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Karger AB, Long T, Inker LA, Eckfeldt JH. Improved Performance in Measurement of Serum Cystatin C by Laboratories Participating in the College of American Pathologists' 2019 CYS Survey. Arch Pathol Lab Med 2022; 146:1218-1223. [PMID: 35192685 DOI: 10.5858/arpa.2021-0306-cp] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Use of cystatin C for glomerular filtration rate estimation (eGFR) has garnered heightened interest as a means to avoid race-based medicine, since eGFRcys equations do not require specification of race. Before considering more widespread use of cystatin C, it is important to confirm that assays provide accurate measurements of cystatin C concentration, to ensure accurate GFR estimates. OBJECTIVE.— To determine if the accuracy of cystatin C measurements in laboratories participating in the College of American Pathologists' (CAP) Cystatin C (CYS) survey has improved since 2014. DESIGN.— Two fresh frozen serum pools, the first from healthy donors without chronic kidney disease (CKD), and the second from patients with CKD, along with a synthetically prepared elevated cystatin C pool, were sent to laboratories participating in the 2019 CYS-A survey. Target values were established by using 2 immunoassays and a bracketed 2-point calibration with diluted ERM-DA471/IFCC reference material. RESULTS.— For the healthy donor fresh frozen pool (ERM-DA471/IFCC-traceable target of 0.725 mg/L), the all-method mean (standard deviation, coefficient of variation) was 0.731 mg/L (0.071, 9.7%). For the CKD pool (ERM-DA471/IFCC-traceable target of 2.136 mg/L), the all-method mean was 2.155 mg/L (0.182, 8.4%). For the synthetically spiked pool (ERM-DA471/IFCC-traceable target of 1.843 mg/L), the all-method mean was 1.886 mg/L (0.152, 8.1%). This represents marked improvement in accuracy and between-method agreement compared to the 2014 CAP survey. CONCLUSIONS.— Manufacturers have markedly improved accuracy and between-method agreement of cystatin C measurement procedures since 2014, which allows for greater confidence in estimated GFR relying on cystatin C.
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Affiliation(s)
- Amy B Karger
- From the Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis (Karger, Eckfeldt)
| | - Thomas Long
- The Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Long)
| | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts (Inker)
| | - John H Eckfeldt
- From the Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis (Karger, Eckfeldt)
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Emerson JF, Shulman IA, Chambliss AB, Keyser AJ, Chan KMM, Hiti AL, Eckfeldt JH, Lai KKY. In Memoriam: David Bruce Endres, PhD, DABCC (1945-2021). J Appl Lab Med 2021. [PMID: 34095953 DOI: 10.1093/jalm/jfab049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jane F Emerson
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - Ira A Shulman
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - Allison B Chambliss
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - Anthony J Keyser
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | | | - Alan L Hiti
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Keane K Y Lai
- Department of Pathology, University of Southern California, Los Angeles, CA, USA.,Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, CA, USA
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Inker LA, Couture SJ, Tighiouart H, Abraham AG, Beck GJ, Feldman HI, Greene T, Gudnason V, Karger AB, Eckfeldt JH, Kasiske BL, Mauer M, Navis G, Poggio ED, Rossing P, Shlipak MG, Levey AS. A New Panel-Estimated GFR, Including β 2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population. Am J Kidney Dis 2021; 77:673-683.e1. [PMID: 33301877 PMCID: PMC8102017 DOI: 10.1053/j.ajkd.2020.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVE Glomerular filtration rate (GFR) estimation based on creatinine and cystatin C (eGFRcr-cys) is more accurate than estimated GFR (eGFR) based on creatinine or cystatin C alone (eGFRcr or eGFRcys, respectively), but the inclusion of creatinine in eGFRcr-cys requires specification of a person's race. β2-Microglobulin (B2M) and β-trace protein (BTP) are alternative filtration markers that appear to be less influenced by race than creatinine is. STUDY DESIGN Study of diagnostic test accuracy. SETTING AND PARTICIPANTS Development in a pooled population of 7 studies with 5,017 participants with and without chronic kidney disease. External validation in a pooled population of 7 other studies with 2,245 participants. TESTS COMPARED Panel eGFR using B2M and BTP in addition to cystatin C (3-marker panel) or creatinine and cystatin C (4-marker panel) with and without age and sex or race. OUTCOMES GFR measured as the urinary clearance of iothalamate, plasma clearance of iohexol, or plasma clearance of [51Cr]EDTA. RESULTS Mean measured GFRs were 58.1 and 83.2 mL/min/1.73 m2, and the proportions of Black participants were 38.6% and 24.0%, in the development and validation populations, respectively. In development, addition of age and sex improved the performance of all equations compared with equations without age and sex, but addition of race did not further improve the performance. In validation, the 4-marker panels were more accurate than the 3-marker panels (P < 0.001). The 3-marker panel without race was more accurate than eGFRcys (percentage of estimates greater than 30% different from measured GFR [1 - P30] of 15.6% vs 17.4%; P = 0.01), and the 4-marker panel without race was as accurate as eGFRcr-cys (1 - P30 of 8.6% vs 9.4%; P = 0.2). Results were generally consistent across subgroups. LIMITATIONS No representation of participants with severe comorbid illness and from geographic areas outside of North America and Europe. CONCLUSIONS The 4-marker panel eGFR is as accurate as eGFRcr-cys without requiring specification of race. A more accurate race-free eGFR could be an important advance.
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Affiliation(s)
- Lesley A Inker
- Division of Nephrology, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
| | - Sara J Couture
- Division of Nephrology, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Alison G Abraham
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Tom Greene
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Kopavogur, Iceland
| | - Amy B Karger
- Departments of Laboratory Medicine and Pathology, University of Minnesota; Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - John H Eckfeldt
- Departments of Laboratory Medicine and Pathology, University of Minnesota; Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Bertram L Kasiske
- University of Minnesota; Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Michael Mauer
- Medicine, University of Minnesota; Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Gerjan Navis
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Peter Rossing
- Steno Diabetes Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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Fan L, Steubl D, Inker LA, Tighiouart H, Simon AL, Foster MC, Karger AB, Eckfeldt JH, Li H, Tang J, He Y, Xie M, Xiong F, Li H, Zhang H, Hu J, Liao Y, Ye X, Shafi T, Chen W, Yu X, Levey AS. Estimating total small solute clearance in patients treated with continuous ambulatory peritoneal dialysis without urine and dialysate collection. Perit Dial Int 2021; 40:84-92. [PMID: 32063147 DOI: 10.1177/0896860819878658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND International Society for Peritoneal Dialysis guidelines recommend to routinely monitor the total measured clearance (mCl) of small solutes such as creatinine; however, collection of 24-h urine and peritoneal dialysis (PD) fluid is burdensome to patients and prone to errors. We hypothesized that equations could be developed to estimate mCl (estimated clearance (eCl)) using endogenous filtration markers. METHODS In the Guangzhou PD Study (n = 980), we developed eCl equations using linear regression in two-third and validated them in the remaining one-third. Reference tests were mCl for urea nitrogen (UN) (mClUN, ml/min) and average mCl for UN and creatinine (mClUN-cr, ml/min/1.73 m2). Index tests were various eCl equations using UN, creatinine, low-molecular-weight proteins (LMWPs) (beta-trace protein (BTP), beta-2 microglobulin (B2M), and cystatin C), demographic variables, and body size. After reexpression of the equations in the combined data set, we analyzed accuracy (eCl within ± 2.0 units of mCl) and the predictive value of eCl to detect a weekly total standard Kt/V (weekly mClUN indexed for total body water) > 1.7 using receiver operating characteristic curve. RESULTS Mean age of the cohort was 50 ± 15 years, 53% were male; mClUN was 6.9 ± 1.8 and mClUN-cr was 7.5 ± 2.8. Creatinine but not UN contributed to eCl for both mCl. LMWP did not improve accuracy for mClUN (range 88-89%). BTP and B2M improved the accuracy for mClUN-cr (82% vs. 80%); however, differences were small. The area under the curve for predicting a weekly Kt/V > 1.7 was similar for all equations (range 0.79-0.80). CONCLUSIONS Total small solute clearance can be estimated moderately well in continuous ambulatory PD patients using serum creatinine and demographic variables without urine and dialysate collection.
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Affiliation(s)
- Li Fan
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.,Equal contributors
| | - Dominik Steubl
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA.,Abteilung für Nephrologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Equal contributors
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Andrew L Simon
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | | | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Hongyan Li
- Department of Nephrology, Huadu District People's Hospital of Guangzhou, Huadu, China
| | - Jiamin Tang
- Department of Nephrology, Huadu District People's Hospital of Guangzhou, Huadu, China
| | - Yongcheng He
- Department of Nephrology, Shenzhen Second People's Hospital and the First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Minyan Xie
- Department of Nephrology, Guangzhou Panyu Central Hospital, Panyu, China
| | - Fei Xiong
- Department of Nephrology, Wuhan No.1 Hospital and Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Hongbo Li
- Department of Nephrology, Wuhan No.1 Hospital and Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Hao Zhang
- Department of Nephrology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jing Hu
- Department of Nephrology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Yunhua Liao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xudong Ye
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.,Institute of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
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Karger AB, Eckfeldt JH, Rynders GP, Chaudhari J, Miao S, Van Lente F, Coresh J, Levey AS, Inker LA. Long-Term Longitudinal Stability of Kidney Filtration Marker Measurements: Implications for Epidemiological Studies and Clinical Care. Clin Chem 2020; 67:425-433. [PMID: 33257944 DOI: 10.1093/clinchem/hvaa237] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Establishment and improvement of glomerular filtration rate estimating equations requires accurate and precise laboratory measurement procedures (MPs) for filtration markers. The Advanced Research and Diagnostic Laboratory (ARDL) at the University of Minnesota, which has served as the central laboratory for the Chronic Kidney Disease Epidemiology Collaboration since 2009, has implemented several quality assurance measures to monitor the accuracy and stability of filtration marker assays over time. METHODS To assess longitudinal stability for filtration marker assays, a 40-sample calibration panel was created using pooled serum, divided into multiple frozen aliquots stored at -80 °C. ARDL monitored 4 markers-creatinine, cystatin C, beta-2-microglobulin (B2M) and beta-trace protein-measuring 15 calibration panel aliquots from 2009 to 2019. Initial target values were established using the mean of the first 3 measurements performed in 2009-10, and differences from target were monitored over time. New MPs for cystatin C and B2M were added in 2012, with target values established using the first measurement. RESULTS The mean percentage difference from mean target values across time was <2% for all original MPs (-0.59% for creatinine; -0.94% for cystatin C; -0.82% for B2M; 1.24% for beta-trace protein). CONCLUSIONS Close monitoring of filtration marker trends with a calibration panel at ARDL demonstrates remarkable long-term stability of the MPs. Routine use of a calibration panel for both research studies and clinical care is recommended for filtration markers where longitudinal monitoring is important to detect analytical biases, which can mask or confound true clinical trends in patients.
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Affiliation(s)
- Amy B Karger
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN
| | - John H Eckfeldt
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN
| | - Gregory P Rynders
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN
| | - Juhi Chaudhari
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Shiyuan Miao
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Frederick Van Lente
- Preventive Research Laboratory and Laboratory Diagnostic Core, Cleveland Clinic, Cleveland, OH
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Andrew S Levey
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
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6
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Seegmiller JC, Eckfeldt JH. Racial Demographics in Glomerular Filtration Rate Estimating Equations. Clin Chem 2020; 66:1485-1488. [PMID: 33257981 DOI: 10.1093/clinchem/hvaa234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Jesse C Seegmiller
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN
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Li D, Misialek JR, Jing M, Tsai MY, Eckfeldt JH, Steffen LM, Knopman D, Wruck L, Gottesman R, Mosley TH, Sharrett AR, Alonso A. Plasma phospholipid very-long-chain SFAs in midlife and 20-year cognitive change in the Atherosclerosis Risk in Communities (ARIC): a cohort study. Am J Clin Nutr 2020; 111:1252-1258. [PMID: 32320012 PMCID: PMC7266687 DOI: 10.1093/ajcn/nqaa048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Very-long-chain SFAs (VLSFAs) have recently gained considerable attention as having beneficial effects on health and aging. OBJECTIVES The objective of this study was to assess the associations of plasma phospholipid VLSFAs [arachidic acid (20:0), behenic acid (22:0), tricosanoic acid (23:0), and lignoceric acid (24:0)] with 20-y cognitive decline in the Atherosclerosis Risk in Communities (ARIC) participants. Furthermore, this study compared the associations of plasma phospholipid VLSFAs with 5 common groups of fatty acids [i.e., total SFAs, total MUFAs, total ω-3 (n-3) PUFAs, total marine-derived ω-3 PUFAs, total ω-6 PUFAs]. METHODS This study used a cohort study design of 3229 ARIC participants enrolled at the Minnesota field center. Fatty acids were measured at visit 1 (1987-1989); and cognition was assessed at visits 2 (1990-1992), 4 (1996-1998), and 5 (2011-2013) using 3 tests: the Delayed Word Recall Test (DWRT), the Digit-Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). RESULTS Higher proportions of plasma phospholipid total VLSFAs and each individual VLSFA were associated with less decline in WFT, a test of verbal fluency. For example, 1 SD higher in total VLSFAs at baseline was associated with 0.057 SD (95% CI: 0.018, 0.096, P = 0.004) less cognitive decline over 20 y as measured by WFT score. None of the 5 common fatty acid groups were associated with change in WFT, but a higher proportion of plasma phospholipid total MUFAs was associated with greater decline in DWRT; higher total ω-6 PUFAs with less decline in DWRT; and higher total ω-3 and total marine-derived ω-3 PUFAs with less decline in DSST. CONCLUSIONS This study suggests that higher proportions of plasma phospholipid VLSFAs in midlife may be associated with less 20-y cognitive decline.
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Affiliation(s)
- Danni Li
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ma Jing
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Tom H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Barton JC, Wiener HH, Acton RT, Adams PC, Eckfeldt JH, Gordeuk VR, Harris EL, McLaren CE, Harrison H, McLaren GD, Reboussin DM. Prevalence of iron deficiency in 62,685 women of seven race/ethnicity groups: The HEIRS Study. PLoS One 2020; 15:e0232125. [PMID: 32324809 PMCID: PMC7179917 DOI: 10.1371/journal.pone.0232125] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Few cross-sectional studies report iron deficiency (ID) prevalence in women of different race/ethnicity and ages in US or Canada. Materials and methods We evaluated screening observations on women who participated between 2001–2003 in a cross-sectional, primary care-based sample of adults ages ≥25 y whose observations were complete: race/ethnicity; age; transferrin saturation; serum ferritin; and HFE p.C282Y and p.H63D alleles. We defined ID using a stringent criterion: combined transferrin saturation <10% and serum ferritin <33.7 pmol/L (<15 μg/L). We compared ID prevalence in women of different race/ethnicity subgrouped by age and determined associations of p.C282Y and p.H63D to ID overall, and to ID in women ages 25–44 y with or without self-reported pregnancy. Results These 62,685 women included 27,079 whites, 17,272 blacks, 8,566 Hispanics, 7,615 Asians, 449 Pacific Islanders, 441 Native Americans, and 1,263 participants of other race/ethnicity. Proportions of women with ID were higher in Hispanics and blacks than whites and Asians. Prevalence of ID was significantly greater in women ages 25–54 y of all race/ethnicity groups than women ages ≥55 y of corresponding race/ethnicity. In women ages ≥55 y, ID prevalence did not differ significantly across race/ethnicity. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy. Conclusions ID prevalence was greater in Hispanic and black than white and Asian women ages 25–54 y. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy.
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Affiliation(s)
- James C. Barton
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA and Southern Iron Disorders Center, Birmingham, AL, United States of America
- * E-mail:
| | - Howard H. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Ronald T. Acton
- USA and Southern Iron Disorders Center, Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Paul C. Adams
- Department of Medicine, London Health Sciences Centre, London, ONT, Canada
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States of America
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Emily L. Harris
- Division of Cancer Control and Population Sciences, Epidemiology and Genomics Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Christine E. McLaren
- Department of Epidemiology, University of California, Irvine, CA, United States of America
| | - Helen Harrison
- The Western-Fanshawe Collaborative BScN Program, Fanshawe College, London, ONT, Canada
| | - Gordon D. McLaren
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA and Department of Veterans Affairs Long Beach Healthcare System, Long Beach, CA, United States of America
| | - David M. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
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9
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Chen N, Shi H, Zhang L, Zuo L, Xie J, Xie D, Karger AB, Miao S, Ren H, Zhang W, Wang W, Pan Y, Minji W, Sui Z, Okparavero A, Simon A, Chaudhari J, Eckfeldt JH, Inker LA, Levey AS. GFR Estimation Using a Panel of Filtration Markers in Shanghai and Beijing. Kidney Med 2020; 2:172-180. [PMID: 32734236 PMCID: PMC7380432 DOI: 10.1016/j.xkme.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RATIONALE & OBJECTIVES Estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFRcr-cys) may be less accurate compared to measured GFR (mGFR) in China than in North America, Europe, and Australia due to variation across regions in their non-GFR determinants. The non-GFR determinants of β2-microglobulin (B2M) and β-trace protein (BTP) differ from those of creatinine and cystatin C. Thus, the average eGFR using all 4 markers (eGFRavg) could be more accurate than eGFRcr-cys in China. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS 1,066 participants in Shanghai and Beijing with creatinine and cystatin C and 666 participants with all 4 filtration markers. TESTS COMPARED Index tests were previously developed equations for eGFR using creatinine, cystatin C, B2M, and BTP and combinations. The reference test was mGFR using plasma clearance of iohexol. We compared the performance of eGFRavg to eGFRcr-cys using the proportion of participants with errors in eGFR >30% of mGFR (1 - P30) and root mean square error (RMSE) of the regression of eGFR on mGFR on the logarithmic scale. We also compared classification and reclassification of mGFR categories using eGFRavg compared to eGFRcr-cys. OUTCOMES Accuracy was significantly better for eGFRavg (1 - P30 of 10.4% and RMSE of 0.214) compared to eGFRcr-cys (1 - P30 of 13.8% and RMSE of 0.232; P = 0.004 and P = 0.006, respectively). However, improvements in accuracy did not generally translate into significant improvement in classification or reclassification of mGFR categories. LIMITATIONS Study population may not be generalizable to clinical settings other than large urban medical centers in China. CONCLUSIONS A panel of endogenous filtration markers including B2M and BTP in addition to creatinine and cystatin C may improve GFR estimation in China. Further study is necessary to determine whether GFR estimation using B2M and BTP can be improved and whether these improvements lead to useful clinical applications.
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Affiliation(s)
- Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Shi
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Peking University, Center for Data Science in Health and Medicine, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danshu Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Shiyuan Miao
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujing Pan
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Wei Minji
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Zhun Sui
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | | | - Andrew Simon
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Juhi Chaudhari
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
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Inker LA, Levey AS, Tighiouart H, Shafi T, Eckfeldt JH, Johnson C, Okparavero A, Post WS, Coresh J, Shlipak MG. Performance of glomerular filtration rate estimating equations in a community-based sample of Blacks and Whites: the multiethnic study of atherosclerosis. Nephrol Dial Transplant 2019; 33:417-425. [PMID: 28505377 DOI: 10.1093/ndt/gfx042] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/16/2017] [Indexed: 01/27/2023] Open
Abstract
Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations are recommended for glomerular filtration rate (GFR) estimation in the general population. They have not been evaluated in community-based populations, including Blacks at higher levels of GFR, but are commonly applied in such populations. Methods In an ancillary study of Multi-Ethnic Study of Atherosclerosis conducted at one site, we evaluated the performance of the CKD-EPI equations for creatinine (eGFRcr), cystatin C (eGFRcys) or the combination (eGFRcr-cys) compared with GFR measured as plasma clearance of iohexol. Results Among 294 participants, the mean age was 71 (SD 9) years, 47% were Black, 48% were women and the mean measured GFR (mGFR) was 72.6 (SD 18.8) mL/min/1.73 m2. The CKD-EPI equations overestimated mGFR with a larger median bias for eGFRcr and eGFRcr-cys than eGFRcys [-8.3 (95% confidence interval -9.7, -6.5), -7.8 (-9.2, -6.2) and -3.7 (-5.0, -1.8) mL/min/1.73 m2, respectively], with smaller bias for those with lower compared with higher eGFR and by race compared with sex. Conclusion The small differential bias of the CKD-EPI equation between races suggests that they can be used in Blacks as well as Whites in older community-based adults. The large differential bias in women versus men in all equations is in contrast to other studies and is unexplained. Further studies are required in multiracial and multiethnic community-based cohorts, taking into account differences in GFR measurement methods.
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Affiliation(s)
- Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Tariq Shafi
- Johns Hopkins University, Baltimore, MD, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Craig Johnson
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | - Michael G Shlipak
- Division of Nephrology, University of California, San Francisco, CA, USA
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11
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Schmit DJ, Carroll LJ, Eckfeldt JH, Seegmiller JC. Verification of separate measurement procedures where analytical determinations influence the clinical interpretation of GFR: Iohexol quantitation by HPLC and LC-MS/MS. Clin Biochem 2019; 67:16-23. [DOI: 10.1016/j.clinbiochem.2019.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
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12
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Steubl D, Fan L, Michels WM, Inker LA, Tighiouart H, Dekker FW, Krediet RT, Simon AL, Foster MC, Karger AB, Eckfeldt JH, Li H, Tang J, He Y, Xie M, Xiong F, Li H, Zhang H, Hu J, Liao Y, Ye X, Shafi T, Chen W, Yu X, Levey AS. Development and Validation of Residual Kidney Function Estimating Equations in Dialysis Patients. Kidney Med 2019; 1:104-114. [PMID: 32734191 PMCID: PMC7380427 DOI: 10.1016/j.xkme.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE & OBJECTIVE Measurement of residual kidney function is recommended for the adjustment of the dialysis prescription, but timed urine collections are difficult and prone to errors. Equations to calculate residual kidney function from serum concentrations of endogenous filtration markers and demographic parameters would simplify monitoring of residual kidney function. However, few equations to estimate residual kidney function using serum concentrations of small solutes and low-molecular-weight proteins have been developed and externally validated. STUDY DESIGN Study of diagnostic test accuracy. SETTING & PARTICIPANTS 823 Chinese peritoneal dialysis (PD) patients (development cohort) and 826 PD and hemodialysis patients from the Netherlands NECOSAD study (validation cohort). TESTS COMPARED Equations to estimate residual kidney function (estimated clearance [eCl]) using serum creatinine, urea nitrogen, cystatin C, β2-microglobulin (B2M), β-trace protein (BTP), and combinations, as well as demographic variables (age, sex, height, and weight). Equations were developed using multivariable linear regression analysis in the development cohort and then tested in the validation cohort. Equations were compared with published validated equations. OUTCOMES Residual kidney function measured as urinary clearance (mCl) of urea nitrogen (mClUN) and average of creatinine and urea nitrogen clearance (mClUN-cr). RESULTS In external validation, bias (difference between mCl and eCl) was within ± 1.0 unit for all equations. Accuracy (percent of differences within ± 2.0 units) was significantly better for eClBTP, eClB2M, and eClBTP-B2M than eClUN-cr for both mClUN (78%, 80%, and 81% vs 72%; P < 0.05 for all) and mClUN-cr (72%, 78%, and 79% vs 68%; P < 0.05 for all). The area under the curve for predicting mClUN > 2.0 mL/min was highest for eClB2M (0.853) and eClBTP-B2M (0.848). Results were similar for other validated equations. LIMITATIONS Development cohort only consisted of PD patients, no gold-standard method for residual kidney function measurement. CONCLUSIONS These results confirm the validity and extend the generalizability of residual kidney function estimating equations from serum concentrations of low-molecular-weight proteins without urine collection.
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Affiliation(s)
- Dominik Steubl
- Division of Nephrology, Tufts Medical Center, Boston, MA
- Abteilung für Nephrologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Li Fan
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, NHC Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Wieneke M. Michels
- Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Hongyan Li
- Department of Nephrology, Huadu District People's Hospital of Guangzhou, Huadu
| | - Jiamin Tang
- Department of Nephrology, Huadu District People's Hospital of Guangzhou, Huadu
| | - Yongcheng He
- Department of Nephrology, Shenzhen Second People's Hospital and the First Affiliated Hospital of Shenzhen University, Shenzhen
| | - Minyan Xie
- Department of Nephrology, Guangzhou Panyu Central Hospital, Panyu
| | - Fei Xiong
- Department of Nephrology, Wuhan No.1 Hospital and Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan
| | - Hongbo Li
- Department of Nephrology, Wuhan No.1 Hospital and Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan
| | - Hao Zhang
- Department of Nephrology, Third Xiangya Hospital of Central South University, Changsha
| | - Jing Hu
- Department of Nephrology, Third Xiangya Hospital of Central South University, Changsha
| | - Yunhua Liao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xudong Ye
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, NHC Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, NHC Key Laboratory of Nephrology (Sun Yat-sen University), Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
- Institute of Nephrology, Guangdong Medical University, Zhanjiang, China
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13
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Waikar SS, Rebholz CM, Zheng Z, Hurwitz S, Hsu CY, Feldman HI, Xie D, Liu KD, Mifflin TE, Eckfeldt JH, Kimmel PL, Vasan RS, Bonventre JV, Inker LA, Coresh J. Biological Variability of Estimated GFR and Albuminuria in CKD. Am J Kidney Dis 2018; 72:538-546. [PMID: 30031564 DOI: 10.1053/j.ajkd.2018.04.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/30/2018] [Indexed: 01/02/2023]
Abstract
RATIONALE & OBJECTIVE Determining whether a change in estimated glomerular filtration rate (eGFR) or albuminuria is clinically significant requires knowledge of short-term within-person variability of the measurements, which few studies have addressed in the setting of chronic kidney disease. STUDY DESIGN Cross-sectional study with multiple collections over less than 4 weeks. SETTING & PARTICIPANTS Clinically stable outpatients with chronic kidney disease (N=50; mean age, 56.8 years; median eGFR, 40mL/min/1.73m2; median urinary albumin-creatinine ratio (UACR), 173mg/g). EXPOSURE Repeat measurements from serially collected samples across 3 study visits. OUTCOMES Measurements of urine albumin concentration (UAC), UACR, and plasma creatinine, cystatin C, β2-microglobulin (B2M), and beta trace protein (BTP). ANALYTICAL APPROACH We calculated within-person coefficients of variation (CVw) values and corresponding reference change positive and negative (RCVpos and RCVneg) values using log-transformed measurements. RESULTS Median CVw (RCVpos; RCVneg) values of filtration markers were 5.4% (+16%; -14%) for serum creatinine, 4.1% (+12%; -11%) for cystatin C, 7.4% (+23%; -18%) for BTP, and 5.6% (+17%; -14%) for B2M. Results for albuminuria were 33.2% (+145%; -59%) for first-morning UAC, 50.6% (+276%; -73%) for random spot UAC, 32.5% (+141%; -58%) for first-morning UACR, and 29.7% (124%; -55%) for random spot UACR. CVw values for filtration markers were comparable across the range of baseline eGFRs. CVw values for UAC and UACR were comparable across the range of baseline albuminuria values. LIMITATIONS Small sample size limits the ability to detect differences in variability across markers. Participants were recruited and followed up in a clinical and not research setting, so some preanalytical factors could not be controlled. CONCLUSIONS eGFR markers appear to have relatively low short-term within-person variability, whereas variability in albuminuria appears to be high, making it difficult to distinguish random variability from meaningful biologic changes.
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Affiliation(s)
| | | | | | | | - Chi-Yuan Hsu
- University of California, San Francisco, San Francisco, CA
| | | | - Dawei Xie
- University of Pennsylvania, Philadelphia, PA
| | - Kathleen D Liu
- University of California, San Francisco, San Francisco, CA
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14
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Seegmiller JC, Eckfeldt JH, Lieske JC. Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective. Adv Chronic Kidney Dis 2018; 25:84-92. [PMID: 29499892 DOI: 10.1053/j.ackd.2017.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/11/2022]
Abstract
The assessment of kidney function is a cornerstone in the clinical management and health of the patient. Although the kidneys perform many physiologic functions and are essential for maintaining homeostasis, kidney function is typically evaluated, quantitated, and understood using the glomerular filtration rate (GFR). Although GFR can be directly measured using a variety of externally administered glomerular filtration markers, in general practice, the GFR is usually estimated (eGFR) using endogenous markers that are cleared primarily by kidney filtration. Common situations exist where the GFR needs to be measured (mGFR) in order to proceed with care. This manuscript will review laboratory challenges in the assessment of GFR. Key points to consider when implementing a mGFR testing protocol are the following: marker selection, clearance methodology (urinary vs solely plasma measurements of filtration marker), sample collection, number of samples to collect, staff required, and analytical measurement technology for the filtration marker selected. We suggest those wanting to implement mGFR testing examine site-specific institutional resources along with patient population and proceed with the approaches best suited for their clinical needs and laboratory resources available.
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15
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Karger AB, Inker LA, Coresh J, Levey AS, Eckfeldt JH. Novel Filtration Markers for GFR Estimation. EJIFCC 2017; 28:277-288. [PMID: 29333147 PMCID: PMC5746837] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Creatinine-based glomerular filtration rate estimation (eGFRcr) has been improved and refined since the 1970s through both the Modification of Diet in Renal Disease (MDRD) Study equation in 1999 and the CKD Epidemiology Collaboration (CKD-EPI) equation in 2009, with current clinical practice dependent primarily on eGFR for accurate assessment of GFR. However, researchers and clinicians have recognized limitations of relying on creatinine as the only filtration marker, which can lead to inaccurate GFR estimates in certain populations due to the influence of non-GFR determinants of serum or plasma creatinine. Therefore, recent literature has proposed incorporation of multiple serum or plasma filtration markers into GFR estimation to improve precision and accuracy and decrease the impact of non-GFR determinants for any individual biomarker. To this end, the CKD-EPI combined creatinine-cystatin C equation (eGFRcr-cys) was developed in 2012 and demonstrated superior accuracy to equations relying on creatinine or cystatin C alone (eGFRcr or eGFRcys). Now, the focus has broadened to include additional novel filtration markers to further refine and improve GFR estimation. Beta-2-microglobulin (B2M) and beta-trace-protein (BTP) are two filtration markers with established assays that have been proposed as candidates for improving both GFR estimation and risk prediction. GFR estimating equations based on B2M and BTP have been developed and validated, with the CKD-EPI combined BTP-B2M equation (eGFRBTP-B2M) demonstrating similar performance to eGFR and eGFR. Additionally, several studies have demonstrated that both B2M and BTP are associated with outcomes in CKD patients, including cardiovascular events, ESRD and mortality. This review will primarily focus on these two biomarkers, and will highlight efforts to identify additional candidate biomarkers through metabolomics-based approaches.
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Affiliation(s)
- Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA,Department of Laboratory Medicine and Pathology University of Minnesota 420 Delaware St SE MMC 609, Minneapolis, MN 55455 United States of America
| | - Lesley A. Inker
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew S. Levey
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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16
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Schwartz GJ, Wang H, Erway B, Nordin G, Seegmiller J, Lieske JC, Back SE, Miller WG, Eckfeldt JH. Multicenter Laboratory Comparison of Iohexol Measurement. J Appl Lab Med 2017; 2:711-724. [PMID: 31276084 DOI: 10.1373/jalm.2017.024240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Iohexol is utilized for measurement of kidney glomerular filtration rate (GFR). Until recently, there have not been available proficiency standards to assist in calibrating a laboratory's results. In view of a shift in calibration at the University of Rochester Medical Center (URMC) laboratory, serving as Central Biochemistry Laboratory for the CKiD study, we performed a multi-centered laboratory comparison. Methods Two batches of 30 fortified sera and patient samples from serum or heparinized plasma were sent for duplicate analysis to URMC, University of Minnesota (UMN), Mayo Clinic, and University of Lund. Five proficiency testing materials from Equalis AB were also provided. Iohexol calibration was performed using dilutions of Omnipaque™ 300 and concentrations measured by HPLC or LC-MS/MS (Mayo). Results UMN and Lund agreed well. URMC calibration was 11-13% lower, and Mayo was 4-8% lower for fortified samples. URMC corrected calibration was 3-8% higher for these samples. When measured values were adjusted for the results of the Equalis samples, all laboratories agreed within 1-2% on all iohexol concentrations. Conclusions For 12 URMC calibrator lots from 11/ 2006 to 3/ 2016, the factor quantifying the underestimation of measured to true iohexol concentration was 0.89. If each concentration were divided by 0.89, the calculated GFRs would be reduced by 10-11%. GFR results for CKiD were adjusted for this shift in calibration. Regular examination of iohexol proficiency testing materials, free exchange of samples among laboratories, and standardized dilution of the stock iohexol for calibration would help to bring more universal agreement to this assay.
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Affiliation(s)
- George J Schwartz
- Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | | | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA
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Phinney KW, Sempos CT, Tai SSC, Camara JE, Wise SA, Eckfeldt JH, Hoofnagle AN, Carter GD, Jones J, Myers GL, Durazo-Arvizu R, Miller WG, Bachmann LM, Young IS, Pettit J, Caldwell G, Liu A, Brooks SPJ, Sarafin K, Thamm M, Mensink GBM, Busch M, Rabenberg M, Cashman KD, Kiely M, Galvin K, Zhang JY, Kinsella M, Oh K, Lee SW, Jung CL, Cox L, Goldberg G, Guberg K, Meadows S, Prentice A, Tian L, Brannon PM, Lucas RM, Crump PM, Cavalier E, Merkel J, Betz JM. Baseline Assessment of 25-Hydroxyvitamin D Reference Material and Proficiency Testing/External Quality Assurance Material Commutability: A Vitamin D Standardization Program Study. J AOAC Int 2017; 100:1288-1293. [PMID: 28797319 DOI: 10.5740/jaoacint.17-0291] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Vitamin D Standardization Program (VDSP) coordinated a study in 2012 to assess the commutability of reference materials and proficiency testing/external quality assurance materials for total 25-hydroxyvitamin D [25(OH)D] in human serum, the primary indicator of vitamin D status. A set of 50 single-donor serum samples as well as 17 reference and proficiency testing/external quality assessment materials were analyzed by participating laboratories that used either immunoassay or LC-MS methods for total 25(OH)D. The commutability test materials included National Institute of Standards and Technology Standard Reference Material 972a Vitamin D Metabolites in Human Serum as well as materials from the College of American Pathologists and the Vitamin D External Quality Assessment Scheme. Study protocols and data analysis procedures were in accordance with Clinical and Laboratory Standards Institute guidelines. The majority of the test materials were found to be commutable with the methods used in this commutability study. These results provide guidance for laboratories needing to choose appropriate reference materials and select proficiency or external quality assessment programs and will serve as a foundation for additional VDSP studies.
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Affiliation(s)
- Karen W Phinney
- National Institute of Standards and Technology, Biomolecular Measurement Division, Gaithersburg, MD
| | | | - Susan S-C Tai
- National Institute of Standards and Technology, Chemical Sciences Division, Gaithersburg, MD
| | - Johanna E Camara
- National Institute of Standards and Technology, Chemical Sciences Division, Gaithersburg, MD
| | - Stephen A Wise
- National Institutes of Health, Office of Dietary Supplements, Bethesda, MD
| | - John H Eckfeldt
- University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, MN
| | - Andrew N Hoofnagle
- University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Graham D Carter
- Vitamin D External Quality Assessment Scheme, Charing Cross Hospital, London, United Kingdom
| | - Julia Jones
- Vitamin D External Quality Assessment Scheme, Charing Cross Hospital, London, United Kingdom
| | - Gary L Myers
- Joint Committee for Traceability in Laboratory Medicine, Smyrna, GA
| | | | | | | | | | - Juanita Pettit
- Health Surveys, Australian Bureau of Statistics, Canberra, ACT, Australia
| | - Grahame Caldwell
- Douglass Hanly Moir Pathology, Sonic Healthcare, Sydney, NSW, Australia
| | - Andrew Liu
- Douglass Hanly Moir Pathology, Sonic Healthcare, Sydney, NSW, Australia
| | | | - Kurtis Sarafin
- Health Canada, Nutrition Research Division, Ottawa, ON, Canada
| | | | | | | | | | - Kevin D Cashman
- University College Cork, School of Food and Nutritional Sciences, Cork Centre for Vitamin D and Nutrition Research, Cork, Ireland
| | - Mairead Kiely
- University College Cork, School of Food and Nutritional Sciences, Cork Centre for Vitamin D and Nutrition Research, Cork, Ireland
| | - Karen Galvin
- University College Cork, School of Food and Nutritional Sciences, Cork Centre for Vitamin D and Nutrition Research, Cork, Ireland
| | - Joy Y Zhang
- University College Cork, School of Food and Nutritional Sciences, Cork Centre for Vitamin D and Nutrition Research, Cork, Ireland
| | - Michael Kinsella
- University College Cork, School of Food and Nutritional Sciences, Cork Centre for Vitamin D and Nutrition Research, Cork, Ireland
| | - Kyungwon Oh
- Korea Centers for Disease Control and Prevention, Division of Health and Nutrition Survey, Seoul, Korea
| | | | | | - Lorna Cox
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Gail Goldberg
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Kate Guberg
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Sarah Meadows
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Ann Prentice
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Lu Tian
- Stanford University, Department of Biomedical Data Science, Palo Alto, CA
| | - Patsy M Brannon
- Cornell University, Division of Nutritional Sciences, Ithaca, NY
| | - Robyn M Lucas
- Australian National University, Research School of Population Health, National Centre for Epidemiology and Population Health, Canberra, ACT, Australia
| | - Peter M Crump
- University Computing and Biometry, of Wisconsin-Madison, Madison, WI
| | - Etienne Cavalier
- University of Liege, Centre Hospitalier Universitaire du Sart-Tilman, Liege, Belgium
| | - Joyce Merkel
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892
| | - Joseph M Betz
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892
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Rebholz CM, Inker LA, Chen Y, Liang M, Foster MC, Eckfeldt JH, Kimmel PL, Vasan RS, Feldman HI, Sarnak MJ, Hsu CY, Levey AS, Coresh J. Risk of ESRD and Mortality Associated With Change in Filtration Markers. Am J Kidney Dis 2017. [PMID: 28648303 DOI: 10.1053/j.ajkd.2017.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Using change in estimated glomerular filtration rate (eGFR) based on creatinine concentration as a surrogate outcome in clinical trials of chronic kidney disease has been proposed. Risk for end-stage renal disease (ESRD) and all-cause mortality associated with change in concentrations of other filtration markers has not been studied in chronic kidney disease populations. STUDY DESIGN Observational analysis of 2 clinical trials. SETTING & PARTICIPANTS Participants in the MDRD (Modification of Diet in Renal Disease; n=317) Study and AASK (African American Study of Kidney Disease and Hypertension; n=373). PREDICTORS Creatinine, cystatin C, β-trace protein (BTP), and β2-microglobulin (B2M) were measured in serum samples collected at the 12- and 24-month follow-up visits, along with measured GFR (mGFR) at these time points. OUTCOMES ESRD and all-cause mortality. MEASUREMENTS Poisson regression was used to estimate incidence rate ratios and 95% CIs for ESRD and all-cause mortality during long-term follow-up (10-16 years) per 30% decline in mGFR or eGFR for each filtration marker and the average of all 4 markers. RESULTS 1-year decline in mGFR, eGFRcr, eGFRBTP, and the average of the 4 filtration markers was significantly associated with increased risk for incident ESRD in both studies (all P≤0.02). Compared to mGFR, only decline in eGFRBTP was statistically significantly more strongly associated with ESRD risk in both studies (both P≤0.03). Decline in eGFRcr, but not mGFR or the other filtration markers, was significantly associated with risk for all-cause mortality in AASK only (incidence rate ratio per 30% decline, 4.17; 95% CI, 1.78-9.74; P<0.001), but this association was not significantly different from decline in mGFR (P=0.2). LIMITATIONS Small sample size. CONCLUSIONS Declines in mGFR, eGFRcr, eGFRBTP, and the average of 4 filtration markers (creatinine, cystatin C, BTP, and B2M) were consistently associated with progression to ESRD.
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Affiliation(s)
- Casey M Rebholz
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Yuan Chen
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Menglu Liang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meredith C Foster
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA; Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Harold I Feldman
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark J Sarnak
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Andrew S Levey
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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19
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White CA, Akbari A, Eckfeldt JH, Chakraborty D, McCudden C, Flemming JA, Lowe C, Labrecque P, Parent JL, Fergusson D, Gill JS, Knoll GA. β-Trace Protein Assays: A Comparison Between Nephelometric and ELISA Methodologies. Am J Kidney Dis 2017; 69:866-868. [DOI: 10.1053/j.ajkd.2017.02.371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/17/2017] [Indexed: 11/11/2022]
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Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
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21
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Inker LA, Coresh J, Sang Y, Hsu CY, Foster MC, Eckfeldt JH, Karger AB, Nelson RG, Liu X, Sarnak M, Appel LJ, Grams M, Xie D, Kimmel PL, Feldman H, Ramachandran V, Levey AS. Filtration Markers as Predictors of ESRD and Mortality: Individual Participant Data Meta-Analysis. Clin J Am Soc Nephrol 2017; 12:69-78. [PMID: 28062677 PMCID: PMC5220652 DOI: 10.2215/cjn.03660316] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/04/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Serum β-trace protein (BTP) and β-2 microglobulin (B2M) are associated with risk of ESRD and death in the general population and in populations at high risk for these outcomes (GP/HR) and those with CKD, but results differ among studies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed an individual patient-level meta-analysis including three GP/HR studies (n=17,903 participants) and three CKD studies (n=5415). We compared associations, risk prediction, and improvement in reclassification of eGFR using BTP (eGFRBTP) and B2M (eGFRB2M) alone and the average (eGFRavg) of eGFRBTP, eGFRB2M, creatinine (eGFRcr), and cystatin C (eGFRcys), to eGFRcr, eGFRcys, and their combination (eGFRcr-cys) for ESRD (2075 events) and death (7275 events). RESULTS Mean (SD) follow up times for ESRD and mortality for GP/HR and CKD studies were 13 (4), 6.2 (3.2), 14 (5), and 7.5 (3.9) years, respectively. Compared with eGFRcr, eGFRBTP and eGFRB2M improved risk associations and modestly improved prediction for ESRD and death even after adjustment for established risk factors. eGFRavg provided the most consistent improvement in associations and prediction across both outcomes and populations. Assessment of heterogeneity did not yield clinically relevant differences. For ESRD, addition of albuminuria substantially attenuated the improvement in risk prediction and risk classification with novel filtration markers. For mortality, addition of albuminuria did not affect the improvement in risk prediction with the use of novel markers, but lessened improvement in risk classification, especially for the CKD cohort. CONCLUSIONS These markers do not provide substantial additional prognostic information to eGFRcr and albuminuria, but may be appropriate in circumstances where eGFRcr is not accurate or albuminuria is not available. Educational efforts to increase measurement of albuminuria in clinical practice may be more cost-effective than measurement of BTP and B2M for improving prognostic information.
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Affiliation(s)
- Lesley A. Inker
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Yingying Sang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Chi-yuan Hsu
- Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Meredith C. Foster
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Robert G. Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Xun Liu
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mark Sarnak
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Morgan Grams
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Dawei Xie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul L. Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Harold Feldman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrew S. Levey
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - for the CKD Biomarkers Consortium
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, University of California-San Francisco, San Francisco, California
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and
- Boston University School of Medicine, Boston, Massachusetts
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22
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Silvestre OM, Gonçalves A, Nadruz W, Claggett B, Couper D, Eckfeldt JH, Pankow JS, Anker SD, Solomon SD. Ferritin levels and risk of heart failure-the Atherosclerosis Risk in Communities Study. Eur J Heart Fail 2016; 19:340-347. [PMID: 27976478 DOI: 10.1002/ejhf.701] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/22/2016] [Accepted: 10/09/2016] [Indexed: 12/17/2022] Open
Abstract
AIMS Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community-based cohort. METHODS AND RESULTS We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987-1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30-200 ng/mL in women and 30-300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow-up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15-4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01-3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11-4.68; P = 0.03). CONCLUSION Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
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Affiliation(s)
- Odilson M Silvestre
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Alexandra Gonçalves
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,University of Porto Medical School, Porto, Portugal
| | - Wilson Nadruz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,University of Campinas, Campinas, Brazil
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | | | | | | | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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23
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Liu X, Foster MC, Tighiouart H, Anderson AH, Beck GJ, Contreras G, Coresh J, Eckfeldt JH, Feldman HI, Greene T, Hamm LL, He J, Horwitz E, Lewis J, Ricardo AC, Shou H, Townsend RR, Weir MR, Inker LA, Levey AS. Non-GFR Determinants of Low-Molecular-Weight Serum Protein Filtration Markers in CKD. Am J Kidney Dis 2016; 68:892-900. [PMID: 27663042 PMCID: PMC5123901 DOI: 10.1053/j.ajkd.2016.07.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/18/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Unlike the case with creatinine, conditions affecting the non-glomerular filtration rate (GFR) determinants of low-molecular-weight serum proteins, β-trace protein (BTP), β2-microglobulin (B2M), and cystatin C, are not well characterized. STUDY DESIGN Pooled cross-sectional analysis of 3 studies. SETTING & PARTICIPANTS 3,156 persons with chronic kidney disease from the MDRD (Modification of Diet in Renal Disease) Study, AASK (African American Study of Kidney Disease and Hypertension), and CRIC (Chronic Renal Insufficiency Cohort) Study. PREDICTORS Demographic and clinical factors hypothesized to be associated with non-GFR determinants of the filtration markers, selected from literature review and physiologic and clinical considerations. OUTCOMES Serum creatinine, BTP, B2M, and cystatin C levels. RESULTS In multivariable-adjusted errors-in-variables regression models that included adjustment for measured GFR (mGFR) and mGFR measurement error, creatinine level had stronger associations with male sex, black race, and higher urine creatinine excretion than the other filtration markers. BTP was associated less strongly with age, similar in direction with sex, and opposite in direction with race than creatinine level. Like cystatin C, B2M level was associated less strongly with age, sex, and race than creatinine level. BTP, B2M, and cystatin C levels were associated more strongly than creatinine level with other factors, including urine protein excretion and weight for BTP, smoking and urine protein excretion for B2M, and smoking for cystatin C. LIMITATIONS Findings may not be generalizable to populations without chronic kidney disease, and residual confounding with GFR due to incomplete adjustment for GFR measurement error. CONCLUSIONS Like creatinine, serum levels of low-molecular-weight proteins are affected by conditions other than GFR. Knowledge of these conditions can aid the interpretation of GFR estimates and risk using these markers and guide the use of these filtration markers in developing GFR estimating equations.
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Affiliation(s)
- Xun Liu
- Division of Nephrology, Department of Internal Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guanghzou, China
| | | | | | - Amanda H Anderson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Josef Coresh
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Harold I Feldman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Haochang Shou
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Raymond R Townsend
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
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Thyagarajan B, Howard AG, Durazo-Arvizu R, Eckfeldt JH, Gellman MD, Kim RS, Liu K, Mendez AJ, Penedo FJ, Talavera GA, Youngblood ME, Zhao L, Sotres-Alvarez D. Analytical and biological variability in biomarker measurement in the Hispanic Community Health Study/Study of Latinos. Clin Chim Acta 2016; 463:129-137. [PMID: 27756543 DOI: 10.1016/j.cca.2016.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/28/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Biomarker variability, which includes within-individual variability (CVI), between-individual variability (CVG) and methodological variability (CVP+A) is an important determinant of our ability to detect biomarker-disease associations. Estimates of CVI and CVG may be population specific and little data exists on biomarker variability in diverse Hispanic populations. Hence, we evaluated all 3 components of biomarker variability in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) using repeat blood collections (n=58) and duplicate blood measurements (n=761-929 depending on the biomarker). METHODS We estimated the index of individuality (II) ((CVI+CVP+A)/CVG) for 41 analytes and evaluated differences in the II across sexes and age groups. RESULTS Biomarkers such as fasting glucose, triglycerides and ferritin had substantially higher inter-individual variability and lower II in HCHS/SOL as compared to the published literature. We also found significant sex-specific differences in the II for neutrophil count, platelet count, hemoglobin, % eosinophils and fasting glucose. The II for fasting insulin, post oral glucose tolerance test glucose and cystatin C was significantly higher among the 18-44y age group as compared to the 45+y age group. CONCLUSIONS The implications of these findings for determining biomarker-disease associations in Hispanic populations need to be evaluated in future studies.
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Affiliation(s)
- Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States.
| | - Annie Green Howard
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Ramon Durazo-Arvizu
- Department of Public Health Sciences, Division of Biostatistics, Loyola University Chicago, Maywood, IL, United States
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Marc D Gellman
- Department of Psychology, Behavioral Medicine Research Center, University of Miami, Miami, FL, United States
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Armando J Mendez
- Department of Psychology, Behavioral Medicine Research Center, University of Miami, Miami, FL, United States
| | - Frank J Penedo
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Gregory A Talavera
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, United States
| | - Marston E Youngblood
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
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25
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Lutsey PL, Parrinello CM, Misialek JR, Hoofnagle AN, Henderson CM, Laha TJ, Michos ED, Eckfeldt JH, Selvin E. Short-term Variability of Vitamin D-Related Biomarkers. Clin Chem 2016; 62:1647-1653. [PMID: 27694392 DOI: 10.1373/clinchem.2016.261461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Quantifying the variability of biomarkers is important, as high within-person variability can lead to misclassification of individuals. Short-term variability of important markers of vitamin D metabolism is relatively unknown. METHODS A repeatability study was conducted in 160 Atherosclerosis Risk in Communities study participants (60% female, 28% black, mean age 76 years). Fasting serum was drawn at 2 time points, a median of 6 (range 3-13) weeks apart. Vitamin D binding protein (VDBP) and 25-hydroxyvitamin D [25(OH)D] were measured by LC-MS, fibroblast growth factor (FGF23) and parathyroid hormone (PTH) by enzyme-linked immunoassay, and calcium and phosphorus by Roche Cobas 6000. Free and bioavailable 25(OH)D were calculated. We calculated the within-person CV (CVW), intraclass correlation coefficient (ICC), Spearman rank correlation coefficient (r), and percent reclassified. RESULTS The CVW was lowest for calcium (2.0%), albumin (3.6%), 25(OH)D (6.9%), VDBP (7.0%) and phosphorus (7.6%); intermediate for free 25(OH)D (9.0%) and bioavailable 25(OH)D (9.9%); and highest for PTH (16.7%) and FGF23 (17.8%). Reclassification was highest for PTH, VDBP, and phosphorus (all 7.5%). The ICC and r were highest (≥0.80) for 25(OH)D, free 25(OH)D, bioavailable 25(OH)D and PTH, but somewhat lower (approximately 0.60-0.75) for the other biomarkers. CONCLUSIONS Six-week short-term variability, as assessed by CVW, was quite low for VDBP, calcium and phosphorus, but fairly high for FGF23 and PTH. As such, multiple measurements of FGF23 and PTH may be needed to minimize misclassification. These results provide insight into the extent of potential misclassification of vitamin D markers in research and clinical settings.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN;
| | - Christina M Parrinello
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Andy N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Clark M Henderson
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Thomas J Laha
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Inker LA, Shafi T, Okparavero A, Tighiouart H, Eckfeldt JH, Katz R, Johnson WC, Dermond N, Tariq Z, Benayache I, Post WS, Coresh J, Levey AS, Shlipak MG. Effects of Race and Sex on Measured GFR: The Multi-Ethnic Study of Atherosclerosis. Am J Kidney Dis 2016; 68:743-751. [PMID: 27555103 DOI: 10.1053/j.ajkd.2016.06.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/27/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Kidney failure disproportionately affects older blacks versus whites. The reasons are unknown and may be related to lower measured glomerular filtration rate (GFR) and higher levels of albuminuria in community-based population samples. STUDY DESIGN Cross-sectional analysis of a substudy of a prospective cohort. SETTING & PARTICIPANTS Ancillary study following Multi-Ethnic Study of Atherosclerosis (MESA) visit 5. PREDICTOR Age, sex, and race. OUTCOMES & MEASUREMENTS Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio (ACR). RESULTS GFR was measured in 294 participants. Mean age was 71±9 (SD) years, 47% were black, 48% were women, mean GFR was 73±19mL/min/1.73m2, and median ACR was 10.0 (IQR, 5.8-20.9) mg/g. Measured GFR was on average 1.02 (95% CI, 0.79-1.24) mL/min/1.73m2 lower per year older. Mean GFR indexed for body surface area was not different between blacks versus whites (mean difference, 2.94 [95% CI, -1.37 to 7.26] mL/min/1.73m2), but was lower in women than men (mean difference, -9.34 [95% CI, -13.53 to -5.15] mL/min/1.73m2); this difference persisted and remained significant after adjustment for demographics, clinical characteristics, and measures of body size. The difference between men and women, but not between blacks and whites, was substantially greater when GFR was not indexed for body surface area. ACR was higher in older versus younger participants (mean difference, 3.2% [95% CI, 1.5%-4.8%] per year), but geometric mean ratio of ACR did not differ between blacks versus whites (mean difference, 19.7%; 95% CI, -39.1% to 6.1%) or between men versus women (mean difference, -4.4%; 95% CI, -27.7% to 26.3%). LIMITATIONS This is a study of survivors. People who agreed to participate were younger than those who refused. CONCLUSIONS In this first community-based study that included blacks and whites, no differences in measured GFR between races were found, suggesting that other factors must account for the disproportionately higher burden of kidney failure in older blacks versus whites.
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Affiliation(s)
- Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA.
| | | | | | - Hocine Tighiouart
- Division of Nephrology, Tufts Medical Center, Boston, MA; The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Ronit Katz
- University of Washington, Kidney Research Institute, Seattle, WA
| | - W Craig Johnson
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA
| | - Norma Dermond
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA
| | | | | | | | | | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA
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Franceschini N, Deng Y, Flessner MF, Eckfeldt JH, Kramer HJ, Lash JP, Lee DJ, Melamed ML, Moncrieft AE, Ricardo AC, Rosas SE, Kaplan RC, Raij L, Cai J. Smoking patterns and chronic kidney disease in US Hispanics: Hispanic Community Health Study/Study of Latinos. Nephrol Dial Transplant 2016; 31:1670-6. [PMID: 27257272 DOI: 10.1093/ndt/gfw210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/17/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Intermittent smoking is prevalent among Hispanics, but little is known about whether this smoking pattern associates with increased chronic kidney disease (CKD) risk in this population. The objective of the present study is to identify patterns of exposure associated with CKD in US Hispanics. METHODS We used cross-sectional data on 15 410 participants of the Hispanics Community Health Study/the Study of Latinos, a population-based study of individuals aged 18-74 years, recruited in 2008 to 2011 from four US field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA). Smoking exposure was obtained through a questionnaire. CKD was defined by an estimated glomerular filtration rate of <60 mL/min/1.73 m(2) or a urine albumin-to-creatinine ratio of ≥30 mg/g. RESULTS Approximately 14% of individuals were daily and 7% were intermittent smokers, and 16% were past smokers. There was a significant interaction between smoking status and pack-years of exposure (P = 0.0003). In adjusted models, there was an increased odds of CKD among daily, intermittent and past smokers by pack-years compared with never smokers. The association of intermittent smokers was significant at 10 pack-years [odds ratio (OR) = 1.38, 95% confidence intervals (CI) 1.06, 1.81], whereas for daily smokers this association was observed at 40 pack-years (OR = 1.43, 95% CI 1.09, 1.89). CONCLUSIONS Our findings of increased risk of CKD among Hispanics who are intermittent smokers support screening and smoking cessation interventions targeted to this population for the prevention of CKD. It also suggests novel mechanistic pathways for kidney toxicity that should be further explored in future studies.
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Affiliation(s)
- Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yu Deng
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael F Flessner
- National Institute of Diabetes, Digestive, and Kidney Disease, Bethesda, MD, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Holly J Kramer
- Division of Nephrology, Loyola University, Maywood, IL, USA
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Harvard University, Boston, MA, USA
| | | | | | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Parrinello CM, Grams ME, Sang Y, Couper D, Wruck LM, Li D, Eckfeldt JH, Selvin E, Coresh J. Iterative Outlier Removal: A Method for Identifying Outliers in Laboratory Recalibration Studies. Clin Chem 2016; 62:966-72. [PMID: 27197675 DOI: 10.1373/clinchem.2016.255216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Extreme values that arise for any reason, including those through nonlaboratory measurement procedure-related processes (inadequate mixing, evaporation, mislabeling), lead to outliers and inflate errors in recalibration studies. We present an approach termed iterative outlier removal (IOR) for identifying such outliers. METHODS We previously identified substantial laboratory drift in uric acid measurements in the Atherosclerosis Risk in Communities (ARIC) Study over time. Serum uric acid was originally measured in 1990-1992 on a Coulter DACOS instrument using an uricase-based measurement procedure. To recalibrate previous measured concentrations to a newer enzymatic colorimetric measurement procedure, uric acid was remeasured in 200 participants from stored plasma in 2011-2013 on a Beckman Olympus 480 autoanalyzer. To conduct IOR, we excluded data points >3 SDs from the mean difference. We continued this process using the resulting data until no outliers remained. RESULTS IOR detected more outliers and yielded greater precision in simulation. The original mean difference (SD) in uric acid was 1.25 (0.62) mg/dL. After 4 iterations, 9 outliers were excluded, and the mean difference (SD) was 1.23 (0.45) mg/dL. Conducting only one round of outlier removal (standard approach) would have excluded 4 outliers [mean difference (SD) = 1.22 (0.51) mg/dL]. Applying the recalibration (derived from Deming regression) from each approach to the original measurements, the prevalence of hyperuricemia (>7 mg/dL) was 28.5% before IOR and 8.5% after IOR. CONCLUSIONS IOR is a useful method for removal of extreme outliers irrelevant to recalibrating laboratory measurements, and identifies more extraneous outliers than the standard approach.
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Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Yingying Sang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa M Wruck
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Danni Li
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.
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Foster MC, Coresh J, Hsu CY, Xie D, Levey AS, Nelson RG, Eckfeldt JH, Vasan RS, Kimmel PL, Schelling J, Simonson M, Sondheimer JH, Anderson AH, Akkina S, Feldman HI, Kusek JW, Ojo AO, Inker LA. Serum β-Trace Protein and β2-Microglobulin as Predictors of ESRD, Mortality, and Cardiovascular Disease in Adults With CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2016; 68:68-76. [PMID: 26948990 DOI: 10.1053/j.ajkd.2016.01.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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: 08/27/2015] [Accepted: 01/05/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Serum β-trace protein (BTP) and β2-microglobulin (B2M) are independently associated with end-stage renal disease (ESRD) and mortality in the general population and high-risk groups with diabetes or advanced chronic kidney disease (CKD). Less is known about their associations with outcomes and predictive ability in adults with moderate CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,613 adults from the CRIC (Chronic Renal Insufficiency Cohort) Study (45% women; mean age, 57.9 years; 41.0% non-Hispanic black; 51.9% with diabetes). PREDICTORS BTP and B2M levels with a reciprocal transformation to reflect their associations with filtration, creatinine-based estimated glomerular filtration rate (eGFRcr), measured GFR, and a 4-marker composite score combining BTP, B2M, creatinine, and cystatin C levels. Predictors were standardized as z scores for comparisons across filtration markers. OUTCOMES ESRD, all-cause mortality, and new-onset cardiovascular disease. RESULTS During a 6-year median follow-up, 755 (21%) participants developed ESRD, 653 died, and 292 developed new-onset cardiovascular disease. BTP, B2M, and the 4-marker composite score were independent predictors of ESRD and all-cause mortality, and B2M and the 4-marker composite score of cardiovascular events, after multivariable adjustment. These associations were stronger than those observed for eGFRcr (P vs eGFRcr≤0.02). The 4-marker composite score led to improvements in C statistic and 2.5-year risk reclassification beyond eGFRcr for all outcomes. LIMITATIONS Filtration markers measured at one time point; measured GFR available in subset of cohort. CONCLUSIONS BTP and B2M levels may contribute additional risk information beyond eGFRcr, and the use of multiple markers may improve risk prediction beyond this well-established marker of kidney function among persons with moderate CKD.
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Affiliation(s)
| | | | - Chi-Yuan Hsu
- University of California, San Francisco, San Francisco, CA
| | - Dawei Xie
- University of Pennsylvania, Philadelphia, PA
| | | | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | | | | | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Akinlolu O Ojo
- University of Michigan School of Medicine, Ann Arbor, MI
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Affiliation(s)
- John H. Eckfeldt
- Department of Laboratory Medicine and Pathology and the Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - W. Greg Miller
- W. Greg Miller, PhD, Department of Pathology, Virginia Commonwealth University, Richmond
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Shafi T, Michels WM, Levey AS, Inker LA, Dekker FW, Krediet RT, Hoekstra T, Schwartz GJ, Eckfeldt JH, Coresh J. Estimating residual kidney function in dialysis patients without urine collection. Kidney Int 2016; 89:1099-1110. [PMID: 26924062 DOI: 10.1016/j.kint.2015.10.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022]
Abstract
Residual kidney function contributes substantially to solute clearance in dialysis patients but cannot be assessed without urine collection. We used serum filtration markers to develop dialysis-specific equations to estimate urinary urea clearance without the need for urine collection. In our development cohort, we measured 24-hour urine clearances under close supervision in 44 patients and validated these equations in 826 patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. For the development and validation cohorts, median urinary urea clearance was 2.6 and 2.4 ml/min, respectively. During the 24-hour visit in the development cohort, serum β-trace protein concentrations remained in steady state but concentrations of all other markers increased. In the validation cohort, bias (median measured minus estimated clearance) was low for all equations. Precision was significantly better for β-trace protein and β2-microglobulin equations and the accuracy was significantly greater for β-trace protein, β2-microglobulin, and cystatin C equations, compared with the urea plus creatinine equation. Area under the receiver operator characteristic curve for detecting measured urinary urea clearance by equation-estimated urinary urea clearance (both 2 ml/min or more) were 0.821, 0.850, and 0.796 for β-trace protein, β2-microglobulin, and cystatin C equations, respectively; significantly greater than the 0.663 for the urea plus creatinine equation. Thus, residual renal function can be estimated in dialysis patients without urine collections.
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Affiliation(s)
- Tariq Shafi
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Wieneke M Michels
- Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Andrew S Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lesley A Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Friedo W Dekker
- Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raymond T Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Tiny Hoekstra
- Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - George J Schwartz
- Division of Nephrology, Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Departments of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Bis JC, Sitlani C, Irvin R, Avery CL, Smith AV, Sun F, Evans DS, Musani SK, Li X, Trompet S, Krijthe BP, Harris TB, Quibrera PM, Brody JA, Demissie S, Davis BR, Wiggins KL, Tranah GJ, Lange LA, Sotoodehnia N, Stott DJ, Franco OH, Launer LJ, Stürmer T, Taylor KD, Cupples LA, Eckfeldt JH, Smith NL, Liu Y, Wilson JG, Heckbert SR, Buckley BM, Ikram MA, Boerwinkle E, Chen YDI, de Craen AJM, Uitterlinden AG, Rotter JI, Ford I, Hofman A, Sattar N, Slagboom PE, Westendorp RGJ, Gudnason V, Vasan RS, Lumley T, Cummings SR, Taylor HA, Post W, Jukema JW, Stricker BH, Whitsel EA, Psaty BM, Arnett D. Drug-Gene Interactions of Antihypertensive Medications and Risk of Incident Cardiovascular Disease: A Pharmacogenomics Study from the CHARGE Consortium. PLoS One 2015; 10:e0140496. [PMID: 26516778 PMCID: PMC4627813 DOI: 10.1371/journal.pone.0140496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/25/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hypertension is a major risk factor for a spectrum of cardiovascular diseases (CVD), including myocardial infarction, sudden death, and stroke. In the US, over 65 million people have high blood pressure and a large proportion of these individuals are prescribed antihypertensive medications. Although large long-term clinical trials conducted in the last several decades have identified a number of effective antihypertensive treatments that reduce the risk of future clinical complications, responses to therapy and protection from cardiovascular events vary among individuals. METHODS Using a genome-wide association study among 21,267 participants with pharmaceutically treated hypertension, we explored the hypothesis that genetic variants might influence or modify the effectiveness of common antihypertensive therapies on the risk of major cardiovascular outcomes. The classes of drug treatments included angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, and diuretics. In the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, each study performed array-based genome-wide genotyping, imputed to HapMap Phase II reference panels, and used additive genetic models in proportional hazards or logistic regression models to evaluate drug-gene interactions for each of four therapeutic drug classes. We used meta-analysis to combine study-specific interaction estimates for approximately 2 million single nucleotide polymorphisms (SNPs) in a discovery analysis among 15,375 European Ancestry participants (3,527 CVD cases) with targeted follow-up in a case-only study of 1,751 European Ancestry GenHAT participants as well as among 4,141 African-Americans (1,267 CVD cases). RESULTS Although drug-SNP interactions were biologically plausible, exposures and outcomes were well measured, and power was sufficient to detect modest interactions, we did not identify any statistically significant interactions from the four antihypertensive therapy meta-analyses (Pinteraction > 5.0×10-8). Similarly, findings were null for meta-analyses restricted to 66 SNPs with significant main effects on coronary artery disease or blood pressure from large published genome-wide association studies (Pinteraction ≥ 0.01). Our results suggest that there are no major pharmacogenetic influences of common SNPs on the relationship between blood pressure medications and the risk of incident CVD.
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Affiliation(s)
- Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Colleen Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Ryan Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Christy L. Avery
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Albert Vernon Smith
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fangui Sun
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
| | - Solomon K. Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Xiaohui Li
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Bouwe P. Krijthe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, United States of America
| | - P. Miguel Quibrera
- Collaborative Studies Coordinating Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Barry R. Davis
- Department of Biostatistics, University of Texas School of Public Health, Houston, Texas, United States of America
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Gregory J. Tranah
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Leslie A. Lange
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, 27599, United States of America
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiology Division, University of Washington, Seattle, Washington, United States of America
| | - David J. Stott
- Institute of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- University of North Carolina—GSK Center of Excellence in Pharmacoepidemiology, Chapel Hill, North Carolina, United States of America
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- The Framingham Heart Study, Framingham, Massachusetts, United States of America
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Seattle Epidemiologic Research and Information Center of the Department of Veterans Affairs Office of Research and Development, Seattle, Washington, United States of America
- Group Health Research Institute, Group Health, Seattle, Washington, United States of America
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Group Health Research Institute, Group Health, Seattle, Washington, United States of America
| | - Brendan M. Buckley
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Boerwinkle
- Institute for Molecular Medicine, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Anton J. M. de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine, Glasgow, United Kingdom
| | - P. Eline Slagboom
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi G. J. Westendorp
- Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ramachandran S. Vasan
- The Framingham Heart Study, Framingham, Massachusetts, United States of America
- Boston University School of Medicine, Boston, Massachusetts, United States of America
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Steven R. Cummings
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
| | - Herman A. Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Wendy Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Inspectorate for Health Care, the Hague, The Netherlands
| | - Eric A. Whitsel
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina United States of America
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Health Services, University of Washington, Seattle, Washington, United States of America
- Group Health Research Institute, Group Health, Seattle, Washington, United States of America
- * E-mail:
| | - Donna Arnett
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Parrinello CM, Lutsey PL, Couper D, Eckfeldt JH, Steffes MW, Coresh J, Selvin E. Total Short-term Variability in Biomarkers of Hyperglycemia in Older Adults. Clin Chem 2015; 61:1540-1. [PMID: 26503966 DOI: 10.1373/clinchem.2015.246231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention Epidemiology and Clinical Research Johns Hopkins Bloomberg School of Public Health Baltimore, MD
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health University of Minnesota School of Public Health, Minneapolis, MN
| | - David Couper
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill, NC
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology University of Minnesota Minneapolis, MN
| | - Michael W Steffes
- Department of Laboratory Medicine and Pathology University of Minnesota Minneapolis, MN
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention Epidemiology and Clinical Research Johns Hopkins Bloomberg School of Public Health Baltimore, MD Division of General Internal Medicine Department of Medicine Johns Hopkins University Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention Epidemiology and Clinical Research Johns Hopkins Bloomberg School of Public Health Baltimore, MD Division of General Internal Medicine Department of Medicine Johns Hopkins University Baltimore, MD
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34
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Rebholz CM, Grams ME, Lutsey PL, Hoofnagle AN, Misialek JR, Inker LA, Levey AS, Selvin E, Hsu CY, Kimmel PL, Vasan RS, Eckfeldt JH, Coresh J. Biomarkers of Vitamin D Status and Risk of ESRD. Am J Kidney Dis 2015; 67:235-42. [PMID: 26475393 DOI: 10.1053/j.ajkd.2015.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 08/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Disordered mineral metabolism is characteristic of decreased kidney function. However, the prospective associations between circulating levels of vitamin D binding protein, vitamin D, and end-stage renal disease (ESRD) have not been extensively evaluated in epidemiologic studies. STUDY DESIGN Nested case-control study. SETTING & PARTICIPANTS Middle-aged black and white men and women from 4 US communities. PREDICTORS Baseline levels of vitamin D binding protein, 25-hydroxyvitamin D (25[OH]D), and 1,25-dihydroxyvitamin D (1,25[OH]2D) were measured in blood samples collected at study visit 4 (1996-1998) of the ARIC (Atherosclerosis Risk in Communities) Study. OUTCOME ESRD cases (n=184) were identified through hospitalization diagnostic codes from 1996 to 2008 and were frequency matched to controls (n=251) on categories of estimated glomerular filtration rate, albuminuria, diabetes mellitus, sex, and race. MEASUREMENTS Logistic regression was used to estimate the association between mineral metabolism biomarkers (vitamin D binding protein, 25(OH)D, and 1,25(OH)2D) and incident ESRD, adjusting for age, sex, race, estimated glomerular filtration rate, albuminuria, diabetes mellitus, hypertension, education, specimen type, and serum levels of calcium, phosphate, and parathyroid hormone. RESULTS Higher vitamin D binding protein levels were associated with elevated risk for incident ESRD (OR, 1.76; 95% CI, 1.22-2.54; P=0.003). Higher free and bioavailable 25(OH)D levels were associated with reduced risk for incident ESRD (ORs of 0.65 [95% CI, 0.46-0.92; P=0.02] and 0.63 [95% CI, 0.43-0.91; P=0.02] for free and bioavailable 25[OH]D, respectively). There was no association between ESRD and overall levels of 25(OH)D (OR, 0.83; 95% CI, 0.58-1.19; P=0.3) or 1,25(OH)2D (OR, 0.73; 95% CI, 0.48-1.13; P=0.2). LIMITATIONS Lack of direct measurement of free and bioavailable vitamin D. CONCLUSIONS In the general population, blood levels of vitamin D binding protein were positively associated and blood levels of free and bioavailable 25(OH)D were inversely associated with new-onset ESRD during follow-up.
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Affiliation(s)
- Casey M Rebholz
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Morgan E Grams
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Andrew S Levey
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA; Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Henderson CM, Lutsey PL, Misialek JR, Laha TJ, Selvin E, Eckfeldt JH, Hoofnagle AN. Measurement by a Novel LC-MS/MS Methodology Reveals Similar Serum Concentrations of Vitamin D-Binding Protein in Blacks and Whites. Clin Chem 2015; 62:179-87. [PMID: 26453697 DOI: 10.1373/clinchem.2015.244541] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Vitamin D deficiency is associated with poor bone health and other adverse health outcomes; however, the associations are greatly attenuated in black vs white individuals. One possible explanation for this attenuation is different concentrations of bioavailable vitamin D metabolites in plasma, which are estimated with equations that include the total concentration of vitamin D binding globulin (VDBG) and haplotype-specific dissociation constants. METHODS We developed a method to quantify VDBG with LC-MS/MS that could also identify the haplotypes/isoforms of VDBG present. We validated the method according to recent recommendations for publications of biomarker studies. We determined serum VDBG concentrations in samples from the Atherosclerosis Risk in Communities cohort and compared the results with a widely used monoclonal immunoassay. RESULTS With 10 μL of serum or plasma, the lower limit of quantification for the assay (<20% CV) was 71 μg/mL. The assay was linear from 62 to 434 μg/mL, with total imprecision of 7.3-9.0% CV at approximately 250 μg/mL. Significant hemolysis interfered with quantification. The identification of isoforms was 97% concordant with genotyping (κ coefficient). Method comparison with immunoassay revealed significant isoform-specific effects in the immunoassay. Mean concentrations (SD) of VDBG by mass spectrometry were similar in whites and blacks [262 (25) vs 266 (35) μg/mL, respectively; P = 0.43]. CONCLUSIONS Validated mass spectrometric methods for the quantification of proteins in human samples can provide additional information beyond immunoassay. Counter to prior observations by immunoassay, VDBG concentrations did not vary by race.
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Affiliation(s)
| | | | | | | | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Department of Medicine, University of Washington, Seattle, WA;
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Ricardo AC, Flessner MF, Eckfeldt JH, Eggers PW, Franceschini N, Go AS, Gotman NM, Kramer HJ, Kusek JW, Loehr LR, Melamed ML, Peralta CA, Raij L, Rosas SE, Talavera GA, Lash JP. Prevalence and Correlates of CKD in Hispanics/Latinos in the United States. Clin J Am Soc Nephrol 2015; 10:1757-66. [PMID: 26416946 DOI: 10.2215/cjn.02020215] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/13/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of ESRD among Hispanics/Latinos is 2-fold higher than in non-Hispanic whites. However, little is known about the prevalence of earlier stages of CKD among Hispanics/Latinos. This study estimated the prevalence of CKD in US Hispanics/Latinos. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional study of 15,161 US Hispanic/Latino adults of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds enrolled in the multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL). In addition, the prevalence of CKD in Hispanics/Latinos was compared with other racial/ethnic groups in the 2007-2010 National Health and Nutrition Examination Survey (NHANES). Prevalent CKD was defined as an eGFR <60 ml/min per 1.73 m(2) (estimated with the 2012 Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C equation) or albuminuria based on sex-specific cut points determined at a single point in time. RESULTS The overall prevalence of CKD among Hispanics/Latinos was 13.7%. Among women, the prevalence of CKD was 13.0%, and it was lowest in persons with South American background (7.4%) and highest (16.6%) in persons with Puerto Rican background. In men, the prevalence of CKD was 15.3%, and it was lowest (11.2%) in persons with South American background and highest in those who identified their Hispanic background as "other" (16.0%). The overall prevalence of CKD was similar in HCHS/SOL compared with non-Hispanic whites in NHANES. However, prevalence was higher in HCHS/SOL men and lower in HCHS/SOL women versus NHANES non-Hispanic whites. Low income, diabetes mellitus, hypertension, and cardiovascular disease were each significantly associated with higher risk of CKD. CONCLUSIONS Among US Hispanic/Latino adults, there was significant variation in CKD prevalence among Hispanic/Latino background groups, and CKD was associated with established cardiovascular risk factors.
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Affiliation(s)
- Ana C Ricardo
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Michael F Flessner
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - John H Eckfeldt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Paul W Eggers
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nora Franceschini
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alan S Go
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nathan M Gotman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Holly J Kramer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - John W Kusek
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Laura R Loehr
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michal L Melamed
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Carmen A Peralta
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Leopoldo Raij
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sylvia E Rosas
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Gregory A Talavera
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - James P Lash
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Levey AS, Eckfeldt JH. Using glomerular filtration rate estimating equations: clinical and laboratory considerations. Clin Chem 2015; 61:1226-9. [PMID: 26296582 DOI: 10.1373/clinchem.2015.245282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/03/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
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Shafi T, Levey AS, Inker LA, Schwartz GJ, Knight C, Abraham AG, Eckfeldt JH, Coresh J. Plasma Iohexol Clearance for Assessing Residual Kidney Function in Dialysis Patients. Am J Kidney Dis 2015. [PMID: 26209541 DOI: 10.1053/j.ajkd.2015.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tariq Shafi
- Johns Hopkins University, Baltimore, Maryland.
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Honig LS, Kang MS, Cheng R, Eckfeldt JH, Thyagarajan B, Leiendecker-Foster C, Province MA, Sanders JL, Perls T, Christensen K, Lee JH, Mayeux R, Schupf N. Heritability of telomere length in a study of long-lived families. Neurobiol Aging 2015; 36:2785-90. [PMID: 26239175 DOI: 10.1016/j.neurobiolaging.2015.06.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
Chromosomal telomere length shortens with repeated cell divisions. Human leukocyte DNA telomere length (LTL) has been shown to shorten during aging. LTL shortening has correlated with decreased longevity, dementia, and other age-associated processes. Because LTL varies widely between individuals in a given age group, it has been hypothesized to be a marker of biological aging. However, the principal basis for the variation of human LTL has not been established, although various studies have reported heritability. Here, we use a family-based study of longevity to study heritability of LTL in 3037 individuals. We show that LTL is shorter in older individuals, and in males, and has a high heritability (overall h(2) = 0.54). In the offspring generation, who are in middle-life, we find an ordinal relationship: persons more-closely-related to elderly probands have longer LTL than persons less-closely-related, who nonetheless have longer LTL than unrelated spouses of the offspring generation. These results support a prominent genetic underpinning of LTL. Elucidation of such genetic bases may provide avenues for intervening in the aging process.
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Affiliation(s)
- Lawrence S Honig
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Min Suk Kang
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Rong Cheng
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - John H Eckfeldt
- Department Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Bharat Thyagarajan
- Department Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | | | - Michael A Province
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason L Sanders
- Department of Epidemiology, Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas Perls
- Section of Geriatrics, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Kaare Christensen
- The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Joseph H Lee
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Medical Center, New York, NY, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
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Parrinello CM, Grams ME, Couper D, Ballantyne CM, Hoogeveen RC, Eckfeldt JH, Selvin E, Coresh J. Recalibration of blood analytes over 25 years in the atherosclerosis risk in communities study: impact of recalibration on chronic kidney disease prevalence and incidence. Clin Chem 2015; 61:938-47. [PMID: 25952043 DOI: 10.1373/clinchem.2015.238873] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Equivalence of laboratory tests over time is important for longitudinal studies. Even a small systematic difference (bias) can result in substantial misclassification. METHODS We selected 200 Atherosclerosis Risk in Communities Study participants attending all 5 study visits over 25 years. Eight analytes were remeasured in 2011-2013 from stored blood samples from multiple visits: creatinine, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and high-sensitivity C-reactive protein. Original values were recalibrated to remeasured values with Deming regression. Differences >10% were considered to reflect substantial bias, and correction equations were applied to affected analytes in the total study population. We examined trends in chronic kidney disease (CKD) pre- and postrecalibration. RESULTS Repeat measures were highly correlated with original values [Pearson r > 0.85 after removing outliers (median 4.5% of paired measurements)], but 2 of 8 analytes (creatinine and uric acid) had differences >10%. Original values of creatinine and uric acid were recalibrated to current values with correction equations. CKD prevalence differed substantially after recalibration of creatinine (visits 1, 2, 4, and 5 prerecalibration: 21.7%, 36.1%, 3.5%, and 29.4%, respectively; postrecalibration: 1.3%, 2.2%, 6.4%, and 29.4%). For HDL cholesterol, the current direct enzymatic method differed substantially from magnesium dextran precipitation used during visits 1-4. CONCLUSIONS Analytes remeasured in samples stored for approximately 25 years were highly correlated with original values, but 2 of the 8 analytes showed substantial bias at multiple visits. Laboratory recalibration improved reproducibility of test results across visits and resulted in substantial differences in CKD prevalence. We demonstrate the importance of consistent recalibration of laboratory assays in a cohort study.
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Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology and
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christie M Ballantyne
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ron C Hoogeveen
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD;
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Eckfeldt JH, Karger AB, Miller WG, Rynders GP, Inker LA. Performance in Measurement of Serum Cystatin C by Laboratories Participating in the College of American Pathologists 2014 CYS Survey. Arch Pathol Lab Med 2015; 139:888-93. [PMID: 25884370 DOI: 10.5858/arpa.2014-0427-cp] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Cystatin C is becoming an increasingly popular biomarker for estimating glomerular filtration rate, and accurate measurements of cystatin C concentrations are necessary for accurate estimates of glomerular filtration rate. OBJECTIVE To assess the accuracy of cystatin C concentration measurements in laboratories participating in the College of American Pathologists CYS Survey. DESIGN Two fresh frozen serum pools, the first from apparently healthy donors and the second from patients with chronic kidney disease, were prepared and distributed to laboratories participating in the CYS Survey along with the 2 usual processed human plasma samples. Target values were established for each pool by using 2 immunoassays and ERM DA471/IFCC international reference material. RESULTS For the normal fresh frozen pool (ERM-DA471/IFCC-traceable target of 0.960 mg/L), the all-method mean (SD, % coefficient of variation [CV]) reported by all of the 123 reporting laboratories was 0.894 mg/L (0.128 mg/L, 14.3%). For the chronic kidney disease pool (ERM-DA471/IFCC-traceable target of 2.37 mg/L), the all-method mean (SD, %CV) was 2.258 mg/L (0.288 mg/L, 12.8%). There were substantial method-specific biases (mean milligram per liter reported for the normal pool was 0.780 for Siemens, 0.870 for Gentian, 0.967 for Roche, 1.061 for Diazyme, and 0.970 for other/not specified reagents; and mean milligram per liter reported for the chronic kidney disease pool was 2.052 for Siemens, 2.312 for Gentian, 2.247 for Roche, 2.909 for Diazyme, and 2.413 for other/not specified reagents). CONCLUSIONS Manufacturers need to improve the accuracy of cystatin C measurement procedures if cystatin C is to achieve its full potential as a biomarker for estimating glomerular filtration rate.
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Affiliation(s)
| | | | | | | | - Lesley A Inker
- From the Department of Laboratory Medicine and Pathology (Drs Eckfeldt and Karger).,and the Advanced Research and Diagnostic Laboratory (Mr Rynders).,University of Minnesota, Minneapolis; the Department of Pathology, Virginia Commonwealth University, Richmond (Dr Miller);,and the Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (Dr Inker)
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Lutsey PL, Michos ED, Misialek JR, Pankow JS, Loehr L, Selvin E, Reis JP, Gross M, Eckfeldt JH, Folsom AR. Race and Vitamin D Binding Protein Gene Polymorphisms Modify the Association of 25-Hydroxyvitamin D and Incident Heart Failure: The ARIC (Atherosclerosis Risk in Communities) Study. JACC Heart Fail 2015; 3:347-356. [PMID: 25863973 DOI: 10.1016/j.jchf.2014.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to determine if low serum 25-hydroxyvitamin D (25[OH]D) is associated with incident heart failure (HF) and if the association is: 1) partly mediated by traditional cardiovascular risk factors; 2) stronger among whites than blacks; and 3) stronger among those genetically predisposed to having high levels of vitamin D binding protein (DBP). BACKGROUND Suboptimal 25(OH)D is a potential cardiovascular risk factor. METHODS A total of 12,215 ARIC (Atherosclerosis Risk in Communities) study participants free of HF at baseline (1990 to 1992; median age, 56; 24% black) were followed through 2010. Total serum 25(OH)D was measured at baseline using liquid chromatography-mass spectrometry. Incident HF events were identified by a hospital discharge code of ICD9-428 and parallel International Classification of Diseases codes for HF deaths. RESULTS During 21 years of follow-up, 1,799 incident HF events accrued. The association between 25(OH)D and HF varied by race (p-interaction = 0.02). Among whites, risk was 2-fold higher for those in the lowest (≤17 ng/ml) versus highest (≥31 ng/ml) quintile of 25(OH)D. The association was attenuated but remained significant with covariate adjustment. In blacks there was no overall association. In both races, those with low 25(OH)D and the rs7041 G allele, which predisposes to high DBP, were at greater risk (p-interaction = 0.01). CONCLUSIONS Low serum 25(OH)D was independently associated with incident HF among whites, but not among blacks. However, in both races, low 25(OH)D was associated with HF risk among those genetically predisposed to high DBP. These findings provide novel insight into metabolic differences that may underlie racial variation in the association between 25(OH)D and cardiovascular risk.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Laura Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Selvin
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Myron Gross
- Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - John H Eckfeldt
- Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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Foster MC, Inker LA, Hsu CY, Eckfeldt JH, Levey AS, Pavkov ME, Myers BD, Bennett PH, Kimmel PL, Vasan RS, Coresh J, Nelson RG. Filtration markers as predictors of ESRD and mortality in Southwestern American Indians with type 2 diabetes. Am J Kidney Dis 2015; 66:75-83. [PMID: 25773485 DOI: 10.1053/j.ajkd.2015.01.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/08/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND A growing number of serum filtration markers are associated with mortality and end-stage renal disease (ESRD) in adults. Whether β-trace protein (BTP) and β2-microglobulin (B2M) are associated with these outcomes in adults with type 2 diabetes is not known. STUDY DESIGN Longitudinal cohort study. SETTING & PARTICIPANTS 250 Pima Indians with type 2 diabetes (69% women; mean age, 42 years; mean diabetes duration, 11 years). PREDICTORS Serum BTP, B2M, and glomerular filtration rate measured by iothalamate clearance (mGFR) or estimated using creatinine (eGFRcr) or cystatin C level (eGFRcys). OUTCOMES & MEASUREMENTS Incident ESRD and all-cause mortality through December 2013. HRs were reported per interquartile range decrease of the inverse of BTP and B2M (1/BTP and 1/B2M) using Cox regression. Improvement in risk prediction with the addition of BTP or B2M level to established markers (eGFRcys with mGFR or eGFRcr) was evaluated using C statistics, continuous net reclassification improvement, and relative integrated discrimination improvement (RIDI). RESULTS During a median follow-up of 14 years, 69 participants developed ESRD and 95 died. Both novel markers were associated with ESRD in multivariable models. BTP level remained statistically significant after further adjustment for mGFR (1/BTP, 1.53 [95% CI, 1.01-2.30]; 1/B2M, 1.54 [95% CI, 0.98-2.42]). B2M level was associated with mortality in multivariable models and after further adjustment for mGFR (HR, 2.12; 95% CI, 1.38-3.26). The addition of B2M level to established markers increased the C statistic for mortality but only weakly when assessed by either continuous net reclassification improvement or RIDI; none was improved for ESRD by the addition of these markers. LIMITATIONS Small sample size, single measurements of markers. CONCLUSIONS In Pima Indians with type 2 diabetes, BTP and, to a lesser extent, B2M levels were associated with ESRD. B2M level was associated with mortality after adjustment for traditional risk factors and established filtration markers. Further studies are warranted to confirm whether inclusion of B2M level in a multimarker approach leads to improved risk prediction for mortality in this population.
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Affiliation(s)
| | | | - Chi-Yuan Hsu
- University of California, San Francisco, San Francisco, CA
| | | | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Peter H Bennett
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
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Hsu CY, Ballard S, Batlle D, Bonventre JV, Böttinger EP, Feldman HI, Klein JB, Coresh J, Eckfeldt JH, Inker LA, Kimmel PL, Kusek JW, Liu KD, Mauer M, Mifflin TE, Molitch ME, Nelsestuen GL, Rebholz CM, Rovin BH, Sabbisetti VS, Van Eyk JE, Vasan RS, Waikar SS, Whitehead KM, Nelson RG. Cross-Disciplinary Biomarkers Research: Lessons Learned by the CKD Biomarkers Consortium. Clin J Am Soc Nephrol 2015; 10:894-902. [PMID: 25739849 DOI: 10.2215/cjn.11541114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Significant advances are needed to improve the diagnosis, prognosis, and management of persons with CKD. Discovery of new biomarkers and improvements in currently available biomarkers for CKD hold great promise to achieve these necessary advances. Interest in identification and evaluation of biomarkers for CKD has increased substantially over the past decade. In 2009, the National Institute of Diabetes and Digestive and Kidney Diseases established the CKD Biomarkers Consortium (http://www.ckdbiomarkersconsortium.org/), a multidisciplinary, collaborative study group located at over a dozen academic medical centers. The main objective of the consortium was to evaluate new biomarkers for purposes related to CKD in established prospective cohorts, including those enriched for CKD. During the first 5 years of the consortium, many insights into collaborative biomarker research were gained that may be useful to other investigators involved in biomarkers research. These lessons learned are outlined in this Special Feature and include a wide range of issues related to biospecimen collection, storage, and retrieval, and the internal and external quality assessment of laboratories that performed the assays. The authors propose that investigations involving biomarker discovery and validation are greatly enhanced by establishing and following explicit quality control metrics, including the use of blind replicate and proficiency samples, by carefully considering the conditions under which specimens are collected, handled, and stored, and by conducting pilot and feasibility studies when there are concerns about the condition of the specimens or the accuracy or reproducibility of the assays.
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Affiliation(s)
- Chi-Yuan Hsu
- University of California-San Francisco, San Francisco, California
| | - Shawn Ballard
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel Batlle
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Harold I Feldman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jon B Klein
- University of Louisville, Louisville, Kentucky
| | | | | | | | - Paul L Kimmel
- National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - John W Kusek
- National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Kathleen D Liu
- University of California-San Francisco, San Francisco, California
| | | | - Theodore E Mifflin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mark E Molitch
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | - Jennifer E Van Eyk
- Johns Hopkins University, Baltimore, Maryland; Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Krista M Whitehead
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert G Nelson
- National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
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Lutsey PL, Eckfeldt JH, Ogagarue ER, Folsom AR, Michos ED, Gross M. The 25-hydroxyvitamin D3 C-3 epimer: distribution, correlates, and reclassification of 25-hydroxyvitamin D status in the population-based Atherosclerosis Risk in Communities Study (ARIC). Clin Chim Acta 2015; 442:75-81. [PMID: 25578393 DOI: 10.1016/j.cca.2014.12.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is known about the vitamin D3 epimer [3-epi-25(OH)D3], particularly in adults. We describe characteristics of the D3 epimer within the community-based ARIC cohort. METHODS The vitamin D3 epimer, 25(OH)D3, and 25(OH)D2 were measured using LC-MS/MS in stored serum collected in 1990-1992 from 9,887 white and 3,221 black ARIC study participants, aged 46-70years. Cross-sectional characteristics were explored. RESULTS Concentrations of the epimer were quantifiable (≥1.41ng/ml) in 33.4% of whites and 15.0% of blacks and made up on average 3.23% and 2.25% of total D3 [epimer+25(OH)D3] concentrations, respectively. Epimer levels were positively correlated with 25(OH)D3 in both whites (r=0.54) and blacks (r=0.36) and were unrelated to 25(OH)D2 concentrations. Overall, epimer levels were associated with participant characteristics in a manner similar to that typically observed for 25(OH)D3. Including the epimer in the calculation of total 25(OH)D resulted in approximately 2% of participants being reclassified from being clinically 25(OH)D deficient to having suboptimal levels. CONCLUSIONS Low concentrations of the D3 epimer were present in adult serum and overall the epimer concentration is moderately correlated with the 25(OH)D3 concentration. The reclassification of participant's clinical 25(OH)D status upon inclusion of the epimer was minimal.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, 1300 So 2nd Street, Suite 300, Minneapolis, MN, United States.
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
| | - Ejovwoke R Ogagarue
- Department of Urology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, 1300 So 2nd Street, Suite 300, Minneapolis, MN, United States
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
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Alonso A, Misialek JR, Eckfeldt JH, Selvin E, Coresh J, Chen LY, Soliman EZ, Agarwal SK, Lutsey PL. Circulating fibroblast growth factor-23 and the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities study. J Am Heart Assoc 2014; 3:e001082. [PMID: 25237047 PMCID: PMC4323781 DOI: 10.1161/jaha.114.001082] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Increased concentrations of circulating fibroblast growth factor 23 (FGF‐23) have been associated with higher risk of cardiovascular disease. The association between FGF‐23 and the risk of atrial fibrillation (AF), a common arrhythmia, is less defined. Thus, we explored whether FGF‐23 concentration was associated with AF incidence in a large community‐based cohort. Methods and Results We studied 12 349 men and women enrolled in the Atherosclerosis Risk in Communities (ARIC) study, without prevalent AF at baseline in 1990–1992. Serum intact FGF‐23 concentration was measured with the Kainos 2‐site ELISA. Incident AF through 2010 was ascertained from study ECGs and hospital discharge codes. Cox proportional hazards models adjusted for potential confounding factors, including kidney function, were used to estimate the association between FGF‐23 and AF risk. We identified 1572 AF events during a mean follow‐up of 17 years. In multivariable analysis, a difference of 1 SD (16 pg/mL) in baseline FGF‐23 was not associated with the risk of AF (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.99, 1.09). Results were similar when FGF‐23 was modeled in quartiles (HR, 1.09; 95% CI, 0.94, 1.26, comparing extreme quartiles). Reduced kidney function was associated with increased AF risk across quartiles of FGF‐23 levels. Conclusion In this large community‐based cohort, baseline FGF‐23 levels were not associated with AF risk independently of kidney function. Our results do not support a major role for FGF‐23 as a risk factor for AF or as a mediator of the association between chronic kidney disease and AF.
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Affiliation(s)
- Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (A.A., J.R.M., P.L.L.)
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (A.A., J.R.M., P.L.L.)
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN (J.H.E.)
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., J.C., S.K.A.)
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., J.C., S.K.A.)
| | - Lin Y Chen
- Division of Cardiovascular Sciences, University of Minnesota Medical School, Minneapolis, MN (L.Y.C.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.)
| | - Sunil K Agarwal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., J.C., S.K.A.)
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (A.A., J.R.M., P.L.L.)
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48
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Do AN, Irvin MR, Lynch AI, Claas SA, Boerwinkle E, Davis BR, Ford CE, Eckfeldt JH, Tiwari HK, Limdi NA, Arnett DK. The effects of angiotensinogen gene polymorphisms on cardiovascular disease outcomes during antihypertensive treatment in the GenHAT study. Front Pharmacol 2014; 5:210. [PMID: 25278896 PMCID: PMC4165277 DOI: 10.3389/fphar.2014.00210] [Citation(s) in RCA: 7] [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: 04/30/2014] [Accepted: 08/27/2014] [Indexed: 11/18/2022] Open
Abstract
Previous studies have reported that risk of cardiovascular morbidity and mortality substantially increases in hypertensive patients, especially among those with inadequate blood pressure control. Two common antihypertensive drug classes including thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors affect different enzymes in the renin-angiotensin-aldosterone system (RAAS). In the RAAS, angiotensinogen is converted into angiotensin II which increases blood pressure through vasoconstriction. Using a case-only design with 3448 high-risk hypertensive individuals from the Genetics of Hypertension Associated Treatment (GenHAT) study, we examined whether seven single nucleotide polymorphisms (SNPs) in the angiotensinogen gene (AGT) interact with three classes of antihypertensive drugs including chlorthalidone (a thiazide diuretic), lisinopril (an ACE inhibitor), and amlodipine (a calcium channel blocker) to modify the risk of incident coronary heart disease (CHD) and heart failure (HF) among Caucasian and African American participants, separately. We found no gene by treatment interactions to be statistically significant after correction for multiple testing. However, some suggestive results were found. African American participants with the minor allele of rs11122576 had over two-fold higher risk of CHD when using chlorthalidone compared to using amlodipine, or lisinopril compared to amlodipine (p = 0.006 and p = 0.01, respectively). Other marginal associations are also reported among both race groups. The findings reported here suggest that rs11122576 could contribute to future personalization of antihypertensive treatment among African Americans though more studies are needed.
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Affiliation(s)
- Anh N Do
- Department of Epidemiology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Amy I Lynch
- Department of Epidemiology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Steven A Claas
- Department of Epidemiology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Eric Boerwinkle
- Division of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston Houston, TX, USA
| | - Barry R Davis
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston Houston, TX, USA
| | - Charles E Ford
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston Houston, TX, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota Minneapolis, MN, USA
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham Birmingham, AL, USA
| | - Nita A Limdi
- Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Donna K Arnett
- Department of Epidemiology, University of Alabama at Birmingham Birmingham, AL, USA
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49
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Folsom AR, Alonso A, Misialek JR, Michos ED, Selvin E, Eckfeldt JH, Coresh J, Pankow JS, Lutsey PL. Parathyroid hormone concentration and risk of cardiovascular diseases: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2014; 168:296-302. [PMID: 25173540 DOI: 10.1016/j.ahj.2014.04.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND According to a recent meta-analysis, parathyroid hormone (PTH) excess is associated with increased cardiovascular disease (CVD) risk, but existing studies are limited. We examined in a prospective study the association of PTH with the incidence of CVD, taking into account vitamin D and other confounding variables. METHODS The ARIC study measured PTH using a second-generation assay (Roche, Indianapolis, IN) in stored serum samples from 1990 to 1992 and related levels in 10,392 adults to incident cardiovascular outcomes (coronary heart disease [n = 808], heart failure [n = 1,294], stroke [n = 586], peripheral artery disease [n = 873], atrial fibrillation [n = 1,190], and CVD mortality [n = 647]) through 2010 (median follow-up 19 years). RESULTS Contrary to the hypothesis, PTH level was not associated positively with any CVD outcome. The associations of incident heart failure, peripheral artery disease, and CVD mortality with PTH actually were weakly inverse (P trend = .02-.04) in the most fully adjusted models. For example, the hazard ratios across PTH quartiles were 1.00, 1.07, 1.07, and 0.96 (P trend = .74) for coronary heart disease incidence and were 1.00, 0.69, 0.74, and 0.74 (P trend = .02) for CVD mortality. Patterns were similar when restricted to participants with normal baseline kidney function. CONCLUSIONS This large prospective study failed to support the hypothesis that elevated PTH is an independent risk marker for incident CVD. When our data were added to the previous meta-analysis, the pooled hazard ratio remained statistically significant but weakened.
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50
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Rebholz CM, Grams ME, Coresh J, Selvin E, Inker LA, Levey AS, Kimmel PL, Vasan RS, Eckfeldt JH, Feldman HI, Hsu CY, Lutsey PL. Serum fibroblast growth factor-23 is associated with incident kidney disease. J Am Soc Nephrol 2014; 26:192-200. [PMID: 25060052 DOI: 10.1681/asn.2014020218] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Fibroblast growth factor-23 is a bone-derived hormone that increases urinary phosphate excretion and inhibits hydroxylation of 25-hydroxyvitamin D. Recent studies suggest that fibroblast growth factor-23 may be an early biomarker of CKD progression. However, its role in kidney function decline in the general population is unknown. We assessed the relationship between baseline (1990-1992) serum levels of intact fibroblast growth factor-23 and incident ESRD in 13,448 Atherosclerosis Risk in Communities study participants (56.1% women, 74.7% white) followed until December 31, 2010. At baseline, the mean age of participants was 56.9 years and the mean eGFR was 97 ml/min per 1.73 m(2). During a median follow-up of 19 years, 267 participants (2.0%) developed ESRD. After adjustment for demographic characteristics, baseline eGFR, traditional CKD risk factors, and markers of mineral metabolism, the highest fibroblast growth factor-23 quintile (>54.6 pg/ml) compared with the lowest quintile (<32.0 pg/ml) was associated with risk of developing ESRD (hazard ratio, 2.10; 95% confidence interval, 1.31 to 3.36; trend P<0.001). In a large, community-based study comprising a broad range of kidney function, higher baseline fibroblast growth factor-23 levels were associated with increased risk of incident ESRD independent of the baseline level of kidney function and a number of other risk factors.
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Affiliation(s)
- Casey M Rebholz
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
| | - Morgan E Grams
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Divisions of Nephrology and
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Andrew S Levey
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ramachandran S Vasan
- Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Harold I Feldman
- Departments of Biostatistics and Epidemiology, and Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; and
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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