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Uzendu A, Kennedy K, Chertow G, Amin AP, Giri JS, Rymer JA, Bangalore S, Lavin K, Anderson C, Spertus JA. Implications of a Race Term in GFR Estimates Used to Predict AKI After Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2309-2320. [PMID: 37758386 DOI: 10.1016/j.jcin.2023.07.031] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The prediction of mortality, bleeding, and acute kidney injury (AKI) after percutaneous coronary intervention (PCI) traditionally relied on race-based estimates of the glomerular filtration rate (GFR). Recently, race agnostic equations were developed to advance equity. OBJECTIVES The authors aimed to compare the accuracy and implications of various GFR equations when used to predict AKI after PCI. METHODS Using the National Cardiovascular Data Registry (NCDR) CathPCI data set, we identified patients undergoing PCI in 2020 and calculated their AKI risk using the 2014 NCDR AKI risk model. We created 4 AKI models per patient for each estimate of baseline renal function: the traditional GFR equation with a race term, 2 GFR equations without a race term, and serum creatinine alone. We then compared each model's performance predicting AKI. RESULTS Among 455,806 PCI encounters, the median age was 67 years, 32.2% were women, and 8.5% were Black. In Black patients, risk models without a race term were better calibrated than models incorporating an equation with a race term (intercept: -0.01 vs 0.15). Race-agnostic models reclassified 6% of Black patients into higher-risk categories, potentially prompting appropriate mitigation efforts. However, even with a race-agnostic model, AKI occurred in Black patients 18% more often than expected, which was not explained by captured patient or procedural characteristics. CONCLUSIONS Incorporating a GFR estimate without a Black race term into the NCDR AKI risk prediction model yielded more accurate prediction of AKI risk for Black patients, which has important implications for reducing disparities and benchmarking.
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Affiliation(s)
- Anezi Uzendu
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA.
| | - Kevin Kennedy
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Glenn Chertow
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Amit P Amin
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay S Giri
- Penn Center for Quality, Outcomes, and Evaluative Research, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer A Rymer
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sripal Bangalore
- Department of Medicine, New York University Langone, New York, New York, USA
| | - Kimberly Lavin
- Department of Science and Quality, American College of Cardiology, Washington, DC, USA
| | - Cornelia Anderson
- Department of Science and Quality, American College of Cardiology, Washington, DC, USA
| | - John A Spertus
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
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Uzendu A, Kennedy K, Chertow G, Amin AP, Giri JS, Rymer JA, Bangalore S, Lavin K, Anderson C, Wang TY, Curtis JP, Spertus JA. Contemporary Methods for Predicting Acute Kidney Injury After Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2294-2305. [PMID: 37758384 PMCID: PMC10795198 DOI: 10.1016/j.jcin.2023.07.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is the most common complication after percutaneous coronary intervention (PCI). Accurately estimating patients' risks not only creates a means of benchmarking performance but can also be used prospectively to inform practice. OBJECTIVES The authors sought to update the 2014 National Cardiovascular Data Registry (NCDR) AKI risk model to provide contemporary estimates of AKI risk after PCI to further improve care. METHODS Using the NCDR CathPCI Registry, we identified all 2020 PCIs, excluding those on dialysis or lacking postprocedural creatinine. The cohort was randomly split into a 70% derivation cohort and a 30% validation cohort, and logistic regression models were built to predict AKI (an absolute increase of 0.3 mg/dL in creatinine or a 50% increase from preprocedure baseline) and AKI requiring dialysis. Bedside risk scores were created to facilitate prospective use in clinical care, along with threshold contrast doses to reduce AKI. We tested model calibration and discrimination in the validation cohort. RESULTS Among 455,806 PCI procedures, the median age was 67 years (IQR: 58.0-75.0 years), 68.8% were men, and 86.8% were White. The incidence of AKI and new dialysis was 7.2% and 0.7%, respectively. Baseline renal function and variables associated with clinical instability were the strongest predictors of AKI. The final AKI model included 13 variables, with a C-statistic of 0.798 and excellent calibration (intercept = -0.03 and slope = 0.97) in the validation cohort. CONCLUSIONS The updated NCDR AKI risk model further refines AKI prediction after PCI, facilitating enhanced clinical care, benchmarking, and quality improvement.
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Affiliation(s)
- Anezi Uzendu
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA.
| | - Kevin Kennedy
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Glenn Chertow
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Amit P Amin
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay S Giri
- Penn Center for Quality, Outcomes, and Evaluative Research, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer A Rymer
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sripal Bangalore
- Department of Medicine, New York University Langone, New York, New York, USA
| | - Kimberly Lavin
- Department of Science and Quality, American College of Cardiology, Washington, DC, USA
| | - Cornelia Anderson
- Department of Science and Quality, American College of Cardiology, Washington, DC, USA
| | - Tracy Y Wang
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John A Spertus
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
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Wang F, Zhou L, Eliaz A, Hu C, Qiang X, Ke L, Chertow G, Eliaz I, Peng Z. The potential roles of galectin-3 in AKI and CKD. Front Physiol 2023; 14:1090724. [PMID: 36909244 PMCID: PMC9995706 DOI: 10.3389/fphys.2023.1090724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Acute kidney injury (AKI) is a common condition with high morbidity and mortality, and is associated with the development and progression of chronic kidney disease (CKD). The beta-galactoside binding protein galectin-3 (Gal3), with its proinflammatory and profibrotic properties, has been implicated in the development of both AKI and CKD. Serum Gal3 levels are elevated in patients with AKI and CKD, and elevated Gal3 is associated with progression of CKD. In addition, Gal3 is associated with the incidence of AKI among critically ill patients, and blocking Gal3 in murine models of sepsis and ischemia-reperfusion injury results in significantly lower AKI incidence and mortality. Here we review the role of Gal3 in the pathophysiology of AKI and CKD, as well as the therapeutic potential of targeting Gal3.
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Affiliation(s)
- Fengyun Wang
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Lixin Zhou
- Department of Critical Care Medicine, The First People's Hospital of Foshan, Foshan, China
| | - Amity Eliaz
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Chang Hu
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Xinhua Qiang
- Department of Critical Care Medicine, The First People's Hospital of Foshan, Foshan, China
| | - Li Ke
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Glenn Chertow
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Isaac Eliaz
- Amitabha Medical Center, Santa Rosa, CA, United States
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China.,Center of Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Azizi M, Mahfoud F, Weber MA, Sharp ASP, Schmieder RE, Lurz P, Lobo MD, Fisher NDL, Daemen J, Bloch MJ, Basile J, Sanghvi K, Saxena M, Gosse P, Jenkins JS, Levy T, Persu A, Kably B, Claude L, Reeve-Stoffer H, McClure C, Kirtane AJ, Mullin C, Thackeray L, Chertow G, Kahan T, Dauerman H, Ullery S, Abbott JD, Loening A, Zagoria R, Costello J, Krathan C, Lewis L, McElvarr A, Reilly J, Cash M, Williams S, Jarvis M, Fong P, Laffer C, Gainer J, Robbins M, Crook S, Maddel S, Hsi D, Martin S, Portnay E, Ducey M, Rose S, DelMastro E, Bangalore S, Williams S, Cabos S, Rodriguez Alvarez C, Todoran T, Powers E, Hodskins E, Paladugu V, Tecklenburg A, Devireddy C, Lea J, Wells B, Fiebach A, Merlin C, Rader F, Dohad S, Kim HM, Rashid M, Abraham J, Owan T, Abraham A, Lavasani I, Neilson H, Calhoun D, McElderry T, Maddox W, Oparil S, Kinder S, Radhakrishnan J, Batres C, Edwards S, Garasic J, Drachman D, Zusman R, Rosenfield K, Do D, Khuddus M, Zentko S, O'Meara J, Barb I, Foster A, Boyette A, Wang Y, Jay D, Skeik N, Schwartz R, Peterson R, Goldman JA, Goldman J, Ledley G, Katof N, Potluri S, Biedermann S, Ward J, White M, Mauri L, Sobieszczky P, Smith A, Aseltine L, Stouffer R, Hinderliter A, Pauley E, Wade T, Zidar D, Shishehbor M, Effron B, Costa M, Semenec T, Roongsritong C, Nelson P, Neumann B, Cohen D, Giri J, Neubauer R, Vo T, Chugh AR, Huang PH, Jose P, Flack J, Fishman R, Jones M, Adams T, Bajzer C, Mathur A, Jain A, Balawon A, Zongo O, Bent C, Beckett D, Lakeman N, Kennard S, D’Souza RJ, Statton S, Wilkes L, Anning C, Sayer J, Iyer SG, Robinson N, Sevillano A, Ocampo M, Gerber R, Faris M, Marshall AJ, Sinclair J, Pepper H, Davies J, Chapman N, Burak P, Carvelli P, Jadhav S, Quinn J, Rump LC, Stegbauer J, Schimmöller L, Potthoff S, Schmid C, Roeder S, Weil J, Hafer L, Agdirlioglu T, Köllner T, Böhm M, Ewen S, Kulenthiran S, Wachter A, Koch C, Fengler K, Rommel KP, Trautmann K, Petzold M, Ott C, Schmid A, Uder M, Heinritz U, Fröhlich-Endres K, Genth-Zotz S, Kämpfner D, Grawe A, Höhne J, Kaesberger B, von zur Mühlen C, Wolf D, Welzel M, Heinrichs G, Trabitzsch B, Cremer A, Trillaud H, Papadopoulos P, Maire F, Gaudissard J, Sapoval M, Livrozet M, Lorthioir A, Amar L, Paquet V, Pathak A, Honton B, Cottin M, Petit F, Lantelme P, Berge C, Courand PY, Langevin F, Delsart P, Longere B, Ledieu G, Pontana F, Sommeville C, Bertrand F, Feyz L, Zeijen V, Ruiter A, Huysken E, Blankestijn P, Voskuil M, Rittersma Z, Dolmans H, Kroon A, van Zwam W, Vranken J, de Haan. C, Renkin J, Maes F, Beauloye C, Lengelé JP, Huyberechts D, Bouvie A, Witkowski A, Januszewicz A, Kądziela J, Prejbisj A, Hering D, Ciecwierz D, Jaguszewski MJ, Owczuk R. Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial. JAMA Cardiol 2022; 7:1244-1252. [PMID: 36350593 PMCID: PMC9647563 DOI: 10.1001/jamacardio.2022.3904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Importance Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. Objectives To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. Design, Setting, and Participants This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m2 or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. Interventions uRDN vs sham procedure in conjunction with added medications to target BP control. Main Outcomes and Measures Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. Results A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m2 had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of -2.4 [16.6] vs -7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. Conclusions and Relevance In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. Trial Registration ClinicalTrials.gov Identifier: NCT02649426.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, F-75006 Paris, France,Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France,INSERM, CIC1418, F-75015 Paris, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Kably
- Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Pharmacology, Paris, France
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Danny Do
- for the RADIANCE-HTN Investigators
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jay Giri
- for the RADIANCE-HTN Investigators
| | | | - Thu Vo
- for the RADIANCE-HTN Investigators
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Moura F, Wiviott S, Chertow G, Dwyer J, Gause-Nilsson I, Johansson P, Langkilde A, McMurray J, Mosenzon O, Raz I, Rossing P, Wheeler D, Sabatine M, Heerspink H. Effects of dapagliflozin on cardiovascular and kidney events by baseline eGFR and UACR in patients with type 2 diabetes mellitus: a patient-level pooled analysis of DECLARE-TIMI 58 and DAPA-CKD trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The sodium glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin reduced the risk of hospitalization for heart failure (HHF) or cardiovascular death (CVD) and the risk of kidney events in patients type 2 diabetes mellitus (T2DM) and high cardiovascular risk or chronic kidney disease in the DECLARE-TIMI 58 and DAPA-CKD trials. These events are more common at lower levels of kidney function. Combining data from the two trials creates an opportunity to examine the effect of dapagliflozin across the spectrum of baseline kidney function.
Purpose
To determine the effects of dapagliflozin on HHF/CVD and kidney endpoints across a broad range of kidney function in the combined dataset.
Methods
We conducted a post hoc analysis of pooled patient-level data from DECLARE and DAPA-CKD. The effects of dapagliflozin compared with placebo on HHF/CVD and kidney endpoints (defined as sustained eGFR decrease ≥40%, end-stage kidney disease, or renal death) were assessed in the combined cohorts and in subgroups of baseline eGFR (<45, 45-<60, 60-<90, ≥90 mL/min/1.73 m2) and urinary albumin:creatinine ratio (UACR) (<30, 30-<300, 300-<1000, ≥1000 mg/g).
Results
A total of 19,748 patients with T2DM were included. Median (IQR) follow up time was 4.1 (3.7–4.4) years. Median eGFR was 85 (65–95) mL/min/1.73 m2 and UACR 18.2 (7–135) mg/g. Overall, dapagliflozin reduced the risk of HHF/CVD by 18% (HR 0.82, 95% CI 0.73–0.92, p<0.001) and kidney endpoints by 40% (HR 0.60, 95% CI 0.52–0.69, p<0.001). Overall rates of HHF/CVD and kidney endpoints were higher with lower eGFR (p<0.001) and with higher UACR (p<0.001). There were consistent relative risk reductions in HHF/CVD and kidney events with dapagliflozin across eGFR (p-interaction 0.25 and 0.32, respectively, Figure 1) and UACR (p-interaction 0.29 and 0.83, respectively, Figure 2) subgroups. The absolute rate difference (ARD) with dapagliflozin for CVD/HHF ranged from 0.1 events per 1000 patient years in patients in normal categories of eGFR and UACR to 1.0–1.7 events in patients in the most abnormal categories. Likewise, the ARD for kidney events ranged from 0.2 events per 1000 patient years in the normal eGFR and UACR groups to 2.5–4.3 events in patients in the most abnormal categories.
Conclusion
In this pooled analysis of pts with T2DM, there was higher risk of HHF/CVD and kidney events with lower eGFR and higher UACR. Dapagliflozin consistently reduced these events regardless of baseline eGFR and UACR, with large absolute risk reductions in patients with lower eGFR and higher UACR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Moura
- Brigham and Women'S Hospital, Harvard Medical School, TIMI Study Group, Division of Cardiovascular Medicine , Boston , United States of America
| | - S Wiviott
- Brigham and Women'S Hospital, Harvard Medical School, TIMI Study Group, Division of Cardiovascular Medicine , Boston , United States of America
| | - G Chertow
- School of Medicine, Department of Epidemiology and Population Health and Department of Medicine , Stanford , United States of America
| | - J Dwyer
- University of Utah Health Care , Salt Lake City , United States of America
| | | | | | | | - J McMurray
- University of Glasgow, Institute of Cardiovascular and Medical Sciences , Glasgow , United Kingdom
| | - O Mosenzon
- University of Glasgow, Institute of Cardiovascular and Medical Sciences , Glasgow , United Kingdom
| | - I Raz
- The Hebrew University of Jerusalem, Diabetes Unit, Hadassah Medical Center , Jerusalem , Israel
| | - P Rossing
- University of Copenhagen, Department of Clinical Medicine , Copenhagen , Denmark
| | - D Wheeler
- University College London, Department of Renal Medicine , London , United Kingdom
| | - M Sabatine
- Brigham and Women'S Hospital, Harvard Medical School, TIMI Study Group, Division of Cardiovascular Medicine , Boston , United States of America
| | - H Heerspink
- University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Lambers Heerspink H, Jong N, Stefansson B, Chertow G, Maria Langkilde A, Mcmurray J, Correa-Rotter R, Rossing P, Toto R, Wheeler D. FC082: Effects of Dapagliflozin in Patients with Chronic Kidney Disease According to Background Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Dose. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac115.002] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Treatment guidelines for patients with chronic kidney disease (CKD) recommend renin–angiotensin system inhibition (RASi) with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) to reduce the risk of kidney failure. However, patients with more advanced CKD do not always tolerate RASi. The sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of kidney failure in patients with CKD in the DAPA-CKD trial. We performed a post hoc analysis of this trial to assess the efficacy of dapagliflozin by baseline dose level of ACEi or ARB.
METHOD
Participants with CKD [estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73 m2; urinary albumin-to-creatinine ratio (UACR) 200–5000 mg/g), with or without type 2 diabetes, were randomized 1:1 to dapagliflozin 10 mg or placebo, once daily. Participants were to be treated with the recommended target dose, or a stable tolerated dose of ACEi or ARB, unless medically contraindicated, for ≥4 weeks prior to inclusion. The primary outcome was a composite of sustained ≥50% eGFR decline, end-stage kidney disease or death from a kidney or cardiovascular cause. A prespecified kidney-specific secondary outcome was the same as the primary endpoint, but without cardiovascular death. A composite cardiovascular outcome (heart failure hospitalization or cardiovascular death), and all-cause mortality were other secondary endpoints. Time-to-event analyses were performed to assess the effects of dapagliflozin versus placebo according to baseline prescription and dose of ACEi or ARB treatment.
RESULTS
Of 4296 (99.9%) participants with available data on ACEi/ARB doses, 1231 (28.7%) were using the target dose, 1867 (43.5%) a dose ≥50% to <100% of target, 1068 (24.9%) a dose 0 to <50% of target and 130 (3.0%) were not using an ACEi/ARB. In the placebo group, the event rate for the primary outcome was highest among participants not using ACEi/ARBs compared to the other subgroups (figure 1). The benefit of dapagliflozin on the primary composite outcome was consistent regardless of use or non-use of the target dose of ACEi/ARBs. This consistency was maintained for the secondary outcomes (Figure 1). Dapagliflozin compared to placebo reduced the rate of eGFR decline over the study by –0.93 [95% confidence interval (95% CI) 0.61–1.25] mL/min/1.73 m2. This effect was present regardless of the use or non-use of target doses of ACEi/ARBs (P for interaction 0.877).
CONCLUSION
Dapagliflozin was similarly efficacious in reducing major adverse kidney and cardiovascular outcomes in participants with CKD regardless of the use or dose of ACEi/ARB.
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Affiliation(s)
- Hiddo Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Sydney, Australia
| | - Niels Jong
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bergur Stefansson
- AstraZeneca, Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Glenn Chertow
- Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna Maria Langkilde
- AstraZeneca, Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - John Mcmurray
- Institute of Cardiovascular and Medical, University of Glasgow, Glasgow, UK
| | - Ricardo Correa-Rotter
- The National Medical Science and Nutrition Institute Salvador Zubiran, Meixco City, Mexico
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Toto
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - David Wheeler
- Department of Renal Medicine, University College London, London, UK
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7
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Parfrey P, Chertow G, Eckardt KU, Burke S, Luo W, Minga T, Winkelmayer W. MO532: Cardiovascular Events in Patients With Non–Dialysis-Dependent Chronic Kidney Disease and Anemia: Regional Analysis of Patients Previously Treated With Erythropoiesis-Stimulating Agents in the PRO2TECT Trial. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac072.014] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor being investigated for the treatment of anemia due to chronic kidney disease (CKD). In global phase 3 trials, vadadustat has demonstrated non-inferiority to darbepoetin alfa for time to major adverse cardiovascular event (MACE) in patients with dialysis-dependent CKD (INNO2VATE trials), but not with non–dialysis-dependent CKD (NDD-CKD; PRO2TECT trials) [1, 2]. In a prespecified subgroup analysis of the PRO2TECT trials, a difference in the relative safety between vadadustat and darbepoetin alfa was observed between the US and non-US regions [1]. We investigated regional differences in MACE in patients with NDD-CKD-administered vadadustat and darbepoetin alfa who were previously treated with erythropoietin-stimulating agents (ESAs) in the PRO2TECT trials.
METHOD
Two phase 3, open-label, randomized, active-controlled clinical trials comparing vadadustat with darbepoetin alfa were conducted in North America, Latin America, Europe, Africa, and the Asia-Pacific region. This post hoc analysis evaluated MACE in patients in the PRO2TECT trial who were actively maintained on ESAs at study entry with ≥1 dose received within 6 weeks before or during screening (Conversion trial; NCT02680574) and who received ≥1 dose of trial drug, stratified by region (USA versus Europe versus non-US/non-Europe). MACE was defined as a composite of death from any cause, nonfatal myocardial infarction or nonfatal stroke. Expanded MACE was defined as MACE plus hospitalization for heart failure or thromboembolic event, excluding vascular access failure.
RESULTS
A total of 1723 ESA-treated patients were randomized in the conversion trial of the PRO2TECT program and received ≥1 dose of study drug, including 665 patients in the USA, 444 in Europe, and 614 outside the USA and Europe. Europe had a lower proportion of patients with diabetes and more patients who had received intravenous (IV) iron, while patients in the non-US/non-European region were younger and had a lower prevalence of cardiovascular (CV) disease. A higher proportion of patients in Europe were using darbepoetin alfa at baseline than in other regions (59%–63% versus 14%–28%), though ESA dose was lower (57–61 versus 93–149 IV epoetin equivalent U/kg/week). The hazard ratio for MACE in the overall population for vadadustat versus darbepoetin alfa was 1.16 (95% CI 0.93–1.45). Across regions, event rates were similar in the vadadustat groups, but event rates in the darbepoetin alfa group were lower in Europe compared with the US and non-US/non-Europe (Table 1), which was driven by fewer total deaths (non-CV and CV) reported in Europe in the darbepoetin alfa arm (n = 24/220) compared with the vadadustat arm (n = 38/224) (Table 2). Additional post hoc analyses of MACE accounting for several baseline characteristics, including ESA dose, did not alter the outcomes of the study.
CONCLUSION
Regional differences in time to first MACE were observed in patients with NDD-CKD who were treated with ESA and randomized to receive vadadustat or darbepoetin alfa as part of the PRO2TECT program. It remains unclear if the lower risk of MACE observed in Europe with the darbepoetin alfa group was related to differences in unobserved baseline characteristics, regional treatment practices, methodological reasons or chance.
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Affiliation(s)
| | - Glenn Chertow
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Wenli Luo
- Akebia Therapeutics, Inc., Cambridge, MA, USA
| | - Todd Minga
- Akebia Therapeutics, Inc., Cambridge, MA, USA
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8
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Winkelmayer W, Arnold S, Burke S, Chertow G, Eckardt KU, Luo W, Minga T, Parfrey P. MO536: Cardiovascular Events in Patients With Anemia Associated With Non–Dialysis-Dependent Chronic Kidney Disease: Regional Analysis of Patients not Previously Treated With Erythropoiesis-Stimulating Agents in The PRO2TECT Trial. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac072.018] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor being investigated for treatment of anemia due to chronic kidney disease (CKD). In global phase 3 trials, vadadustat has demonstrated non-inferiority to darbepoetin alfa for time to major adverse cardiovascular event (MACE) in patients with dialysis-dependent CKD (INNO2VATE trials), but not with non–dialysis-dependent CKD (NDD-CKD; PRO2TECT trials) [1,2]. In a prespecified subgroup analysis of the PRO2TECT trials, no difference in cardiovascular safety was observed in the USA, but a higher risk of MACE was found for patients treated with vadadustat outside the USA.1 We investigated regional differences in MACE in patients previously untreated with erythropoietin-stimulating agents (ESAs) in the PRO2TECT trial.
METHOD
Two phase 3, open-label, randomized, active-controlled clinical trials comparing vadadustat with darbepoetin alfa were conducted in North America, Latin America, Europe, Africa, and the Asia-Pacific region. This post hoc analysis evaluated MACE in patients in the PRO2TECT trial not treated with ESAs within 8 weeks of enrollment (correction trial; NCT02648347) and who received ≥1 dose of trial drug, stratified by region (USA versus Europe versus non-USA/non-Europe). MACE was defined as a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. Expanded MACE was defined as MACE plus hospitalization for heart failure or thromboembolic event, excluding vascular access failure.
RESULTS
A total of 1748 ESA-untreated patients receiving ≥1 dose of study drug were enrolled in the PRO2TECT trial, including 1058 patients in the USA, 139 in Europe and 551 outside the USA and Europe. Patients in the non-USA/non-European countries were younger and had a lower mean eGFR than patients in the USA or Europe. Furthermore, 34.7% of patients randomized to vadadustat had a baseline eGFR <10 mL/min/1.73 m2 versus 24.0% of patients randomized to darbepoetin alfa in the non-USA/non-European countries. The hazard ratio for MACE in the overall population for vadadustat versus darbepoetin alfa was 1.16 [95% confidence interval (CI) 0.96–1.41]. When analyzed by region, higher event rate for MACE was observed in the vadadustat arm in the non-USA/non-European countries compared with the USA and Europe (Table 1). The higher event rates for MACE in the non-USA/non-European countries were driven by 21 excess MACEs reported in the vadadustat group. Many deaths in the non-USA/non-European countries were related to kidney failure (n = 25/43 in the vadadustat group; n = 20/30 in the darbepoetin alfa group; Table 2), and were concentrated in Brazil and South Africa, countries that enrolled a higher proportion of patients with end-stage kidney failure who may not have had access to dialysis. The adverse event profiles for vadadustat and darbepoetin alfa were similar across regions.
CONCLUSION
Regional differences in time to first MACE were observed in patients with NDD-CKD who were not previously treated with ESAs and randomized to receive vadadustat or darbepoetin alfa as part of the PRO2TECT trial. The higher event rate in the vadadustat group in non-USA/non-European countries may have been related to randomization imbalances and/or design and methodological issues. These findings should help inform care providers as they assess the overall safety of vadadustat for the treatment of anemia associated with NDD-CKD.
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Affiliation(s)
| | - Susan Arnold
- Excellentis Clinical Trial Consultants, Medicine, George, South Africa
| | - Steven Burke
- Research and Development, Akebia Therapeutics, Inc., Cambridge, MA, USA
| | - Glenn Chertow
- Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kai-Uwe Eckardt
- Nephrology, Charité–Universitätsmedizi Berlin, Berlin, Germany
| | | | - Todd Minga
- Nephrology, Akebia Therapeutics, Inc., Cambridge, MA, USA
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9
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Garcia P, Han J, Montez-Rath M, Sun S, Shang T, Parsonnet J, Chertow G, Anand S, Schiller B, Abra G. SARS-CoV-2 Booster Vaccine Response among Patients Receiving Dialysis. Clin J Am Soc Nephrol 2022; 17:1036-1038. [PMID: 35383042 PMCID: PMC9269633 DOI: 10.2215/cjn.00890122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Pablo Garcia
- P Garcia, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Jialin Han
- J Han, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Maria Montez-Rath
- M Montez-Rath, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Sumi Sun
- S Sun, Satellite Healthcare, San Jose, United States
| | - Tiffany Shang
- T Shang, Satellite Healthcare, San Jose, United States
| | - Julie Parsonnet
- J Parsonnet, Departments of Medicine (Infectious Diseases and Geographic Medicine), and Epidemiology and Population Health, Stanford University, Stanford, United States
| | - Glenn Chertow
- G Chertow, Departments of Medicine (Nephrology), and Epidemiology and Population Health, Stanford Medicine, Stanford, United States
| | - Shuchi Anand
- S Anand, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Brigitte Schiller
- B Schiller, Department of Medicine (Nephrology), Stanford Medicine, Stanford, United States
| | - Graham Abra
- G Abra, Department of Medicine (Nephrology), Stanford University, Stanford, United States
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Abstract
BACKGROUND The goal is to provide a national analysis of organ procurement organization (OPO) costs. METHODS Five years of data, for 51 of the 58 OPOs (2013-2017, a near census) were obtained under a FOIA. OPOs are not-for-profit federal contractors with a geographic monopoly. A generalized 15-factor cost regression model was estimated with adjustments to precision of estimates (P) for repeated observations. Selected measures were validated by comparison to IRS forms. RESULTS Decease donor organ procurement is a $1B/y operation with over 26 000 transplants/y. Over 60% of the cost of an organ is overhead. Profits are $2.3M/OPO/y. Total assets are $45M/OPO and growing at 9%/y. "Tissue" (skin, bones) generates $2-3M profit/OPO/y. A comparison of the highest with the lower costing OPOs showed our model explained 75% of the cost difference. Comparing costs across OPOs showed that highest-cost OPOs are smaller, import 44% more kidneys, face 6% higher labor costs, report 98% higher compensation for support personnel, spend 46% more on professional education, have 44% fewer assets, compensate their Executive Director 36% less, and have a lower procurement performance (SDRR) score. CONCLUSIONS Profits and assets suggest that OPOs are fiscally secure and OPO finances are not a source of the organ shortage. Asset accumulation ($45M/OPO) of incumbents suggests establishing a competitive market with new entrants is unlikely. Kidney-cost allocations support tissue procurements. Professional education spending does not reduce procurement costs. OPO importing of organs from other OPOs is a complex issue possibly increasing cost ($6K/kidney).
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Affiliation(s)
- Philip J Held
- Division of Nephrology, Stanford University of Medicine, Palo Alto, CA
| | | | - Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, FL
| | | | - Glenn Chertow
- Division of Nephrology, Stanford University of Medicine, Palo Alto, CA
| | | | - John P Roberts
- Abdominal Transplantation, Department of Surgery, University of California, San Francisco, San Francisco, CA
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11
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Jong N, Chertow G, Hou FF, McMurray J, Correa-Rotter R, Rossing P, Sjöström D, Stefansson B, Toto R, Langkilde AM, Wheeler DC, Lambers Heerspink H. FC 063DAPAGLIFLOZIN DECREASES ALBUMINURIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE WITH AND WITHOUT TYPE 2 DIABETES: INSIGHTS FROM THE DAPA-CKD TRIAL. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab136.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Reductions in albuminuria are consistently associated with a subsequent lower risk of kidney failure. The sodium glucose co-transporter 2 inhibitor dapagliflozin significantly reduced albuminuria in patients with type 2 diabetes. Whether this effect persist in patients with chronic kidney disease (CKD) with and without diabetes is unknown. We therefore assessed and compared the effects of dapagliflozin on albuminuria in patients with CKD with and without type 2 diabetes from the DAPA-CKD trial.
Method
We randomized 4304 patients with CKD and an eGFR of 25-75 ml/min/1.73m2 and urinary albumin-to-creatinine ratio (UACR) 200-5000 mg/g to dapagliflozin (10 mg once daily) or placebo. Change in albuminuria was a pre-specified exploratory outcome. We used regression in UACR stage, defined as a transition from macroalbuminuria (≥300 mg/g) to micro- or normoalbuminuria (<300 mg/g), and progression in UACR stage, defined as a transition from non-nephrotic (<3000 mg/g) to nephrotic range albuminuria (≥3000 mg/g), as additional endpoints. Subgroup analyses were performed according to baseline type 2 diabetes status.
Results
Median (25th to 75th Percentile) UACR was 949 (477-1885) mg/g. In patients with and without type 2 diabetes baseline median UACR was 1017 mg/g and 861 mg/g, respectively. Dapagliflozin, compared to placebo, reduced UACR by 29.3% (95% confidence interval [CI] 25.2, 33.1; p<0.001), with a 35.1% (95%CI 30.6, 39.4) reduction in patients with type 2 diabetes and 14.8% (95%CI 5.9, 22.9) reduction in patients without type 2 diabetes (p for interaction <0.001). Among 3860 patients with UACR ≥300 mg/g at baseline, dapagliflozin significantly increased the likelihood of regression in UACR stage (hazard ratio [HR] 1.81; 95%CI 1.60, 2.05). The corresponding HRs for patients with and without type 2 diabetes were 2.06 (95%CI 1.78, 2.39) and 1.33 (95%CI 1.07, 1.66), respectively (p for interaction 0.001). Among 3820 patients with UACR <3000 mg/g at baseline, dapagliflozin significantly decreased the risk of nephrotic range albuminuria (HR 0.41; 95%CI 0.32, 0.52). The corresponding HRs for patients with and without type 2 diabetes were 0.39 (95%CI 0.29, 0.51) and 0.50 (95%CI 0.30, 0.82), respectively (p for interaction 0.401).
Conclusion
In patients with CKD with and without type 2 diabetes dapagliflozin significantly reduced albuminuria, with a larger reduction in patients with type 2 diabetes. The similar effects of dapagliflozin on clinical outcomes in patients with or without type 2 diabetes, but different effects on UACR suggest that part of dapagliflozin’s protective effect in patients without diabetes is mediated through pathways unrelated to UACR reduction.
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Affiliation(s)
- Niels Jong
- University Medical Center Groningen, Groningen, The Netherlands
| | - Glenn Chertow
- Stanford University, Stanford, United States of America
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China
| | | | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Peter Rossing
- Steno Diabetes Center, Copenhagen, Gentofte, Denmark
- Copenhagen University, København, Denmark
| | - David Sjöström
- Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Bergur Stefansson
- Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Robert Toto
- UT Southwestern Medical Center, Dallas, United States of America
| | - Anna Maria Langkilde
- Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - David C Wheeler
- University College London, United Kingdom
- The George Institute for Global Health, Newtown, Australia
| | - Hiddo Lambers Heerspink
- University Medical Center Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Newtown, Australia
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12
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Abdul Sultan A, Batista MC, Cabrera C, Card-Gowers J, Chadban S, Chertow G, Garcia Sanchez JJ, Kanda E, Li G, Nolan S, Retat L, Tangri N, Webber L, Wish J, Xu M. MO518 INSIDE CKD: MODELLING THE ECONOMIC BURDEN OF CHRONIC KIDNEY DISEASE IN THE AMERICAS AND THE ASIA-PACIFIC REGION USING PATIENT-LEVEL MICROSIMULATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab087.0038] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Chronic kidney disease (CKD) is a debilitating and costly condition, with an estimated global prevalence of approximately 10%. Progression of CKD is associated with end-stage renal disease, cardiovascular events and premature mortality, as well as increased requirement for renal replacement therapies (RRTs), which are associated with significant healthcare costs and resource use. Furthermore, patients with CKD often have additional comorbidities, which are associated with CKD progression and increased costs. The trajectories of CKD prevalence, progression, outcomes and the related costs are therefore critical considerations for public health and policy planning. Using country-specific, patient-level microsimulation, Inside CKD aims to model the global clinical and economic burden of CKD from 2020 to 2025.
Method
We used the Inside CKD microsimulation to model the economic burden of CKD in the Americas and Asia-Pacific region. We developed a virtual general population for each country using national survey data and relevant data from published literature. Data inputs included country demographics, the prevalence of CKD and RRT, comorbidities and complication rates as well as associated healthcare costs. CKD stages were defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 recommendations and patients were categorized according to estimated glomerular filtration rate and albuminuria status. We calibrated the RRT modelling against historical trends from country-specific renal registries. We conducted model validation and calibration using established methods for health economic modelling. Here, we report the results from the US and Canada analyses, with further analyses currently underway for additional countries in the Americas and Asia-Pacific region.
Results
Initial results for the US and Canada revealed that, between 2020 and 2025, annual healthcare costs associated with CKD will increase linearly from US$232.3B to US$376.2B in the US and from C$21.4B to C$34.1B in Canada (this figure does not include complication costs). In the US, the largest absolute increase in cost was observed in CKD stage 3a ($98.4B); however, CKD stage 4 had the largest relative increase in cost with an approximately three-fold increase (US$7.30B to US$23.3B). In Canada, the largest absolute increase in cost was observed in CKD stage 3a (C$5.84B); whereas CKD stage 5 had the largest relative increase in cost with an approximately five-fold increase (C$0.27B to C$1.41B). By 2025, costs associated with CKD will increase across all age categories (18–34, 35–64 and 65+ years) in both countries. In the US, the 35–64 age group had the largest absolute increase in costs with an increase of $74B (US$58.3B to US$132B). The largest relative increase in cost was observed in the 18–34 age category, with approximately a three-fold increase in costs (US$3.76B to US$10.2B). In Canada, the 65+ age group had the largest absolute increase in costs with an increase of C$7.9B (C$16.4B to C$24.3B). Both the 18–34 and 35–64 age categories had the largest relative increase in costs, with an approximately two-fold increase (C$0.25B to C$0.49B and C$4.77B to C$9.31B, respectively).
Conclusion
Initial results from Inside CKD demonstrate that CKD poses a significant economic burden over the next 5 years. CKD stage 3a was associated with the most pronounced cost increases in both the US and Canada, likely due to the increased prevalence of this stage. In the US, the largest increase in CKD costs was observed in the 35–64-year-old ‘working’ population, whereas the largest increase in Canada was observed in the 65 years old and over population. Further policy interventions aimed at early diagnosis and proactive management should be considered to slow disease progression, improve patient outcomes and reduce the economic burden associated with CKD.
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Affiliation(s)
| | - Marcelo Costa Batista
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Universidade Federal de São Paulo, Nephrology Division, São Paulo, Brazil
| | | | | | | | - Glenn Chertow
- Stanford University School of Medicine, Palo Alto, United States of America
| | | | | | - Guisen Li
- Sichuan Academy of Medical Science, Sichuan Provincial People’s Hospital, Chengdu, P.R. China
| | - Stephen Nolan
- AstraZeneca, BioPharmaceuticals Medical, Cambridge, United Kingdom
| | | | | | | | - Jay Wish
- Indiana University School of Medicine, Indianapolis, United States of America
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13
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Garcia Sanchez JJ, Abdul Sultan A, Batista MC, Cabrera C, Card-Gowers J, Chadban S, Chertow G, Kanda E, Li G, Nolan S, Retat L, Tangri N, Webber L, Wish J, Xu M. MO486 INSIDE CKD: MODELLING THE IMPACT OF IMPROVED SCREENING FOR CHRONIC KIDNEY DISEASE IN THE AMERICAS AND ASIA-PACIFIC REGION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab087.006] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
With an estimated global prevalence of 10%, chronic kidney disease (CKD) and its associated complications place a substantial strain on healthcare systems worldwide, which is compounded by the burden of undiagnosed CKD. Early CKD diagnosis followed by guideline-recommended interventions can improve patient outcomes and reduce associated healthcare-related costs, particularly by delaying or preventing the development of complications and progression to kidney failure. Urinary albumin-to-creatinine ratio (UACR) can be used to screen for CKD, but adherence to screening recommendations is suboptimal in routine care. Inside CKD aims to model the global clinical and economic burden of CKD using country-specific, patient-level microsimulation models. We used the Inside CKD microsimulation to model the potential clinical and economic impacts of routine measurement of UACR followed by appropriate intervention in patients aged 45 years and over in the US and Canada.
Method
The Inside CKD microsimulation model was used to model the clinical and economic impacts associated with measurement of UACR with subsequent appropriate intervention during routine primary care visits versus current practice in individuals aged 45 years and over. The model covers the period 2020–2025. In preliminary analyses, virtual populations representing the general populations of the US and Canada were constructed using published country-specific data, including demographics, prevalence of CKD and comorbidities (type 2 diabetes, uncontrolled hypertension and heart failure), incidence of complications (heart failure, myocardial infarction, stroke and acute kidney injury) and costs associated with CKD. The model also included parameters relating to the proportion of patients who visit a primary care physician at least once a year, the proportion of patients who agreed to UACR measurements, and the diagnostic sensitivity and specificity of UACR measurements. The modelling is being expanded to additional countries in the Americas and the Asia-Pacific region.
Results
Preliminary results from the US and Canada show that over the 2020–2025 period routine measurement of UACR during primary care visits followed by appropriate intervention could prevent progression to CKD stages 3b–5 in approximately 1.3M patients in the US and 160 000 in Canada, compared with current clinical practice, with linear increases in the cumulative numbers of prevented cases (Figure). Associated savings in healthcare costs in 2025 are projected to be approximately US$16B in the US and C$2.5B in Canada, corresponding to a reduction in cost for that year of 4.4% and 7.4%, respectively, compared with current clinical practice.
Conclusion
Preliminary results from the Inside CKD microsimulation model in the US and Canada show that routine measurement of UACR with subsequent intervention in primary care would prevent progression to CKD stages 3b–5 in a substantial number of patients compared with current screening practices, and could therefore decrease associated healthcare costs considerably. This analysis is being extended to further countries in the Americas and the Asia-Pacific region.
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Affiliation(s)
| | | | | | | | | | - Steven Chadban
- Royal Prince Alfred Hospital, Renal Medicine, Camperdown, Australia
| | - Glenn Chertow
- Stanford University School of Medicine, Division of Nephrology, Palo Alto, United States of America
| | - Eiichiro Kanda
- Kawasaki Medical University, Medical Science, Okayama, Japan
| | - Guisen Li
- Sichuan Academy of Medical Science, Sichuan Provincial People’s Hospital, Chengdu, P.R. China
| | - Stephen Nolan
- AstraZeneca, BioPharmaceuticals Medical, Cambridge, United Kingdom
| | | | - Navdeep Tangri
- University of Manitoba, Chronic Disease Innovation Center, Winnipeg, Canada
| | | | - Jay Wish
- Indiana University School of Medecine, Division of Nephrology, Indianapolis, United States of America
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14
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Briguori C, Mavromatis K, Huang Z, Mathew R, Hickson L, Lau WL, Ye Z, Mathew A, Mahajan S, Wheeler D, Claes K, Chen G, Nolasco F, Fleg J, Sidhu M, Chertow G, Hochman J, Maron D, Bangalore S. DIALYSIS INITIATION IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE AND SEVERE CHRONIC KIDNEY DISEASE IN THE ISCHEMIA-CKD TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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GARCIA SANCHEZ J, Tangri N, Abdul Sultan A, Batista M, Cabrera C, Chadban S, Chertow G, Kanda E, Li G, Nolan S, Retat L, Xin S, Webber L, Wish J, Xu M. POS-322 INSIDE CKD: PROJECTING THE FUTURE BURDEN OF CHRONIC KIDNEY DISEASE IN THE AMERICAS AND THE ASIA-PACIFIC REGION USING MICROSIMULATION MODELLING. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Peters TG, Bragg-Gresham JL, Klopstock AC, Roberts JP, Chertow G, McCormick F, Held PJ. Estimated impact of novel coronavirus-19 and transplant center inactivity on end-stage renal disease-related patient mortality in the United States. Clin Transplant 2021; 35:e14292. [PMID: 33749935 PMCID: PMC8250232 DOI: 10.1111/ctr.14292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 12/24/2022]
Abstract
To predict whether the COVID‐19 pandemic and transplant center responses could have resulted in preventable deaths, we analyzed registry information of the US end‐stage renal disease (ESRD) patient population awaiting kidney transplantation. Data were from the Organ Procurement and Transplantation Network (OPTN), the US Centers for Disease Control and Prevention, and the United States Renal Data System. Based on 2019 OPTN reports, annualized reduction in kidney transplantation of 25%–100% could result in excess deaths of wait‐listed (deceased donor) transplant candidates from 84 to 337 and living donor candidate excess deaths from 35 to 141 (total 119–478 potentially preventable deaths of transplant candidates). Changes in transplant activity due to COVID‐19 varied with some centers shutting down while others simply heeded known or suspected pandemic risks. Understanding potential excess mortality for ESRD transplant candidates when circumstances compel curtailment of transplant activity may inform policy and procedural aspects of organ transplant systems allowing ways to best inform patients and families as to potential risks in shuttering organ transplant activity. Considering that more than 700 000 Americans have ESRD with 100 000 awaiting a kidney transplant, our highest annual estimate of 478 excess total deaths from postponing kidney transplantation seems modest.
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Affiliation(s)
- Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | | | - Annie C Klopstock
- Department of Economics, San Diego State University, San Diego, CA, USA
| | - John P Roberts
- Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Glenn Chertow
- Department of Medicine - Med/Nephrology, Stanford University, Stanford, CA, USA
| | | | - Philip J Held
- Department of Medicine - Med/Nephrology, Stanford University, Stanford, CA, USA
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McCoy I, Montez-Rath M, Chertow G, Chang T. Does really central venous pressure affect the risk of diuretic-associated acute kidney injury after cardiac surgery? Am Heart J 2020; 226:252. [PMID: 32811639 DOI: 10.1016/j.ahj.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Raggi P, Bellasi A, Bushinsky D, Bover J, Rodriguez M, Ketteler M, Sinha S, Garg R, Padgett C, Perelló J, Gold A, Chertow G. SO086SNF472 CONSISTENTLY SLOWS PROGRESSION OF CORONARY CALCIFICATION IN PATIENTS ON HEMODIALYSIS: SUBGROUP ANALYSIS OF THE CALIPSO STUDY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa139.so086] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
In the CaLIPSO study, SNF472 significantly attenuated progression of coronary artery calcium (CAC) volume score compared with placebo. This pre-specified analysis examined the effect of SNF472 on CAC progression in key subgroups of patients in CaLIPSO.
Method
Patients with a CAC Agatston score of 100 to 3500 at baseline were randomized to SNF472 300 mg (n=92), SNF472 600 mg (n=91), or placebo (n=91), infused during hemodialysis (HD) thrice weekly for 52 weeks. Patients received standard of care therapy, including phosphate binders and calcimimetics as determined by investigator. The primary endpoint (change in log CAC volume score from baseline to week 52 in the combined dose groups vs placebo) was analyzed for patients who received SNF472 or placebo and had an evaluable CT scan post-randomization (modified ITT population). Sensitivity analysis was also performed for the per protocol population of patients that met entry criteria, received 80% of scheduled treatment, completed the study procedures, and had both a baseline and week 52 evaluable CT scan. The analysis plan pre-specified key subgroups: age, sex, diabetes, dialysis vintage, and arteriosclerotic cardiovascular disease (ASCVD), as well as baseline use of non-calcium phosphate binders, calcium-based phosphate binders, calcimimetics, activated vitamin D, warfarin, or statins.
Results
Demographics and disease characteristics were similar across the treatment groups. Age (mean±SD) at baseline was 63.6±8.9 years and 39% of the patients were female; 62% had diabetes and 41% had prior ASCVD. Median dialysis vintage was 42.4 months; 33% had received hemodialysis for ≥5 years. Concomitant medications at baseline were: non-calcium phosphate binders, 62%; calcium-based phosphate binders, 28%; calcimimetics, 31%; activated vitamin D, 51%; warfarin, 8%; and statins, 64%. CAC volume progression was 11% for the combined dose groups and 20% for placebo (p=0.016). Treatment differences for CAC volume score progression from baseline to week 52 were similar across the subgroups (FIGURE). All interaction p-values were non-significant, and comparisons favored SNF472 vs placebo in each subgroup for both the modified ITT and per protocol population.
Conclusion
SNF472 treatment for 52 weeks attenuated CAC progression compared with placebo in all subgroups of the CaLIPSO study. These results support the potential benefit of SNF472 across a broad population of patients with cardiovascular calcification. Future studies are needed to determine the effects of SNF472 on cardiovascular events in patients receiving HD.
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Affiliation(s)
- Paolo Raggi
- Mazankowski Alberta Heart Institute, Edmonton, Canada
- University of Alberta, Medicine, Edmonton, Canada
| | - Antonio Bellasi
- ASST Papa Giovanni XXIII, Research, Innovation and Brand Reputation Unit, Bergamo, Italy
| | - David Bushinsky
- University of Rochester Medical Center, Medicine, Rochester, United States of America
| | - Jordi Bover
- Fundació Puigvert and Universitat Autònoma, IIB Sant Pau, REDinREN, Nephrology, Barcelona, Spain
| | - Mariano Rodriguez
- Hospital Universitario Reina Sofia, IMIBIC, REDinREN, Nephrology, Córdoba, Spain
| | - Markus Ketteler
- Robert-Bosch-Krankenhaus, General Internal Medicine and Nephrology, Stuttgart, Germany
| | - Smeeta Sinha
- Salford Royal NHS Foundation Trust, Renal Medicine, Salford, United Kingdom
| | - Rekha Garg
- Sanifit Therapeutics, Research and Development, San Diego, United States of America
| | - Claire Padgett
- Sanifit Therapeutics, Research and Development, San Diego, United States of America
| | - Joan Perelló
- Sanifit Therapeutics, Research and Development, Palma, Spain
- University of the Balearic Islands, Palma, Spain
| | - Alex Gold
- Sanifit Therapeutics, Research and Development, San Diego, United States of America
- Stanford University, Medicine, Palo Alto, United States of America
| | - Glenn Chertow
- Stanford University, Medicine, Palo Alto, United States of America
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Raggi P, Bellasi A, Sanjuan JB, Rodriguez JM, Ketteler M, Sinha S, Chertow G, Bushinsky DA, Salcedo C, Garg R, Gold A, Perelló J. FP633A DOUBLE-BLIND, RANDOMISED, PLACEBO-CONTROLLED PHASE 2B STUDY TO ASSESS THE EFFECT OF SNF472 ADDED TO STANDARD OF CARE ON PROGRESSION OF CARDIOVASCULAR CALCIFICATION IN PATIENTS WITH END-STAGE RENAL DISEASE ON MAINTENANCE HAEMODIALYSIS (CaLIPSO STUDY). Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Jordi Bover Sanjuan
- Hospital Santa Creu I Sant Pau, IDIBAPS, RedinRen Autònoma University Barcelona, Barcelona, Spain
| | - J Mariano Rodriguez
- Hospital Universitario Reina Sofía, IMIBIC, University of Córdoba, Córdoba, Spain
| | | | - Smeeta Sinha
- Salford Royal NHS Foundation Trust and University of Manchester, Salford, United Kingdom
| | - Glenn Chertow
- Stanford University, Palo Alto, United States of America
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Sinha S, Chertow G, Brandenburg V, Gould L, Miller S, Salcedo C, Garg R, Gold A, Perelló J. SP655DESIGN OF A PHASE 3, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY TO ASSESS THE EFFICACY AND SAFETY OF SNF472 FOR THE TREATMENT OF CALCIFIC UREMIC ARTERIOLOPATHY (CALCIPHYLAXIS). Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Smeeta Sinha
- Salford Royal NHS Foundation Trust and University of Manchester, Salford, United Kingdom
| | - Glenn Chertow
- Stanford University, Palo Alto, United States of America
| | | | - Lisa Gould
- South Shore Health System, Weymouth, United States of America
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Block G, Block M, Smits G, Kooienga L, Mehta R, Isakova T, Wolf M, Chertow G. LB05RANDOMIZED TRIAL OF THE EFFECTS OF FERRIC CITRATE IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy146.lb05] [Citation(s) in RCA: 2] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Martha Block
- Denver Nephrologists, PC, Denver, CO, United States
| | | | | | - Rupal Mehta
- Northwestern University, Chicago, IL, United States
| | | | - Myles Wolf
- Duke Uniersity, Raleigh-Durham, NC, United States
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Wanner C, Bakris G, Block G, Chin M, Goldsberry A, Inker L, Meyer C, O'Grady M, Pergola P, Warnock D, Chertow G. FO022BARDOXOLONE METHYL PREVENTS EGFR DECLINE IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4 AND TYPE 2 DIABETES - POST-HOC ANALYSES FROM BEACON. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fo022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christoph Wanner
- Department of Medicine, University Hospital Wurzburg, Würzburg, Germany
| | - George Bakris
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | | | - Melanie Chin
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Angie Goldsberry
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Lesley Inker
- Department of Medicine, Tufts Medical Center, Boston, MA, United States
| | - Colin Meyer
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Megan O'Grady
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | | | - David Warnock
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Glenn Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States
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Rossing P, Block G, Chertow G, Chin M, Goldsberry A, McCullough P, Meyer C, Packham D, Spinowitz B, Sprague S, Warnock D, Pergola P. FP152EFFECT OF BARDOXOLONE METHYL TREATMENT ON URINARY ALBUMIN IN PATIENTS WITH TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE - POST-HOC ANALYSIS FROM BEAM AND BEACON. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Glenn Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Melanie Chin
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Angie Goldsberry
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | | | - Colin Meyer
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - David Packham
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Bruce Spinowitz
- Department of Medicine, New York Presbyterian Queens, Flushing, NY, United States
| | - Stuart Sprague
- School of Medicine, Northshore Medical University Health System, University of Chicago, Evanston, IL, United States
| | - David Warnock
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Vervloet M, Cooper K, Block G, Chertow G, Fouqueray B, Moe S, Sun Y, Tomlin H, Wolf M, Oberbauer R. FP378BASELINE LEVELS OF FGF23 AND EFFECTS OF ETELCALCETIDE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Vervloet
- Nephrology, VU University Medical Center, Amsterdam, Netherlands
| | - K Cooper
- Global Medical, Amgen Inc, Thousand Oaks, CA, United States
| | - G Block
- Nephrology, Denver Nephrology, Denver, CO, United States
| | - G Chertow
- Nephrology, Stanford University, Stanford, CA, United States
| | | | - S Moe
- Nephrology, Indiana University, Indianapolis, IN, United States
| | - Y Sun
- Biostatistics, Amgen Inc, Thousand Oaks, CA, United States
| | - H Tomlin
- Global Medical, Amgen Inc, Thousand Oaks, CA, United States
| | - M Wolf
- Nephrology, Duke University, Durham, NC, United States
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Rossing P, Appel G, Block G, Chertow G, Chin M, Coyne D, Goldsberry A, Meyer C, Molitch M, Pergola P, Spinowitz B, Sprague S, Raskin P. SP104DECREASES IN WEIGHT WITH BARDOXOLONE METHYL IN OBESE PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4 AND TYPE 2 DIABETES - POST-HOC ANALYSES FROM BEACON. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Gerald Appel
- Glomerular Kidney Disease Center, Columbia University Medical Center, New York, NY, United States
| | | | - Glenn Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Melanie Chin
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Daniel Coyne
- Division of Nephrology, Washington University School of Medicine, St. Louis, MO, United States
| | - Angie Goldsberry
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Colin Meyer
- Product Development, Reata Pharmaceuticals, Irving, TX, United States
| | - Mark Molitch
- Northwestern University - Feinberg School of Medicine, Chicago, IL, United States
| | | | - Bruce Spinowitz
- Department of Medicine, New York Presbyterian Queens, Flushing, NY, United States
| | - Stuart Sprague
- School of Medicine, Northshore Medical University Health System, University of Chicago, Evanston, IL, United States
| | - Philip Raskin
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Sun A, Thomas IC, Ganesan C, Sylman J, Pao A, Wagner T, Brooks J, Chertow G, Leppert J. MP28-07 RENAL FUNCTION VARIABILITY: A SIMPLE METHOD TO IDENTIFY SUBCLINICAL KIDNEY DISEASE BEFORE NEPHRECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sun A, Thomas IC, Ganesan C, Sylman J, Pao A, Wagner T, Brooks J, Chertow G, Leppert J. MP28-15 PREOPERATIVE KIDNEY FUNCTION TRENDS: IMPROVING ESTIMATES OF BASELINE KIDNEY FUNCTION PRIOR TO KIDNEY CANCER SURGERY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wolf M, Block G, Chertow G, Cooper K, Fouqueray B, Moe S, Sun Y, Tomlin H, Vervloet M, Oberbauer R. SO033IMPACT OF ETELCALCETIDE ON FGF23 LEVELS DURING THE TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS ON HEMODIALYSIS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx105.so033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wilhelm-Leen E, Montez-Rath ME, Chertow G. Estimating the Risk of Radiocontrast-Associated Nephropathy. J Am Soc Nephrol 2016; 28:653-659. [PMID: 27688297 DOI: 10.1681/asn.2016010021] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [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: 01/07/2016] [Accepted: 07/12/2016] [Indexed: 11/03/2022] Open
Abstract
Estimates of the incidence of radiocontrast-associated nephropathy vary widely and suffer from misclassification of the cause of AKI and confounding. Using the Nationwide Inpatient Sample, we created multiple estimates of the risk of radiocontrast-associated nephropathy among adult patients hospitalized in the United States in 2009. First, we stratified patients according to the presence or absence of 12 relatively common diagnoses associated with AKI and evaluated the rate of AKI between strata. Next, we created a logistic regression model, controlling for comorbidity and acuity of illness, to estimate the risk of AKI associated with radiocontrast administration within each stratum. Finally, we performed an analysis stratified by the degree of preexisting comorbidity. In general, patients who received radiocontrast did not develop AKI at a clinically significant higher rate. Adjusted only for the complex survey design, patients to whom radiocontrast was and was not administered developed AKI at rates of 5.5% and 5.6%, respectively. After controlling for comorbidity and acuity of illness, radiocontrast administration associated with an odds ratio for AKI of 0.93 (95% confidence interval, 0.88 to 0.97). In conclusion, the risk of radiocontrast-associated nephropathy may be overstated in the literature and overestimated by clinicians. More accurate AKI risk estimates may improve clinical decision-making when attempting to balance the potential benefits of radiocontrast-enhanced imaging and the risk of AKI.
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Affiliation(s)
- Emilee Wilhelm-Leen
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Maria E Montez-Rath
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Glenn Chertow
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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Rasooly J, Ashley J, Tran I, Yost L, Chertow G. MP517EFFECTIVENESS OF UV LIGHT IN THE DISINFECTION OF PERITONEAL DIALYSIS CATHETER CONNECTIONS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw195.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leppert J, Golla A, Thomas IC, Lamberts R, Chung B, Sonn G, Srinivas S, Fan A, Wagner T, Master V, Brooks J, Chertow G, Patel C. MP03-17 SYSTEMATIC EVALUATION OF LABORATORY VALUES ASSOCIATED WITH SURVIVAL IN METASTATIC RENAL CELL CARCINOMA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Molfino A, Johansen K, Chertow G, Doyle J, Dwyer T, Rossi Fanelli F, Kaysen G. PP196-SUN: Performance of 4 Anorexia Tools in Hemodialysis (HD) Patients and their Relationship with Clinical Markers. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wheeler DC, Abdalla S, Chertow G, Parfrey P, Herzog C, Mikolasevic I, Racki S, Lukenda V, Milic S, Devcic B, Orlic L, Suttorp MM, Hoekstra T, Ocak G, Van Diepen ATN, Ott I, Mittelman M, Rabelink TJ, Krediet RT, Dekker FW, Simone S, Dell'Oglio MPS, Ciccone M, Corciulo R, Castellano G, Balestra C, Grandaliano G, Gesualdo L, Pertosa G, Nishida M, Ando M, Karasawa K, Iwamoto Y, Tsuchiya K, Nitta K, Krzanowski M, Janda K, Gajda M, Dumnicka P, Fedak D, Lis G, Ja kowski P, Litwin JA, Su owicz W, Freitas GR, Silva VB, Abensur H, Luders C, Pereira BJ, Castro MC, Oliverira RB, Moyses RM, Elias RM, Silva BC, Tekce H, Ozturk S, Aktas G, Kin Tekce B, Erdem A, Ozyasar M, Taslamacioglu Duman T, Yazici M, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Voroneanu L, Siriopol D, Nistor I, Apetrii M, Hogas S, Onofriescu M, Covic A, An WS, Kim SE, Son YK, Oh YJ, Gelev S, Toshev S, Trajceska L, Selim G, Dzekova P, Shikole A, Park J, Lee JS, Shin ES, Ann SH, Kim SJ, Chung HC, Janda K, Krzanowski M, Gajda M, Dumnicka P, Fedak D, Lis G, Litwin JA, Sulowicz W, Elewa U, Bichari W, Abo-Seif K, Seferi S, Rroji M, Likaj E, Spahia N, Barbullushi M, Thereska N, Kopecky CM, Genser B, Maerz W, Wanner C, Saemann MD, Weichhart T, Sezer S, Gurlek Demirci B, Tutal E, Bal Z, Erkmen Uyar M, Ozdemir Acar FN, Macunluoglu B, Atakan A, Ari Bakir E, Georgianos P, Sarafidis PA, Stamatiadis DN, Liakopoulos V, Zebekakis PE, Papagianni A, Lasaridis AN, Eftimovska - Otovic N, Babalj-Banskolieva E, Kostadinska-Bogdanoska S, Grozdanovski R, Aono M, Sato Y, El Amrani M, Asserraji M, Benyahia M, Lee YK, Choi SR, Cho A, Kim JK, Choi MJ, Kim SJ, Yoon JW, Koo JR, Kim HJ, Noh JW, Inagaki H, Yokota N, Sato Y, Chiyotanda S, Fukami K, Fujimoto S, Kendi Celebi Z, Kutlay S, Sengul S, Nergizoglu G, Erturk S, Ates K, Vishnevskii KA, Rumyantsev AS, Zemchenkov AY, Smirnov AV, Reinhardt B, Knaup R, Esteve Simo V, Carneiro Oliveira J, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Duarte Gallego V, Ramirez De Arellano Serna M, Turkmen K, Demirtas L, Akbas EM, Bakirci EM, Buyuklu M, Timuroglu A, Georgianos PI, Sarafidis PA, Karpetas A, Liakopoulos V, Stamatiadis DN, Papagianni A, Lasaridis AN, Taira T, Nohtomi K, Takemura T, Chiba T, Hirano T, Chang CT, Huang CC, Chen CJ, El Amrani M, Mohamed A, Benyahia M, Kanai H, Tamura Y, Kaizu Y, Kali A, Yayar O, Erdogan B, Eser B, Ercan Z, Buyukbakkal M, Merhametsiz O, Haspulat A, Yildirim T, Bozkurt B, Ayli MD, Bal Z, Erkmen Uyar M, Gokustun D, Gurlek Demirci B, Tutal E, Sezer S, Markaki A, Grammatikopoulou M, Fragkiadakis G, Stylianou K, Venyhaki M, Chatzi V, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Gelev S, Petronievic Z, Sikole A, Moyseyenko V, Nykula T, Fernandes RT, Barreto DV, Rodrigues GGC, Misael A, Branco-Martins CT, Barreto FC, Yayar O, Ercan Z, Eser B, Merhametsiz O, Haspulat A, Buyukbakkal M, Erdogan B, Yildirim T, Bozkurt B, Ayli MD. DIALYSIS CARDIOVASCULAR COMPLICATIONS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kurnatowska I, Grzelak P, Masajtis-Zagajewska A, Kaczmarska M, Stefa czyk L, Vermeer C, Maresz K, Nowicki M, Patel L, Bernard LM, Elder GJ, Leonardis D, Mallamaci F, Tripepi G, D'Arrigo G, Postorino M, Enia G, Caridi G, Marino F, Parlongo G, Zoccali C, Genovese F, Boor P, Papasotiriou M, Leeming DJ, Karsdal MA, Floege J, Delmas-Frenette C, Troyanov S, Awadalla P, Devuyst O, Madore F, Jensen JM, Mose FH, Kulik AEO, Bech JN, Fenton RA, Pedersen EB, Lucisano S, Villari A, Benedetto F, Pettinato G, Cernaro V, Lupica R, Trimboli D, Costantino G, Santoro D, Buemi M, Carmone C, Robben JH, Hadchouel J, Rongen G, Deinum J, Navis GJ, Wetzels JF, Deen PM, Block G, Fishbane S, Shemesh S, Sharma A, Wolf M, Chertow G, Gracia M, Arroyo D, Betriu A, Valdivielso JM, Fernandez E, Cantaluppi V, Medica D, Quercia AD, Dellepiane S, Gai M, Leonardi G, Guarena C, Migliori M, Panichi V, Biancone L, Camussi G, Covic A, Ketteler M, Rastogi A, Spinowitz B, Sprague SM, Botha J, Rakov V, Floege J, Floege J, Ketteler M, Rastogi A, Spinowitz B, Sprague SM, Botha J, Braunhofer P, Covic A, Kaku Y, Ookawara S, Miyazawa H, Ito K, Ueda Y, Hirai K, Hoshino T, Mori H, Nabata A, Yoshida I, Tabei K, El-Shahawy M, Cotton J, Kaupke J, Wooldridge TD, Weiswasser M, Smith WT, Covic A, Ketteler M, Rastogi A, Spinowitz B, Sprague SM, Botha J, Braunhofer P, Floege J, Hanowski T, Jager K, Rong S, Lesch T, Knofel F, Kielstein H, McQuarrie EP, Mark PB, Freel EM, Taylor A, Jardine AG, Wang CL, Du Y, Nan L, :Hess K, Savvaidis A, Lysaja K, Dimkovic N, Floege J, Marx N, Schlieper G, Skrunes R, Larsen KK, Svarstad E, Tondel C, Singh B, Ash SR, Lavin PT, Yang A, Rasmussen HS, Block GA, Egbuna O, Zeig S, Pergola PE, Singh B, Braun A, Yu Y, Sohn W, Padhi D, Block G, Chertow G, Fishbane S, Rodriguez M, Chen M, Shemesh S, Sharma A, Wolf M, Delgado G, Kleber ME, Grammer TB, Kraemer BK, Maerz W, Scharnagl H, Ichii M, Ishimura E, Shima H, Ohno Y, Tsuda A, Nakatani S, Ochi A, Mori K, Inaba M, Filiopoulos V, Manolios N, Hadjiyannakos D, Arvanitis D, Karatzas I, Vlassopoulos D, Floege J, Botha J, Chong E, Sprague SM, Cosmai L, Porta C, Foramitti M, Masini C, Sabbatini R, Malberti F, Elewa U, Nastou D, Fernandez B, Egido J, Ortiz A, Hara S, Tanaka K, Kushiyama A, Sakai K, Sawa N, Hoshino J, Ubara Y, Takaichi K, Bouquegneau A, Vidal-Petiot E, Vrtovsnik F, Cavalier E, Krzesinski JM, Flamant M, Delanaye P, Kilis-Pstrusinska K, Prus-Wojtowicz E, Szepietowski JC, Raj DS, Amdur R, Yamamoto J, Mori M, Sugiyama N, Inaguma D, Youssef DM, Alshal AA, Elbehidy RM, Bolignano D, Palmer S, Navaneethan S, Strippoli G, Kim YN, Park K, Gwoo S, Shin HS, Jung YS, Rim H, Rhew HY, Tekce H, Kin Tekce B, Aktas G, Schiepe F, Draz Y, Rakov V, Yilmaz MI, Siriopol D, Saglam M, Kurt YG, Unal H, Eyileten T, Gok M, Cetinkaya H, Oguz Y, Sari S, Vural A, Mititiuc I, Covic A, Kanbay M, Filiopoulos V, Manolios N, Hadjiyannakos D, Arvanitis D, Karatzas I, Vlassopoulos D, Okarska-Napierala M, Ziolkowska H, Pietrzak R, Skrzypczyk P, Jankowska K, Werner B, Roszkowska-Blaim M, Cernaro V, Trifiro G, Lorenzano G, Lucisano S, Buemi M, Santoro D, Krause R, Fuhrmann I, Degenhardt S, Daul AE, Sallee M, Dou L, Cerini C, Poitevin S, Gondouin B, Jourde-Chiche N, Brunet P, Dignat-George F, Burtey S, Massimetti C, Achilli P, Madonna MPP, Muratore MTT, Fabbri GDD, Brescia F, Feriozzi S, Unal HU, Kurt YG, Gok M, Cetinkaya H, Karaman M, Eyileten T, Vural A, Oguz Y, Y lmaz MI, Sugahara M, Sugimoto I, Aoe M, Chikamori M, Honda T, Miura R, Tsuchiya A, Hamada K, Ishizawa K, Saito K, Sakurai Y, Mise N, Gama-Axelsson T, Quiroga B, Axelsson J, Lindholm B, Qureshi AR, Carrero JJ, Pechter U, Raag M, Ots-Rosenberg M, Vande Walle J, Greenbaum LA, Bedrosian CL, Ogawa M, Kincaid JF, Loirat C, Liborio A, Leite TT, Neves FMDO, Torres De Melo CB, Leitao RDA, Cunha L, Filho R, Sheerin N, Loirat C, Greenbaum L, Furman R, Cohen D, Delmas Y, Bedrosian CL, Legendre C, Koibuchi K, Aoki T, Miyagi M, Sakai K, Aikawa A, Pozna Ski P, Sojka M, Kusztal M, Klinger M, Fakhouri F, Bedrosian CL, Ogawa M, Kincaid JF, Loirat C, Heleniak Z, Aleksandrowicz E, Wierblewska E, Kunicka K, Bieniaszewski L, Zdrojewski Z, Rutkowski B. CKD PATHOPHYSIOLOGY AND CLINICAL STUDIES. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rocco M, Daugirdas J, Greene T, Lockridge R, Chan C, Pierratos A, Lindsay R, Larive B, Chertow G, Beck G, Eggers P, Kliger A, Laville M, Dorval M, Fort Ros J, Fay R, Cridlig J, Nortier JL, Juillard L, D bska- lizie A, Fernandez Lorente L, Thibaudin D, Franssen CF, Schulz M, Moureau F, Loughraieb N, Rossignol P, Kliger AS, Chertow GM, Levin NW, Beck GJ, Daugirdas JT, Eggers PW, Larive B, Rocco MV, Greene T, Marcelli D, Jirka T, Merello JI, Ponce P, Ladanyi E, Di Benedetto A, Rosenberger J, Stuard S, Scholz C, Canaud B. NEW DIALYSIS TECHNIQUES. Nephrol Dial Transplant 2014; 29:iii37-iii38. [PMCID: PMC4049063 DOI: 10.1093/ndt/gfu125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Weinberg A, Patel C, Chertow G, Leppert J. 66 DIABETIC SEVERITY AND RISK OF KIDNEY STONE DISEASE. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brown WV, Bakris G, Lerma E, Chertow G. Assessment and management of vascular disease risk in patients with chronic kidney disease. J Clin Lipidol 2011; 5:251-60. [PMID: 21784369 DOI: 10.1016/j.jacl.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 04/26/2011] [Accepted: 05/01/2011] [Indexed: 11/17/2022]
Affiliation(s)
- W Virgil Brown
- Emory University School of Medicine, 1670 Clairmont Road, Atlanta, GA 30033, USA.
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Hostetter TH, Kochis DJ, Shaffer RN, Chertow G, Harmon WE, Klotman PE, Powe NR, Sedor JR, Smedberg PC, Watnick S, Winkelmayer WC. World Kidney Day 2011. J Am Soc Nephrol 2011; 22:397-8. [DOI: 10.1681/asn.2011020115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abbasi M, Chertow G, Hall Y. End-stage Renal Disease. Am Fam Physician 2010; 82:1512. [PMID: 21166372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Raggi P, Chertow G, Block G, Urena P, Csiky B, Naso A, Nossuli K, Moustafa M, Goodman W, Lopez N, Downey G, Dehmel B, Floege J. 242: A Randomized Controlled Trial to Evaluate the Effects of Cinacalcet Plus Low-Dose Vitamin D on Vascular Calcification in Hemodialysis Patients. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fried LF, Boudreau R, Lee JS, Chertow G, Kurella-Tamura M, Shlipak MG, Ding J, Sellmeyer D, Tylavsky FA, Simsonick E, Kritchevsky SB, Harris TB, Newman AB. Kidney function as a predictor of loss of lean mass in older adults: health, aging and body composition study. J Am Geriatr Soc 2007; 55:1578-84. [PMID: 17908060 DOI: 10.1111/j.1532-5415.2007.01398.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the association between kidney function and change in body composition in older individuals. DESIGN Prospective cohort study. SETTING Two sites, Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS Three thousand twenty-six well-functioning, participants aged 70 to 79 in the Health, Aging and Body Composition Study. MEASUREMENTS Body composition (bone-free lean mass and fat mass) was measured using dual x-ray absorptiometry annually for 4 years. Kidney function was measured at baseline according to serum creatinine (SCr). Comorbidity and inflammatory markers were evaluated as covariates in mixed-model, repeated-measures analysis. RESULTS High SCr was associated with loss of lean mass in men but not women, with a stronger relationship in black men (P=.02 for difference between slopes for white and black men). In white men, after adjustment for age and comorbidity, higher SCr remained associated with loss of lean mass (-0.07+/-0.03 kg/y greater loss per 0.4 mg/dL (1 standard deviation (SD)), P=.009) but was attenuated after adjustment for inflammatory factors (-0.05+/-0.03 kg/y greater loss per SD, P=.10). In black men, the relationship between SCr and loss of lean mass (-0.19+/-0.04 kg/y per SD, P<.001) persisted after adjustment for inflammation and overall weight change. CONCLUSION Impaired kidney function may contribute to loss of lean mass in older men. Inflammation appeared to mediate the relationship in white but not black men. Future studies should strive to elucidate mechanisms linking kidney disease and muscle loss and identify treatments to minimize loss of lean mass and its functional consequences.
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Affiliation(s)
- Linda F Fried
- Renal Section, Veterans Affairs Pittsburgh Healthcare System Pittsburgh, Pennsylvania 15240, USA.
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Hall Y, Chertow G. End stage renal disease. Clin Evid 2005:1048-59. [PMID: 16135286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Yoshio Hall
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, California, USA
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