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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Fu EL, Levey AS, Coresh J, Grams ME, Faucon AL, Elinder CG, Dekker FW, Delanaye P, Inker LA, Carrero JJ. Accuracy of GFR estimating equations based on creatinine, cystatin C or both in routine care. Nephrol Dial Transplant 2024; 39:694-706. [PMID: 37813817 DOI: 10.1093/ndt/gfad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND New equations to estimate glomerular filtration rate based on creatinine (eGFRcr), cystatin C (eGFRcys) or both (eGFRcr-cys) have been developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the European Kidney Function Consortium (EKFC). There is a need to evaluate the performance of these equations in diverse European settings to inform implementation decisions, especially among people with key comorbid conditions. METHODS We performed a cross-sectional study including 6174 adults referred for single-point plasma clearance of iohexol in Stockholm, Sweden, with 9579 concurrent measurements of creatinine and cystatin C. We assessed the performance of the CKD-EPI 2009/2012/2021, EKFC 2021/2023, revised Lund-Malmö (RLM) 2011 and Caucasian, Asian, Pediatric and Adult (CAPA) 2014 equations against measured GFR (mGFR). RESULTS Mean age was 56 years, median mGFR was 62 mL/min/1.73 m2 and 40% were female. Comorbid conditions were common: cardiovascular disease (30%), liver disease (28%), diabetes (26%) and cancer (26%). All eGFRcr-cys equations had small bias and P30 (the percentage of estimated values within 30% of mGFR) close to 90%, and performed better than eGFRcr or eGFRcys equations. Among eGFRcr equations, CKD-EPI 2009 and CKD-EPI 2021 showed larger bias and lower P30 than EKFC 2021 and RLM. There were no meaningful differences in performance across eGFRcys equations. Findings were consistent across comorbid conditions, and eGFRcr-cys equations showed good performance in patients with liver disease, cancer and heart failure. CONCLUSIONS In conclusion, eGFRcr-cys equations performed best, with minimal variation among equations in this Swedish cohort. The lower performance of CKD-EPI eGFRcr equations compared with EKFC and RLM may reflect differences in population characteristics and mGFR methods. Implementing eGFRcr equations will require a trade-off between accuracy and uniformity across regions.
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Affiliation(s)
- Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew S Levey
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Anne-Laure Faucon
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- INSERM UMR 1018, Department of Clinical Epidemiology, Paris-Saclay University, Paris, France
| | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Intervention, and Technology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Liu L, Wang C, Hu Z, Deng S, Yang S, Zhu X, Deng Y, Wang Y. Not only baseline but cumulative exposure of remnant cholesterol predicts the development of nonalcoholic fatty liver disease: a cohort study. Environ Health Prev Med 2024; 29:5. [PMID: 38325840 PMCID: PMC10853394 DOI: 10.1265/ehpm.23-00289] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND AIM Remnant cholesterol (remnant-C) mediates the progression of major adverse cardiovascular events. It is unclear whether remnant-C, and particularly cumulative exposure to remnant-C, is associated with nonalcoholic fatty liver disease (NAFLD). This study aimed to explore whether remnant-C, not only baseline but cumulative exposure, can be used to independently evaluate the risk of NAFLD. METHODS This study included 1 cohort totaling 21,958 subjects without NAFLD at baseline who underwent at least 2 repeated health checkups and 1 sub-cohort totaling 2,649 subjects restricted to those individuals with at least 4 examinations and no history of NAFLD until Exam 3. Cumulative remnant-C was calculated as a timeweighted model for each examination multiplied by the time between the 2 examinations divided the whole duration. Cox regression models were performed to estimate the association between baseline and cumulative exposure to remnant-C and incident NAFLD. RESULTS After multivariable adjustment, compared with the quintile 1 of baseline remnant-C, individuals with higher quintiles demonstrated significantly higher risks for NAFLD (hazard ratio [HR] 1.48, 95%CI 1.31-1.67 for quintile 2; HR 2.07, 95%CI 1.85-2.33 for quintile 3; HR 2.55, 95%CI 2.27-2.88 for quintile 4). Similarly, high cumulative remnant-C quintiles were significantly associated with higher risks for NAFLD (HR 3.43, 95%CI 1.95-6.05 for quintile 2; HR 4.25, 95%CI 2.44-7.40 for quintile 3; HR 6.29, 95%CI 3.59-10.99 for quintile 4), compared with the quintile 1. CONCLUSION Elevated levels of baseline and cumulative remnant-C were independently associated with incident NAFLD. Monitoring immediate levels and longitudinal trends of remnant-C may need to be emphasized in adults as part of NAFLD prevention strategy.
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Affiliation(s)
- Lei Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Changfa Wang
- General Surgery Department, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Zhongyang Hu
- Department of Neurology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Shuwen Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Saiqi Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Xiaoling Zhu
- Health Management Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Yuling Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
| | - Yaqin Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, Hunan, China, 410013
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Lomstein FB, Kjærgaard M, Skovgaard N, Pedersen ML, Backe MB. Reporting chronic kidney disease in Greenland. Int J Circumpolar Health 2023; 82:2261223. [PMID: 37742312 PMCID: PMC10519261 DOI: 10.1080/22423982.2023.2261223] [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] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is a major health burden affecting more than 10% of the global population. It is a multifactorial disease with many risk factors attributed lifestyle diseases. The prevalence of CKD in Greenland is unknown; however, the prevalence of risk factors contributing to CKD is increasing.Objectives: To estimate the prevalence of CKD in Greenland.Methods: The study was a cross-sectional register-study including all Greenlandic residents aged ≥20 years with serum creatinine analysis within the last 2 years. We identified those with CKD based on eGFR and UACR and those registered with a CKD diagnosis code. Two limitations of the study are possible lack of data completeness and the reliance of a single time point to report CKD.Results: A total of 2,157 patients were identified with CKD with an age-standardised prevalence of 3.01%. Only 75 patients were registered with a diagnosis code for CKD. Approximately 80% of patients were classified with CKD stages 1-2.Conclusion: This is the first study reporting CKD in Greenland. We found a lower prevalence of CKD than reported by other studies, and a low number of patients correctly diagnosed with CKD. We call for increased awareness and diagnosis coding of CKD in Greenland.
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Affiliation(s)
- Fabian Bøgild Lomstein
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
| | - Marie Kjærgaard
- Department of Internal Medicine, Queen Ingrid’s Hospital, Nuuk, Greenland
- Department of Nephrology, Sygehus Lillebælt, Kolding, Denmark
| | - Nils Skovgaard
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland’s Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland’s Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Marie Balslev Backe
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland’s Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Inker LA, Tighiouart H, Adingwupu OM, Shlipak MG, Doria A, Estrella MM, Froissart M, Gudnason V, Grubb A, Kalil R, Mauer M, Rossing P, Seegmiller J, Coresh J, Levey AS. CKD-EPI and EKFC GFR Estimating Equations: Performance and Other Considerations for Selecting Equations for Implementation in Adults. J Am Soc Nephrol 2023; 34:1953-1964. [PMID: 37796982 PMCID: PMC10703072 DOI: 10.1681/asn.0000000000000227] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
SIGNIFICANCE STATEMENT New eGFR equations from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) using creatinine (eGFRcr), cystatin C (eGFRcys), and both (eGFRcr-cys) have sufficient accuracy for use in clinical practice, leading to uncertainty in selecting equations for implementation. The authors evaluated performance of equations in an independent population of 4050 adults and evaluated other considerations important for implementation. They found that CKD-EPI and EKFC equations are approaching convergence, with better performance of eGFRcr-cys equations in the overall group and fewer differences among race, sex, and age subgroups than eGFRcr equations. Larger differences among eGFRcr equations reflect regional population differences in creatinine, forcing a trade-off between accuracy and uniformity in global implementation of eGFRcr equations. More widespread use of cystatin C could avoid this trade-off. BACKGROUND New CKD-EPI and EKFC eGFR equations using eGFRcr, eGFRcys, and both (eGFRcr-cys) have sufficient accuracy for use in clinical practice. A better understanding of the equations, including their performance in race, sex and age subgroups, is important for selection of eGFR equations for global implementation. METHODS We evaluated performance (bias and P 30 ) of equations and methods used for equation development in an independent study population comprising 4050 adults pooled from 12 studies. The mean (SD) measured GFR was 76.4 (29.6) ml/min per 1.73 m 2 and age 57.0 (17.4) years, with 1557 (38%) women and 579 (14%) Black participants. RESULTS Coefficients for creatinine, cystatin C, age, and sex in the CKD-EPI and EKFC equations are similar. Performance of the eGFRcr-cys equations in the overall population (bias <±5 ml/min per 1.73 m 2 and P 30 >90%) was better than the eGFRcr or eGFRcys equations, with fewer differences among race, sex, and age subgroups. Differences in performance across subgroups reflected differences in diversity of source populations and use of variables for race and sex for equation development. Larger differences among eGFRcr equations reflected regional population differences in non-GFR determinants of creatinine. CONCLUSION CKD-EPI and EKFC equations are approaching convergence. It is not possible to maximize both accuracy and uniformity in selecting one of the currently available eGFRcr equations for implementation across regions. Decisions should consider methods for equation development in addition to performance. Wider use of cystatin C with creatinine could maximize both accuracy and uniformity of GFR estimation using currently available equations.
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Affiliation(s)
- Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | | | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affair Medical Center and University of California, San Francisco, California
| | - Alessandro Doria
- Section on Genetics & Epidemiology, Joslin Diabetes Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, San Francisco Veterans Affair Medical Center and University of California, San Francisco, California
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care System and University of California, San Francisco, California
| | - Marc Froissart
- Department of Research and Education, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Anders Grubb
- Department of Clinical Chemistry and Pharmacology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Roberto Kalil
- Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Mauer
- Divisions of Pediatric and Adult Nephrology, University of Minnesota, Minneapolis, Minnesota
| | - Peter Rossing
- Steno Diabetes Center Copenhagen and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesse Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Josef Coresh
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew S. Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Wang Y, Yuan T, Deng S, Zhu X, Deng Y, Liu X, Liu L, Wang C. Metabolic health phenotype better predicts subclinical atherosclerosis than body mass index-based obesity phenotype in the non-alcoholic fatty liver disease population. Front Nutr 2023; 10:1104859. [PMID: 37794971 PMCID: PMC10546180 DOI: 10.3389/fnut.2023.1104859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD), especially lean NAFLD is associated with an increased risk of atherosclerotic cardiovascular disease (CVD). It is not currently known which clinical phenotypes of NAFLD contribute most to individual subclinical atherosclerosis risk. We examined the relationship between body mass index (BMI), the metabolically healthy status, and subclinical atherosclerosis in the NAFLD population. Methods Data from asymptomatic NAFLD subjects who participated in a routine health check-up examination were collected. Participants were stratified by BMI (cutoff values: 24.0-27.9 kg/m2 for overweight and ≥28.0 kg/m2 for obesity) and metabolic status, which was defined by Adult Treatment Panel III criteria. Subclinical atherosclerosis was evaluated by brachial-ankle pulse wave velocity (baPWV) in 27,738 participants and by carotid plaque in 14,323 participants. Results Within each BMI strata, metabolically unhealthy subjects had a significantly higher prevalence of subclinical atherosclerosis than metabolically healthy subjects, whereas fewer differences were observed across subjects within the same metabolic category. When BMI and metabolic status were assessed together, a metabolically unhealthy status was the main contributor to the association of clinical phenotypes with the subclinical atherosclerosis burden (all p < 0.001). When BMI and metabolic abnormalities were assessed separately, the incidence of subclinical disease did not increase across BMI categories; however, it increased with an increase in the number of metabolic abnormalities (0, 1, 2 and ≥3). Conclusion A metabolically healthy status in NAFLD patients was closely correlated with subclinical atherosclerosis, beyond that of the BMI-based obesity phenotype. The application of metabolic phenotyping strategies could enable more precise classification in evaluating cardiovascular risk in NAFLD.
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Affiliation(s)
- Yaqin Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ting Yuan
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuwen Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoling Zhu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuling Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xuelian Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lei Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Changfa Wang
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
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Liu L, Wang C, Deng S, Yuan T, Zhu X, Deng Y, Qin Y, Wang Y, Yang P. Transition patterns of metabolic dysfunction-associated fatty liver disease status in relation to arterial stiffness progression: a health check-up cohort study. Sci Rep 2023; 13:9690. [PMID: 37322025 PMCID: PMC10272131 DOI: 10.1038/s41598-023-35733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new diagnostic criterion based on hepatic steatosis and metabolic dysfunction. However, a comprehensive evaluation of the association of MAFLD dynamic transitions with arterial stiffness progression has yet to be conducted. This cohort study included 8807 Chinese health check-up participants (median follow-up = 50.2 months). Participants were categorized into four groups according to MAFLD status at baseline and follow-up (none, persistent, developed and regressed). Arterial stiffness progression was assessed by the annual brachial-ankle pulse wave velocity (ba-PWV) increase and arterial stiffness incidence. Compared with the non-MAFLD group, the annual increase in ba-PWV was highest in the persistent-MAFLD group [6.75 cm/s/year, (95% CI 4.03-9.33)], followed by the developed-[6.35 cm/s/year, (95% CI 3.80-8.91)] and the regressed-[1.27 cm/s/year, (95% CI - 2.18 to 4.72)] MAFLD groups. Similarly, compared with the non-MAFLD group, the persistent-MAFLD group had a 1.31-fold increased arterial stiffness risk [OR 1.31; 95% CI 1.03-1.66]. The associations of MAFLD transition patterns with arterial stiffness incidence did not differ across any clinically specific subgroups evaluated. Furthermore, the potential effect of dynamic changes in cardiometabolic risk factors on arterial stiffness incidence among persistent-MAFLD participants was mostly driven by annual fasting glucose and triglyceride increases. In conclusion, persistent MAFLD was associated with an increased risk of arterial stiffness development. Moreover, in persistent-MAFLD subjects, elevated blood glucose and triglyceride levels might facilitate the arterial stiffness incidence.
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Affiliation(s)
- Lei Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Changfa Wang
- General Surgery Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Shuwen Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Ting Yuan
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Xiaoling Zhu
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Yuling Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Yuexiang Qin
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Yaqin Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China.
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China.
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Wang Y, Wang J, Liu L, Yang P, Deng S, Liu X, Zhao L, Wang C, Li Y. Baseline level and change trajectory of the triglyceride-glucose index in relation to the development of NAFLD: a large population-based cohort study. Front Endocrinol (Lausanne) 2023; 14:1137098. [PMID: 37223043 PMCID: PMC10200880 DOI: 10.3389/fendo.2023.1137098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Background Insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD) are closely related. The triglyceride-glucose index (TyG index) has been proposed as a new indicator of IR. It remains unclear whether the triglyceride-glucose (TyG) index is prospectively associated with incident nonalcoholic fatty liver disease (NAFLD). Methods This large-scale study comprised 1 prospective cohort totaling 22,758 subjects without NAFLD at baseline who underwent repeated health examinations and 1 subcohort totaling 7,722 subjects with more than three visits. The TyG index was ascertained mathematically by ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). NAFLD was diagnosed by ultrasound without other concomitant liver diseases. A combinatorial Cox proportional hazard model and latent class growth mixture modeling method were used to identify the association of the TyG index and its transition trajectories with NAFLD risk. Results During 53,481 person-years of follow-up, there were 5319 incident cases with NAFLD. Compared with those in the lowest quartile of the baseline TyG index, participants in the highest quartile had 2.52-fold (95% confidence interval, 2.21-2.86) higher odds of incident NAFLD. Similarly, restricted cubic spline analysis showed a dose-response relationship (p nonlinearity<0.001). Subgroup analyses showed a more significant association in the female and normal body size populations (p for interaction<0.001). Three distinct trajectories of changes in the TyG index were identified. Compared with the continued low group, the moderately increasing and highly increasing groups conferred 1.91-fold (1.65-2.21) and 2.19-fold (1.73-2.77) higher NAFLD risk, respectively. Conclusions Participants with a higher baseline TyG index or a higher excessive TyG exposure were associated with an increased NAFLD risk. The findings imply that lifestyle interventions and modulation of IR might be considered to both reduce TyG index levels and prevent NAFLD development.
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Affiliation(s)
- Yaqin Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiangang Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lei Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuwen Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuelian Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linlin Zhao
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Changfa Wang
- General Surgery Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Xia F, Hao W, Liang J, Zhao Z, Wu Y, Yu F, Hu W, Fang X, Liu W. Comparison of estimated glomerular filtration rate equations based on serum creatinine-, cystatin C- and creatinine-cystatin C in elderly Chinese patients. Int Urol Nephrol 2023; 55:943-952. [PMID: 36169900 DOI: 10.1007/s11255-022-03370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND This study aimed to further evaluate the accuracy of eleven GFR equations in different subgroups of an elderly Chinese hospitalized population. METHODS All participants of the study were divided into seven separate groups including age-subgroup, sex-subgroup, GFR Staging-subgroup and whether combined with diabetic, hypertensive, coronary heart disease (CHD) and cerebrovascular disease. Referring to Tc-99m-DTPA dual plasma sample clearance method, six serum creatinine (Cr)-based [Cockcroft-Gault (CG), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr), Lund-Malmö Revised (LMR), Berlin Initiative Study (BIS1), Full Age Spectrum (FASCr) and European Kidney Function Consortium (EKFC)], two serum cystatin C(Cys)-based (CKD-EPICys and FASCys), and three Cr-Cys combination based (CKD-EPICr-Cys, BIS2 and FASCr-Cys) equations were employed. Bias, interquartile range of the median difference (IQR), P30, and GFR misclassification rate were calculated to compare the performance of the selected equations. RESULTS A total of 359 elderly Chinese patients were enrolled. Overall, median mGFR was 36.91(25.26,56.32)ml/min/1.73 m2. Smaller biases (ml/min/1.73 m2) were shown in CKD-EPICr and BIS1 equations (0.75 and 0.61). IQR (ml/min/1.73m2) was least with BIS2 equation and FASCr-Cys equation (10.34 and 10.65). For accuracy (P30), performance of FASCr-Cys, BIS2, and BIS1 equation was superior (78.3%, 78.0%, and 74.7%, respectively). In terms of RMSE (ml/min/1.73 m2), BIS1 and FASCr-Cys equation performed better (12.44 and 12.51). CONCLUSIONS Overall, this study showed that the eGFR equations were less accurate in the diabetic and non-hypertension group than in the non-diabetic and hypertension group, respectively. Among all enrolled equations, the BIS2 and FASCr-Cys equations might be the best choice to evaluate glomerular filtration rate in Chinese elderly patients.
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Affiliation(s)
- Fangxiao Xia
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenke Hao
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Jinxiu Liang
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Zhi Zhao
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Yanhua Wu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng Yu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wenxue Hu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Xiaowu Fang
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wei Liu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Tang Y, Hou L, Sun T, Li S, Cheng J, Xue D, Wang X, Du Y. Improved equations to estimate GFR in Chinese children with chronic kidney disease. Pediatr Nephrol 2023; 38:237-247. [PMID: 35467153 DOI: 10.1007/s00467-022-05552-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/07/2020] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is currently no specific equation for estimating glomerular filtration rate (GFR) in Chinese children with chronic kidney disease (CKD). The commonly used equations are less robust than expected; we therefore sought to derive more appropriate equations for GFR estimation. METHODS A total of 751 Chinese children with CKD were divided into 2 groups, training group (n = 501) and validation group (n = 250). In the training group, a univariate linear regression model was used to calculate predictability of variables associated with GFR. Residuals were compared to determine multivariate predictability of GFR in the equation. Standard regression techniques for Gaussian data were used to determine coefficients of GFR-estimating equations after logarithmic transformation of measured GFR (iGFR), height/serum creatinine (height/Scr), cystatin C, blood urea nitrogen (BUN), and height. These were compared with other well-known equations using the validation group. RESULTS Median 99mTc-DTPA GFR was 90.1 (interquartile range: 67.3-108.6) mL/min/1.73 m2 in training dataset. Our CKD equation, eGFR (mL/min/1.73 m2) = 91.021 [height(m)/Scr(mg/dL)/2.7]0.443 [1.2/Cystatin C(mg/L)]0.335 [13.7/BUN (mg/dL)]-0.095 [ 0.991male] [height(m)/1.4]0.275, was derived. This was further tested in the validation group, with percentages of eGFR values within 30% and 15% of iGFR (P30 and P15) of 76.00% and 48.40%, respectively. For centres with no access to cystatin C, a creatinine-based equation, eGFR (mL/min/1.73 m2) = 89.674 [height(m)/Scr(mg/dL)/2.7]0.579 [ 1.007male] [height(m)/1.4]0.187, was derived, with P30 and P15 73.60% and 49.20%, respectively. These were significantly higher compared to other well-known equations (p < 0.05). CONCLUSION We developed equations for GFR estimation in Chinese children with CKD based on Scr, BUN and cystatin C. These are more accurate than commonly used equations in this population.
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Affiliation(s)
- Ying Tang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tingting Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shanping Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Junli Cheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dan Xue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiuli Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
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Jin Y, Ma J, Wang Z, Zou Y, Wang G, Wu Y, Wang Y, Liu H, Yin T, Ye P. Performance of the ABCD-GENE Score for Predicting Clinical Outcomes in Clopidogrel-Treated Patients with ACS. J Cardiovasc Transl Res 2022; 15:1385-1392. [PMID: 35437618 DOI: 10.1007/s12265-022-10255-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
The ABCD-GENE score was constructed to identify patients with high platelet reactivity (HPR) after 30 days of clopidogrel treatment. In our study, 1297 eligible patients with acute coronary syndrome (ACS) were included, and 44 (3.4%) major adverse cardiovascular events (MACEs) occurred during the 12-month clopidogrel treatment. The score with a cutoff of ≥ 10 was independently associated with the risk of 5-day HPR (adjusted HR: 1.73, 95% CI: 1.09-2.74, P = 0.020) and MACEs (adjusted HR: 2.25, 95% CI: 1.19-4.25, P = 0.013). The risk of MACEs increased when the multivariable model with the score (≥ 10) plus 5-day HPR was used (adjusted HR: 4.37, 95% CI: 1.90-10.10, P = 0.001). The c-statistic for MACEs was 0.60 when using the score threshold of ≥ 10 and 0.63 when using the model with the score plus 5-day HPR. As a simple tool, the ABCD-GENE score could identify clopidogrel-treated Chinese patients with ACS who are at increased risk of MACEs. The addition of 5-day HPR could slightly improve the diagnostic ability of the score.
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Affiliation(s)
- Ying Jin
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
- Department of Geriatrics, Air Force Medical Center of Chinese PLA, Beijing, 100141, China
| | - Jing Ma
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100142, China
| | - Ziqian Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
| | - Yuting Zou
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
| | - Guanyun Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
| | - Yangxun Wu
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
| | - Yuyan Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
| | - Haiping Liu
- Medical School of Chinese PLA, Beijing, 100853, China
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China
| | - Tong Yin
- Medical School of Chinese PLA, Beijing, 100853, China.
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China.
| | - Ping Ye
- Medical School of Chinese PLA, Beijing, 100853, China.
- Institute of Geriatrics and Department of Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese, PLA General Hospital, No. 28 Fu Xing Road, Beijing, 100853, China.
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Lei L, Changfa W, Jiangang W, Zhiheng C, Ting Y, Xiaoling Z, Yuling D, Yaqin W. Association between non-alcoholic fatty liver disease and metabolically healthy deterioration across different body shape phenotypes at baseline and change patterns. Sci Rep 2022; 12:14786. [PMID: 36042236 DOI: 10.1038/s41598-022-18988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome (MetS), and the relationship between NAFLD and metabolic deterioration remains unclear. This study aimed to investigate dynamic changes in metabolically healthy phenotypes and to assess the impact of non-alcoholic fatty liver disease (NAFLD) on the conversion from metabolically healthy (MH) to metabolically unhealthy (MU) phenotypes across body shape phenotypes and phenotypic change patterns. We defined body shape phenotypes using both the body mass index (BMI) and waist circumference (WC) and defined metabolic health as individuals scoring ≤ 1 on the NCEP-ATP III criteria, excluding WC. A total of 12,910 Chinese participants who were MH at baseline were enrolled in 2013 and followed-up in 2019 or 2020. During a median follow-up of 6.9 years, 27.0% (n = 3,486) of the MH individuals developed an MU phenotype. According to the multivariate Cox analyses, NAFLD was a significant predictor of conversion from the MH to MU phenotype, independent of potential confounders (HR: 1.12; 95% confidence interval: 1.02–1.22). For the MH-normal weight group, the relative risk of NAFLD in phenotypic conversion was 1.21 (95% CI 1.03–1.41, P = 0.017), which was relatively higher than that of MH-overweight/obesity group (HR: 1.14, 95% CI 1.02–1.26, P = 0.013). Interestingly, the effect of NAFLD at baseline on MH deterioration was stronger in the “lean” phenotype group than in the “non-lean” phenotype group at baseline and in the “fluctuating non-lean” phenotype change pattern group than in the “stable non-lean” phenotype change pattern group during follow-up. In conclusion, lean NAFLD is not as benign as currently considered and requires more attention during metabolic status screening.
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Fabian J, Kalyesubula R, Mkandawire J, Hansen CH, Nitsch D, Musenge E, Nakanga WP, Prynn JE, Dreyer G, Snyman T, Ssebunnya B, Ramsay M, Smeeth L, Tollman S, Naicker S, Crampin A, Newton R, George JA, Tomlinson L. Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study. Lancet Glob Health 2022; 10:e1159-e1169. [PMID: 35839814 DOI: 10.1016/s2214-109x(22)00239-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The burden of kidney disease in many African countries is unknown. Equations used to estimate kidney function from serum creatinine have limited regional validation. We sought to determine the most accurate way to measure kidney function and thus estimate the prevalence of impaired kidney function in African populations. METHODS We measured serum creatinine, cystatin C, and glomerular filtration rate (GFR) using the slope-intercept method for iohexol plasma clearance (mGFR) in population cohorts from Malawi, Uganda, and South Africa. We compared performance of creatinine and cystatin C-based estimating equations to mGFR, modelled and validated a new creatinine-based equation, and developed a multiple imputation model trained on the mGFR sample using age, sex, and creatinine as the variables to predict the population prevalence of impaired kidney function in west, east, and southern Africa. FINDINGS Of 3025 people who underwent measured GFR testing (Malawi n=1020, South Africa n=986, and Uganda n=1019), we analysed data for 2578 participants who had complete data and adequate quality measurements. Among 2578 included participants, creatinine-based equations overestimated kidney function compared with mGFR, worsened by use of ethnicity coefficients. The greatest bias occurred at low kidney function, such that the proportion with GFR of less than 60 mL/min per 1·73 m2 either directly measured or estimated by cystatin C was more than double that estimated from creatinine. A new creatinine-based equation did not outperform existing equations, and no equation, including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 race-neutral equation, estimated GFR within plus or minus 30% of mGFR for 75% or more of the participants. Using a model to impute kidney function based on mGFR, the estimated prevalence of impaired kidney function was more than two-times higher than creatinine-based estimates in populations across six countries in Africa. INTERPRETATION Estimating GFR using serum creatinine substantially underestimates the individual and population-level burden of impaired kidney function in Africa with implications for understanding disease progression and complications, clinical care, and service provision. Scalable and affordable ways to accurately identify impaired kidney function in Africa are urgently needed. FUNDING The GSK Africa Non-Communicable Disease Open Lab. TRANSLATIONS For the Luganda, Chichewa and Xitsonga translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Robert Kalyesubula
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Mkandawire
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Surgery, Pan-African Academy of Christian Surgeons, Malamulo, Thyolo, Malawi; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eustasius Musenge
- Division of Biostatistics and Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wisdom P Nakanga
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi; Institute of Cardiovascular Science, University College London, London, UK
| | - Gavin Dreyer
- Department of Nephrology, Barts Health National Health Service Trust, London, UK
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Billy Ssebunnya
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and their Health Network, Accra, Ghana
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Newton
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurie Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Affiliation(s)
- Andrew S Levey
- From the Division of Nephrology, Tufts Medical Center, Boston (A.S.L., L.A.I.); and the Division of Precision Medicine, Department of Medicine, New York University, New York (M.E.G.)
| | - Morgan E Grams
- From the Division of Nephrology, Tufts Medical Center, Boston (A.S.L., L.A.I.); and the Division of Precision Medicine, Department of Medicine, New York University, New York (M.E.G.)
| | - Lesley A Inker
- From the Division of Nephrology, Tufts Medical Center, Boston (A.S.L., L.A.I.); and the Division of Precision Medicine, Department of Medicine, New York University, New York (M.E.G.)
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15
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Koelling EE, Jazaeri O. An overview of renal insufficiency, race, and glomerular filtration rate calculation for the vascular surgeon. J Vasc Surg 2021; 75:3-4. [PMID: 34949382 DOI: 10.1016/j.jvs.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/07/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Erin E Koelling
- Division of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, Md; F. Edwards Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md.
| | - Omid Jazaeri
- Department of Bioengineering, Rocky Vista University School of Medicine, University of Colorado Denver, Aurora, Colo; Cardiothoracic and Vascular Surgery Associates, Aurora, Colo
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Marzinke MA, Greene DN, Bossuyt PM, Chambliss AB, Cirrincione LR, McCudden CR, Melanson SEF, Noguez JH, Patel K, Radix AE, Takwoingi Y, Winston-McPherson G, Young BA, Hoenig MP. Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review. Clin Chem 2021; 68:521-533. [DOI: 10.1093/clinchem/hvab279] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Commonly used estimated glomerular filtration rate (eGFR) equations include a Black race modifier (BRM) that was incorporated during equation derivation. Race is a social construct, and a poorly characterized variable that is applied inconsistently in clinical settings. The BRM results in higher eGFR for any creatinine concentration, implying fundamental differences in creatinine production or excretion in Black individuals compared to other populations. Equations without inclusion of the BRM have the potential to detect kidney disease earlier in patients at the greatest risk of chronic kidney disease (CKD), but also has the potential to over-diagnose CKD or impact downstream clinical interventions. The purpose of this study was to use an evidence- based approach to systematically evaluate the literature relevant to the performance of the eGFR equations with and without the BRM and to examine the clinical impact of the use or removal.
Content
PubMed and Embase databases were searched for studies comparing measured GFR to eGFR in racially diverse adult populations using the Modification of Diet in Renal Disease or the 2009-Chronic Kidney Disease Epidemiology Collaboration-creatinine equations based on standardized creatinine measurements. Additionally, we searched for studies comparing clinical use of eGFR calculated with and without the BRM. 8,632 unique publications were identified; an additional 3 studies were added post-hoc. In total, 96 studies were subjected to further analysis and 44 studies were used to make a final assessment.
Summary
There is limited published evidence to support the use of a BRM in eGFR equations.
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Affiliation(s)
- Mark A Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology; University of Washington, Seattle, WA; Kaiser Permanente, Renton, WA
| | - Patrick M Bossuyt
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Christopher R McCudden
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital; University of Ottawa; Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Stacy E F Melanson
- Department of Pathology; Brigham and Women’s Hospital; Harvard Medical School, Boston, MA
| | - Jaime H Noguez
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Khushbu Patel
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY
| | - Yemisi Takwoingi
- Institute of Applied Health Research,University of Birmingham and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | | | - Bessie A Young
- Office of Healthcare Equity, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Melanie P Hoenig
- Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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Kim SM, Lee HS, Kim MJ, Park HD, Lee SY. Diagnostic Value of Multiple Serum Biomarkers for Vancomycin-Induced Kidney Injury. J Clin Med 2021; 10:5005. [PMID: 34768522 DOI: 10.3390/jcm10215005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a major contributor to in-hospital morbidity and mortality. Vancomycin, one of the most commonly used antibiotics in a clinical setting, is associated with AKI, with its incidence ranging up to 43%. Despite the high demand, few studies have investigated serum biomarkers to detect vancomycin-induced kidney injury (VIKI). Here, we evaluated the diagnostic value of nine candidate serum biomarkers for VIKI. A total of 23,182 cases referred for vancomycin concentration measurement from January 2018 to December 2019 were screened and 28 subjects with confirmed VIKI were enrolled (VIKI group). Age- and sex- matched control group consisted of 21 subjects who underwent vancomycin therapy without developing VIKI (non-VIKI group), and 23 healthy controls (HC group). The serum concentrations of clusterin, retinol binding protein 4 (RBP4), interleukin-18 (IL-18), tumor necrosis factor receptor 1 (TNF-R1), C-X-C motif chemokine ligand 10 (CXCL10), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin, trefoil factor-3 (TFF3), and cystatin C were compared among the three groups, and their correlations with estimated glomerular filtration rate (eGFR) and diagnostic values for VIKI were assessed. All of the biomarkers except clusterin and RBP4 exhibited significant elevation in the VIKI group. Serum TFF3, cystatin C, TNF-R1, and osteopontin demonstrated an excellent diagnostic value for VIKI (TFF3, area under the curve (AUC) 0.932; cystatin C, AUC 0.917; TNF-R1, AUC 0.866; osteopontin, AUC 0.787); and except osteopontin, a strong negative correlation with eGFR (TFF3, r = −0.71; cystatin C, r = −0.70; TNF-R1, r = −0.60). IL-18, CXCL10, and NGAL showed weak correlation with eGFR and moderate diagnostic value for VIKI. This study tested multiple serum biomarkers for VIKI and showed that serum TFF3, cystatin C, TNF-R1, and osteopontin could efficiently discriminate VIKI patients. Further studies are warranted to clarify the diagnostic value of these biomarkers in VIKI.
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Mohd Nasir MZ, Malek KA, Isa MR, Hamdan MF, Abdul Kadir RF, Ahmad F, Wan Adib WF. Association between elevated carotid intima-media thickness and serum uric acid levels among patients with essential hypertension in primary care setting in Sungai Buloh, Malaysia. Int J Clin Pract 2021; 75:e14445. [PMID: 34105862 PMCID: PMC8459283 DOI: 10.1111/ijcp.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/19/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS Our study aimed to investigate the association between elevated carotid-intima media thickness (CIMT) and serum uric acid (SUA) levels in hypertensive patients attending primary care clinics in Sungai Buloh, Malaysia. METHODS We conducted a cross-sectional study on 140 hypertensive patients attending outpatient follow-up in two primary care clinics in Sungai Buloh, Malaysia, using a convenient sampling method. SUA levels were measured and divided into four quartiles. Two radiologist specialists performed B mode ultrasonography to assess the thickness of the right and left carotid intima media in all participants. RESULTS Participants' mean SUA level was 355.75 ± 0.13. Their mean age was 53.44 (± 9.90), with a blood pressure control of 137.09 ± 13.22/81.89 ± 8.95. Elevated CIMT taken at ≥75th percentile was 0.666 for the left and 0.633 for the right common carotid arteries. By using a hierarchical method of multiple logistic regression, compared with the first quartile of the SUA level as reference group, the odd of elevated CIMT in quartile 4 in the common carotid artery was (OR = 2.00; 95% CI = 0.64-6.27, P = .576) for the right and (OR = 0.62; 95% CI = 0.20-2.00, P = .594) for the left. Waist circumference (P = .001), body mass index (P = .013), triglycerides (P < .001), and high-density lipoprotein cholesterol (P = .001) were significantly associated with the SUA quartiles. CONCLUSION Although there was an increasing trend in the odd of elevated right CIMT across the SUA quartiles, this association, however, was not significant. Preventive effort to tackle the clustering effect of metabolic markers within this study population is needed to reduce the future risk of developing cardiovascular disease.
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Affiliation(s)
- Mohd Zulhilmie Mohd Nasir
- Department of Primary Care MedicineFaculty of MedicineUniversitiTeknologi MARA (UiTM)SelangorMalaysia
| | - Khasnur Abd Malek
- Department of Primary Care MedicineFaculty of MedicineUniversitiTeknologi MARA (UiTM)SelangorMalaysia
| | - Mohamad Rodi Isa
- Department Public Health MedicineFaculty of MedicineUniversitiTeknologi MARA (UiTM)SelangorMalaysia
| | - Mohd Farhan Hamdan
- Department of RadiologyFaculty of MedicineUniversitiTeknologi MARA (UiTM)SelangorMalaysia
| | | | - Fauziah Ahmad
- Sungai Buloh Health ClinicMinistry of HealthSelangorMalaysia
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19
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Affiliation(s)
- Malika A Fair
- Association of American Medical Colleges, Washington, DC, USA. .,Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Sapkota S, Khatiwada S, Shrestha S, Baral N, Maskey R, Majhi S, Chandra L, Lamsal M. Diagnostic Accuracy of Serum Cystatin C for Early Recognition of Nephropathy in Type 2 Diabetes Mellitus. Int J Nephrol 2021; 2021:8884126. [PMID: 33996155 DOI: 10.1155/2021/8884126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of serum cystatin C in detecting diabetic nephropathy at earlier stages. Materials and Methods This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. Results The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p < 0.001). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol (p=0.018) and serum cystatin C (p < 0.001) was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p=0.022), duration of T2DM (r = 0.326, p=0.021), and UACR (r = 0.528, p < 0.001) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = −0.925, p < 0.001). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450–0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265–0.593) though nonsignificant. Conclusion Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.
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21
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Wu J, Ning Y, Gao Y, Shan R, Wang B, Lv J, Li L. Association between Ambient Air Pollution and MRI-Defined Brain Infarcts in Health Examinations in China. Int J Environ Res Public Health 2021; 18:ijerph18084325. [PMID: 33921763 PMCID: PMC8072670 DOI: 10.3390/ijerph18084325] [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] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
The study aimed to evaluate the relationships between air pollutants and risk of magnetic resonance imaging (MRI)-defined brain infarcts (BI). We used data from routine health examinations of 1,400,503 participants aged ≥18 years who underwent brain MRI scans in 174 cities in 30 provinces in China in 2018. We assessed exposures to particulate matter (PM)2.5, PM10, nitrogen dioxide (NO2), and carbon monoxide (CO) from 2015 to 2017. MRI-defined BI was defined as lesions ≥3 mm in diameter. Air pollutants were associated with a higher risk of MRI-defined BI. The odds ratio (OR) (95% CI) for MRI-defined BI comparing the highest with the lowest tertiles of air pollutant concentrations was 2.00 (1.96–2.03) for PM2.5, 1.68 (1.65–1.71) for PM10, 1.58 (1.55–1.61) for NO2, and 1.57 (1.54–1.60) for CO. Each SD increase in air pollutants was associated with 16–42% increases in the risk of MRI-defined BI. The associations were stronger in the elderly subgroup. This is the largest survey to evaluate the association between air pollution and MRI-defined BI. Our findings indicate that ambient air pollution was significantly associated with a higher risk of MRI-defined BI.
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Affiliation(s)
- Jing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
| | - Yi Ning
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
- Meinian Institute of Health, Beijing 100191, China;
- Correspondence: (Y.N.); (L.L.); Tel.: +86-0089-3791 (Y.N.); +86-10-828-01528 (ext. 321) (L.L.)
| | | | - Ruiqi Shan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
| | - Bo Wang
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
- Meinian Institute of Health, Beijing 100191, China;
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.W.); (R.S.); (J.L.)
- Meinian Public Health Institute, Peking University Health Science Center, Beijing 100191, China;
- Correspondence: (Y.N.); (L.L.); Tel.: +86-0089-3791 (Y.N.); +86-10-828-01528 (ext. 321) (L.L.)
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Kim SM, Lee HS, Hwang NY, Kim K, Park HD, Lee SY. Individualized Vancomycin Dosing with Therapeutic Drug Monitoring and Pharmacokinetic Consultation Service: A Large-Scale Retrospective Observational Study. Drug Des Devel Ther 2021; 15:423-440. [PMID: 33692613 PMCID: PMC7939511 DOI: 10.2147/dddt.s285488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
Background To date, outcome data with a large sample size and data regarding the clinical outcomes of pharmacokinetic-guided (PK) dosing of vancomycin are limited. Aim We evaluated the pharmacokinetic and clinical outcomes of a PK-guided dosing advisory program, pharmacokinetic consultation service (PKCS), in vancomycin treatment. Methods We investigated vancomycin therapeutic drug monitoring (TDM) and PKCS use through a retrospective review of patients who had serum vancomycin trough concentration data from October 2017 to November 2018. Among these patients, we selected non-critically ill adult patients satisfying our selection criteria to evaluate the effect of PKCS. Target trough attainment rate, time to target attainment, vancomycin-induced nephrotoxicity (VIN), vancomycin treatment failure rate, and duration of vancomycin therapy were compared between patients whose dosing was adjusted according to PKCS (PKCS group), and those whose dose was adjusted at the discretion of the attending physician (non-PKCS group). Results A total of 280 patients met the selection criteria for the VIN analysis (PKCS, n=134; non-PKCS, n=146). The incidence of VIN was similar between the two groups (PKCS, n=5; non-PKCS, n=5); however, the target attainment rate was higher in the PKCS group (75% vs 60%, P = 0.012). The time to target attainment was similar between the two groups. Further exclusions yielded 112 patients for the clinical outcome evaluation (PKCS, n=51; non-PKCS, n=61). The treatment failure rate was similar, and the duration of vancomycin therapy was longer in the PKCS group (12 vs 8 days, P = 0.008). Conclusion In non-critically ill patients, an increase in target trough achieved by PKCS did not lead to decreased vancomycin treatment failures, shorter vancomycin treatment, or decreased nephrotoxicity in vancomycin treatment. Considering the excessive amount of effort currently put into vancomycin dosing and monitoring, more selective criteria for individualized pharmacokinetic-guided dosing needs to be applied.
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Affiliation(s)
- Sang-Mi Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Seung Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Na-Young Hwang
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Clinical Pharmacology & Therapeutics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
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Liang J, Jiang Y, Huang Y, Huang Y, Liu F, Zhang Y, Yang M, Wu J, Xiao M, Cao S, Gu J. Comorbidities and factors influencing frequent gout attacks in patients with gout: a cross-sectional study. Clin Rheumatol 2021; 40:2873-2880. [PMID: 33538925 DOI: 10.1007/s10067-021-05595-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/03/2020] [Revised: 12/06/2020] [Accepted: 01/17/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objective was to identify the comorbidities of gout, to compare gender difference and independent factors of frequent gout attacks (> 20 times). METHOD Demographic, clinical variables, self-reported comorbidities, and biochemical variables (i.e., initial serum uric acid (UA) and UA at visit) were collected in this cross-sectional study. Gout attack times were recorded as ≤ 5, 6-10, 11-20, and > 20. Adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated to explore the association between selected risk factors and frequent gout attacks. RESULTS Six hundred fifty-three gout patients with a mean age of 48.3 ± 15.8 years were included, 84.7% of whom were males. The median gout duration was 6.0 (3.0-12.0) years. The most common comorbidities involved hypertension (166, 25.4%), coronary artery disease (CAD) (67, 10.3%), chronic kidney disease (66, 10.1%), and hyperlipidemia (57, 8.7%). Abnormalities including nephrolithiasis (29.4%), hydronephrosis (3.2%), and gallstones (11.9%) were also found. Although female patients had a longer disease duration and more CAD, they had a lower level of UA, creatine, and C-reactive protein (CRP) but higher high-density lipoprotein cholesterol (HDL-C) (p < 0.05). A positive correlation between UA and triglycerides was found in females (p = 0.039). Patients with renal insufficiency or nephrolithiasis had longer disease duration and more gout attacks (p < 0.001). In multivariable regression analysis, only gout duration (OR = 7.89, p < 0.001) and UA (OR = 1.48, p < 0.001) was independent factors of frequent gout attacks. CONCLUSIONS Comorbidity screening involving dyslipidemia is often neglected in gout patients. Gout duration and UA are the risk factors of frequent gout attacks. Key Points • Comorbidities can be overlooked if the screening for lipid levels, cardiovascular disease, and kidney disease is not completed. • There are differences in comorbidities and biochemical findings between male and female patients with gout. • Gout duration and serum uric acid level are independent risk factors of frequent gout attacks.
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Affiliation(s)
- Jing Liang
- Department of Rheumatology and Immunology, Huadu Affiliated Hospital of Southern Medical University, Huadu District People's Hospital, Guangzhou, 510800, China
| | - Yutong Jiang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yefei Huang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yulan Huang
- Department of Rheumatology and Immunology, Huadu Affiliated Hospital of Southern Medical University, Huadu District People's Hospital, Guangzhou, 510800, China
| | - Feng Liu
- Department of Rheumatology and Immunology, Huadu Affiliated Hospital of Southern Medical University, Huadu District People's Hospital, Guangzhou, 510800, China
| | - Yanli Zhang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Mingcan Yang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jialing Wu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Min Xiao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Shuangyan Cao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.
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Borrell LN, Elhawary JR, Fuentes-Afflick E, Witonsky J, Bhakta N, Wu AHB, Bibbins-Domingo K, Rodríguez-Santana JR, Lenoir MA, Gavin JR, Kittles RA, Zaitlen NA, Wilkes DS, Powe NR, Ziv E, Burchard EG. Race and Genetic Ancestry in Medicine - A Time for Reckoning with Racism. N Engl J Med 2021; 384:474-480. [PMID: 33406325 PMCID: PMC8979367 DOI: 10.1056/nejmms2029562] [Citation(s) in RCA: 327] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Luisa N Borrell
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Jennifer R Elhawary
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Elena Fuentes-Afflick
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Jonathan Witonsky
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Nirav Bhakta
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Alan H B Wu
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Kirsten Bibbins-Domingo
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - José R Rodríguez-Santana
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Michael A Lenoir
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - James R Gavin
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Rick A Kittles
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Noah A Zaitlen
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - David S Wilkes
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Neil R Powe
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Elad Ziv
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
| | - Esteban G Burchard
- From the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York (L.N.B.); the Departments of Medicine (J.R.E., J.W., N.B., N.R.P., E.Z., E.G.B.), Pediatrics (E.F.-A., J.W.), Laboratory Medicine (A.H.B.W.), and Epidemiology and Biostatistics (K.B.-D.), Priscilla Chan and Mark Zuckerberg San Francisco General Hospital (K.B.-D., N.R.P.), the Division of General Internal Medicine and the Institute of Human Genetics, Helen Diller Family Comprehensive Cancer Center (E.Z.), and the Department of Bioengineering and Therapeutic Sciences (E.G.B.), University of California, San Francisco, San Francisco, Bay Area Pediatrics, Oakland (M.A.L.), the Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte (R.A.K.), and the Department of Neurogenetics, University of California, Los Angeles, Los Angeles (N.A.Z.) - all in California; the Centro de Neumología Pediátrica, San Juan, PR (J.R.R.-S.); Emory University School of Medicine, Atlanta (J.R.G.); and the School of Medicine, University of Virginia, Charlottesville (D.S.W.)
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Kittiskulnam P, Tiskajornsiri K, Katavetin P, Chaiwatanarat T, Eiam-Ong S, Praditpornsilpa K. The failure of glomerular filtration rate estimating equations among obese population. PLoS One 2020; 15:e0242447. [PMID: 33206712 DOI: 10.1371/journal.pone.0242447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity is a major public health with increasing numbers of obese individuals are at risk for kidney disease. However, the validity of serum creatinine-based glomerular filtration rate (GFR) estimating equations in obese population is yet to be determined. METHODS We evaluated the performance of the reexpressed Modification of Diet in Renal Disease (MDRD), reexpressed MDRD with Thai racial factor, Thai estimated GFR (eGFR) as well as Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations among obese patients, defined as body mass index (BMI) ≥25 kg/m2 with the reference measured GFR (mGFR) determined by 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) plasma clearance method. Serum creatinine levels were measured using standardized enzymatic method simultaneously with GFR measurement. The statistical methods in assessing agreement for continuous data including total deviation index (TDI), concordance correlation coefficient (CCC), and coverage probability (CP) for each estimating equation were compared with the reference mGFR. Accuracy within 10% representing the percentage of estimations falling within the range of ±10% of mGFR values for all equations were also tested. RESULTS A total of 240 Thai obese patients were finally recruited with mean BMI of 31.5 ± 5.8 kg/m2. In the total population, all eGFR equations underestimated the reference mGFR. The average TDI values were 55% indicating that 90% of the estimates falling within the range of -55 to +55% of the reference mGFR. The CP values averaged 0.23 and CCC scores ranged from 0.75 to 0.81, reflecting the low to moderate levels of agreement between each eGFR equation and the reference mGFR. The proportions of patients achieving accuracy 10% ranged from 23% for the reexpressed MDRD equation to 33% for the Thai eGFR formula. Among participants with BMI more than 35 kg/m2 (n = 48), the mean error of all equations was extremely wide and significantly higher for all equations compared with the lower BMI category. Also, the strength of agreement evaluated by TDI, CCC, and CP were low in the subset of patients with BMI ≥35 kg/m2. CONCLUSION Estimating equations generally underestimated the reference mGFR in subjects with obesity. The overall performance of GFR estimating equations demonstrated poor concordance with the reference mGFR among individuals with high BMI levels. In certain clinical settings such as decision for dialysis initiation, the direct measurements of GFR are required to establish real renal function among obese population.
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Kong JY, Kim JS, Kang MH, Hwang HS, Won CW, Jeong KH. Renal dysfunction is associated with decline of cognitive function in community-dwelling older adults: Korean frailty and aging cohort study. BMC Geriatr 2020; 20:462. [PMID: 33172388 PMCID: PMC7654158 DOI: 10.1186/s12877-020-01862-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background Cognitive decline is common in older adults. Similarly, the prevalence of renal dysfunction is also increased in the elderly population. We conducted this study to clarify the relationship between renal dysfunction and decline of cognitive function in community-dwelling elderly population. Methods A cross-sectional analysis was performed using data from the Korean Frailty and Aging Cohort Study, a nationwide cohort study. Total 2847 (1333 men, 1514 women) eligible participants were enrolled for this study. The estimated glomerular filtration rate (eGFR, mL/min/1.73m2) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Global cognitive function was assessed with the Mini-mental State Examination-Korean version. Other domains of cognitive function were tested with the Consortium to Establish a Registry for Alzheimer’s disease and the Frontal Assessment Battery. Results The mean age of all participants was 76.0 ± 3.9 years and eGFR (all in mL/min/1.73 m2) was 77.5 ± 14.3. And the mean eGFR was 91.7 ± 3.2 in quartile 1, 84.9 ± 1.8 in quartile 2, 76.1 ± 3.7 in quartile 3, and 57.2 ± 10.8 in quartile 4. In baseline characteristics, participants with lower eGFR tend to have lower cognitive function scores than participant with higher eGFR. In linear regression analysis, eGFR was correlated with the word list memory (β = 0.53, P = 0.005), word list recall (β = 0.86, P < 0.001), and word list recognition (β = 0.43, P = 0.030) after adjustment of confounding variables. Moreover, after multivariate adjustment the association with cognitive impairment in quartile 2 was stronger (adjusted OR: 1.535, 95% CI: 1.111–2.120, P = 0.009), and the ORs of cognitive impairment were 1.501 (95% CI: 1.084–2.079, P = 0.014) in quartile 3 and 1.423 (95% CI: 1.022–1.983, P = 0.037) in quartile 4. Conclusion In older adults, the immediate, recent memory, and recognition domains were significantly related to renal function. Also, the mild renal dysfunction was independently associated with impairment of global cognitive function. These results suggest that the early stages of renal dysfunction could be an effective target to prevent worsening of cognitive impairment. Therefore, regular monitoring and early detection of mild renal dysfunction in elderly population might be needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01862-8.
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Affiliation(s)
- Ji Yoon Kong
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jin Sug Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Min Hye Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Zou LX, Sun L, Nicholas SB, Lu Y, K SS, Hua R. Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation. Eur J Intern Med 2020; 80:29-34. [PMID: 32522444 DOI: 10.1016/j.ejim.2020.04.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The directly measured glomerular filtrate rate (mGFR) is the gold standard for kidney function, but it is invasive and costly. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have been widely used to estimate GFR, however, the comparative accuracy of estimated GFR (eGFR) using creatinine and cystatin C in CKD-EPI equations remains unclear. We performed this meta-analysis to assess the bias and accuracy of eGFR using equations of CKD-EPIcrea, CKD-EPIcys, and CKD-EPIcrea/cys in adult populations relevant to primary health care. METHODS Pubmed, Web of Science, EMBASE, and the Cochrane Library were searched from inception until December 2019 for related studies. RESULTS A total of 35 studies with 23,667 participants, which reported the data on the bias, and/or P30, and/or R were included. The difference in the bias of eGFR using CKD-EPIcys was 4.84 mL/min/1.73 m2 (95% CI, 1.88~7.80) lower than using CKD-EPIcrea, and 1.50 mL/min/1.73 m2 (95% CI, 0.05~2.95) lower than using CKD-EPIcrea/cys. These gaps increased in subgroups of low mGFR (<60 mL/min/1.73 m2). CKD-EPIcrea/cys eGFR achieved the highest accuracy, 7.50% higher than CKD-EPIcrea (95% CI, 4.81~10.18), and 3.21% higher than CKD-EPIcys (95% CI, -0.43~6.85); and the best correlation with mGFR, with Fisher's z transformed R of 1.20 (95% CI, 0.89-1.50). CONCLUSIONS CKD-EPIcrea/cys and CKD-EPIcys gave less bias and more accurate estimates of mGFR than CKD-EPIcrea. More variables and coefficients could be added in CKD-EPI equations to achieve less bias and more accuracy in future research.
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Affiliation(s)
- Lu-Xi Zou
- Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ling Sun
- Division of Nephrology, Xuzhou Central Hospital, Medical College of Southeast University, Xuzhou, Jiangsu, China; Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Susanne B Nicholas
- Divisions of Nephrology and Endocrinology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Yan Lu
- Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Satyesh Sinha K
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Ruixue Hua
- Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Chang YL, Wang JS, Yeh HC, Ting IW, Huang HC, Chiang HY, Hsiao CT, Chu PL, Kuo CC. Dialysis timing may be deferred toward very late initiation: An observational study. PLoS One 2020; 15:e0233124. [PMID: 32401817 PMCID: PMC7219782 DOI: 10.1371/journal.pone.0233124] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/28/2020] [Indexed: 01/20/2023] Open
Abstract
The optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of <5 mL/min/1.73 m2 is unknown. We hypothesized that dialysis initiation time can be deferred in this population even with high uremic burden. A case-crossover study with case (0-30 days before dialysis initiation [DI]) and control (90-120 days before DI) periods was conducted in 1,079 hemodialysis patients aged 18-90 years at China Medical University Hospital between 2006 and 2015. The uremic burden was quantified based on 7 uremic indicators that reached the predefined threshold in case period, namely hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate. Dialysis timing was classified as standard (met 0-2 uremic indicators), late (3-5 indicators), and very late (6-7 indicators). Median eGFR-DI of the 1,079 patients was 3.4 mL/min/1.73 m2 and was 2.7 mL/min/1.73 m2 in patients with very late initiation. The median follow-up duration was 2.42 years. Antibiotics, diuretics, antihypertensive medications, and non-steroidal anti-inflammatory drugs (NSAIDs) were more prevalently used during the case period. The fully adjusted hazards ratios of all-cause mortality for the late and very late groups were 0.97 (95% confidence interval 0.76-1.24) and 0.83 (0.61-1.15) compared with the standard group. It is safe to defer dialysis initiation among patients with chronic kidney disease (CKD) having an eGFR of <5 mL/min/1.73 m2 even when patients having multiple biochemical uremic burdens. Coordinated efforts in acute infection prevention, optimal fluid management, and prevention of accidental exposure to NSAIDs are crucial to prolong the dialysis-free survival.
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Affiliation(s)
- Yun-Lun Chang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Jie-Sian Wang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiung-Tzu Hsiao
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, 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
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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Abstract
Assessment of GFR is central to clinical practice, research, and public health. Current Kidney Disease Improving Global Outcomes guidelines recommend measurement of serum creatinine to estimate GFR as the initial step in GFR evaluation. Serum creatinine is influenced by creatinine metabolism as well as GFR; hence, all equations to estimate GFR from serum creatinine include surrogates for muscle mass, such as age, sex, race, height, or weight. The guideline-recommended equation in adults (the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation) includes a term for race (specified as black versus nonblack), which improves the accuracy of GFR estimation by accounting for differences in non-GFR determinants of serum creatinine by race in the study populations used to develop the equation. In that study, blacks had a 16% higher average measured GFR compared with nonblacks with the same age, sex, and serum creatinine. The reasons for this difference are only partly understood, and the use of race in GFR estimation has limitations. Some have proposed eliminating the race coefficient, but this would induce a systematic underestimation of measured GFR in blacks, with potential unintended consequences at the individual and population levels. We propose a more cautious approach that maintains and improves accuracy of GFR estimates and avoids disadvantaging any racial group. We suggest full disclosure of use of race in GFR estimation, accommodation of those who decline to identify their race, and shared decision making between health care providers and patients. We also suggest mindful use of cystatin C as a confirmatory test as well as clearance measurements. It would be preferable to avoid specification of race in GFR estimation if there was a superior, evidence-based substitute. The goal of future research should be to develop more accurate methods for GFR estimation that do not require use of race or other demographic characteristics.
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Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
| | - Silvia M Titan
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California, San Francisco, California; and
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Chen N, Shi H, Zhang L, Zuo L, Xie J, Xie D, Karger AB, Miao S, Ren H, Zhang W, Wang W, Pan Y, Minji W, Sui Z, Okparavero A, Simon A, Chaudhari J, Eckfeldt JH, Inker LA, Levey AS. GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing. Kidney Med 2020; 2:172-180. [PMID: 32734236 PMCID: PMC7380432 DOI: 10.1016/j.xkme.2019.11.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RATIONALE & OBJECTIVES Estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFRcr-cys) may be less accurate compared to measured GFR (mGFR) in China than in North America, Europe, and Australia due to variation across regions in their non-GFR determinants. The non-GFR determinants of β2-microglobulin (B2M) and β-trace protein (BTP) differ from those of creatinine and cystatin C. Thus, the average eGFR using all 4 markers (eGFRavg) could be more accurate than eGFRcr-cys in China. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS 1,066 participants in Shanghai and Beijing with creatinine and cystatin C and 666 participants with all 4 filtration markers. TESTS COMPARED Index tests were previously developed equations for eGFR using creatinine, cystatin C, B2M, and BTP and combinations. The reference test was mGFR using plasma clearance of iohexol. We compared the performance of eGFRavg to eGFRcr-cys using the proportion of participants with errors in eGFR >30% of mGFR (1 - P30) and root mean square error (RMSE) of the regression of eGFR on mGFR on the logarithmic scale. We also compared classification and reclassification of mGFR categories using eGFRavg compared to eGFRcr-cys. OUTCOMES Accuracy was significantly better for eGFRavg (1 - P30 of 10.4% and RMSE of 0.214) compared to eGFRcr-cys (1 - P30 of 13.8% and RMSE of 0.232; P = 0.004 and P = 0.006, respectively). However, improvements in accuracy did not generally translate into significant improvement in classification or reclassification of mGFR categories. LIMITATIONS Study population may not be generalizable to clinical settings other than large urban medical centers in China. CONCLUSIONS A panel of endogenous filtration markers including B2M and BTP in addition to creatinine and cystatin C may improve GFR estimation in China. Further study is necessary to determine whether GFR estimation using B2M and BTP can be improved and whether these improvements lead to useful clinical applications.
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Affiliation(s)
- Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Shi
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Peking University, Center for Data Science in Health and Medicine, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danshu Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Shiyuan Miao
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujing Pan
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Wei Minji
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Zhun Sui
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | | | - Andrew Simon
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Juhi Chaudhari
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
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Levey AS, Coresh J, Tighiouart H, Greene T, Inker LA. Measured and estimated glomerular filtration rate: current status and future directions. Nat Rev Nephrol 2019; 16:51-64. [DOI: 10.1038/s41581-019-0191-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 12/28/2022]
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Jang MS, Nam JS, Jo JY, Kang CH, Ryu SA, Lee EH, Choi IC. The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study. BMC Anesthesiol 2019; 19:88. [PMID: 31138135 DOI: 10.1186/s12871-019-0763-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Although serum creatinine concentration has been traditionally used as an index of renal function in clinical practice, it is considered relatively inaccurate, especially in patients with mild renal dysfunction. This study investigated the usefulness of preoperative estimated glomerular filtration rate (eGFR) in predicting complications after cardiovascular surgery in patients with normal serum creatinine concentrations. Methods This study included 2208 adults undergoing elective cardiovascular surgery. Preoperative eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration equations. The relationships between preoperative eGFR and 90 day postoperative composite major complications were analyzed, including 90 day all-cause mortality, major adverse cardiac and cerebrovascular events, severe acute kidney injury, respiratory and gastrointestinal complications, wound infection, sepsis, and multi-organ failure. Results Of the 2208 included patients, 185 (8.4%) had preoperative eGFR < 60 mL/min/1.73 m2 and 328 (14.9%) experienced postoperative major complications. Multivariable logistic regression analyses showed that preoperatively decreased eGFR was independently associated with an increased risk of composite 90 day major postoperative complications (adjusted odds ratio: 1.232; 95% confidence interval [CI]: 1.148–1.322; P < 0.001). eGFR was a better discriminator of composite 90 day major postoperative complications than serum creatinine, with estimated c-statistics of 0.724 (95% CI: 0.694–0.754) for eGFR and 0.712 (95% CI: 0.680–0.744) for serum creatinine (P = 0.008). Conclusions Decreased eGFR was significantly associated with an increased risk of major complications after cardiovascular surgery in patients with preoperatively normal serum creatinine concentrations. Electronic supplementary material The online version of this article (10.1186/s12871-019-0763-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Francoz
- Hepatology and Liver Intensive Care, Hospital Beaujon, Clichy, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France.
| | - Elsa Sola
- Liver Unit, Hospital Clínic Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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Crass RL, Pai MP. Estimating Renal Function in Drug Development: Time to Take the Fork in the Road. J Clin Pharmacol 2018; 59:159-167. [PMID: 30184267 DOI: 10.1002/jcph.1314] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 07/12/2018] [Accepted: 08/15/2018] [Indexed: 01/29/2023]
Abstract
Renal function is the most commonly applied patient-specific quantitative variable used to determine drug doses. Measurement of renal function is not practical in most clinical settings; therefore, clinicians often rely on estimates when making dosing decisions. Similarly, renal function estimates are used to assign subjects in phase 1 pharmacokinetic studies, which inform dosing in late-phase clinical trials and ultimately the product label. The Cockcroft-Gault estimate of creatinine clearance has been the standard renal function metric; however, this paradigm is shifting toward the Modification of Diet in Renal Diseases (MDRD) estimate of the glomerular filtration rate (GFR). The proportion of approved new drug labels with dosing recommendations based on the MDRD equation was 16.7% in 2015, 70.0% in 2016, and 46.7% in 2017. Disharmonious recommendations from the United States Food and Drug Administration and the European Medicines Agency will continue to increase this heterogeneity in the assessment of renal function in drug development and negatively impact industry, health systems, and clinicians. In this review, we discuss the current regulatory guidance for the conduct of renal impairment pharmacokinetic studies and review the implications of this guidance across the medication use system with 3 recently approved antibiotics: ceftazidime/avibactam, delafloxacin, and meropenem/vaborbactam. Finally, we suggest measuring GFR in phase 1 studies and employing the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to integrate data across clinical trials. This will help to harmonize CKD staging, population pharmacokinetic analyses, and dosing by estimated renal function.
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Affiliation(s)
- Ryan L Crass
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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