: 33442912 PMCID: PMC7986192 DOI: 10.1111/nep.13849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
AIM We conducted a prospective cohort study to evaluate the effectiveness of an integrated care model on delaying chronic kidney disease (CKD) progression in routine clinical practice in rural primary care setting. METHODS After enrolment, patients with stages 3 to 4 CKD patients from five district hospitals in a northern province of Thailand (400 km from Bangkok) received integrated care comprising hospital multidisciplinary care and home visits by community care teams. Clinical characteristics and biochemical data were collected at baseline and every 3-month interval thereafter for 36 months. The primary outcome was the rate of estimated glomerular filtration rate (eGFR) decline. RESULTS Nine hundred and fourteen stage -3 and - 4 CKD patients were enrolled. The mean age of our cohort was 62 years. Diabetic kidney disease (DKD) was the main cause of CKD (53%) whereas hypertension was the most common co-morbidity (92%). The mean rate of eGFR decline was -0.92 mL/min/1.73 m2 /year. The rate of eGFR decline among patients with DKD was about three times faster than patients without DKD. Patients with higher blood pressure, metabolic acidosis, proteinuria or anaemia had a faster rate of eGFR decline. CONCLUSION This integrated care model at the community level was effective in delaying CKD progression in routine clinical practice situation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Krit Pongpirul
- Department of MedicineKing Chulalongkorn Memorial Hospital, Chulalongkorn UniversityBangkokThailand
| | | | - Kriang Tungsanga
- Bhumirajanagarindra Kidney InstituteBangkokThailand
- Department of MedicineKing Chulalongkorn Memorial Hospital, Chulalongkorn UniversityBangkokThailand
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Al-Jewari K, Baban R, Manuti J. Serum and urinary soluble α-Klotho levels in patients with chronic kidney disease. Baghdad J Biochem Appl Biol Sci 2021. [DOI: 10.47419/bjbabs.v2i01.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Chronic kidney disease is an epidemic global health problem that leads to death. To prevent any disease progression and treatment, the diagnosis must be made in the early stage by studying renal damage. Klotho is a protein found in many organs of the human body, but it is mainly abundant in the kidney.
Objectives: This study is aimed to evaluate klotho’s clinical significance as an additional biomarker for diagnosing chronic kidney disease in its early stages.
Methods: One hundred subjects were included in this study to measure their serum and urinary klotho. Forty patients with chronic kidney disease (pre-dialysis) and sixty normal subjects were enrolled in this study. Serum and urinary klotho were determined using the ELISA technique in addition to other renal function tests.
Results: Serum and urinary alpha klotho were decreased in CKD patients when compared with control subjects. A positive correlation was found between serum creatinine and urinary alpha klotho in the patients’ group.
Conclusion: Serum and urinary alpha klotho levels were decreased significantly in patients with chronic kidney disease compared with healthy controls.
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14
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Abstract
PURPOSE Chronic kidney disease (CKD) is a major morbidity, and its prevalence increases with age. However, there appears to be some confusion about the prognosis of CKD in aged patients, because, it has its own characteristics different from youngers. In this study, we investigated the progression of CKD and related factors in aged patients. METHODS This was a retrospective study including 334 patients over 80 years of age that were diagnosed with stage 3-4 CKD at our CKD clinic. CKD progression was assessed as an annual decline in the estimated glomerular filtration rate (eGFR). Comorbidities were globally categorized with the Charlson comorbidity index (CCI), but diabetes mellitus, hypertension, and cardiac morbidities were evaluated separately. Patients were grouped as either 'progression to end-stage renal disease (ESRD)' or 'others'. RESULTS During the follow-up period, 191 (57.2%) patients exhibited progression; the annual median eGFR declined by 0.8 ml/min/1.73 m2. Only 27 (8.1%) of these patients progressed to ESRD. In univariant and multivariate models, respectively, progressing to ESRD was significantly associated with cardiac comorbidities (p < 0.001, p < 0.001), proteinuria (p < 0.001, p = 0.03), and the baseline eGFR value (p < 0.001, p < 0.001). CONCLUSION In aged patients, CKD progressed slowly, but particularly high initial creatinine levels and proteinuria could be indicator of progression. In addition, cardiac comorbidities may facilitate progression to ESRD.
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Affiliation(s)
- Murat Tuğcu
- Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District, Muhsin Yazıcıoğlu Street No:10 Pendik, 34899, Istanbul, Turkey.
| | - Dilek Barutçu Ataş
- Marmara University Pendik Training and Research Hospital, Fevzi Çakmak District, Muhsin Yazıcıoğlu Street No:10 Pendik, 34899, Istanbul, Turkey
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15
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Zitouni K, Steyn MRCP, Lyka E, Kelly FJ, Cook P, Ster IC, Earle KA. Derepression of glomerular filtration, renal blood flow and antioxidant defence in patients with type 2 diabetes at high-risk of cardiorenal disease. Free Radic Biol Med 2020; 161:283-289. [PMID: 33039650 DOI: 10.1016/j.freeradbiomed.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of antioxidant status on microvascular blood flow and glomerular filtration (eGFR) in patients with type 2 diabetes and hypertension whose risk of progressive renal disease varies by ethnicity is unknown. METHODS Adult, non-Caucasian (n = 101) and Caucasian (n = 69) patients with type 2 diabetes, hypertension and/or microalbuminuria and an eGFR > 45 mL/min/1.73 m2 were randomised to receive 400 IU vitamin E and/or 20 μg selenium daily or matching placebo. eGFR (CKD-EPI) was measured at baseline, 3,6 and 12 months and renal blood flow by contrast-enhanced ultrasonography in a sub-group (n = 9) at baseline and 3 months by assessing the area under the time intensity curve (TIC). Circulating glutathione peroxidase 3 (GPx-3) activity was measured as a biomarker of oxidative defence status. RESULTS The time to change in eGFR was shortest with combined vitamin E and selenium than usual care (5.6 [4.0-7.0] vs 8.9 [6.8-10.9 months]; p = 0.006). Area under the TIC was reduced compared to baseline (38.52 [22.41-90.49] vs 123 [86.98-367.03]dB.s; P ≤ 0.05 and 347 [175.88-654.92] vs 928.03 [448.45-1683]dB.s; P ≤ 0.05, respectively] at 3 months suggesting an increase in rate of perfusion. The proportional change in eGFR at 12 months was greater in the group whose GPx-3 activity was above, compared with those below the cohort median (360 U/L) in the non-Caucasian and the Caucasian groups (19.1(12.5-25.7] % vs 6.5[-3.5 to 16.5] % and 12.8 [0.7 to 24] % vs 0.2 [-6.1 to 6.5] %). CONCLUSION In these patients with type 2 diabetes and early CKD, antioxidant treatment derepresses renal blood flow and a rise in eGFR correlated directly with GPx-3 activity. SIGNIFICANCE Diabetes mellitus is the world's leading cause of end-stage renal disease which has a predilection for black and minor ethnic groups compared with Caucasians. The differences in risk despite the benefits of conventional care may be related to oxidative stress. We found that glomerular filtration and renal blood flow is suppressed when renal function is preserved in high-risk patients with type 2 diabetes. Conventional care supplemented with selenium - the co-factor for glutathione peroxidase-3 (GPx-3) - improves renal perfusion and increase glomerular filtration according to host antioxidant defence determined by GPx-3 activity. Circulating GPx-3 activity warrants further investigation as a novel biomarker of reversible haemodynamic changes in early diabetic kidney disease to better enable targeting of renoprotective strategies.
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Affiliation(s)
- Karima Zitouni
- St Georges University of London, Institute of Infection and Immunity, London, UK
| | - M R C P Steyn
- St Georges University Hospitals NHS Foundation Trust, Thomas Addison Unit, London, UK
| | - Eliza Lyka
- St Georges University of London, Institute of Biomedical & Medical Education, London, UK
| | - Frank J Kelly
- Kings College London, Analytical, Environmental and Forensic Sciences Department, London, UK
| | - Paul Cook
- University Hospital Southampton NHS Foundation Trust, Trace Element Unit, Southampton, UK
| | - Irina Chis Ster
- St Georges University of London, Institute of Infection and Immunity, London, UK
| | - Kenneth Anthony Earle
- St Georges University Hospitals NHS Foundation Trust, Thomas Addison Unit, London, UK; St Georges University of London, Institute of Biomedical & Medical Education, London, UK.
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16
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Wallin H, Jansson E, Wallquist C, Hylander Rössner B, Jacobson SH, Rickenlund A, Eriksson MJ. Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: a longitudinal study. BMC Nephrol 2020; 21:475. [PMID: 33176704 PMCID: PMC7656689 DOI: 10.1186/s12882-020-02110-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Aerobic exercise capacity is reduced in non-dialysis chronic kidney disease (CKD), but the magnitude of changes in exercise capacity over time is less known. Our main hypothesis was that aerobic ExCap would decline over 5 years in individuals with mild-to-moderate CKD along with a decline in renal function. A secondary hypothesis was that such a decline in ExCap would be associated with a decline in muscle strength, cardiovascular function and physical activity. Methods We performed a 5-year-prospective study on individuals with mild-to-moderate CKD, who were closely monitored at a nephrology clinic. Fiftytwo individuals with CKD stage 2–3 and 54 age- and sex-matched healthy controls were included. Peak workload was assessed through a maximal cycle exercise test. Muscle strength and lean body mass, cardiac function, vascular stiffness, self-reported physical activity level, renal function and haemoglobin level were evaluated. Tests were repeated after 5 years. Statistical analysis of longitudinal data was performed using linear mixed models. Results Exercise capacity did not change significantly over time in either the CKD group or controls, although the absolute workloads were significantly lower in the CKD group. Only in a CKD subgroup reporting low physical activity at baseline, exercise capacity declined. Renal function decreased in both groups, with a larger decline in CKD (p = 0.05 between groups). Peak heart rate, haemoglobin level, handgrip strength, lean body mass and cardiovascular function did not decrease significantly over time in CKD individuals. Conclusions On a group level, aerobic exercise capacity and peak heart rate were maintained over 5 years in patients with well-controlled mild-to-moderate CKD, despite a slight reduction in glomerular filtration rate. In line with the maintained exercise capacity, cardiovascular and muscular function were also preserved. In individuals with mild-to-moderate CKD, physical activity level at baseline seems to have a predictive value for exercise capacity at follow-up.
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Affiliation(s)
- Helena Wallin
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden. .,Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Eva Jansson
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carin Wallquist
- Department of Nephrology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Britta Hylander Rössner
- Department of Nephrology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden
| | - Anette Rickenlund
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Maria J Eriksson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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17
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Lin CJ, Wason JM. Efficient analysis of time-to-event endpoints when the event involves a continuous variable crossing a threshold. J Stat Plan Inference 2020; 208:119-129. [PMID: 32884165 PMCID: PMC7097971 DOI: 10.1016/j.jspi.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 02/15/2020] [Accepted: 02/15/2020] [Indexed: 01/29/2023]
Abstract
In many trials, the duration between patient enrolment and an event occurring is used as the efficacy endpoint. Common endpoints of this type include the time until relapse, progression to the next stage of a disease, or time until remission. The criteria of an event may be defined by multiple components, one or more of which may be a continuous measurement being above or below a threshold. Typical analyses consider all components as binary variables and record the first time at which the patient has an event. This is analysed through constructing and testing survival functions using Kaplan-Meier, parametric models or Cox models. This approach ignores information contained in the continuous components. We propose a method that makes use of this information to improve the precision of analyses using these types of endpoints. We use joint modelling of the continuous and binary components to construct survival curves. We show how to compute confidence intervals for quantities of interest, such as the median or mean event time. We assess the properties of the proposed method using simulations and data from a phase II cancer trial and an observational study in renal disease.
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Affiliation(s)
- Chien-Ju Lin
- Medical Research Council Biostatistics Unit, University of Cambridge, UK
| | - James M.S. Wason
- Medical Research Council Biostatistics Unit, University of Cambridge, UK
- Population Health Sciences Institute, Newcastle University, UK
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18
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Wu CL, Liou CH, Liu SA, Sheu WHH, Tsai SF. Health Literacy Varies According to Different Background Disease Natures and Characteristics of Participants for Patient Support Groups. Int J Environ Res Public Health 2020; 17:ijerph17165702. [PMID: 32784560 PMCID: PMC7460350 DOI: 10.3390/ijerph17165702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Abstract
Introduction: Patient support groups (PSGs) should be designed according to the backgrounds of participants and the nature of their diseases. Using health literacy as an outcome indicator for PSGs is rare. Methods: All questionnaires (Mandarin Multidimensional Health Literacy Questionnaire, MMHLQ) were collected from eight PSGs to evaluate the health literacy of participants. Background data of participants were also collected, including patient or family, age, and first-time participation or not. Results: A total of 458 questionnaires were collected from eight PSGs. The diseases were: autoimmune disease (systemic lupus nephritis (SLE), malignancy (head and neck cancer (HNC), chronic disease (diabetes mellitus or DM), chronic kidney disease (CKD), hemodialysis and chronic obstructive pulmonary disease (COPD), genetic disease (autosomal dominant polycystic kidney disease (ADPKD), and degenerative disease (osteoporosis). For vasculitis (42.21 ± 16.49 years old for SLE) and genetic disease (48.95 ± 17.58 years old for ADPKD), participants were younger. More significant differences between first-time participation and MMHLQ scores were found in disease of osteoporosis, CKD, COPD, and hemodialysis. More significant differences between role of participation (patients themselves or family) and MMHLQ scores were found in SLE, ADPKD, hemodialysis, and CKD. More significant differences between age (elderly or not) and MMHLQ score were found in HNC, DM, CKD, COPD, and osteoporosis. Conclusion: Background data of participants varied across different diseases. Different disease natures and patient background statuses should therefore demand different designs in PSG. MMHLQ before PSGs can be used to help to improve the PSG curriculum on the health literacy of patients.
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Affiliation(s)
- Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- Department of Automatic Control Engineering, Feng Chia University, Taichung 407, Taiwan
| | - Chia-Hua Liou
- Center for Quality Management, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-H.L.); (S.-A.L.)
| | - Shih-An Liu
- Center for Quality Management, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-H.L.); (S.-A.L.)
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Otolaryngolog, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Wayne H.-H. Sheu
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Shang-Feng Tsai
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Life Science, Tunghai University, Taichung 407, Taiwan
- Correspondence: ; Tel.: +886-423-592-525; Fax: +886-423-594-980
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19
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Åberg F, Berntsson J, Herlenius G, Castedal M, Bennet W. Everolimus and long-term decline in renal function after liver transplantation: real-life experience with measured GFR. Scand J Gastroenterol 2020; 55:718-724. [PMID: 32479116 DOI: 10.1080/00365521.2020.1770328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Switching from calcineurin-inhibitors (CNI) to everolimus >6-12-months after liver transplantation (LT) seems inefficient in improving renal function, but whether everolimus halts further renal-function decline compared to low-dose CNI remains unclear. In a retrospective single-center study of everolimus after LT (2008-2016) with routine measured glomerular filtration rates (mGFR; 51Cr-EDTA- or iohexol clearance), we compared by propensity-score matching everolimus therapy to low-dose CNI therapy. The study comprised 36 patients with everolimus introduced on average 22 months post-LT (range 2-105 months, median follow-up 3.4 years), and 36 matched controls. Everolimus introduction was associated with a mean improvement in mGFR of 7 mL/min up to 1 year (p = .003), restricted to patients switched <1-year post-transplant and at tacrolimus trough levels >5 ng/mL. The differences between the everolimus group and controls in delta-mGFR from baseline to 1 year (7.3 vs 4.3 mL/min, p = .25) or 1-year to last follow-up (-0.8 vs -0.2 mL/min/year, p = .71) were non-significant. Proportions with mGFR decline >3 mL/min/year were similar between groups (11% and 14%, p = 1.00). Everolimus was stopped in three patients (8%), and acute rejection occurred in 17%. In conclusion, despite an early improvement in renal function after everolimus introduction, we found no evidence that everolimus halts the long-term mGFR decline compared to continued low-dose CNI therapy. Due to retrospective design, small sample size and heterogenous characteristics, definite conclusions require prospective studies.
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Affiliation(s)
- Fredrik Åberg
- The Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Berntsson
- The Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gustaf Herlenius
- The Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Castedal
- The Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - William Bennet
- The Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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Reichel H, Zee J, Tu C, Young E, Pisoni RL, Stengel B, Duttlinger J, Lonnemann G, Robinson BM, Pecoits-Filho R, Fliser D. Chronic kidney disease progression and mortality risk profiles in Germany: results from the Chronic Kidney Disease Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2020; 35:803-810. [PMID: 31953939 PMCID: PMC7203560 DOI: 10.1093/ndt/gfz260] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) progression among German patients in a representative setting has not been described previously. The Verband Deutsche Nierenzentren and Chronic Kidney Disease Outcomes and Practice Patterns Study established a longitudinal observational cohort among German CKD patients to research variations in patient care and outcomes in real-world nephrology practices. METHODS A cohort of CKD Stages 3 (25%) and 4 (75%) patients was established from German nephrologist-run CKD clinics in 2013-16. Linear models were used to determine the estimated glomerular filtration rate (eGFR) slope during follow-up and Cox models were used to assess outcomes of end-stage kidney disease (ESKD) and death. RESULTS A total of 1834 patients (median age 75 years, 58% male, 42% diabetics, median baseline eGFR 25 mL/min/1.73 m2) were followed for a median of 29 months. More than 50% had slow or no decline and 17% declined ≥5 mL/min/1.73 m2/year. After 4.5 years, the incidence of ESKD was 8% and of deaths without ESKD 16% among patients with eGFR ≥30 mL/min/1.73 m2 and 37% and 19% for eGFR <30 mL/min/1.73 m2. Adjusted models showed higher risks of ESKD or death for patients with worse kidney function at baseline, male sex, diabetes and higher blood pressure; a higher risk of ESKD with higher albuminuria; and a higher risk of death with older age or cardiovascular comorbidity. CONCLUSIONS Routine nephrology care of patients in Germany comprises mostly elderly patients, many with slow CKD progression. Identification of risk factors for CKD progression and mortality may help guide resources by closer follow-up of high-risk patients.
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Affiliation(s)
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Charlotte Tu
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Eric Young
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Bénédicte Stengel
- French National Institute of Health and Medical Research, Villejuif, France
| | | | | | | | | | - Danilo Fliser
- Internal Medicine - Nephrology and Hypertension, University Hospital of the Saarland, Homburg, Germany
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21
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Liu CH, Lee MH, Lin JW, Liu CJ, Su TH, Tseng TC, Chen PJ, Chen DS, Kao JH. Evolution of eGFR in chronic HCV patients receiving sofosbuvir-based or sofosbuvir-free direct-acting antivirals. J Hepatol 2020; 72:839-846. [PMID: 31790766 DOI: 10.1016/j.jhep.2019.11.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Data regarding the nephrotoxicity of sofosbuvir (SOF) remain controversial. We compared the evolution of estimated glomerular filtration rate (eGFR) in patients with chronic HCV infection receiving SOF-based or SOF-free direct-acting antivirals (DAAs). METHODS A total of 481 patients with compensated liver diseases and eGFR ≥30 ml/min/1.73m2, receiving SOF-based (n = 308) or SOF-free (n = 173) DAAs for 12 weeks, were prospectively enrolled. The eGFR was assessed from baseline to off-treatment week 24 using the chronic kidney disease (CKD)-epidemiology collaboration equation. Differences in the evolution of eGFR between regimens were compared by a generalized linear mixed-effects model. Multivariate analysis was performed for factors affecting eGFR evolution. RESULTS Patients receiving SOF-based DAAs experienced a significant on-treatment decline in eGFR (adjusted slope coefficient difference: -1.24 ml/min/1.73m2/month; 95% CI -1.35 to -1.13; p <0.001) and a significant off-treatment improvement (adjusted slope coefficient difference: 0.14 ml/min/1.73m2/month; 95% CI 0.08 to 0.21; p = 0.004) compared to patients receiving SOF-free DAAs. Multivariate analysis showed age per 1-year increase (adjusted slope coefficient difference: -0.05 ml/min/1.73m2/month; 95% CI -0.05 to -0.04; p <0.001), SOF-based DAAs (adjusted slope coefficient difference: -0.33 ml/min/1.73m2/month; 95% CI -0.49 to -0.17; p <0.001), and CKD stage (adjusted slope coefficient difference: -1.44 ml/min/1.73m2/month; 95% CI -1.58 to -1.30; p <0.001 for stage 3 vs. 1, and -3.59 ml/min/1.73m2/month; 95% CI -3.88 to -3.30; p <0.001 for stage 2 vs. 1) were independent factors affecting eGFR evolution from baseline to off-treatment week 24. CONCLUSIONS Patients receiving SOF-based DAAs exhibited a quadratic trend, with eGFR worsening on treatment and improving off treatment. Increasing age, SOF-based DAAs, and more advanced baseline CKD stage are independently associated with a decline in eGFR in patients with HCV receiving DAAs. LAY SUMMARY While the efficacy of sofosbuvir for the treatment of hepatitis C virus is clear, data regarding its possible nephrotoxicity are controversial. Herein, we showed that sofosbuvir worsened on-treatment kidney function but led to an off-treatment improvement. Our findings suggest that treating physicians should be alert to risk factors for kidney dysfunction before initiating direct-acting antiviral treatment for patients with hepatitis C virus infection. CLINICAL TRIAL NUMBER NCT04047680.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jou-Wei Lin
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Chung Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
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22
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Olaniran KO, Allegretti AS, Zhao SH, Achebe MM, Eneanya ND, Thadhani RI, Nigwekar SU, Kalim S. Kidney Function Decline among Black Patients with Sickle Cell Trait and Sickle Cell Disease: An Observational Cohort Study. J Am Soc Nephrol 2019; 31:393-404. [PMID: 31810990 DOI: 10.1681/asn.2019050502] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sickle cell trait and sickle cell disease are thought to be independent risk factors for CKD, but the trajectory and predictors of kidney function decline in patients with these phenotypes are not well understood. METHODS Our multicenter, observational study used registry data (collected January 2005 through June 2018) and included adult black patients with sickle cell trait or disease (exposures) or normal hemoglobin phenotype (reference) status (ascertained by electrophoresis) and at least 1 year of follow-up and three eGFR values. We used linear mixed models to evaluate the difference in the mean change in eGFR per year. RESULTS We identified 1251 patients with sickle cell trait, 230 with sickle cell disease, and 8729 reference patients, with a median follow-up of 8 years. After adjustment, eGFR declined significantly faster in patients with sickle cell trait or sickle cell disease compared with reference patients; it also declined significantly faster in patients with sickle cell disease than in patients with sickle cell trait. Male sex, diabetes mellitus, and baseline eGFR ≥90 ml/min per 1.73 m2 were associated with faster eGFR decline for both phenotypes. In sickle cell trait, low hemoglobin S and elevated hemoglobin A were associated with faster eGFR decline, but elevated hemoglobins F and A2 were renoprotective. CONCLUSIONS Sickle cell trait and disease are associated with faster eGFR decline in black patients, with faster decline in sickle cell disease. Low hemoglobin S was associated with faster eGFR decline in sickle cell trait but may be confounded by concurrent hemoglobinopathies. Prospective and mechanistic studies are needed to develop best practices to attenuate eGFR decline in such patients.
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Affiliation(s)
- Kabir O Olaniran
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; .,Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophia H Zhao
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maureen M Achebe
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Ravi I Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahir Kalim
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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23
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Chou YH, Yen CJ, Lai TS, Chen YM. Old age is a positive modifier of renal outcome in Taiwanese patients with stages 3-5 chronic kidney disease. Aging Clin Exp Res 2019; 31:1651-1659. [PMID: 30628047 DOI: 10.1007/s40520-018-01117-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The incidence of end-stage renal disease (ESRD) is increasing in elderly patients with chronic kidney disease (CKD). This contradicts the general notion that elderly people are more likely to die than to ever reach ESRD. And racial disparity in relation to age on kidney disease outcomes has always been a subject of research interest. AIMS We investigated the effect of age on outcome in a cohort with stages 3-5 CKD patients by age category. METHODS A total of 430 patients with a mean age of 65.6 years were enrolled and followed till death, ESRD, or end of 2015. Multivariable Cox regression was used to identify predictors of all-cause mortality. Competing risk-adjusted Cox regression was used to identify determinants of ESRD. The median follow-up was 7.3 (interquartile range 8.8) years. RESULTS Cox regression showed old age and low mean arterial pressure were predictors of mortality before and after onset of ESRD. Competing risk analysis revealed patients aged 20-39 years and 40-64 years exhibited greater risks of ESRD, compared to those aged over 75 years. These effects of age on outcomes occurred independently of traditional risk factors such as low estimated glomerular filtration rate and high proteinuria. CONCLUSIONS Age over 75 years is associated with decreased risk for ESRD even after adjustment for competing mortality. Given the global trends in population aging, there is a need to develop age-specific strategies, on top of the existing stage-based measures, to optimize the management of CKD in the elderly.
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Affiliation(s)
- Yu-Hsiang Chou
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, No. 7, Yulu Rd., Wuhu Village, Jinshan Dist, New Taipei City, 20844, Taiwan
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan
| | - Chung-Jen Yen
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan
| | - Tai-Shuan Lai
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan
| | - Yung-Ming Chen
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan.
- Department of Internal Medicine, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Section 1, Taipei, 100, Taiwan.
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24
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Kang H, Hong SH. Risk of Kidney Dysfunction from Polypharmacy among Older Patients: A Nested Case-Control Study of the South Korean Senior Cohort. Sci Rep 2019; 9:10440. [PMID: 31320704 DOI: 10.1038/s41598-019-46849-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 07/03/2019] [Indexed: 12/20/2022] Open
Abstract
Polypharmacy, the concurrent use of multiple medicines, could increase the risk of kidney dysfunction among older adults because it likely burdens the aging kidneys to excrete multiple pharmaceutical ingredients and their metabolites. This study aimed to examine the relation between polypharmacy and kidney dysfunction among older patients. A nested case-control study was conducted using the National Health Insurance Service - Senior Cohort (NHIS-SC, 2009-2013), representative of the Korean senior population. It consisted of all health insurance claims linked to records of mandatory health examination. Kidney dysfunction was defined as having an eGFR lower than 60, with a decline rate of 10% or more compared to the baseline eGFR. Polypharmacy was defined based on daily counts of pharmaceutical ingredients during one year prior to the case's event date. It was classified into polypharmacy (five to 10 ingredients) and excessive polypharmacy (10 or more ingredients). After matching case and control groups based on a range of potential confounders, conditional logistic regression was performed incorporating adjustments on disease-specific, medication-specific, and lifestyle-related risk factors. The matching resulted in 14,577 pairs of cases and controls. Exposure to polypharmacy was significantly associated with increase in the risk of kidney dysfunction; i.e., crude model (polypharmacy: OR = 1.572, 95% CI = 1.492-1.656; excessive polypharmacy: OR = 2.069, 95% CI = 1.876-2.283) and risk adjustment model (polypharmacy: OR = 1.213, 95% CI = 1.139-1.292; excessive polypharmacy: OR = 1.461, 95% CI = 1.303-1.639). The significant associations were robust across different definitions of kidney dysfunction. These findings inform healthcare providers and policy makers of the importance of polypharmacy prevention to protect older adults from kidney dysfunction.
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Kawamoto R, Ninomiya D, Kikuchi A, Akase T, Kasai Y, Ohtsuka N, Kumagi T. Serum uric acid to creatinine ratio is a useful predictor of renal dysfunction among diabetic persons. Diabetes Metab Syndr 2019; 13:1851-1856. [PMID: 31235105 DOI: 10.1016/j.dsx.2019.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Serum uric acid (SUA) has been shown to be a predictor of renal disease progression in most but not all studies. This study aims to test whether renal function-normalized SUA {i.e, SUA/creatinine (Cr) ratio} is a predictor of decreased renal function among diabetic patients. METHODS The subjects comprised 185 men aged 72 ± 11 (mean ± standard deviation) years and 175 women aged 77 ± 10 years from a rural hospital. We examined the relationship between SUA/creatinine (Cr) ratio and renal function evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. RESULTS Annual eGFR decline rate was significantly increased with increased tertile of baseline SUA/Cr ratio (p = 0.011), and prevalence of the rapid progression types (≥3.0 ml/min/1.73 m2/year) was significantly higher in the second and third tertile (≥7,21) of baseline SUA/Cr ratio than the first tertile (<5.86) (p = 0.032). Pearson's correlation coefficient showed that baseline SUA/Cr ratio (r = 0.136, p = 0.012) as well as systolic blood pressure (SBP) and SUA were significantly correlated with annual eGFR decline rate. Multiple regression analysis using annual eGFR decline rate as an objective variable, adjusted for confounding factors as explanatory variables, showed that baseline SUA/Cr ratio (β = 0.334, p < 0.001) as well as gender and SBP were significantly and independently associated with annual eGFR decline rate. The multivariate-adjusted odds ratios (ORs) (95% confidence interval) of the baseline tertile of the SUA/Cr ratio for rapid progression of annual eGFR decline rate were 1.0, 3.15 (1.66-5.95) and 3.19 (1.57-6.51), respectively. CONCLUSION Our data demonstrated that baseline SUA/Cr ratio was independently and significantly associated with future renal function decline among diabetic patients.
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Affiliation(s)
- Ryuichi Kawamoto
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Daisuke Ninomiya
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Asuka Kikuchi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Taichi Akase
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Yoshihisa Kasai
- Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Nobuyuki Ohtsuka
- Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Teru Kumagi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan.
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Wang Y, Lee YT, Lee WC, Ng HY, Wu CH, Lee CT. Goal attainment and renal outcomes in patients enrolled in the chronic kidney disease care program in Taiwan: a 3-year observational study. Int J Qual Health Care 2019; 31:252-260. [PMID: 30060200 DOI: 10.1093/intqhc/mzy161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/14/2018] [Accepted: 07/07/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To analyze the effects of chronic kidney disease (CKD) care programs on clinical outcomes. DESIGN An observational, retrospective study with medical record review. SETTING Kaohsiung Chang Gung Memorial Hospital. PARTICIPANTS Patients diagnosed with CKD. INTERVENTIONS CKD care programs conducted by nephrologists-based team from 2006 to 2013 in our hospital. MAIN OUTCOME MEASURES We set 10 goals with treatment target ranges based on the guidelines suggested by the following organizations: Kidney Disease Improving Global Outcomes (2012) and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (2003). RESULTS In total, 1486 patients were enrolled. Their average estimated glomerular filtration rate (ml/min/1.73 m2) was 31.9 at baseline and declined to 28.9 in Year 3 (P < 0.001). The all-goals attainment rate increased from 59.4% at baseline to 60.5% in Year 3, with an especially significant improvement for low-density lipoprotein (from 46.8% to 67.0%) and glycated hemoglobin (from 55.0% to 64.0%). Achievement rates decreased for hemoglobin (from 34.2% to 31.0%), calcium (from 94.6% to 92.3%) and phosphate (from 89.9% to 82.5%) between baseline and Year 3. Albuminuria was the least achieved goal (from 23.4% to 24.0%). Subgroup analysis revealed that estimated glomerular filtration rate did not decline in patients who had a good achievement rate, but decreased significantly in patients with a poor achievement rate. CONCLUSION Enrolment in CKD care programs resulted in a significant improvement in goal attainment by patients. Further, a good achievement rate was associated with better preservation of residual renal function.
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Affiliation(s)
- Yi Wang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yueh-Ting Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Hwee-Yeong Ng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
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27
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Lee CK, Choi SK, Shin DA, Yi S, Ha Y, Kim KN, Kim I. Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study. PLoS One 2019; 14:e0213858. [PMID: 30875413 PMCID: PMC6420006 DOI: 10.1371/journal.pone.0213858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/02/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the relationship between comorbidities, medical cost, and surgical outcome in patients with lumbar spinal stenosis (LSS) and diabetes mellitus (DM). Methods Data on patients with LSS (n = 14,298) were collected from the Korean National Health Insurance Service database from 2005 to 2007. After 8 years of follow-up, a “DM group” (n = 3,478) and a “non-DM group” (n = 10,820) were compared according to outcome measures. Cox proportional hazard regressions were performed to examine the relationship between DM, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), cerebrovascular disease (CbVD), and surgery for LSS. The admission rate and medical cost as well asthe overall survival rate for those who underwent lumbar surgery were also assessed among patients with DM and LSS. Results Mortality was about 1.35 times higher in the DM group than in the non-DM group. Patients with DM and comorbidities including HTN (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.25–1.56; p<0.001), CVD (HR, 1.53; 95% CI, 1.36–1.73; p<0.001), CKD (HR, 3.18; 95% CI, 2.7–3.76; p<0.001), and CbVD (HR, 1.69; 95% CI, 1.49–1.91; p<0.001) showed an increased risk of mortality. The mean hospitalization time and average medical cost of patients with DM who underwent lumbar surgery were 60.8 days, and 7,127 USD, respectively. This was 31.3 days longer, and 6,207 USD higher, respectively, than those of patients with DM who underwent conservative treatment for LSS. Within the DM group, the survival rate of surgical management of LSS had a significant tendency for positive prognosis compared with those administered conservative treatment (p = 0.046). Conclusions In patients with LSS, DM was associated both with poor prognosis (most significantly in those with CKD), and increased medical cost in those who underwent surgery. Nevertheless, surgical treatment for LSS in patients with DM was related to favorable prognosis compared with conservative treatment.
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Affiliation(s)
- Chang Kyu Lee
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
| | - Sun Kyu Choi
- Department of Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Insoo Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
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28
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Tsai CW, Huang HC, Chiang HY, Chung CW, Chang SN, Chu PL, Kuo CC. Longitudinal lipid trends and adverse outcomes in patients with CKD: a 13-year observational cohort study. J Lipid Res 2019; 60:648-660. [PMID: 30642880 DOI: 10.1194/jlr.p084590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Studies on the effects of longitudinal lipid trajectories on end-stage renal disease (ESRD) development and deaths among patients with chronic kidney disease (CKD) are limited. We conducted a registry-based prospective study using data from a 13-year multidisciplinary pre-ESRD care program. The final study population comprised 4,647 patients with CKD. Using group-based trajectory modeling, we dichotomized longitudinal trajectories of total cholesterol (T-CHO), triglyceride (TG), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C). Time to ESRD or death was analyzed using multiple Cox regression. At baseline, higher levels of T-CHO and LDL-C were associated with rapid progression to ESRD, whereas only HDL-C was positively associated with all-cause mortality [adjusted hazard ratio (HR), 1.20; 95% CI, 1.06-1.36; P-value, 0.005]. Compared with those with a normal T-CHO trajectory, the fully adjusted HR of patients with a high T-CHO trajectory for ESRD risk was 1.21 (P-value, 0.019). Subgroup analysis showed that a high TG trajectory was associated with a 49% increase in mortality risk in CKD patients without diabetes (P-value for interaction, 0.012). In contrast to what was observed based on baseline HDL-C, patients with a trajectory of frequent hypo-HDL cholesterolemia had higher risk of all-cause mortality (adjusted HR, 1.53; P-value, 0.014). Thus, only T-CHO, both at baseline and over the longitudinal course, demonstrated a significant potential risk of incident ESRD. The inconsistency in the observed directions of association between baseline levels and longitudinal trajectories of HDL-C warrants further research to unveil specific pathogenic mechanisms underlying the HDL-C metabolism in patients with CKD.
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Affiliation(s)
- Ching-Wei Tsai
- Big Data Center, China Medical University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine China Medical University Hospital, China Medical University, Taichung, Taiwan.,College of Medicine China Medical University, Taichung, Taiwan
| | - Han-Chun Huang
- Big Data Center, China Medical University, Taichung, Taiwan
| | | | - Chih-Wei Chung
- Big Data Center, China Medical University, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University, Taichung, Taiwan
| | - Pei-Lun Chu
- Division of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan .,School of Medicine Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University, Taichung, Taiwan .,Division of Nephrology, Department of Internal Medicine China Medical University Hospital, China Medical University, Taichung, Taiwan.,College of Medicine China Medical University, Taichung, Taiwan
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29
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Seija M, Nin M, Santiago J, Apaza L, Castaño A, Poggi L, Urioste I, Chiossoni A, Fernandez A, Navarrine N, Garau M, Astesiano R, Ferrari MS, Noboa O. Being Overweight Is Related to Faster Decline in Annual Glomerular Filtration Rate in Kidney Transplant. Transplant Proc 2018; 50:3392-3396. [PMID: 30577211 DOI: 10.1016/j.transproceed.2018.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/08/2018] [Accepted: 04/12/2018] [Indexed: 01/02/2023]
Abstract
Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR. METHODS A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m2), slow progressors (> -1 and < -5 mL/min/1.73 m2), and fast progressors (< -5 mL/min/1.73 m2). Percentage of achievement of KDIGO target was also analyzed. RESULTS The mean GFR was 62.5 mL/min/1.73 m2. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m2), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]). CONCLUSIONS High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.
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Affiliation(s)
- M Seija
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay; Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay.
| | - M Nin
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - J Santiago
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - L Apaza
- Hospital Obrero N°1, La Paz, Bolivia
| | - A Castaño
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - L Poggi
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - I Urioste
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - A Chiossoni
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - A Fernandez
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - N Navarrine
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - M Garau
- Departamento de Métodos Cuantitativos, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - R Astesiano
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - M S Ferrari
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
| | - O Noboa
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina, UdeLaR, Montevideo, Uruguay
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30
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Xu JZ, Garrett ME, Soldano KL, Chen ST, Clish CB, Ashley-Koch AE, Telen MJ. Clinical and metabolomic risk factors associated with rapid renal function decline in sickle cell disease. Am J Hematol 2018; 93:1451-1460. [PMID: 30144150 DOI: 10.1002/ajh.25263] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
Sickle cell disease (SCD) nephropathy and lower estimated glomerular filtration rate (eGFR) are risk factors for early mortality. Furthermore, rate of eGFR decline predicts progression to end-stage renal disease in many clinical settings. However, factors predicting renal function decline in SCD are poorly documented. Using clinical, laboratory, genetic, and metabolomic data, we evaluated predictors of renal function decline in a longitudinal cohort of 288 adults (mean age 33.0 years). In 193 subjects with 5-year follow-up data, mean rate of eGFR decline was 2.35 mL/min/1.73 m2 /year, nearly twice that of African American adults overall. Hyperfiltration was prevalent at baseline (61.1%), and 36.8% of subjects experienced rapid eGFR decline (≥3 mL/min/1.73 m2 /year). Severe Hb genotype; proteinuria; higher platelet and reticulocyte counts, and systolic BP; and lower Hb level and BMI were associated with rapid decline. A risk scoring system was created using these 7 variables and was highly predictive of rapid eGFR decline, with odds of rapid decline increasing 1.635-fold for every point increment (P < 0.0001). Rapid eGFR decline was also associated with higher organ system severity score and peak creatinine. Additionally, two metabolites (asymmetric dimethylarginine and quinolinic acid) were associated with rapid decline. Further investigation into longitudinal SCD nephropathy (SCDN) trajectory, early markers of SCDN, and tools for risk stratification should inform interventional studies targeted to slowing GFR decline and improving SCD outcomes.
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Affiliation(s)
- Julia Z Xu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Melanie E Garrett
- Department of Medicine, Division of Nephrology and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Karen L Soldano
- Department of Medicine, Division of Nephrology and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Sean T Chen
- Duke University School of Medicine, Durham, North Carolina
| | - Clary B Clish
- Metabolite Profiling, Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Allison E Ashley-Koch
- Department of Medicine, Division of Nephrology and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - Marilyn J Telen
- Department of Medicine, Division of Hematology and Duke Comprehensive Sickle Cell Center, Duke University Medical Center, Durham, North Carolina
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Yoon K, Lee KW, Oh S, Kim H, Kim HS, Hong S, Ahn SW, Yi NJ, Suh KS. Urinary Neutrophil Gelatinase-Associated Lipocalin as a Biomarker for Renal Injury in Liver Transplant Recipients Using Calcineurin Inhibitors. Transplant Proc 2018; 50:3667-3672. [DOI: 10.1016/j.transproceed.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022]
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Yamaguchi Y, Akagaki F, Nakamori A, Sugiura T. Chronological renal resistive index increases related to atherosclerotic factors, and effect of renin-angiotensin system inhibitors. Clin Exp Nephrol 2019; 23:513-20. [PMID: 30426291 DOI: 10.1007/s10157-018-1667-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/30/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Renal resistive index (RI) calculated using renal Doppler ultrasonography (RDU) has recently been considered a clinically important indicator of renal outcome, survival, and systemic arteriosclerotic disorders. However, the cause of RI elevation remains unclear. The present study was an effort to first, identify the factors related to RI elevation, and second, understand the effect of renin-angiotensin system inhibitors (RAS-Is) on renal RI elevation. METHODS We carried out this single-center case-control study among 100 CKD patients, recruited from outpatients who underwent RDU more than twice, at least a year apart. The rate of renal RI change per year (dRIpy) was chosen as the dependent variable: [(last examined renal RI-initial examined renal RI)/(initial examined renal RI × period of observation) × 100 (%/year)]. We examined the association between dRIpy and other clinical and biological data. RESULTS Among 100 CKD patients, the average serum creatinine and eGFR were 1.76 ± 0.84 mg/dL and 37.0 ± 18.2 ml/min/1.73 m2, respectively. The average dRIpy in all patients was 1.8 ± 1.4%/year. The linear multiple regression demonstrated that dRIpy was positively associated with the presence of diabetes mellitus (DM) and high low-density lipoprotein cholesterol (LDL) levels, and negatively with eGFR and RAS-I use. CONCLUSIONS This study demonstrated that the elevation of RI was related to DM, eGFR, high LDL, and the use of RAS-Is. In particular, RAS-Is could contribute towards suppressing the elevation of RI in CKD patients and towards preventing the development of renal failure in CKD patients.
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Fadini GP, Solini A, Manca ML, Zatti G, Karamouzis I, Di Benedetto A, Frittitta L, Avogaro A. Phenotyping normal kidney function in elderly patients with type 2 diabetes: a cross-sectional multicentre study. Acta Diabetol 2018; 55:1121-1129. [PMID: 30090961 DOI: 10.1007/s00592-018-1194-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022]
Abstract
AIMS Type 2 diabetes (T2D) accelerates the decline in glomerular function; however, some individuals do not develop chronic kidney disease despite advanced age and long-lasting T2D. We aimed to phenotype patients with T2D aged 80 years or older who presented with a fully preserved kidney function. METHODS From an Italian population of 281,217 T2D outpatients, we collected data on demographics, anthropometrics, diabetes duration, HbA1c, fasting plasma glucose, lipids, liver enzymes, estimated glomerular filtration rate (eGFR), albumin excretion rate (AER), chronic complications, and medication use. We primarily compared patients with a fully preserved kidney function (eGFR > 90 ml/min/1.73 m2 and AER < 30 mg/24 h, or G1A1) with those with mild kidney impairment (eGFR 60-90 ml/min/1.73 m2 and AER < 30 mg/24 h, or G2A1). RESULTS N = 113,860 had available data for eGFR and AER, 21,648 of whom were aged ≥ 80. G1A1 (n = 278) and G2A1 (n = 6647) patients represented 1.3 and 30.7% of aged T2D patients, respectively, with an average diabetes duration of 16 years. Differences between the G1A1 and G2A1 groups were entered in a multiple logistic regression analysis with and without imputation of missing data. After adjustment and in both imputed and non-imputed datasets, younger age, lower BMI and lower triglycerides were associated with fully preserved versus mildly impaired kidney function. The comparison between G1A1 and G1A2/3 yielded different results. CONCLUSIONS In a rare population of patients with a fully preserved kidney function despite old age and long-lasting diabetes, lower BMI and triglycerides suggest that protection from lipotoxicity may preserve kidney function over time.
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Affiliation(s)
- G P Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - A Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - M L Manca
- Department of Mathematics, University of Pisa, Pisa, Italy
| | - G Zatti
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - I Karamouzis
- Ospedale Maggiore di Novara, 28100, Novara, Italy
| | - A Di Benedetto
- Department of Clinical and Experimental Medicine, University of Messina, 98122, Messina, Italy
| | - L Frittitta
- Department of Internal and Special Medicine, University of Catania, 95122, Catania, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Chao CT, Chen YM, Ho FH, Lin KP, Chen JH, Yen CJ. 10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns. J Clin Med 2018; 7:jcm7100373. [PMID: 30347853 PMCID: PMC6210637 DOI: 10.3390/jcm7100373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m2/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m2/year) and upward eGFR (≥1 mL/min/1.73 m2/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei 10617, Taiwan.
| | - Yung-Ming Chen
- Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan.
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Fu-Hui Ho
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Chung-Jen Yen
- Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan.
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Xu JZ, Riolueang S, Glomglao W, Tachavanich K, Suksangpleng T, Ekwattanakit S, Viprakasit V. The origin of sickle cell disease in Thailand. Int J Lab Hematol 2018; 41:e13-e16. [PMID: 30264513 DOI: 10.1111/ijlh.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Julia Z Xu
- Department of Medicine, Duke University, Durham, North Carolina
| | - Suchada Riolueang
- Siriraj-Thalassaemia Centre, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waraporn Glomglao
- Division of Haematology/Oncology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kalaya Tachavanich
- Division of Haematology/Oncology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thidarat Suksangpleng
- Siriraj-Thalassaemia Centre, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supachai Ekwattanakit
- Siriraj-Thalassaemia Centre, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vip Viprakasit
- Siriraj-Thalassaemia Centre, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Haematology/Oncology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Kim YM, Kathuria P, Delen D. Machine Learning to Compare Frequent Medical Problems of African American and Caucasian Diabetic Kidney Patients. Healthc Inform Res 2017; 23:241-248. [PMID: 29181232 PMCID: PMC5688022 DOI: 10.4258/hir.2017.23.4.241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 12/29/2022] Open
Abstract
Objectives End-stage renal disease (ESRD), which is primarily a consequence of diabetes mellitus, shows an exemplary health disparity between African American and Caucasian patients in the United States. Because diabetic chronic kidney disease (CKD) patients of these two groups show differences in their medical problems, the markers leading to ESRD are also expected to differ. The purpose of this study was, therefore, to compare their medical complications at various levels of kidney function and to identify markers that can be used to predict ESRD. Methods The data of type 2 diabetic patients was obtained from the 2012 Cerner database, which totaled 1,038,499 records. The data was then filtered to include only African American and Caucasian outpatients with estimated glomerular filtration rates (eGFR), leaving 4,623 records. A priori machine learning was used to discover frequently appearing medical problems within the filtered data. CKD is defined as abnormalities of kidney structure, present for >3 months. Results This study found that African Americans have much higher rates of CKD-related medical problems than Caucasians for all five stages, and prominent markers leading to ESRD were discovered only for the African American group. These markers are high glucose, high systolic blood pressure (BP), obesity, alcohol/drug use, and low hematocrit. Additionally, the roles of systolic BP and diastolic BP vary depending on the CKD stage. Conclusions This research discovered frequently appearing medical problems across five stages of CKD and further showed that many of the markers reported in previous studies are more applicable to African American patients than Caucasian patients.
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Affiliation(s)
- Yong-Mi Kim
- School of Library and Information Studies, University of Oklahoma, Tulsa, OK, USA
| | - Pranay Kathuria
- Division of Nephrology and Hypertension, Department of Medicine, School of Community Medicine, University of Oklahoma, Tulsa, OK, USA
| | - Dursun Delen
- Spears School of Business, Oklahoma State University, Tulsa, OK, USA
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Caravaca-Fontán F, Azevedo L, Luna E, Caravaca F. Patterns of progression of chronic kidney disease at later stages. Clin Kidney J 2017; 11:246-253. [PMID: 29644066 PMCID: PMC5888389 DOI: 10.1093/ckj/sfx083] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/19/2017] [Indexed: 01/29/2023] Open
Abstract
Background At later stages of chronic kidney disease (CKD), a pattern of linear and irreversible renal function decline is thought to be the most common. The objective of this study was to describe the characteristics of the different patterns of CKD progression, and to investigate potentially modifiable factors associated with the rate of decline of renal function. Methods This was a retrospective, observational study in a cohort of adult patients with CKD Stage 4 or 5 not on dialysis. Decline in renal function was estimated as the slope of the individual linear regression line of estimated glomerular filtration rate (eGFR) over time. The following patterns of CKD progression were considered: unidentifiable, linear, nonlinear (curvilinear) and positive (improvement of renal function). Results The study group consisted of 915 patients (mean ±SD age 65 ± 14 years, 48% females, median follow-up time 16 months). A linear pattern was observed in 38%, unidentifiable in 23%, nonlinear in 24% and positive in 15% of the study patients. The mean eGFR slope was: −3.35 ± 4.45 mL/min/year. Linear and unidentifiable patterns were associated with more rapid loss of renal function. By multiple linear and logistic regression analysis, the magnitude of proteinuria, the systolic blood pressure and the treatment with dual renin–angiotensin system blockade were associated with more rapid CKD progression. On the contrary, older age and discontinuation of commonly prescribed medication with potential influence on renal function or eGFR measurements were associated with slower CKD progression. Conclusions A majority of patients with advanced CKD show patterns of renal function decline different from linear, and several of the main determinants of CKD progression are potentially modifiable.
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Affiliation(s)
| | - Lilia Azevedo
- Nephrology Department, Hospital Infanta Cristina, Badajoz, Spain
| | - Enrique Luna
- Nephrology Department, Hospital Infanta Cristina, Badajoz, Spain
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