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Bi M, Feng A, Liu Y, Tian S. U-shaped association of serum uric acid with cardiovascular disease risk scores and the modifying role of sex among Chinese adults. Nutr Metab Cardiovasc Dis 2023; 33:1066-1076. [PMID: 36958966 DOI: 10.1016/j.numecd.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND AND AIMS Serum uric acid (SUA) is involved in the development of cardiovascular disease (CVD). However, information on the dose-response relationship between SUA and CVD is limited in the Chinese population. This study aimed to investigate the potential nonlinear dose-response association of SUA with CVD risk in a Chinese population and to explore the effect of sex on these associations. METHODS AND RESULTS Cross-sectional data, from 6252 Chinese adults aged 30-74 years who participated in the China Health and Nutrition Survey 2009, were stratified by SUA deciles. The 10-year risk of CVD was determined using the Framingham risk score. A restricted cubic spline (RCS) was incorporated into the logistic models to assess the nonlinear relationship between SUA and CVD. Among the participants, 65%, 20%, and 15% had low, moderate, and high 10-year CVD risks, respectively. Compared with the reference SUA strata of 225 to <249 μmol/L, CVD risk was significantly increased at SUA ≥294 μmol/L, with adjusted ORs ranging from 2.39 (1.33-4.33) to 4.25 (2.37-7.65). An increasingly higher nonsignificant CVD risk was found at SUA <225 μmol/L and showed a nonlinear U-shaped association. In the fitted RCS model, an approximate U-shaped association between SUA and CVD risk scores was found in women, but this significant nonlinear relationship was not found in men. CONCLUSION This study showed that both lower and higher SUA levels were associated with a higher 10-year CVD risk among Chinese adults, forming a U-shaped relationship, and this pattern was particularly pronounced for women.
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Affiliation(s)
- Mei Bi
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ao Feng
- Department of Prevention and Healthcare, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yazhuo Liu
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Simiao Tian
- Department of Medical Record and Statistics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Safdar A, Akram W, Ahmad Khan M, Muhammad S. Optimal Glomerular Filtration Rate Equations for Various Age Groups, Disease Conditions and Ethnicities in Asia: A Systematic Review. J Clin Med 2023; 12. [PMID: 36902609 DOI: 10.3390/jcm12051822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: The performance of estimated glomerular filtration rate (eGFR) equations in the Asian population has been widely questioned. The primary objective of this study was to gather evidence regarding optimal GFR equations in Asia for various age groups, disease conditions, and ethnicities. The secondary objective was to see whether the equations based on the combination of creatinine and cystatin C biomarkers if employed are satisfactory across different age groups and disease conditions in various ethnicities in Asia compared to those based on either of the single biomarkers. (2) Methods: Validation studies that had both creatinine and cystatin C-based equations either alone or in combination, validated in specific disease conditions, and those which compared the performance of these equations with exogenous markers were eligible only. The bias, precision, and 30% accuracy (P30) of each equation were recorded accordingly. (3) Results: Twenty-one studies consisting of 11,371 participants were included and 54 equations were extracted. The bias, precision, and P30 accuracies of the equations ranged from -14.54 to 9.96 mL/min/1.73 m2, 1.61 to 59.85 mL/min/1.73 m2, and 4.7% to 96.10%. The highest values of P30 accuracies were found for the JSN-CKDI equation (96.10%) in Chinese adult renal transplant recipients, for the BIS-2 equation (94.5%) in Chinese elderly CKD patients, and Filler equation (93.70%) also in Chinese adult renal transplant recipients. (4) Conclusions: Optimal equations were identified accordingly and it was proven that combination biomarker equations are more precise and accurate in most of the age groups and disease conditions. These can be considered equations of choice for the specific age groups, disease conditions, and ethnicities within Asia.
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Wu L, Luo L, Zhou L, Li N, Qin X. GDF-15 and sST-2 act as biomarkers of disease severity but not independent predictors in idiopathic membranous nephropathy. Int Immunopharmacol 2022; 111:109150. [PMID: 36027852 DOI: 10.1016/j.intimp.2022.109150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND We aimed to explore biomarkers of disease severity in idiopathic membranous nephropathy (IMN) and independent predictors of prognosis in IMN. METHODS Clinical data were collected from 79 IMN patients. Serum levels of growth differentiation factor-15 (GDF-15) and soluble suppression of tumorigenicity (sST-2) were tested by enzyme-linked immunosorbent assay (ELISA) in IMN patients and subgroups, and correlation analysis was performed. Univariate and multiple logistic regression analyses were performed to identify independent predictors of IMN, and a combined-factors model was constructed. Moreover, the area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the prognostic efficacy. RESULTS The levels of GDF-15 were significantly higher in the IMN group and subgroups with low estimated glomerular filtration rate (eGFR) and high 24 hour-urine protein (24 h-UP), whiles sST-2 level was only significantly higher in the IMN group. GDF-15 levels were positively correlated with creatinine (Crea), cystatin C (Cys-C) and 24 h-UP and negatively correlated with GFR and albumin (Alb), while sST-2 levels were positively correlated with Urea and Cys-C and negatively correlated with eGFR. After one year of follow-up, 54 patients had incomplete remission. Serum phospholipase A2 receptor antibody (PLA2R-Ab), Urea, high-density lipoprotein cholesterol (HDL-C) and 24 h-UP but not GDF-15 and sST2 were independent predictors of prognosis in IMN patients, but combined factors showed the best prognostic efficacy. CONCLUSION Serum levels of GDF-15 and sST-2 may be potential biomarkers for the severity of IMN, while the combined-factors model is effective for predicting the risk factors of incomplete remission in IMN.
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Tian S, Bi M, Bi Y, Che X, Liu Y. A Bayesian Network Analysis of the Probabilistic Relationships Between Various Obesity Phenotypes and Cardiovascular Disease Risk in Chinese Adults: Chinese Population-Based Observational Study. JMIR Med Inform 2022; 10:e33026. [PMID: 35234651 PMCID: PMC8928047 DOI: 10.2196/33026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risk among individuals with different BMI levels might depend on their metabolic health. The extent to which metabolic health status and BMI affect CVD risk, either directly or through a mediator, in the Chinese population remains unclear. OBJECTIVE In this study, the Bayesian network (BN) perspective is adopted to characterize the multivariable probabilistic connections between CVD risk and metabolic health and obesity status and identify potential factors that influence these relationships among Chinese adults. METHODS The study population comprised 6276 Chinese adults aged 30 to 74 years who participated in the China Health and Nutrition Survey 2009. BMI was used to categorize participants as normal weight, overweight, or obese, and metabolic health was defined by the Adult Treatment Panel-3 criteria. Participants were categorized into 6 phenotypes according to their metabolic health and BMI categorization. The 10-year risk of CVD was determined using the Framingham Risk Score. BN modeling was used to identify the network structure of the variables and compute the conditional probability of CVD risk for the different metabolic obesity phenotypes with the given structure. RESULTS Of 6276 participants, 64.67% (n=4059), 20.37% (n=1279), and 14.95% (n=938) had a low, moderate, and high 10-year CVD risk. An averaged BN with a stable network structure was constructed by learning 300 bootstrapped networks from the data. Using BN reasoning, the conditional probability of high CVD risk increased as age progressed. The conditional probability of high CVD risk was 0.43% (95% CI 0.2%-0.87%) for the 30 to 40 years age group, 2.25% (95% CI 1.75%-2.88%) for the 40 to 50 years age group, 16.13% (95% CI 14.86%-17.5%) for the 50 to 60 years age group, and 52.02% (95% CI 47.62%-56.38%) for those aged ≥70 years. When metabolic health and BMI categories were instantiated to their different statuses, the conditional probability of high CVD risk increased from 7.01% (95% CI 6.27%-7.83%) for participants who were metabolically healthy normal weight to 10.47% (95% CI 7.63%-14.18%) for their metabolically healthy obese (MHO) counterparts and up to 21.74% and 34.48% among participants who were metabolically unhealthy normal weight and metabolically unhealthy obese (MUO), respectively. Sex was a significant modifier of the conditional probability distribution of metabolic obesity phenotypes and high CVD risk, with a conditional probability of high CVD risk of only 2.02% and 22.7% among MHO and MUO women, respectively, compared with 21.92% and 48.21% for their male MHO and MUO counterparts, respectively. CONCLUSIONS BN modeling was applied to investigate the relationship between CVD risk and metabolic health and obesity phenotypes in Chinese adults. The results suggest that both metabolic health and obesity status are important for CVD prevention; closer attention should be paid to BMI and metabolic status changes over time.
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Affiliation(s)
- Simiao Tian
- Department of Research, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Mei Bi
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yanhong Bi
- Department of Research, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xiaoyu Che
- Department of Research, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yazhuo Liu
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Yang SK, Zeng LF, Zhao QY, Zen ZP, Li AM, Zhang LW, Li L, Song N, Liu Y, Zhang H. Comparison of 99mTc-DTPA and serum creatinine, cystatin C in detection of glomerular filtration rate: a retrospective clinical data analysis of 744 Chinese subjects. Nucl Med Commun 2020; 41:219-27. [PMID: 31895760 DOI: 10.1097/MNM.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND To compare the accuracy of various equations for estimating glomerular filtration rate. METHODS Chronic kidney disease was classified by Tc-DTPA scintigraphy (reference glomerular filtration rate), estimating glomerular filtration rate was estimated using various formulas. The similarity to reference glomerular filtration rate decide the accuracy of estimating glomerular filtration rate. RESULTS Overall, the Fengscr-cys equation had significantly higher accuracy and correct proportion in chronic kidney disease stage classification than other equations. The subgroup analysis showed that Fengscr-cys equation was slightly more precise than other equations both in the male and female patients. Moreover, in patients older than 60 years or whose reference glomerular filtration rate was above 60 ml/min, Fengscr-cys equation also showed better accuracy. CONCLUSION Our data suggest that estimating glomerular filtration rate equations evaluated by serum cystatin C were better than serum creatinine-based equations, estimating glomerular filtration rate equations evaluated by both serum creatinine and cystatin C were better than those evaluated by serum creatinine or cystatin C alone. Among all enrolled equations, Fengscr-cys equation might be the best one to evaluate glomerular filtration rate in general Chinese paticipants.
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Flores-Guerrero JL, Minović I, Groothof D, Gruppen EG, Riphagen IJ, Kootstra-Ros J, Muller Kobold A, Hak E, Navis G, Gansevoort RT, de Borst MH, Dullaart RPF, Bakker SJL. Association of Plasma Concentration of Vitamin B12 With All-Cause Mortality in the General Population in the Netherlands. JAMA Netw Open 2020; 3:e1919274. [PMID: 31940038 PMCID: PMC6991261 DOI: 10.1001/jamanetworkopen.2019.19274] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Higher plasma concentrations of vitamin B12 have been associated with mortality in elderly and hospitalized populations, including patients with chronic kidney disease, but the association of plasma concentrations of vitamin B12 with mortality in the general population remains unclear. OBJECTIVE To investigate the association of plasma concentrations of vitamin B12 with all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used post hoc analysis to examine data from participants of the Prevention of Renal and Vascular End-stage Disease Study in Groningen, the Netherlands. Participants included individuals who completed the second screening visit beginning January 1, 2001, excluding those who were missing values of vitamin B12 plasma concentrations or used vitamin B12 supplementation. Follow-up time was defined between the beginning of the second screening round to end of follow-up on January 1, 2011. Data analysis was conducted from October 2, 2018, to February 22, 2019. EXPOSURES Plasma vitamin B12 concentration level. MAIN OUTCOMES AND MEASURES Death as recorded by the Central Bureau of Statistics of Groningen, the Netherlands. RESULTS A total of 5571 participants (mean [SD] age, 53.5 [12.0] years; 2830 [50.8%] men) were included in analyses. Median (interquartile range) plasma concentration of vitamin B12 was 394.42 (310.38-497.42) pg/mL. During the median (interquartile range) of 8.2 (7.7-8.9) years of follow-up, 226 participants (4.1%) died. According to quartiles of the distribution of plasma vitamin B12 concentration levels, mortality rates were 33.8 deaths per 10 000 person-years for the quartile with the lowest plasma concentration of vitamin B12 and 65.7 deaths per 10 000 person-years for the quartile with the highest plasma concentration of vitamin B12. After adjustment for multiple clinical and laboratory variables, Cox regression analyses found a significant association between higher vitamin B12 plasma concentration level and increased risk of all-cause mortality (hazard ratio per 1-SD increase, 1.25 [95% CI, 1.06-1.47]; P = .006). CONCLUSIONS AND RELEVANCE These findings suggest that higher levels of plasma concentrations of vitamin B12 were associated with increased risk of all-cause mortality after adjusting for age, sex, renal function, and other clinical and laboratory variables. The mechanisms underlying this association remain to be established.
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Affiliation(s)
- Jose L. Flores-Guerrero
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Isidor Minović
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Dion Groothof
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Eke G. Gruppen
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Ineke J. Riphagen
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Jenny Kootstra-Ros
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Anneke Muller Kobold
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Ron T. Gansevoort
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Martin H. de Borst
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Robin P. F. Dullaart
- University Medical Center Groningen, Division of Endocrinology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Stephan J. L. Bakker
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
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Affiliation(s)
- Guo Yu
- Institution of Drug Clinical Trial, Subei People's Hospital, #98 West Nantong Rd, Yangzhou, Jiangsu, 225001, China.,College of Pharmacy, Dalian Medical University, Dalian, Liaoning, China
| | - Guo-Fu Li
- Institution of Drug Clinical Trial, Subei People's Hospital, #98 West Nantong Rd, Yangzhou, Jiangsu, 225001, China.
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Flores-Guerrero JL, Groothof D, Connelly MA, Otvos JD, Bakker SJL, Dullaart RPF. Concentration of Branched-Chain Amino Acids Is a Strong Risk Marker for Incident Hypertension. Hypertension 2019; 74:1428-1435. [PMID: 31587574 DOI: 10.1161/hypertensionaha.119.13735] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The potential role of branched-chain amino acids (BCAAs) in the pathogenesis of cardiometabolic diseases is increasingly recognized, but the association of BCAAs with incident hypertension remains unknown. The aim of the present study was to explore the association of BCAAs with incident hypertension in a prospective population-based cohort study. We measured plasma concentrations of BCAAs by means of nuclear magnetic resonance spectroscopy in 4169 participants from the PREVEND (Prevention of Renal and Vascular End-stage Disease) study. We estimated the risk of incident hypertension using multivariable-adjusted Cox regression models. After a median follow-up of 8.6 years, incident hypertension was ascertained in 924 subjects. Cox regression analyses revealed a significant association between BCAAs and incident hypertension. The hazard ratio per one SD of BCAAs was 1.11 (95% CI, 1.02-1.20; P=0.01) after full adjustment for multiple clinical variables. Likewise, the fully adjusted association remained significant when evaluated as categorical variable (hazard ratio for upper quartile with lowest quartile as reference category, 1.36; 95% CI, 1.11-1.68; P=0.003). Furthermore, the net reclassification improvement assessment improved after addition of BCAAs to a traditional risk model (P<0.001). This prospective study revealed that high plasma concentrations of BCAAs are associated with an increased risk of newly developed hypertension. The association remained after adjusting for age, sex, body mass index, and lipid profile.
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Affiliation(s)
- Jose L Flores-Guerrero
- From the Department of Internal Medicine, Division of Nephrology (J.L.F.-G., D.G., S.J.L.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Dion Groothof
- From the Department of Internal Medicine, Division of Nephrology (J.L.F.-G., D.G., S.J.L.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC (M.A.C., J.D.O.)
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC (M.A.C., J.D.O.)
| | - Stephan J L Bakker
- From the Department of Internal Medicine, Division of Nephrology (J.L.F.-G., D.G., S.J.L.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, Division of Endocrinology (R.P.F.D.), University of Groningen, University Medical Center Groningen, the Netherlands
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Xiong J, He T, Wang M, Nie L, Zhang Y, Wang Y, Huang Y, Feng B, Zhang J, Zhao J. Serum magnesium, mortality, and cardiovascular disease in chronic kidney disease and end-stage renal disease patients: a systematic review and meta-analysis. J Nephrol 2019; 32:791-802. [PMID: 30888644 DOI: 10.1007/s40620-019-00601-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies reported that magnesium deficiency was associated with vascular calcifications, atherosclerosis and cardiovascular disease, which might play an independent pathogenic role in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. However, the results of these studies were somewhat underpowered and inconclusive. METHODS Literature was identified by searching PubMed, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL). We included studies that investigated the association between serum magnesium with mortality risk in CKD and ESRD patients. Unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were pooled. RESULTS Twenty studies involving 200,934 participants were included, and the results showed that there was a strong association between hypomagnesemia and the risk of all-cause mortality in patients with CKD and ESRD (HR 1.32; 95% CI 1.19-1.47; p < 0.00001) (hypomagnesemia vs. normal magnesium or hypermagnesemia) after multivariable adjusted. On the contrary, hypermagnesemia was inversely associated with all-cause mortality in patients with CKD and ESRD (HR 0.86; 95% CI 0.79-0.94; p = 0.001) (per unit increase). Moreover, a significant association between hypermagnesemia and decreased risk of cardiovascular mortality was observed (HR 0.71; 95% CI 053-0.97, p = 0.03) in the adjusted model. In addition, subgroup analysis found that hypomagnesemia was strongly associated with increased all-cause mortality in hemodialysis patients (HR 1.29; 95% CI 1.12-1.50; p = 0.0005) (hypomagnesemia vs. normal magnesium or hypermagnesemia). CONCLUSIONS Our results indicate that hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in patients with CKD and ESRD. Further studies evaluating benefits of magnesium correction in CKD and dialysis patients with hypomagnesemia should be performed.
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Affiliation(s)
- Jiachuan Xiong
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Ting He
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Min Wang
- Department of Otorhinolaryngology and Head-Neck Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Ling Nie
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Ying Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Yiqin Wang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Yunjian Huang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Bing Feng
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Jingbo Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Jinghong Zhao
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China.
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Zhao Y, Dong Y, Wang J, Sheng L, Chai Q, Zhang H, Liu Z. Longitudinal association of carotid endothelial shear stress with renal function decline in aging adults with normal renal function: A population-based cohort study. Sci Rep 2019; 9:2051. [PMID: 30765747 PMCID: PMC6376032 DOI: 10.1038/s41598-018-38470-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to investigate the associations between carotid wall shear stress (WSS) and renal function impairment (RFI) and albuminuria in aging adults. A total of 1,447 subjects aged 60 years and older with normal estimated glomerular filtration rate (eGFR ≥ 60 mL·min-1·1.72 m-2) and albumin/creatinine ratio (ACR < 30 mg·g-1) were enrolled between April 2007 and October 2009 in the Shandong area, China. Carotid WSS was assessed at baseline, and eGFR, which is based on serum creatinine and cystatin C, and ACR were assessed at baseline and at the annual follow-up visits. After an average of 62.9 months of follow-up, the reduction in eGFR and the increase in ACR were significantly higher in the Q1+2+3 group than the Q4 group, as classified by either the interquartile of the mean WSS or the interquartile of the peak WSS after adjustment for multi-variabilities, including the average blood pressures at every annual visit and baseline eGFR and ACR. For groups classified by mean WSS, the hazard ratios (95% confidence intervals) were 3.45 (1.36-8.75, p = 0.008) in the incident RFI and 3.24 3.22 (1.37-7.57, p = 0.009) in the incident albuminuria for the Q1+2+3 group compared with the Q4 group. Similar results were observed among groups classified by peak WSS. The Q1+2+3 group was associated with endothelial dysfunction and inflammation with respect to the Q4 group as classified by mean or peak WSS. The results indicate that carotid WSS plays an important role in RFI and albuminuria progression in aging adults. Lower WSS was associated with a higher risk of RFI and albuminuria compared with higher WSS.
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Affiliation(s)
- Yingxin Zhao
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, 250062, China
| | - Yuanli Dong
- Department of Community, Lanshan District People Hospital, Linyi, Shandong, 276002, China
| | - Juan Wang
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, Shandong, 250000, China
| | - Lin Sheng
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, Shandong, 250000, China
| | - Qiang Chai
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, 250062, China
| | - Hua Zhang
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, 250062, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, 250062, China.
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Flores-Guerrero JL, Osté MCJ, Kieneker LM, Gruppen EG, Wolak-Dinsmore J, Otvos JD, Connelly MA, Bakker SJL, Dullaart RPF. Plasma Branched-Chain Amino Acids and Risk of Incident Type 2 Diabetes: Results from the PREVEND Prospective Cohort Study. J Clin Med 2018; 7:jcm7120513. [PMID: 30518023 PMCID: PMC6306832 DOI: 10.3390/jcm7120513] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 01/06/2023] Open
Abstract
Plasma branched-chain amino acids (BCAAs) are linked to metabolic disease, but their relevance for prediction of type 2 diabetes development is unclear. We determined the association of plasma BCAAs with type 2 diabetes risk in the prevention of renal and vascular end-stage disease (PREVEND) cohort. The BCAAs were measured by means of nuclear magnetic resonance spectroscopy. We evaluated the prospective associations of BCAAs with type 2 diabetes in 6244 subjects. The BCAAs were positively associated with HOMA-IR after multivariable adjustment (p < 0.0001). During median follow-up for 7.5 years, 301 cases of type 2 diabetes were ascertained. The Kaplan-Meier plot demonstrated that patients in the highest BCAA quartile presented a higher risk (p log-rank < 0.001). Cox regression analyses revealed a positive association between BCAA and type 2 diabetes; the hazard ratio (HR) for the highest quartile was 6.15 (95% CI: 4.08, 9.24, p < 0.0001). After adjustment for multiple clinical and laboratory variables, the association remained (HR 2.80 (95% CI: 1.72, 4.53), p < 0.0001). C-statistics, Net reclassification improvement, and −2 log likelihood were better after adding BCAAs to the traditional risk model (p = 0.01 to <0.001). In conclusions, high concentrations of BCAAs associate with insulin resistance and with increased risk of type 2 diabetes. This association is independent of multiple risk factors, HOMA-IR and β cell function.
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Affiliation(s)
- Jose L Flores-Guerrero
- Department of Internal Medicine, UMCG, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Maryse C J Osté
- Department of Internal Medicine, UMCG, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Lyanne M Kieneker
- Department of Internal Medicine, UMCG, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Eke G Gruppen
- Department of Endocrinology, UMCG, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | | | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA.
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA.
| | - Stephan J L Bakker
- Department of Internal Medicine, UMCG, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Robin P F Dullaart
- Department of Endocrinology, UMCG, University of Groningen, 9713 GZ Groningen, The Netherlands.
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12
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Guan C, Liang M, Liu R, Qin S, He F, Li J, Zhu X, Dai H, Fu J. Assessment of creatinine and cystatin C-based eGFR equations in Chinese older adults with chronic kidney disease. Int Urol Nephrol 2018; 50:2229-2238. [DOI: 10.1007/s11255-018-1909-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022]
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13
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Guo Y, Wei F, Wang J, Zhao Y, Sun S, Zhang H, Liu Z. Carotid artery wall shear stress is independently correlated with renal function in the elderly. Oncotarget 2018; 9:5251-5262. [PMID: 29435176 PMCID: PMC5797047 DOI: 10.18632/oncotarget.23825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
Hemodynamic has increasingly been regarded as an important factor of renal function. However, the relationship between carotid artery wall shear stress (WSS) and renal function is not clarified. To investigate the relationship between carotid WSS and renal function, we recruited 761 older subjects aged 60 years and over from community-dwelling in the Shandong area, China. Carotid WSS, endothelial function, and estimated glomerular filtration rate (eGFR) were assessed in all subjects. Subjects were grouped by the interquartile of the carotid artery mean WSS. We found that the eGFRs derived from serum creatinine and/or cystatin C using three CKD-EPI equations were significantly higher and albumin/creatinine ratio was lower in the higher interquartile groups than in the lower interquartile groups (P <0.05). The mean WSS was independently correlated with eGFRs even after adjustment for confounders. Similar findings were found between carotid artery peak WSS and eGFRs and albumin/creatinine ratio. In addition, we found that endothelial function was strongly related to carotid WSS and renal function after adjustment for confounders. In conclusion, there is an independent correlation of carotid WSS with renal function in the elderly. The local rheologic forces may play an important role in renal function changing. The correlation may be mediated by regulation of endothelial function.
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Affiliation(s)
- Yuqi Guo
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Fang Wei
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, China
| | - Juan Wang
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Yingxin Zhao
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Shangwen Sun
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Hua Zhang
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
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14
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Guo M, Niu JY, Ye XW, Han XJ, Zha Y, Hong Y, Fang H, Gu Y. Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus. Clin Interv Aging 2017; 12:1661-1672. [PMID: 29070944 PMCID: PMC5640414 DOI: 10.2147/cia.s140289] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The clinical assessment of kidney function based on the estimated glomerular filtration rate (GFR) in older patients remains controversial. This study evaluated the concordance and feasibility of using various creatinine-based equations for estimating GFR in elderly Chinese patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional analytical study was conducted in 21,723 older diabetic patients (≥60 years) based on electronic health records (EHR) for Minhang District, Shanghai, China. The concordance of chronic kidney disease (CKD) classification among different creatinine-based equations was assessed based on Kappa values, intraclass correlation coefficient (ICC) statistics, and the eGFR agreement between the equations was tested using Bland-Altman plots. The GFR was estimated using the Cockcroft-Gault (CG), Berlin Initiative Study 1 (BIS1), simplified Modification of Diet in Renal Disease (MDRD), MDRD modified for Chinese populations (mMDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), CKD-EPI in Asians (CKD-EPI-Asia), and Ruijin equations. RESULTS Overall, the proportion of CKD stages 3-5 (eGFR <60 mL/min/1.73 m2) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFRCG, eGFRBIS1, eGFRMDRD, eGFRmMDRD, eGFRCKD-EPI, eGFRCKD-EPI-Asia, and eGFRRuijin equations, respectively. The concordance of albuminuria and decreased eGFR based on the different equations was poor by both the Kappa (<0.2) and ICC (<0.4) statistics. The CKD-EPI-Asia equation resulted in excellent concordance with the CKD-EPI (ICC =0.931), MDRD (ICC =0.963), mMDRD (ICC =0.892), and Ruijin (ICC =0.956) equations for the classification of CKD stages, whereas the BIS1 equation exhibited good concordance with the CG equation (ICC =0.809). In addition, significant differences were observed for CKD stage 1 among all these equations. CONCLUSION Accurate GFR values are difficult to estimate using creatinine-based equations in older diabetic patients. Kidney function is complex, and the staff need to be aware of the individualized consideration of other risk factors or markers of reduced renal function in clinical practice.
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Affiliation(s)
- Mei Guo
- Zhongshan-Xuhui Hospital, Affiliated with Fudan University
| | - Jian-Ying Niu
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Xian-Wu Ye
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Xiao-Jie Han
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Ying Zha
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Yang Hong
- The Fifth People's Hospital of Shanghai, Fudan University
| | - Hong Fang
- Shanghai Minhang Center for Disease Control and Prevention
| | - Yong Gu
- The Fifth People's Hospital of Shanghai, Fudan University.,Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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15
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Alaini A, Malhotra D, Rondon-Berrios H, Argyropoulos CP, Khitan ZJ, Raj DSC, Rohrscheib M, Shapiro JI, Tzamaloukas AH. Establishing the presence or absence of chronic kidney disease: Uses and limitations of formulas estimating the glomerular filtration rate. World J Methodol 2017; 7:73-92. [PMID: 29026688 PMCID: PMC5618145 DOI: 10.5662/wjm.v7.i3.73] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
The development of formulas estimating glomerular filtration rate (eGFR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease (CKD), which is based on eGFR values and albuminuria. This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based eGFR values and between eGFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all eGFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and, particularly, biomarkers of early renal tissue injury.
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Affiliation(s)
- Ahmed Alaini
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Helbert Rondon-Berrios
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Dominic S C Raj
- Division of Nephrology, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Joseph I Shapiro
- Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Antonios H Tzamaloukas
- Nephrology Section, Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM 87108, United States
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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16
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Qiu X, Liu C, Ye Y, Li H, Chen Y, Fu Y, Liu Z, Huang X, Zhang Y, Liao X, Liu H, Zhao W, Liu X. The diagnostic value of serum creatinine and cystatin c in evaluating glomerular filtration rate in patients with chronic kidney disease: a systematic literature review and meta-analysis. Oncotarget 2017; 8:72985-99. [PMID: 29069842 DOI: 10.18632/oncotarget.20271] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 06/07/2017] [Accepted: 07/30/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Serum biomarkers, such as serum creatinine (SCr) and serum cystatin C (SCysC), have been widely used to evaluate renal function in patients who have chronic kidney disease (CKD). OBJECTIVE This article aims to assess the value of determining SCr and SCysC levels in patients that have long-term kidney disease. Approaches: MEDLINE, EmBase, the Cochrane Library and other databases were searched using both MeSH terms and text words to collect research that assessed the diagnostic value of using SCr and SCysC to evaluate Glomerular Filtration Rate (GFR) in patients with CKD. Data were converted into fourfold tables. Summary Receiver Operating Characteristic Curves and meta-analyses were accomplished via Meta-Disc version 1.4. RESULTS In total, 21 relevant articles involving 3112 study subjects were included in our review. Results showed that the collective sensitivity for SCr and SCysC was 0.77 (95% CI: 0.69-0.84) and 0.87 (95% CI: 0.82-0.91), respectively. The pooled specificity for SCr and SCysC was 0.91 (95% CI: 0.86-0.94) and 0.87 (95% CI: 0.82-0.91), respectively. Subgroup analyses demonstrated that when GFR cut-off values are set to 60 (ml/min/1.73 m2), the pooled sensitivity is 0.94 (95% CI: 0.90-0.96) for SCysC and 0.75 (95% CI: 0.68-0.82) for SCr. CONCLUSIONS The diagnostical accuracy for impaired kidney function favors SCysC. Confidence intervals for the pooled sensitivity and specificity for SCr and SCysC overlap. However, SCysC is more sensitive for estimating GFR than SCr when GFR cut-off values are set to 60 (ml/min/1.73 m2).
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17
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Inoue Y, Howard AG, Thompson AL, Mendez MA, Herring AH, Gordon-Larsen P. The association between urbanization and reduced renal function: findings from the China Health and Nutrition Survey. BMC Nephrol 2017; 18:160. [PMID: 28506221 PMCID: PMC5433002 DOI: 10.1186/s12882-017-0577-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/08/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND While chronic kidney disease (CKD) is a growing public health concern in low- and middle-income countries, such as China, few studies have investigated the association between urbanization and the occurrence of CKD in those countries. METHODS We investigated the association between urbanization and estimated glomerular filtration rate (eGFR), an important CKD risk marker. Data came from the China Health and Nutrition Survey wave 2009, in which we collected fasting serum, individual and household data along with community level urbanization data, which was used to derive a study-specific urbanization measure, in 218 communities across nine provinces. A total of 3644 men and 4154 women participants aged 18 years or older were included in the analysis. Reduced renal function was defined as eGFR of less than 60 mL/min/1.73 m2 measured using serum creatinine concentration (mg/dL). RESULTS After adjusting for socio-demographic (e.g., age, education and household income), a sex-stratified multilevel logistic model revealed that living in a more urbanized community was associated with higher odds of reduced eGFR (odds ratio [OR] = 1.38 per one-standard deviation [SD] increase in the CHNS specific urbanization index, 95% confidence interval [CI] = 1.11-1.73 for men; OR = 1.35, 95% CI = 1.11-1.62 for women). After adjusting for behavioral variables (i.e., alcohol consumption, smoking, physical activity and diet), as well as obesity and cardiometabolic risk factors, the association was attenuated in men (OR = 1.25, 95% CI = 0.98-1.59), but remained statistically significant in women (OR = 1.24, 95% CI = 1.01-1.52). CONCLUSION Our findings suggest that living in an urban environment is linked with higher odds of reduced renal function independently of behavioral and cardiometabolic risk factors, which have been shown to increase along with urbanization.
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Affiliation(s)
- Yosuke Inoue
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
| | - Annie Green Howard
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Amanda L. Thompson
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
- Department of Anthropology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Michelle A. Mendez
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Amy H. Herring
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Penny Gordon-Larsen
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516 USA
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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18
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Barbarash OL, Bykova IS, Kashtalap VV, Zykov MV, Hryachkova ON, Kalaeva VV, Shafranskaya KS, Karetnikova VN, Kutikhin AG. Serum neutrophil gelatinase-associated lipocalin has an advantage over serum cystatin C and glomerular filtration rate in prediction of adverse cardiovascular outcome in patients with ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2017; 17:81. [PMID: 28298190 PMCID: PMC5353887 DOI: 10.1186/s12872-017-0514-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to assess significance of serum neutrophil gelatinase-associated lipocalin (sNGAL) and cystatin C (sCC) in prediction of adverse cardiovascular outcome after ST-segment elevation myocardial infarction (STEMI). Methods We recruited 357 consecutive patients who were admitted to the hospital within 24 h after onset of STEMI. On the 1st and 12th-14th day after hospital admission, we measured levels of sNGAL and sCC. We also determined presence of renal dysfunction (RD), defined as glomerular filtration rate < 60 mL/min/1.73 m2. After 3 years of follow-up, we performed a logistic regression and assessed the value of RD, sNGAL, and sCC in prediction of combined endpoint, defined as cardiovascular death or any cardiovascular complication. Results RD, sCC level ≥ 1.9 mg/L, and sNGAL level ≥ 1.25 ng/mL on the 12th-14th day of hospitalization were associated with a 1.6-fold, 1.9-fold, and 2.9-fold higher risk of adverse cardiovascular outcome, respectively. Area under the ROC curve was the highest for the model based on sNGAL level compared to the models based on sCC level or RD presence. Conclusions Measurement of sNGAL level in patients with STEMI on the 12th-14th day after hospital admission may improve prediction of adverse cardiovascular outcome.
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Affiliation(s)
- Olga L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation.,Kemerovo State Medical University, Voroshilova Street 22a, 650029, Kemerovo, Russian Federation
| | - Irina S Bykova
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation
| | - Vasiliy V Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation.,Kemerovo State Medical University, Voroshilova Street 22a, 650029, Kemerovo, Russian Federation
| | - Mikhail V Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation
| | - Oksana N Hryachkova
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation
| | - Victoria V Kalaeva
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation
| | - Kristina S Shafranskaya
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation
| | - Victoria N Karetnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation.,Kemerovo State Medical University, Voroshilova Street 22a, 650029, Kemerovo, Russian Federation
| | - Anton G Kutikhin
- Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Boulevard 6, 650002, Kemerovo, Russian Federation.
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19
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Pan Y, Jiang S, Qiu D, Shi J, Zhou M, An Y, Ge Y, Xie H, Liu Z. Comparing the GFR estimation equations using both creatinine and cystatin c to predict the long-term renal outcome in type 2 diabetic nephropathy patients. J Diabetes Complications 2016; 30:1478-1487. [PMID: 27593903 DOI: 10.1016/j.jdiacomp.2016.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to determine whether eGFRcre-cys and its slope could improve the prediction of the long-term renal outcome in patients with type 2 diabetic nephropathy (DN). METHODS The cross-sectional and longitudinal analyses included 501 type 2DN patients from 2003 to 2009. GFR was estimated using either eGFRcre-cys or the serum creatinine-based equation (eGFRcre) or the cystatin C-based equation (eGFRcys), and was classified into 3 categories (≥90, 60-90, ≤60ml/min per 1.73m2). The proportion of patients was evaluated in each creatinine-calculated eGFR category for which the category was reclassified based on either cystatin C or the combined measurement. Long-term changes in eGFRcre-cys, eGFRcys and eGFRcre were estimated using linear mixed effect models. The receiver operating characteristic (ROC) curves was applied to study the sensitivity and specificity of different eGFR slopes for predicting the renal endpoint. RESULTS In the cross-sectional analyses, eGFRcre was overestimated compared to eGFRcre-cys [median bias -8.5 (95% CI: -25.01, 1.21)]. The reclassification of eGFRcre to a higher value was associated with an increased risk of ESRD [OR: 4.01 (95% CI: 2.36 to 6.82)]. In the longitudinal analyses for predicting end-stage renal disease (ERSD), the ROC curves for eGFRcre-cys (AUC=0.86±0.03) over 24months were increased compared with the ROC curves for eGFRcre and eGFRcys (p<0.05). CONCLUSIONS The study suggests that the eGFRcre-cys equation may be more precise and sensitive for predicting the renal outcome in T2DN patients. Tracking renal decline using eGFRcre-cys may be used as a surrogate for determining the renal endpoint in a clinical setting.
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Affiliation(s)
- Yu Pan
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Song Jiang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Dandan Qiu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Jingsong Shi
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Minlin Zhou
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Yu An
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Yongchun Ge
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Honglang Xie
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine.
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