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Zhu G, Xiong S, Malhotra R, Chen X, Gong E, Wang Z, Østbye T, Yan LL. Individual perceptions of community efficacy for non-communicable disease management in twelve communities in China: cross-sectional and longitudinal analyses. Public Health 2024; 226:207-214. [PMID: 38086102 DOI: 10.1016/j.puhe.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/08/2023] [Accepted: 11/06/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES This objective of this study was to use empirical data to assess cross-sectional variation singular and changes over time in community efficacy for non-communicable diseases (NCDs) management (COEN) and to examine individual factors associated with changes in COEN. STUDY DESIGN This was a longitudinal observational study. METHODS Participants with hypertension and diabetes were randomly selected from 12 communities from three cities in eastern China, and a baseline survey and a 1-year follow-up were conducted. The COEN scale has five dimensions: community physical environment (CPE), behavioral risk factors (BRF), mental health and social relationships (MHSR), community health management (CHM), and community organisations and activities (COA). Mixed-effects models were used to investigate the change in COEN over time and the association between individual factors and changes in COEN. RESULTS COEN scores showed significant variation singular among the 12 communities (P < 0.001) at the baseline. In the mixed-effects model, CPE (β coefficient: 1.62, P < 0.001), BRF (0.90, P < 0.001), MHSR (0.86, P < 0.001), CHM (0.46, P < 0.001), and total scores (β = 3.57, P < 0.001) increased significantly over time. The changes in COEN were associated with individual characteristics (e.g., older, men, more educated). CONCLUSIONS Cross-sectional variations and changes over time in COEN demonstrated the utility of a sensitive instrument. Factors such as age, gender, marriage, education level, and employment may affect the financial and social resources assignment for NCD management. Our findings suggest that further high-quality studies are needed to better evaluate the effect of community empowerment on the prevention and control of NCDs.
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Affiliation(s)
- G Zhu
- School of Public Health, Wuhan University, Wuhan, Hubei, China; Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - S Xiong
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - R Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore; SingHealth, Duke-NUS Global Health Institute Medical School, Singapore
| | - X Chen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - E Gong
- School of Population Medicine and Public Health, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Z Wang
- Department of Agricultural Economics, College of Agriculture, Purdue University, West Lafayette, USA
| | - T Østbye
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Health Services and Systems Research, Duke-NUS Medical School, Singapore; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - L L Yan
- School of Public Health, Wuhan University, Wuhan, Hubei, China; Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute, Duke University, Durham, NC, USA.
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Hardy TA, Aouad P, Barnett MH, Blum S, Broadley S, Carroll WM, Crimmins D, Griffiths D, Hodgkinson S, Lechner-Scott J, Lee A, Malhotra R, McCombe P, Parratt J, Plummer C, Van der Walt A, Martel K, Walker RA. Onboarding of siponimod in secondary progressive multiple sclerosis patients in Australia: Novel, real-world evidence from the MSGo digital support programme. Mult Scler J Exp Transl Clin 2024; 10:20552173231226106. [PMID: 38222025 PMCID: PMC10787529 DOI: 10.1177/20552173231226106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Siponimod is approved for use in people with secondary progressive multiple sclerosis (pwSPMS). An integrated digital platform, MSGo, was developed for pwSPMS and clinicians to help navigate the multiple steps of the pre-siponimod work-up. Objective To explore real-world onboarding experiences of siponimod amongst pwSPMS in Australia. Methods Retrospective, non-interventional, longitudinal, secondary analysis of data extracted from MSGo (20 April 2022). The primary endpoint was the average time for siponimod onboarding; secondary endpoints were adherence and sub-group analyses of variables influencing onboarding. Results Mixed-cure modelling estimated that 58% of participants (N = 368, females 71%, median age of 59 years) registered in MSGo would ever initiate siponimod. The median time to initiation was 56 days (95% CI [47-59] days). Half of the participants cited 'waiting for vaccination' as the reason for initiation delay. Cox regression analyses found participants with a nominated care partner had faster onboarding (HR 2.1, 95% CI [1.5-3.0]) and were more likely to continue self-reporting daily siponimod dosing than were those without a care partner (HR 2.2, 95% CI [1.3-3.7]). Conclusions Despite the limitations of self-reported data and the challenges of the COVID-19 pandemic, this study provides insights into siponimod onboarding in Australia and demonstrates the positive impact of care partner support.
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Affiliation(s)
- TA Hardy
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P Aouad
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - MH Barnett
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Blum
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Broadley
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - WM Carroll
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Crimmins
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Griffiths
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Hodgkinson
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Lechner-Scott
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Lee
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - R Malhotra
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P McCombe
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Parratt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - C Plummer
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Van der Walt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - K Martel
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - RA Walker
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
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Cahyanto A, Rath P, Teo TX, Tong SS, Malhotra R, Cavalcanti BN, Lim LZ, Min KS, Ho D, Lu WF, Rosa V. Designing Calcium Silicate Cements with On-Demand Properties for Precision Endodontics. J Dent Res 2023; 102:1425-1433. [PMID: 37861249 DOI: 10.1177/00220345231198185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Calcium silicate (C3S) cements are available in kits that do not account for patients' specific needs or clinicians' preferences regarding setting time, radiopacity, mechanical, and handling properties. Moreover, slight variations in powder components and liquid content affect cement's properties and bioactivity. Unfortunately, it is virtually impossible to optimize several cement properties simultaneously via the traditional "one variable at a time" strategy, as inputs often induce trade-offs in properties (e.g., a higher water-to-powder ratio [W/P] increases flowability but decreases mechanical properties). Herein, we used Taguchi's methods and genetic algorithms (GAs) to simultaneously analyze the effect of multiple inputs (e.g., powder composition, radiopacifier concentration, and W/P) on setting time, pH, flowability, diametral tensile strength, and radiopacity, as well as prescribe recipes to produce cements with predicted properties. The properties of cements designed with GAs were experimentally tested, and the results matched the predictions. Finally, we show that the cements increased the genetic expression of odonto/osteogenic genes, alkaline phosphatase activity, and mineralization potential of dental pulp stem cells. Hence, GAs can produce cements with tailor-made properties and differentiation potential for personalized endodontic treatment.
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Affiliation(s)
- A Cahyanto
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
- Department of Dental Materials Science and Technology, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
| | - P Rath
- Faculty of Dentistry, National University of Singapore, Singapore
| | - T X Teo
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - S S Tong
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - R Malhotra
- Faculty of Dentistry, National University of Singapore, Singapore
| | - B N Cavalcanti
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - L Z Lim
- Faculty of Dentistry, National University of Singapore, Singapore
| | - K S Min
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea
| | - D Ho
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore
| | - W F Lu
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - V Rosa
- Faculty of Dentistry, National University of Singapore, Singapore
- ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore
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Ullrich K, Patel BCK, Malhotra R. Material risk: vitreoretinal surgery, evisceration, enucleation and sympathetic ophthalmia-where are we currently? Eye (Lond) 2023; 37:3542-3550. [PMID: 37198435 PMCID: PMC10686393 DOI: 10.1038/s41433-023-02562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
Sympathetic ophthalmia (SO) is known to occur after severe penetrating eye injury, evisceration and even enucleation surgery. Recent evidence suggests that a greater risk lies after multiple vitreoretinal procedures. The risk of SO following evisceration is only minimally greater than that following enucleation surgery. This review evaluates literature on SO to date and provides figures for the risk of developing SO for the purposes of the consent process. The issue of SO and Material Risk following vitreoretinal surgery is reviewed and figures for the purposes of consent are outlined. This is of particular relevance for patients in whom the contralateral eye is and will likely remain the better seeing eye. Sympathetic ophthalmitis is known to occur after severe penetrating eye injury, after evisceration and enucleation. More recently, sympathetic ophthalmitis has been recognised to occur after vitreoretinal surgery. This article reviews the evidence on material risk when consenting patients for elective and emergency eye procedures after ocular trauma or surgery. When a globe needs to be removed because of irreparable ocular injury, previous publications dictated the procedure to be an enucleation because of the fear of an increased risk of SO after an evisceration. Perhaps the issue of material risk of sympathetic ophthalmia (SO) remains over-emphasised by ophthalmic plastic surgeons and under-recognised by vitreoretinal surgeons during the consent process for evisceration, enucleation and vitreoretinal surgery. Antecedent trauma and number of previous surgeries may actually be a more significant risk factor than the type of eye removal. Recent medicolegal cases also help us understand the importance of the discussion of this risk. We present our current understanding of the risk of SO after different procedures and suggest how this information may be included in a patient consent.
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Affiliation(s)
- K Ullrich
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, UK.
- Department of Ophthalmology, Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, Australia.
| | - B C K Patel
- Department of Ophthalmology, Division of Ophthalmic Plastic and Reconstructive Surgery, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, UK
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Kumar M, Vohra V, Ratwan P, Gowane GR, Malhotra R. Sustainable multi-trait selection index based on production, reproduction, and health traits for genetic improvement of Murrah buffaloes. Anim Biotechnol 2023; 34:2505-2513. [PMID: 35875885 DOI: 10.1080/10495398.2022.2101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Selection of Murrah buffaloes based on production, reproduction, and health traits play an important role in sustainable genetic improvement. With the aim to construct an index comprising of production, reproduction and health traits of Murrah buffaloes, the production and reproduction data during a 50-year span (1971-2020) and for health traits data of 27 years (1994-2020) were analyzed. Various three, four, five, and six trait combinations of production, reproduction, and health traits were explored for construction of performance indices. The income and expenditure method was used to calculate relative economic values (REV) for traits under consideration. A total of 37 performance indices were constructed using a multi-trait combination of production, reproduction, and health traits. Out of 37 indices, the (ADMY-PY-DO-AFC-FF) based index was identified as the best, with 78%, 2%, and 20% weightage given to production, reproduction, and female fertility, respectively. Furthermore, when REVs of traits were increased by 25% and 50%, there was no change observed in the relative importance of traits in the best index, indicating that the index was robust to substantial increases in economic values. Therefore, it is recommended that the above constructed composite selection index can be employed in selection of female buffaloes to achieve sustainable genetic gain.
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Affiliation(s)
- Manoj Kumar
- Department of Livestock Farm Complex, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - Vikas Vohra
- Animal Genetic & Breeding Division, ICAR-National Dairy Research Institute, Karnal, Haryana, India
| | - Poonam Ratwan
- Department of Animal Genetics & Breeding, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - Gopal R Gowane
- Animal Genetic & Breeding Division, ICAR-National Dairy Research Institute, Karnal, Haryana, India
| | - R Malhotra
- Division of Dairy Economics, Statistics and Management, ICAR-National Dairy Research Institute, Karnal, Haryana, India
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Malhotra R, Rahimi S, Agarwal U, Katz R, Kumar U, Garimella PS, Gupta V, Chopra T, Kotanko P, Ikizler TA, Larsen B, Cadmus-Bertram L, Ix JH. The Impact of a Wearable Activity Tracker and Structured Feedback Program on Physical Activity in Hemodialysis Patients: The Step4Life Pilot Randomized Controlled Trial. Am J Kidney Dis 2023; 82:75-83. [PMID: 36801430 PMCID: PMC10962931 DOI: 10.1053/j.ajkd.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 12/18/2022] [Indexed: 02/19/2023]
Abstract
RATIONALE & OBJECTIVE People with end-stage kidney disease (ESKD) have very low physical activity, and the degree of inactivity is strongly associated with morbidity and mortality. We assessed the feasibility and effectiveness of a 12-week intervention coupling a wearable activity tracker (FitBit) and structured feedback coaching versus wearable activity tracker alone on changes in physical activity in hemodialysis patients. STUDY DESIGN Randomized controlled trial. SETTING & PARTICIPANTS 55 participants with ESKD receiving hemodialysis who were able to walk with or without assistive devices recruited from a single academic hemodialysis unit between January 2019 and April 2020. INTERVENTIONS All participants wore a Fitbit Charge 2 tracker for a minimum of 12 weeks. Participants were randomly assigned 1:1 to a wearable activity tracker plus a structured feedback intervention versus the wearable activity tracker alone. The structured feedback group was counseled weekly on steps achieved after randomization. OUTCOME The outcome was step count, and the main parameter of interest was the absolute change in daily step count, averaged per week, from baseline to completion of 12 weeks intervention. In the intention-to-treat analysis, mixed-effect linear regression analysis was used to evaluate change in daily step count from baseline to 12-weeks in both arms. RESULTS Out of 55 participants, 46 participants completed the 12-week intervention (23 per arm). The mean age was 62 (± 14 SD) years; 44% were Black, and 36% were Hispanic. At baseline, step count (structured feedback intervention: 3,704 [1,594] vs wearable activity tracker alone: 3,808 [1,890]) and other participant characteristics were balanced between the arms. We observed a larger change in daily step count in the structured feedback arm at 12 weeks relative to use of the wearable activity tracker alone arm (Δ 920 [±580 SD] versus Δ 281 [±186 SD] steps; between-group difference Δ 639 [±538 SD] steps; P<0.05). LIMITATIONS Single-center study and small sample size. CONCLUSION This pilot randomized controlled trial demonstrated that structured feedback coupled with a wearable activity tracker led to a greater daily step count that was sustained over 12 weeks relative to a wearable activity tracker alone. Future studies are required to determine longer-term sustainability of the intervention and potential health benefits in hemodialysis patients. FUNDING Grants from industry (Satellite Healthcare) and government (National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT05241171.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California.
| | - Sina Rahimi
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Ushma Agarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Ujjala Kumar
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Vineet Gupta
- Division of Hospital Medicine, Department of Medicine, University of California-San Diego, San Diego, California
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Peter Kotanko
- Renal Research Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - T Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California-San Diego, San Diego, California
| | | | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California; Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, California
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Claure-Del Granado R, Prudencio-Ribera VC, Gupta V, Yang J, Kashani K, Malhotra R. Bicarbonate-Based Solution for the Management of Established Acute Kidney Injury: A Pilot Open-Label Observation Study. Cureus 2023; 15:e42127. [PMID: 37476296 PMCID: PMC10355685 DOI: 10.7759/cureus.42127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
Background Administration of intravenous (IV) solutions constitutes a key component of acute kidney injury (AKI) management. However, the optimal IV fluid solution in the setting of AKI remains uncertain. In this study, we assessed whether the use of bicarbonate-containing solution in patients with established AKI is associated with early renal recovery as compared to bicarbonate-free solutions. Methods We performed an open-label observational pilot study in 59 patients with established AKI. IV fluid solutions that were used include bicarbonate-based solution with low chloride content (80 mEq/L of 8% sodium bicarbonate in a solution that contains 77 mEq/L of sodium, 77 mEq/L of chloride and 25 g/L of glucose) or solutions without bicarbonate with high chloride content (0.9% normal saline, 0.45% half-saline, normal ringer, or 4% succinylated gelatine). We evaluated the association of IV fluids type with renal recovery. Results The median age of study participants was 66 years (inter-quartile range (IQR) 37-85), and 59% (n=35) were men. The prevalence of diabetes and chronic kidney disease (CKD) stages 1-3 were 34% (n=20) and 39% (n=23), respectively. Patients who received bicarbonate-based IV solutions had a greater reduction of serum creatinine (sCr) per day (delta sCr) as compared with patients who received bicarbonate-free solutions (-0.29±0.47 vs. 0.07±0.42; p=0.007). The renal recovery was faster in patients who received bicarbonate-based solutions as compared to the bicarbonate-free group (days from peak sCr to baseline sCr: 5.6±2.1 vs. 7.6±2.8; p < 0.001, respectively). Conclusions We observed faster renal recovery in patients with established AKI who received the bicarbonate-based solution with low chloride content. Our study findings require confirmation in larger cohorts.
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Affiliation(s)
- Rolando Claure-Del Granado
- Division of Nephrology, Department of Medicine, Hospital Obrero No. 2 - Caja Nacional de Salud (CNS) Universidad Mayor de San Simon, Cochabamba, BOL
| | | | - Vineet Gupta
- Medicine/Hospital Medicine, University of California San Diego School of Medicine, San Diego, USA
| | - Jason Yang
- Medicine, University of California San Diego School of Medicine, San Diego, USA
| | - Kianoush Kashani
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
- Nephrology and Hypertension, Mayo Clinic, Rochester, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego School of Medicine, San Diego, USA
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Bonde SS, Zaman W, Cuomo R, Malhotra R, Macedo E. Risk of de novo proteinuria following hospitalization with acute kidney injury. BMC Nephrol 2023; 24:176. [PMID: 37322414 PMCID: PMC10273748 DOI: 10.1186/s12882-023-03209-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/21/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Acute Kidney Injury (AKI) incidence has continued to rise and is recognized as a major risk factor for kidney disease progression and cardiovascular complications. Early recognition of factors associated with post-AKI complications is fundamental to stratifying patients that could benefit from closer follow-up and management after an episode of AKI. Recent studies have shown that proteinuria is a prevalent sequela after AKI and a strong predictor of complications post-AKI. This study aims to evaluate the frequency and timing of the development of de-novo proteinuria after an AKI episode in patients with known kidney function and no prior history of proteinuria. METHODS We retrospectively analyzed data from adult AKI patients with pre- and post-kidney function information between Jan 2014 and March 2019. The presence of proteinuria determined before and after index AKI encounter was based on ICD-10 code and/or urine dipstick and UPCR during the follow-up period. RESULTS Of 9697 admissions with AKI diagnoses between Jan 2014 and March 2019, 2120 eligible patients with at least one assessment of Scr and proteinuria before AKI index admission were included in the analysis. The median age was 64 (IQR 54-75) years, and 57% were male. 58% (n-1712) patients had stage 1 AKI, 19% (n = 567) stage 2 AKI, and 22% (n = 650) developed stage 3 AKI. De novo proteinúria was found in 62% (n = 472) of patients and was already present by 90 days post-AKI in 59% (209/354). After adjusting for age and comorbidities, severe AKI (stage 2/3 AKI) and diabetes, were independently associated with increased risk for De novo proteinuria. CONCLUSION Severe AKI is an independent risk factor for subsequent de novo proteinuria post-hospitalization. Further prospective studies are needed to determine whether strategies to detect AKI patients at risk of proteinuria and early therapeutics to modify proteinuria can delay the progression of kidney disease.
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Affiliation(s)
- Saniya S Bonde
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Warda Zaman
- East Bay Nephrology Medical Group, Berkeley, CA, USA
| | - Raphael Cuomo
- Department of Anesthesiology, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Etienne Macedo
- Department of Medicine, University of California San Diego, San Diego, CA, USA.
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Kiuchi S, Cooray U, Aida J, Osaka K, Chan A, Malhotra R, Peres MA. Effect of Tooth Loss on Cognitive Function among Older Adults in Singapore. J Dent Res 2023:220345231172109. [PMID: 37278356 DOI: 10.1177/00220345231172109] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Evidence suggests a longitudinal association between tooth loss and cognitive function. However, the temporality of this association is not well understood. We investigated the effect of several emulated tooth loss prevention scenarios on cognitive function. We used data from 3 waves (baseline: 2009, second wave: 2011-2012, and third wave: 2015) of the Panel on Health and Ageing of Singaporean Elderly (PHASE). PHASE targeted older adults, aged ≥60 y, in Singapore. Number of teeth was used as a time-varying exposure (baseline, second wave). Cognitive function (Short Portable Mental Status Questionnaire score) in the third wave was assessed as the outcome. Multiple time-invariant (baseline) and time-varying (baseline and second wave) covariates were included. The "longitudinal modified treatment policy approach" combined with targeted minimum loss-based estimation was used to define and estimate additive effects of emulated tooth loss prevention scenarios. Emulated scenarios were the following: what if edentate people retained 1 to 4 teeth (scenario 1), what if those with <5 teeth retained 5 to 9 teeth (scenario 2), what if those with <10 teeth retained 10 to 19 teeth (scenario 3), and what if everyone retained ≥20 teeth (scenario 4)? A total of 1,516 participants, excluding those with severe cognitive impairment, were included (male: 41.6%). The mean age at baseline was 70.6 y (SD = 7.1). The mean SPMSQ score at baseline was 2.06 (SD = 0.02) for edentulous, 1.55 (SD = 0.04) for 1 to 4 teeth, 1.61 (SD = 0.03) for 5 to 9 teeth, 1.73 (SD = 0.02) for 10 to 19 teeth, and 1.71 (SD = 0.02) for ≥20 teeth. Additive effect of hypothetical intervention gradually increased with intensity of prevention from scenario 1 to scenario 4 (scenario 1: -0.02 [95% CI, -0.08 to 0.04], scenario 2: -0.05 [95% CI, -0.11 to -0.00], scenario 3: -0.07 [95% CI, -0.14 to -0.00], scenario 4: -0.15 [95% CI, -0.23 to -0.06]). Emulated tooth loss prevention interventions were associated with better cognitive function score. Therefore, preventing tooth loss could potentially benefit maintenance of cognitive function among older adults.
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Affiliation(s)
- S Kiuchi
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Aoba-ku, Sendai, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - U Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - J Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - A Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - R Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - M A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
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10
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Boehme HM, Kaminski RJ, Mulrooney T, Brown RA, Malhotra R. Violence Within Food Deserts: A Block-Group Examination of Food Access, Racial Composition, and Violent Crime. Violence Vict 2023; 38:435-456. [PMID: 37348956 DOI: 10.1891/vv-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
While there is substantial public health literature that documents the negative impacts of living in "food deserts" (e.g., obesity and diabetes), little is known regarding whether living in a food desert is associated with increased criminal victimization. With the block group as the unit of analysis, the present study examines whether there is a relationship between food deserts and elevated crime counts, and whether this relationship varies by racial composition. Results from multiple count models suggest that living in a food desert is not associated with higher levels of violent or property crime. But multiplicative models interacting percent Black with food deserts revealed statistically significant associations with violent crime but not property crime. Alternatively, multiplicative models interacting percent White with food deserts revealed statistically significant associational reductions in violent crimes. Several policy and research implications are discussed.
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Affiliation(s)
- Hunter M Boehme
- Department of Criminology and Criminal Justice, University of South Carolina, Columbia, SC, USA
| | - Robert J Kaminski
- Department of Criminology and Criminal Justice, University of South Carolina, Columbia, SC, USA
| | - Timothy Mulrooney
- Department of Environmental, Earth and Geospatial Sciences, North Carolina Central University, Durham, NC, USA
| | - Robert A Brown
- Department of Criminal Justice, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Rakesh Malhotra
- Department of Environmental, Earth and Geospatial Sciences, North Carolina Central University, Durham, NC, USA
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11
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Khan MB, Scherzer R, Lewis CE, Malhotra R, Ix JH, Shlipak MG, Gutiérrez OM. Associations of Urine Biomarkers of Kidney Tubule Health With Incident Hypertension and Longitudinal Blood Pressure Change in Middle-Aged Adults: The CARDIA Study. Hypertension 2023; 80:1353-1362. [PMID: 36987923 PMCID: PMC10192098 DOI: 10.1161/hypertensionaha.123.21084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Urine biomarkers of kidney tubule injury associate with incident hypertension in older adults with comorbidities, but less is known about these associations in younger adults. METHODS In 1170 participants of the CARDIA study (Coronary Artery Risk Development in Young Adults; mean age, 45 years; 40% Black people; 56% women) without hypertension, cardiovascular disease, or kidney disease at baseline, we examined associations of urine MCP-1 (monocyte chemoattractant protein-1), α1m (alpha-1-microglobulin), KIM-1 (kidney injury molecule-1), EGF (epidermal growth factor), IL (interleukin)-18, YKL-40 (chitinase-3-like protein 1), and UMOD (uromodulin) with incident hypertension (onset of systolic blood pressure [BP] ≥130 mm Hg or diastolic BP ≥80 mm Hg or initiation of hypertension medications) and longitudinal BP change in models adjusted for hypertension risk factors, estimated glomerular filtration rate, and albuminuria. RESULTS After a median 9.9 (interquartile range, 5.9-10.2) years, 376 participants developed incident hypertension. In demographic-adjusted analyses, higher tertiles of EGF associated with lower risk of incident hypertension in both Black and White participants. After multivariable adjustment, the risk of incident hypertension remained lower in tertile 2 (hazard ratio, 0.70 [95% CI, 0.50-0.97]) and tertile 3 (hazard ratio, 0.58 [0.39-0.85]) of EGF versus tertile 1. In fully adjusted models, participants in EGF tertile 3 had smaller 10-year increases in systolic (-3.4 [95% CI, -6.1 to -0.7] mm Hg) and diastolic BP (-2.6 [95% CI, -4.6 to -0.6] mm Hg) than tertile 1. Other biomarkers showed inconsistent associations with incident hypertension and BP change. CONCLUSIONS In middle-aged adults without hypertension, cardiovascular disease, or kidney disease, higher urine EGF associated with lower risk of incident hypertension and lower 10-year BP elevations.
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Affiliation(s)
- Muhammad B. Khan
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Rebecca Scherzer
- Department of Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, San Francisco, CA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Rakesh Malhotra
- Division of Nephrology-Hypertension, University of California, San Diego and Nephrology Section Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California, San Diego and Nephrology Section Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Michael G. Shlipak
- Department of Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, San Francisco, CA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Orlando M. Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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12
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Huang M, Vincent Johnson A, Pourafshar N, Malhotra R, Yang J, Shah M, Balogun R, Chopra T. Pathways to improve nephrologist comfort in managing patients on in-center or home self-care dialysis. Hemodial Int 2023. [PMID: 37157127 DOI: 10.1111/hdi.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
In end-stage kidney disease (ESKD), patient engagement and empowerment are associated with improved survival and complications. However, patients lack education and confidence to participate in self-care. The development of in center self-care hemodialysis can enable motivated patients to allocate autonomy, increase satisfaction and engagement, reduce human resource intensiveness, and cultivate a curiosity about home dialysis. In this review, we emphasize the role of education to overcome barriers to home dialysis, strategies of improving home dialysis utilization in the COVID 19 era, the significance of in-center self-care dialysis (e.g., cost containment and empowering patients), and implementation of an in-center self-care dialysis as a bridge to home hemodialysis (HHD).
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Affiliation(s)
- Minghui Huang
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Anita Vincent Johnson
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Negiin Pourafshar
- Division of Nephrology, Department of Medicine, MedStar Georgetown University, Washington, DC, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jason Yang
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Monarch Shah
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rasheed Balogun
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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13
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Shah C, Srinivasan D, Erus G, Kurella Tamura M, Habes M, Detre JA, Haley WE, Lerner AJ, Wright CB, Wright JT, Oparil S, Kritchevsky SB, Punzi HA, Rastogi A, Malhotra R, Still CH, Williamson JD, Bryan RN, Fan Y, Nasrallah IM. Intensive Blood Pressure Management Preserves Functional Connectivity in Patients with Hypertension from the Systolic Blood Pressure Intervention Randomized Trial. AJNR Am J Neuroradiol 2023; 44:582-588. [PMID: 37105682 PMCID: PMC10171386 DOI: 10.3174/ajnr.a7852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE The Systolic Blood Pressure Intervention (SPRINT) randomized trial demonstrated that intensive blood pressure management resulted in slower progression of cerebral white matter hyperintensities, compared with standard therapy. We assessed longitudinal changes in brain functional connectivity to determine whether intensive treatment results in less decline in functional connectivity and how changes in brain functional connectivity relate to changes in brain structure. MATERIALS AND METHODS Five hundred forty-eight participants completed longitudinal brain MR imaging, including resting-state fMRI, during a median follow-up of 3.84 years. Functional brain networks were identified using independent component analysis, and a mean connectivity score was calculated for each network. Longitudinal changes in mean connectivity score were compared between treatment groups using a 2-sample t test, followed by a voxelwise t test. In the full cohort, adjusted linear regression analysis was performed between changes in the mean connectivity score and changes in structural MR imaging metrics. RESULTS Four hundred six participants had longitudinal imaging that passed quality control. The auditory-salience-language network demonstrated a significantly larger decline in the mean connectivity score in the standard treatment group relative to the intensive treatment group (P = .014), with regions of significant difference between treatment groups in the cingulate and right temporal/insular regions. There was no treatment group difference in other networks. Longitudinal changes in mean connectivity score of the default mode network but not the auditory-salience-language network demonstrated a significant correlation with longitudinal changes in white matter hyperintensities (P = .013). CONCLUSIONS Intensive treatment was associated with preservation of functional connectivity of the auditory-salience-language network, while mean network connectivity in other networks was not significantly different between intensive and standard therapy. A longitudinal increase in the white matter hyperintensity burden is associated with a decline in mean connectivity of the default mode network.
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Affiliation(s)
- C Shah
- From the Department of Radiology (C.S.), Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - D Srinivasan
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - G Erus
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Kurella Tamura
- Division of Nephrology (M.K.T.), Stanford University, and VA Palo Alto Geriatric Research and Education Clinical Center, Palo Alto, California
| | - M Habes
- Biggs Institute, University of Texas San Antonio (M.H.), San Antonio, Texas
| | - J A Detre
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - W E Haley
- Department of Nephrology and Hypertension (W.E.H.), Mayo Clinic, Jacksonville, Florida
| | | | - C B Wright
- National Institute of Neurological Disorders and Stroke (C.B.W.), National Institutes of Health, Bethesda, Maryland
| | - J T Wright
- Medicine (J.T.W.), Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - S Oparil
- Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham, Alabama
| | - S B Kritchevsky
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine (S.B.K., J.D.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - H A Punzi
- Punzi Medical Center (H.A.P.), Carrollton, Texas
| | - A Rastogi
- Division of Nephrology (A.R.), Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - R Malhotra
- Division of Nephrology (R.M.), University of California San Diego, San Diego, California
| | - C H Still
- Frances Payne Bolton School of Nursing (C.H.S.), Case Western Reserve University, Cleveland, Ohio
| | - J D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine (S.B.K., J.D.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - R N Bryan
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Y Fan
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - I M Nasrallah
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Alahamadi Z, Agarwal K, Wen A, Gupta V, Chopra T, Khan A, Malhotra R. Race, Sex, and Kidney Disease Trial Participation. Kidney Med 2023; 5:100594. [PMID: 36960440 PMCID: PMC10028468 DOI: 10.1016/j.xkme.2022.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ziad Alahamadi
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California
| | - Krishna Agarwal
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alexander Wen
- Department of Biology, University of California San Diego, San Diego, California
| | - Vineet Gupta
- Division of Hospital Medicine, Department of Medicine, University of California San Diego, San Diego, California
| | - Tushar Chopra
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Adnan Khan
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California
- Address for Correspondence: Dr. Rakesh Malhotra MD, MPH, Division of Nephrology- Hypertension, 3350 La Jolla Village Drive, Mail Code 9111-H, San Diego, CA 92161.
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15
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Singla A, Dadario NB, Singla A, Greenberg P, Yan R, Nanda A, Boison D, Malhotra R, Patel S, Nipun S, Maninderpal K, Castro D, Bdiiwi S, Boktor H, Kyi HH, Sutherland A, Patrawalla A, Ly K, Xie Y, Sonig A, Khandelwal P, Liu J, Koziol J, Finkle D, Subanna S, Libutti SK. A randomized controlled trial to evaluate outcomes with Aggrenox in patients with SARS-CoV-2 infection. PLoS One 2023; 18:e0274243. [PMID: 36716303 PMCID: PMC9886260 DOI: 10.1371/journal.pone.0274243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/23/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an immunoinflammatory and hypercoagulable state that contributes to respiratory distress, multi-organ dysfunction, and mortality. Dipyridamole, by increasing extracellular adenosine, has been postulated to be protective for COVID-19 patients through its immunosuppressive, anti-inflammatory, anti-coagulant, vasodilatory, and anti-viral actions. Likewise, low-dose aspirin has also demonstrated protective effects for COVID-19 patients. This study evaluated the effect of these two drugs formulated together as Aggrenox in hospitalized COVID-19 patients. METHODS In an open-label, single site randomized controlled trial (RCT), hospitalized COVID-19 patients were assigned to adjunctive Aggrenox (Dipyridamole ER 200mg/ Aspirin 25mg orally/enterally) with standard of care treatment compared to standard of care treatment alone. Primary endpoint was illness severity according to changes on the eight-point COVID ordinal scale, with levels of 1 to 8 where higher scores represent worse illness. Secondary endpoints included all-cause mortality and respiratory failure. Outcomes were measured through days 14, 28, and/or hospital discharge. RESULTS From October 1, 2020 to April 30, 2021, a total of 98 patients, who had a median [IQR] age of 57 [47, 62] years and were 53.1% (n = 52) female, were randomized equally between study groups (n = 49 Aggrenox plus standard of care versus n = 49 standard of care alone). No clinically significant differences were found between those who received adjunctive Aggrenox and the control group in terms of illness severity (COVID ordinal scale) at days 14 and 28. The overall mortality through day 28 was 6.1% (3 patients, n = 49) in the Aggrenox group and 10.2% (5 patients, n = 49) in the control group (OR [95% CI]: 0.40 [0.04, 4.01], p = 0.44). Respiratory failure through day 28 occurred in 4 (8.3%, n = 48) patients in the Aggrenox group and 7 (14.6%, n = 48) patients in the standard of care group (OR [95% CI]: 0.21 [0.02, 2.56], p = 0.22). A larger decrease in the platelet count and blood glucose levels, and larger increase in creatinine and sodium levels within the first 7 days of hospital admission were each independent predictors of 28-day mortality (p < 0.05). CONCLUSION In this study of hospitalized patients with COVID-19, while the outcomes of COVID illness severity, odds of mortality, and chance of respiratory failure were better in the Aggrenox group compared to standard of care alone, the data did not reach statistical significance to support the standard use of adjuvant Aggrenox in such patients.
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Affiliation(s)
- Amit Singla
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Nicholas B. Dadario
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Ashima Singla
- Department of OBGYN, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Patricia Greenberg
- Biostatistics and Epidemiology Services Center (RUBIES), Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Rachel Yan
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Detlev Boison
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
- Brain Health Institute, Rutgers University, Piscataway, New Jersey, United States of America
| | - Rakesh Malhotra
- Department of Medicine, Division of Nephrology, UCSD, San Diego, California, United States of America
| | - Sunil Patel
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Suri Nipun
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Kaur Maninderpal
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Dorothy Castro
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Sanaa Bdiiwi
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Hala Boktor
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Htay Htay Kyi
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Anne Sutherland
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Amee Patrawalla
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Kevin Ly
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Yingda Xie
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Ashish Sonig
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Priyank Khandelwal
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - James Liu
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Joseph Koziol
- Department of Neurological Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, United States of America
| | - Diana Finkle
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Sara Subanna
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Steven K. Libutti
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
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16
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Malhotra R, Katz R, Kimmel PL, Vasan RS, Schelling JS, Greenberg JH, Parikh CR, Bonventre JV, Al-Rousan T, Sarnak MJ, Gutierrez OM, Shlipak MG, Ix JH. Biomarkers of kidney tubule injury and dysfunction and risk of incident hypertension in community-living individuals: results from the multi-ethnic study of atherosclerosis. Nephrol Dial Transplant 2023; 38:246-248. [PMID: 36307927 PMCID: PMC9869850 DOI: 10.1093/ndt/gfac293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Paul L Kimmel
- Division of Kidney, Urology and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ramachandran S Vasan
- Division of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey S Schelling
- Division of Nephrology, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, John Hopkins School of Medicine, Baltimore, MA, USA
| | - Joseph V Bonventre
- Renal Division and Division of Engineering in Medicine, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Orlando M Gutierrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, CA, USA
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17
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Malhotra R, Chopra T, Ix JH. Interpreting Estimated GFR Variability and Its Clinical Significance. Kidney Med 2023; 5:100599. [PMID: 36718188 PMCID: PMC9883260 DOI: 10.1016/j.xkme.2023.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, CA,Address for Correspondence: Rakesh Malhotra, MD, MPH, Division of Nephrology and Hypertension, University of California San Diego, 9452 Medical Ctr Dr, La Jolla, CA 92037.
| | - Tushar Chopra
- Division of Nephrology, University of Virginia, Charlottesville, VA
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, CA
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18
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Menakaya CU, Shah M, Ingoe H, Malhotra R, Mannan A, Boddice T, Allgar V, Gopal S, Mohsen A, Muthukumar N. Modern cemented Furlong hemiarthroplasty: Are dislocations rates better? J Perioper Pract 2023; 33:24-29. [PMID: 34380351 DOI: 10.1177/17504589211020674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dislocation following hip hemiarthroplasty is a major complication with increased mortality and morbidity. Data looking at dislocation following contemporary bipolar stems are lacking in literature. METHODS Retrospective review of our prospective national hip fracture database over a two-year period. Group 1 comprised of consecutive patients receiving bipolar Furlong prosthesis (N222) while Group 2 was made up of a historical cohort (uncemented; N254). Clinical and radiological records were reviewed to determine dislocation rates, causes and associative factors of dislocations. Data were analysed using SPSS. RESULTS Following 476 hemiarthroplasties performed during the study period, 12 (2.5%) dislocations were reported (eight in Group 1; four in Group 2). There was no significant difference in dislocation rates (3.6% vs 1.6%) between groups (p = 0.159). Subgroup analysis of Group 1 demonstrated a significant difference in dislocations with Furlong cemented (6%) as compared with Furlong uncemented (0%) hemiarthroplasties (p = 0.024). Following dislocation, death rates increased to 8.3% from 1.7% in both groups. CONCLUSION There is a statistically significant increase in dislocation rate following use of cemented Furlong prosthesis when compared to similar uncemented prosthesis at the same treatment period. However, when compared to traditional uncemented prosthesis, there is no difference in dislocation rates.
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Affiliation(s)
- C U Menakaya
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK
| | - M Shah
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK.,Yorkshire and the Humber Postgraduate Deanery, University of Leeds, Leeds, UK
| | - H Ingoe
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK.,Yorkshire and the Humber Postgraduate Deanery, University of Leeds, Leeds, UK
| | - R Malhotra
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK.,Yorkshire and the Humber Postgraduate Deanery, University of Leeds, Leeds, UK
| | - A Mannan
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK.,Yorkshire and the Humber Postgraduate Deanery, University of Leeds, Leeds, UK
| | - T Boddice
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK.,Yorkshire and the Humber Postgraduate Deanery, University of Leeds, Leeds, UK
| | - V Allgar
- Hull & York Medical School, The University of York, York, UK
| | - S Gopal
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK
| | - A Mohsen
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK
| | - N Muthukumar
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK
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Walsh T, Malhotra R, Sharma M. Radiofrequency techniques for chronic pain. BJA Educ 2022; 22:474-483. [PMID: 36406037 PMCID: PMC9669778 DOI: 10.1016/j.bjae.2022.08.004] [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] [Accepted: 08/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- T. Walsh
- Starship Children's Health, Auckland, New Zealand
| | - R. Malhotra
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M. Sharma
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
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20
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Quesada O, Pico M, Palmer C, Yildiz M, Miranda R, Malhotra R, Setegn E, Legreaux S, Moore B, Philip R, Shrivastava P, Takla R, Henry T. Magnetocardiography as a noninvasive diagnostic strategy for suspected coronary microvascular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) is increasingly recognized as an independent predictor of mortality with a 4-fold higher risk. However current diagnostic modalities are limited by the need for an invasive procedure, access, cost, and exposure of ionizing radiation.
Purpose
To investigate the ability of magnetocardiography (MCG) to identify CMD in patients with suspected ischemia and no obstructive coronary artery disease (INOCA).
Methods
This is an observational, prospective pilot study of patients scheduled for coronary functional angiography (CFA), gold standard for evaluation for CMD (defined as coronary flow reserve (CFR) ≤2). 13 patients underwent both CFA and a noninvasive 36-channel MCG scan. A machine learning model was developed to characterize the presence of CMD in these patients against age matched controls (AMCs). The model consists of a logistic regression classifier which takes features representing the relative strengths of the “characteristic dipoles” of the MCG scan as input. The characteristic dipoles are parameterizations of the three strongest magnetic field map components resulting from a singular value decomposition of the MCG signal. A total of 37 patients were included in this analysis including 13 patients who completed CFA (7 had CMD and 6 had CFR >2 and included in the AMCs group). An additional 24 asymptomatic, healthy patients that did not undergo CFR were also included in the AMC group.
Results
The mean age for AMCs was 57 years (70% women) and mean age for CMD patients was 54 years (100% women). The performance of the model was evaluated using repeated stratified cross-validation with 5 folds and 3 repeats, resulting in 15 different 80%/20% train/test splits. Figure 1 shows the distribution of samples belonging to the CMD and AMC groups in a 2-dimensional representation of the feature space. The clear separation of the two groups and the clustering of the AMCs demonstrates the ability of the model to identify patients with CMD. We found that MCG had a mean accuracy of 94.8% (±6.4%), sensitivity of 100% (±0.0%) and specificity of 93.3% (±8.2%) for the detection of CMD using gold standard CFR ≤2 as reference.
Conclusion(s)
First study to show that MCG can be used with 94.8% accuracy to identify CMD among patients suspicious for INOCA with no exposure to ionization, 90 seconds of scan time and minimal cost. The use of this noninvasive modality to identify CMD warrants further investigation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Genetesis
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Affiliation(s)
- O Quesada
- The Christ Hospital, Women's Heart Center, The Christ Hospital Heart and Vascular Institute , Cincinnati , United States of America
| | - M Pico
- The Christ Hospital, Women's Heart Center, The Christ Hospital Heart and Vascular Institute , Cincinnati , United States of America
| | - C Palmer
- The Christ Hospital, Women's Heart Center, The Christ Hospital Heart and Vascular Institute , Cincinnati , United States of America
| | - M Yildiz
- The Christ Hospital, The Carl and Edyth Lindner Center for Research and Education , Cincinnati , United States of America
| | - R Miranda
- Genetesis , Cincinnati , United States of America
| | - R Malhotra
- Genetesis , Cincinnati , United States of America
| | - E Setegn
- Genetesis , Cincinnati , United States of America
| | - S Legreaux
- Genetesis , Cincinnati , United States of America
| | - B Moore
- Genetesis , Cincinnati , United States of America
| | - R Philip
- Genetesis , Cincinnati , United States of America
| | | | - R Takla
- Genetesis , Cincinnati , United States of America
| | - T Henry
- The Christ Hospital, The Carl and Edyth Lindner Center for Research and Education , Cincinnati , United States of America
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21
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Bullen AL, Ascher SB, Scherzer R, Garimella PS, Katz R, Hallan SI, Cheung AK, Raphael KL, Estrella MM, Jotwani VK, Malhotra R, Seegmiller JC, Shlipak MG, Ix JH. Markers of Kidney Tubular Secretion and Risk of Adverse Events in SPRINT Participants with CKD. J Am Soc Nephrol 2022; 33:1915-1926. [PMID: 35973732 PMCID: PMC9528325 DOI: 10.1681/asn.2022010117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/13/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Kidney tubular secretion is an essential mechanism for clearing many common antihypertensive drugs and other metabolites and toxins. It is unknown whether novel measures of tubular secretion are associated with adverse events (AEs) during hypertension treatment. METHODS Among 2089 SPRINT (Systolic Blood Pressure Intervention Trial) participants with baseline eGFR <60 ml/min per 1.73 m2, we created a summary secretion score by averaging across the standardized spot urine-to-plasma ratios of ten novel endogenous tubular secretion measures, with lower urine-to-plasma ratios reflecting worse tubular secretion. Multivariable Cox proportional hazards models were used to evaluate associations between the secretion score and risk of a composite of prespecified serious AEs (hypotension, syncope, bradycardia, AKI, electrolyte abnormalities, and injurious falls). The follow-up protocol for SPRINT routinely assessed two laboratory monitoring AEs (hyperkalemia and hypokalemia). RESULTS Overall, 30% of participants experienced at least one AE during a median follow-up of 3.0 years. In multivariable models adjusted for eGFR and albuminuria, lower (worse) secretion scores at baseline were associated with greater risk of the composite AE outcome (hazard ratio per 1-SD lower secretion score, 1.16; 95% confidence interval, 1.04 to 1.27). In analyses of the individual AEs, lower secretion score was associated with significantly greater risk of AKI, serious electrolyte abnormalities, and ambulatory hyperkalemia. Associations were similar across randomized treatment assignment groups. CONCLUSION Among SPRINT participants with CKD, worse tubular secretion was associated with greater risk of AEs, independent of eGFR and albuminuria.
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Affiliation(s)
- Alexander L. Bullen
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, California
| | - Simon B. Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California
- Division of Hospital Medicine, University of California Davis, Sacramento, California
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California
| | - Pranav S. Garimella
- Division of Nephrology-Hypertension, University of California, San Diego, California
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Stein I. Hallan
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Nephrology, St Olav University Hospital, Trondheim, Norway
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University and VA Portland Health Care System, Portland, Oregon
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California
| | - Vasantha K. Jotwani
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California
| | - Rakesh Malhotra
- Division of Nephrology-Hypertension, University of California, San Diego, California
| | - Jesse C. Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, California
| | - Joachim H. Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, California
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22
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Ascher SB, Scherzer R, Estrella MM, Berry JD, de Lemos JA, Jotwani VK, Garimella PS, Malhotra R, Bullen AL, Katz R, Ambrosius WT, Cheung AK, Chonchol M, Killeen AA, Ix JH, Shlipak MG. Kidney tubule health, mineral metabolism and adverse events in persons with CKD in SPRINT. Nephrol Dial Transplant 2022; 37:1637-1646. [PMID: 34473302 PMCID: PMC9649818 DOI: 10.1093/ndt/gfab255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Measures of kidney tubule health are risk markers for acute kidney injury (AKI) in persons with chronic kidney disease (CKD) during hypertension treatment, but their associations with other adverse events (AEs) are unknown. METHODS Among 2377 Systolic Blood Pressure Intervention Trial (SPRINT) participants with CKD, we measured at baseline eight urine biomarkers of kidney tubule health and two serum biomarkers of mineral metabolism pathways that act on the kidney tubules. Cox proportional hazards models were used to evaluate biomarker associations with risk of a composite of pre-specified serious AEs (hypotension, syncope, electrolyte abnormalities, AKI, bradycardia and injurious falls) and outpatient AEs (hyperkalemia and hypokalemia). RESULTS At baseline, the mean age was 73 ± 9 years and mean estimated glomerular filtration rate (eGFR) was 46 ± 11 mL/min/1.73 m2. During a median follow-up of 3.8 years, 716 (30%) participants experienced the composite AE. Higher urine interleukin-18, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein-1 (MCP-1), lower urine uromodulin (UMOD) and higher serum fibroblast growth factor-23 were individually associated with higher risk of the composite AE outcome in multivariable-adjusted models including eGFR and albuminuria. When modeling biomarkers in combination, higher NGAL [hazard ratio (HR) = 1.08 per 2-fold higher biomarker level, 95% confidence interval (CI) 1.03-1.13], higher MCP-1 (HR = 1.11, 95% CI 1.03-1.19) and lower UMOD (HR = 0.91, 95% CI 0.85-0.97) were each associated with higher composite AE risk. Biomarker associations did not vary by intervention arm (P > 0.10 for all interactions). CONCLUSIONS Among persons with CKD, several kidney tubule biomarkers are associated with higher risk of AEs during hypertension treatment, independent of eGFR and albuminuria.
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Affiliation(s)
- Simon B Ascher
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, CA, USA.,Division of Hospital Medicine, University of California Davis, Sacramento, CA, USA
| | - Rebecca Scherzer
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, CA, USA
| | - Michelle M Estrella
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, CA, USA
| | - Jarett D Berry
- Divison of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A de Lemos
- Divison of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vasantha K Jotwani
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, CA, USA
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA
| | - Rakesh Malhotra
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA
| | - Alexander L Bullen
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, UT, USA.,Department of Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael G Shlipak
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, CA, USA
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23
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Malhotra R, Huq SS, Chong M, Murphy D, Daruwalla ZJ. Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically. Malays Orthop J 2021; 15:21-28. [PMID: 34966491 PMCID: PMC8667238 DOI: 10.5704/moj.2111.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function. Materials and methods We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year. Results Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients. Conclusions We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.
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Affiliation(s)
- R Malhotra
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - S S Huq
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - M Chong
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - D Murphy
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - Z J Daruwalla
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
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24
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Rosa V, Malhotra R, Agarwalla SV, Morin JLP, Luong-Van EK, Han YM, Chew RJJ, Seneviratne CJ, Silikas N, Tan KS, Nijhuis CA, Castro Neto AH. Graphene Nanocoating: High Quality and Stability upon Several Stressors. J Dent Res 2021; 100:1169-1177. [PMID: 34253090 DOI: 10.1177/00220345211024526] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Titanium implants present 2 major drawbacks-namely, the long time needed for osseointegration and the lack of inherent antimicrobial properties. Surface modifications and coatings to improve biomaterials can lose their integrity and biological potential when exposed to stressful microenvironments. Graphene nanocoating (GN) can be deposited onto actual-size dental and orthopedic implants. It has antiadhesive properties and can enhance bone formation in vivo. However, its ability to maintain structural integrity and quality when challenged by biologically relevant stresses remains largely unknown. GN was produced by chemical vapor deposition and transferred to titanium via a polymer-assisted transfer technique. GN has high inertness and did not increase expression of inflammatory markers by macrophages, even in the presence of lipopolysaccharides. It kept high coverage at the top tercile of tapered dental implant collars after installation and removal from bone substitute and pig maxilla. It also resisted microbiologically influenced corrosion, and it maintained very high coverage area and quality after prolonged exposure to biofilms and their removal by different techniques. Our findings show that GN is unresponsive to harsh and inflammatory environments and that it maintains a promising level of structural integrity on the top tercile of dental implant collars, which is the area highly affected by biofilms during the onset of implant diseases. Our findings open the avenues for the clinical studies required for the use of GN in the development of implants that have higher osteogenic potential and are less prone to implant diseases.
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Affiliation(s)
- V Rosa
- Faculty of Dentistry, National University of Singapore, Singapore
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore
| | - R Malhotra
- Faculty of Dentistry, National University of Singapore, Singapore
| | - S V Agarwalla
- Faculty of Dentistry, National University of Singapore, Singapore
| | - J L P Morin
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore
| | - E K Luong-Van
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Y M Han
- Department of Chemistry, National University of Singapore, Singapore
| | - R J J Chew
- Faculty of Dentistry, National University of Singapore, Singapore
| | | | - N Silikas
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - K S Tan
- Faculty of Dentistry, National University of Singapore, Singapore
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore
| | - C A Nijhuis
- Department of Molecules and Materials, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - A H Castro Neto
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore
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25
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Malhotra R, Goyal A, Shamim SA. Multiple endocrine neoplasia type 2B syndrome. QJM 2021; 114:272-273. [PMID: 32483633 DOI: 10.1093/qjmed/hcaa184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Malhotra
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
| | - A Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
| | - S A Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
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26
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Mohapatra S, R S, Singh A, Dixit AK, Malhotra R, Ponnusamy K. An economic analysis of milk production in Haryana. IJDS 2021. [DOI: 10.33785/ijds.2021.v74i02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Ryan TG, Juniat V, Stewart C, Malhotra R, Hardy TG, McNab AA, Davis G, Selva D. Clinico-radiological findings of neuroendocrine tumour metastases to the orbit. Orbit 2021; 41:44-52. [PMID: 33729098 DOI: 10.1080/01676830.2021.1895845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: We present the clinico-radiological findings of neuroendocrine tumour metastases to the orbit.Methods: This was a multicentre, retrospective study of patients with neuroendocrine tumour metastases to the orbit. Data was collected from medical records across five different sites within Australia and the United Kingdom.Results: Nine patients (eleven lesions) were identified. The most common presenting complaint was diplopia (5/9, 56%). Disease occurred bilaterally in two patients. Seven patients (78%) had extraocular muscle involvement. The lateral recti (4/9, 44%) and superior recti (2/9, 22%) were the most commonly affected. Ocular presentation preceded primary tumour diagnosis in three patients (33%). On orbital imaging, metastases were most commonly reported as well circumscribed, ovoid or round, heterogeneous, contrast-enhancing masses. Features of intralesional haemorrhage and bony invasion are uncommonly reported.Conclusions: Neuroendocrine tumour metastasis to the orbit is uncommon. Metastases have a propensity for the extraocular muscles, commonly presenting as heterogeneous, well circumscribed, contrast-enhancing lesions on neuroimaging. New ocular symptoms, a history of neuroendocrine tumours, and these radiological findings, should lead to high clinical suspicion of metastatic disease. Atypical findings warrant biopsy to exclude other causes of orbital lesions.
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Affiliation(s)
- T G Ryan
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - V Juniat
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - C Stewart
- Department of Ophthalmology, Gold Coast University Hospital, Gold Coast, Australia
| | - R Malhotra
- Oculoplastics Unit, East Grinstead Hospital, East Sussex, UK
| | - T G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - A A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Centre for Eye Research Australia Ltd, University of Melbourne, East Melbourne, Australia
| | - G Davis
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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28
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Malhotra R, Kumar U, Virgen P, Magallon B, Garimella PS, Chopra T, Kotanko P, Ikizler TA, Trzebinska D, Cadmus-Bertram L, Ix JH. Physical activity in hemodialysis patients on nondialysis and dialysis days: Prospective observational study. Hemodial Int 2021; 25:240-248. [PMID: 33650200 DOI: 10.1111/hdi.12913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The physical decline in patients with end-stage kidney disease (ESKD) is associated with morbidity and mortality. Prior studies have attempted to promote physical activity at the time of dialysis; however, physical activity patterns on the nondialysis days are unknown. This study aimed to quantify physical activity on dialysis and nondialysis days in hemodialysis patients using a wearable actigraph. METHODS In this prospective study, subjects receiving hemodialysis were recruited from two outpatient dialysis units in urban San Diego and rural Imperial County, CA, between March 2018 and April 2019. Key inclusion criteria included: (1) receiving thrice weekly hemodialysis for ≥3 months, (2) age ≥ 18 years, and (3) able to walk with or without assistive devices. All participants wore a Fitbit Charge 2 tracker for a minimum of 4 weeks. The primary outcome was the number of steps per day. Each participant completed the Physical Activity Questionnaire, the Patient Health Questionnaire (PHQ)-9, the PROMIS Short form Fatigue Questionnaire at baseline, and the Participant Technology Experience Questionnaire at day 7 after study enrolment. FINDINGS Of the 52 recruited, 45 participants (urban = 25; rural = 20) completed the study. The mean age was 61 ± 15 years, 42% were women, 64% were Hispanic, and the mean dialysis vintage was 4.4 ± 3.0 years. For those with valid Fitbit data (defined as ≥10 hours of wear per day) for 28 days (n = 45), participants walked an average of 3688 steps per day, and 73% of participants were sedentary (<5000 steps/day). Participants aged >80 years were less active than younger (age < 65 years) participants (1232 vs. 4529 steps, P = 0.01). There were no statistical differences between the groups when stratified by gender (women vs. men [2817 vs. 4324 steps, respectively]), urbanicity (rural vs. urban dialysis unit [3141 vs. 4123 steps, respectively]), and dialysis/nondialysis day (3177 vs. 4133 steps, respectively). Due to the small sample size, we also calculated effect sizes. The effect size was medium for the gender differences (cohen's d = 0.57) and small to medium for urbanicity and dialysis/nondialysis day (d = 0.37 and d = 0.33, respectively). We found no association between physical activity and self-reported depression and fatigue scale. The majority of participants (62%, 28/45) found the Fitbit tracker easy to wear and comfortable. DISCUSSION ESKD participants receiving hemodialysis are frequently sedentary, and differences appear more pronounced in older patients. These findings may assist in designing patient-centered interventions to increase physical activity among hemodialysis patients.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Ujjala Kumar
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | | | | | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - T Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danuta Trzebinska
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Lisa Cadmus-Bertram
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA.,Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA.,Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, California, USA
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Malhotra R, Guleria P, Barwad A, Pramanik R, Tandon N. A unique case of light chain (AL) amyloidosis masquerading as hypophosphatemic osteomalacia. Osteoporos Int 2021; 32:387-392. [PMID: 32910218 DOI: 10.1007/s00198-020-05622-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/01/2020] [Indexed: 01/22/2023]
Abstract
Light chain (AL) amyloidosis is the result of a clonal plasma cell disorder which causes organ damage by deposition of misfolded light chains. Kidney is a common site of amyloid deposition. Proteinuria, usually in nephrotic range and unexplained renal insufficiency are the main manifestations of renal injury. We report a unique case of renal involvement by AL amyloidosis masquerading as metabolic bone disease. 38 year old male patient presented with progressively increasing diffuse bony pains, low backache and proximal weakness of both lower limbs since two years. On investigation, he was detected to have hypophosphatemic osteomalacia due to renal phosphate loss which was fibroblast growth factor 23 (FGF23)- independent. He also had nephrotic range low molecular weight proteinuria. Renal biopsy to ascertain the aetiology revealed deposition of amyloid fibrils in the glomerular mesangium on electron microscopy. Its characterization by immunofluorescence (IF) was consistent with immunoglobulin light chain (AL) amyloidosis. In the absence of a demonstrable plasma cell clone on bone marrow biopsy, we made a diagnosis of monoclonal gammopathy of renal significance (MGRS). He was treated with chemotherapy following which there was symptomatic improvement and reduction in phosphaturia. This case describes a unique presentation of renal injury due to AL amyloidosis masquerading as hypophosphatemic osteomalacia. The aim of this report is to highlight that hypophosphatemia in adults is usually acquired and treatment of underlying etiology results in cure, unlike in children where genetic counseling and phosphate replacement is the mainstay of treatment.
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Affiliation(s)
- R Malhotra
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - P Guleria
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - A Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - R Pramanik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - N Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Ginsberg C, Houben AJHM, Malhotra R, Berendschot TTJM, Kooman JP, Webers CAB, Stehouwer CDA, Ix JH. Urinary Phosphate Excretion and Microvascular Function in a Population-Based Cohort. Kidney Med 2020; 2:812-815. [PMID: 33319206 PMCID: PMC7729221 DOI: 10.1016/j.xkme.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Charles Ginsberg
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA.,Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA
| | - Alfons J H M Houben
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Rakesh Malhotra
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA.,Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA
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31
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Malhotra R, Katz R, Jotwani V, Agarwal A, Cohen DL, Cushman WC, Ishani A, Killeen AA, Kitzman DW, Oparil S, Papademetriou V, Parikh CR, Raphael KL, Rocco MV, Tamariz LJ, Whelton PK, Wright JT, Shlipak MG, Ix JH. Estimated GFR Variability and Risk of Cardiovascular Events and Mortality in SPRINT (Systolic Blood Pressure Intervention Trial). Am J Kidney Dis 2020; 78:48-56. [PMID: 33333147 DOI: 10.1053/j.ajkd.2020.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/16/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE AND OBJECTIVE Although low estimated glomerular filtration rate (eGFR) is associated with cardiovascular disease (CVD) events and mortality, the clinical significance of variability in eGFR over time is uncertain. This study aimed to evaluate the associations between variability in eGFR and the risk of CVD events and all-cause mortality. STUDY DESIGN Longitudinal analysis of clinical trial participants. SETTINGS AND PARTICIPANTS 7,520 Systolic Blood Pressure Intervention Trial (SPRINT) participants ≥50 year of age with 1 or more CVD risk factors. PREDICTORS eGFR variability, estimated by the coefficient of variation of eGFR assessments at the 6th, 12th, and 18-month study visits. OUTCOMES The SPRINT primary CVD composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and all-cause mortality from month 18 to the end of follow-up. ANALYTICAL APPROACH Cox models were used to evaluate associations between eGFR variability and CVD outcomes and all-cause mortality. Models were adjusted for demographics, randomization arm, CVD risk factors, albuminuria, and eGFR at month 18. RESULTS Mean age was 68 ± 9 years; 65% were men; and 58% were White. The mean eGFR was 73 ± 21 (SD) mL/min/1.73 m2 at 6 months. There were 370 CVD events and 154 deaths during a median follow-up of 2.4 years. Greater eGFR variability was associated with higher risk for all-cause mortality (hazard ratio [HR] per 1 SD greater variability, 1.29; 95% CI, 1.14-1.45) but not CVD events (HR, 1.05; 95% CI, 0.95-1.16) after adjusting for albuminuria, eGFR, and other CVD risk factors. Associations were similar when stratified by treatment arm and by baseline CKD status, when accounting for concurrent systolic blood pressure changes, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic medications during follow up. LIMITATIONS Persons with diabetes and proteinuria > 1 g/d were excluded. CONCLUSIONS In trial participants at high risk for CVD, greater eGFR variability was independently associated with all-cause mortality but not CVD events.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA
| | - Adhish Agarwal
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah Health, Salt Lake City, UT
| | - Debbie L Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William C Cushman
- Medical Service, Veteran Affairs Medical Center and Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Areef Ishani
- Division of Nephrology, Department of Medicine, University of Minnesota and Veteran Affairs Medical Center, Minneapolis, MN
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Dalane W Kitzman
- Division of Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Vasilios Papademetriou
- Division of Cardiology, Department of Medicine, Georgetown University and Veteran Affairs Medical Center, Washington, DC
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, John Hopkins University, Baltimore, MD
| | - Kalani L Raphael
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah Health, Salt Lake City, UT
| | - Michael V Rocco
- Division of Nephrology, Department of Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Leonardo J Tamariz
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, University Hospital Cleveland Medical Center, Cleveland, OH
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA; Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Joachim H Ix
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA.
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Sharma V, Katyal S, Farooque K, Mathur P, Malhotra R. Antimicrobial susceptibility pattern of pus culture of surgical site infections in Trauma Centre. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nakajima A, Araki M, Kurihara O, Minami Y, Soeda T, Higuma T, Kakuta T, Lee H, Malhotra R, Nakamura S, Jang I. Predictors for rapid progression of coronary calcification: an optical coherence tomography (OCT) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The natural progression of coronary calcification has not been systematically studied. In vivo coronary calcium can be evaluated by OCT.
Purpose
To identify the incidence and predictors for rapid progression of coronary calcification.
Methods
Patients with serial OCT imaging at baseline and at 6 months were selected from our database. Changes in calcium index during 6-month follow-up and predictors for progression of calcification were studied. Calcium index was defined as the product of the mean calcium arc and calcium length. Rapid progression of calcification was defined as an increase in calcium index above the median value.
Results
Among 187 patients who had serial OCT imaging, 235 calcified plaques were identified in 108 patients (57.8%) at baseline with median calcium index of 132.0 (Interquartile range 58.5–281.2). After 6 months, the calcium index increased in 95.3% of calcified plaques from 132.0 to 178.2 (p<0.001). In multivariable analysis, diabetes mellitus (DM), chronic kidney disease (CKD), lipid-rich plaque, and macrophages were found to be independent predictors for rapid progression of coronary calcification (table). Interestingly, rapid progression of calcification was associated with a significant reduction of inflammatory features (thin-cap fibroatheroma [TCFA]; baseline 21.2% vs. follow-up 11.9%, p=0.003, macrophages; baseline 74.6% vs. follow-up 61.0%, p=0.001).
Conclusions
This study demonstrated that DM, CKD, lipid-rich plaque, and macrophages were independent predictors for rapid progression of coronary calcification. High level of vascular inflammation may stimulate rapid progression of calcification.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Nakajima
- Mass General Hopital (MGH), Boston, United States of America
| | - M Araki
- Mass General Hopital (MGH), Boston, United States of America
| | - O Kurihara
- Mass General Hopital (MGH), Boston, United States of America
| | - Y Minami
- Kitasato University School of Medicine, Kanagawa, Japan
| | - T Soeda
- Nara Medical University, Nara, Japan
| | - T Higuma
- St. Marianna University School of Medicine, Kanagawa, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - H Lee
- Mass General Hopital (MGH), Boston, United States of America
| | - R Malhotra
- Mass General Hopital (MGH), Boston, United States of America
| | | | - I.K Jang
- Mass General Hopital (MGH), Boston, United States of America
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Abstract
BACKGROUND Peri-orbital surgical emphysema is a rare complication that can occur after lacrimal surgery. It has only been described in isolated cases, following external dacryocystorhinostomy (n = 2) and Lester Jones tube insertion (n = 1). METHOD A retrospective, non-comparative case series was conducted of patients who developed surgical emphysema following endoscopic dacryocystorhinostomy. RESULTS A total of 356 endoscopic dacryocystorhinostomy cases (primary, n = 316; revision, n = 40) were performed over a six-year period. Seven cases of post-operative surgical emphysema were identified, all of which were preceded by uncontrolled sneezing, nose-blowing or coughing within the first week of surgery. The occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy in our centre was 7 in 356, or 2 per cent, over six years. CONCLUSION This is the first study to report the occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy. Clinicians may wish to suggest patients stifle the aforementioned triggers within the first week to reduce the potential for surgical emphysema.
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Affiliation(s)
- J C Bladen
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - W F Siah
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - P Tan
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - A S Litwin
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - S Ali
- Department of Anaesthesia, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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35
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Jotwani V, Garimella PS, Katz R, Malhotra R, Bates J, Cheung AK, Chonchol M, Drawz PE, Freedman BI, Haley WE, Killeen AA, Punzi H, Sarnak MJ, Segal MS, Shlipak MG, Ix JH. Tubular Biomarkers and Chronic Kidney Disease Progression in SPRINT Participants. Am J Nephrol 2020; 51:797-805. [PMID: 32906135 DOI: 10.1159/000509978] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/21/2020] [Accepted: 07/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kidney tubular atrophy on biopsy is a strong predictor of chronic kidney disease (CKD) progression, but tubular health is poorly quantified by traditional measures including estimated glomerular filtration rate (eGFR) and albuminuria. We hypothesized that urinary biomarkers of impaired tubule function would be associated with faster eGFR declines in persons with CKD. METHODS We measured baseline urine concentrations of uromodulin, β2-microglobulin (β2m), and α1-microglobulin (α1m) among 2,428 participants of the Systolic Blood Pressure Intervention Trial with an eGFR <60 mL/min/1.73 m2. We used linear mixed models to evaluate biomarker associations with annualized relative change in eGFR, stratified by randomization arm. RESULTS At baseline, the mean age was 73 ± 9 years and eGFR was 46 ± 11 mL/min/1.73 m2. In the standard blood pressure treatment arm, each 2-fold higher urinary uromodulin was associated with slower % annual eGFR decline (0.34 [95% CI: 0.08, 0.60]), whereas higher urinary β2m was associated with faster % annual eGFR decline (-0.10 [95% CI: -0.18, -0.02]) in multivariable-adjusted models including baseline eGFR and albuminuria. Associations were weaker and did not reach statistical significance in the intensive blood pressure treatment arm for either uromodulin (0.11 [-0.13, 0.35], p value for interaction by treatment arm = 0.045) or β2m (-0.01 [-0.08, 0.08], p value for interaction = 0.001). Urinary α1m was not independently associated with eGFR decline in the standard (0.01 [-0.22, 0.23]) or intensive (0.03 [-0.20, 0.25]) arm. CONCLUSIONS Among trial participants with hypertension and CKD, baseline measures of tubular function were associated with subsequent declines in kidney function, although these associations were diminished by intensive blood pressure control.
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Affiliation(s)
- Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, California, USA,
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, California, USA,
| | - Pranav S Garimella
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Rakesh Malhotra
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jeffrey Bates
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Alfred K Cheung
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Michel Chonchol
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul E Drawz
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barry I Freedman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - William E Haley
- Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Henry Punzi
- Punzi Medical Center, Trinity Hypertension Research Institute, Carollton, Texas, USA
| | - Mark J Sarnak
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mark S Segal
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael G Shlipak
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, California, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, California, USA
| | - Joachim H Ix
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Abstract
Most of the major planets in the Solar System support populations of co-orbiting bodies, known as Trojans, at their L4 and L5 Lagrange points. In contrast, Earth has only one known co-orbiting companion. This paper presents the results from a search for Earth Trojans using the DECam instrument on the Blanco Telescope at CTIO. This search found no additional Trojans in spite of greater coverage compared to previous surveys of the L5 point. Therefore, the main result of this work is to place the most stringent constraints to date on the population of Earth Trojans. These constraints depend on assumptions regarding the underlying population properties, especially the slope of the magnitude distribution (which in turn depends on the size and albedo distributions of the objects). For standard assumptions, we calculate upper limits to a 90% confidence limit on the L5 population of N ET < 1 for magnitude H < 15.5, N ET =60-85 for H < 19.7, and N ET = 97 for H=20.4. This latter magnitude limit corresponds to Trojans ∼300 m in size for albedo 0.15. At H=19.7, these upper limits are consistent with previous L4 Earth Trojan constraints and significantly improve L5 constraints.
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Affiliation(s)
- Larissa Markwardt
- Department of Astronomy, University of Michigan, 1085 South University Avenue, Ann Arbor, MI 48109, USA
| | - D. W. Gerdes
- Department of Astronomy, University of Michigan, 1085 South University Avenue, Ann Arbor, MI 48109, USA
- Department of Physics, University of Michigan, 450 Church Street, Ann Arbor, MI 48109, USA
| | - R. Malhotra
- Lunar and Planetary Laboratory, The University of Arizona, 1629 E University Boulevard, Tucson, AZ 85721, USA
| | - J. C. Becker
- Department of Astronomy, University of Michigan, 1085 South University Avenue, Ann Arbor, MI 48109, USA
- Division of Geological and Planetary Sciences, California Institute of Technology, 1200 E California Blvd, Pasadena CA 91125, USA
| | - S. J. Hamilton
- Department of Physics, University of Michigan, 450 Church Street, Ann Arbor, MI 48109, USA
| | - F. C. Adams
- Department of Astronomy, University of Michigan, 1085 South University Avenue, Ann Arbor, MI 48109, USA
- Department of Physics, University of Michigan, 450 Church Street, Ann Arbor, MI 48109, USA
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Malhotra R, Katz R, Jotwani V, Ambrosius WT, Raphael KL, Haley W, Rastogi A, Cheung AK, Freedman BI, Punzi H, Rocco MV, Ix JH, Shlipak MG. Urine Markers of Kidney Tubule Cell Injury and Kidney Function Decline in SPRINT Trial Participants with CKD. Clin J Am Soc Nephrol 2020; 15:349-358. [PMID: 32111704 PMCID: PMC7057300 DOI: 10.2215/cjn.02780319] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 03/08/2019] [Accepted: 01/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES eGFR and albuminuria primarily reflect glomerular function and injury, whereas tubule cell atrophy and interstitial fibrosis on kidney biopsy are important risk markers for CKD progression. Kidney tubule injury markers have primarily been studied in hospitalized AKI. Here, we examined the association between urinary kidney tubule injury markers at baseline with subsequent loss of kidney function in persons with nondiabetic CKD who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 2428 SPRINT participants with CKD (eGFR<60 ml/min per 1.73 m2) at baseline, we measured urine markers of tubule injury (IL-18, kidney injury molecule-1 [KIM-1], neutrophil gelatinase-associated lipocalin [NGAL]), inflammation (monocyte chemoattractant protein-1 [MCP-1]), and repair (human cartilage glycoprotein-40 [YKL-40]). Cox proportional hazards models evaluated associations of these markers with the kidney composite outcome of 50% eGFR decline or ESKD requiring dialysis or kidney transplantation, and linear mixed models evaluated annualized change in eGFR. RESULTS Mean participant age was 73±9 (SD) years, 60% were men, 66% were white, and mean baseline eGFR was 46±11 ml/min per 1.73 m2. There were 87 kidney composite outcome events during a median follow-up of 3.8 years. Relative to the respective lowest quartiles, the highest quartiles of urinary KIM-1 (hazard ratio, 2.84; 95% confidence interval [95% CI], 1.31 to 6.17), MCP-1 (hazard ratio, 2.43; 95% CI, 1.13 to 5.23), and YKL-40 (hazard ratio, 1.95; 95% CI, 1.08 to 3.51) were associated with higher risk of the kidney composite outcome in fully adjusted models including baseline eGFR and urine albumin. In linear analysis, urinary IL-18 was the only marker associated with eGFR decline (-0.91 ml/min per 1.73 m2 per year for highest versus lowest quartile; 95% CI, -1.44 to -0.38), a finding that was stronger in the standard arm of SPRINT. CONCLUSIONS Urine markers of tubule cell injury provide information about risk of subsequent loss of kidney function, beyond the eGFR and urine albumin.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine and.,Division of Nephrology and Hypertension, Imperial Valley Family Care Medical Group, El Centro, California
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences and
| | - Kalani L Raphael
- Division of Nephrology and Hypertension, University of Utah Health and Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - William Haley
- Division of Nephrology, Mayo Clinic, Jacksonville, Florida
| | - Anjay Rastogi
- Division of Nephrology, University of California Los Angeles, Los Angeles, California
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah Health and Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Henry Punzi
- Trinity Hypertension and Metabolic Research Instititute, Punzi Medical Center, Carrollton, Texas
| | - Michael V Rocco
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine and .,Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, California.,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California; and
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California.,Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
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38
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Malhotra R, Han YM, Morin JLP, Luong-Van EK, Chew RJJ, Castro Neto AH, Nijhuis CA, Rosa V. Inhibiting Corrosion of Biomedical-Grade Ti-6Al-4V Alloys with Graphene Nanocoating. J Dent Res 2020; 99:285-292. [PMID: 31905311 DOI: 10.1177/0022034519897003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The identification of metal ions and particles in the vicinity of failed implants has raised the concern that biomedical titanium alloys undergo corrosion in healthy and infected tissues. Various surface modifications and coatings have been investigated to prevent the deterioration and biocorrosion of titanium alloys but so far with limited success. Graphene is a cytocompatible atom-thick film made of carbon atoms. It has a very high surface area and can be deposited onto metal objects with complex shapes. As the carbon lattice has a very small pore size, graphene has promising impermeability capacity. Here, we show that graphene coating can effectively protect Ti-6Al-4V from corrosion. Graphene nanocoatings were produced on Ti-6Al-4V grade 5 and 23 discs and subjected to corrosive challenge (0.5M NaCl supplemented with 2-ppm fluoride, pH of 2.0) up to 30 d. The linear polarization resistance curves and electrochemical impedance spectroscopy analysis showed that the graphene-coated samples presented higher corrosion resistance and electrochemical stability at all time points. Moreover, the corrosion rate of the graphene-coated samples was very low and stable (~0.001 mm/y), whereas that of the uncoated controls increased up to 16 and 5 times for grade 5 and 23 (~0.091 mm/y) at the end point, respectively. The surface oxidation, degradation (e.g., crevice defects), and leaching of Ti, Al, and V ions observed in the uncoated controls were prevented by the graphene nanocoating. The Raman mappings confirmed that the graphene nanocoating presented high structural stability and resistance to mechanical stresses and chemical degradation, keeping >99% of coverage after corrosion challenge. Our findings open the avenues for the use of graphene as anticorrosion coatings for metal biomedical alloys and implantable devices.
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Affiliation(s)
- R Malhotra
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Y M Han
- Department of Chemistry, National University of Singapore, Singapore
| | - J L P Morin
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore
| | - E K Luong-Van
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore
| | - R J J Chew
- Faculty of Dentistry, National University of Singapore, Singapore
| | - A H Castro Neto
- Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore.,Department of Materials Science and Engineering, National University of Singapore, Singapore
| | - C A Nijhuis
- Department of Chemistry, National University of Singapore, Singapore.,Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore.,NUSNNI-Nanocore, National University of Singapore, Singapore.,Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - V Rosa
- Faculty of Dentistry, National University of Singapore, Singapore.,Centre for Advanced 2D Materials and Graphene Research Centre, National University of Singapore, Singapore.,Department of Materials Science and Engineering, National University of Singapore, Singapore
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PG A, Verma A, Malhotra R, R S. Economics of milk production in Pune district of Maharashtra: A comparative analysis. IJDS 2020. [DOI: 10.33785/ijds.2019.v72i06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wen Y, Potok OA, Wei X, Paranjpe I, Chan L, Malhotra R, Coca S, Narula J, Olin JW, Nadkarni GN, Garimella PS. Exclusion of Persons with Kidney Disease in Trials of Peripheral Artery Disease: A Systematic Review of Randomized Trials. Clin J Am Soc Nephrol 2019; 15:117-119. [PMID: 31888921 PMCID: PMC6946068 DOI: 10.2215/cjn.10330819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yumeng Wen
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - O Alison Potok
- Division of Nephrology, Department of Medicine, University of California San Diego Medical Center, La Jolla, California
| | - Xin Wei
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Rakesh Malhotra
- Division of Nephrology, Department of Medicine, University of California San Diego Medical Center, La Jolla, California
| | | | - Jagat Narula
- Cardiology, Department of Medicine, Mount Sinai Hospital, New York, New York; and
| | - Jeffrey W Olin
- Cardiology, Department of Medicine, Mount Sinai Hospital, New York, New York; and
| | - Girish N Nadkarni
- Divisions of Nephrology and.,Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pranav S Garimella
- Division of Nephrology, Department of Medicine, University of California San Diego Medical Center, La Jolla, California;
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Ginsberg C, Houben AJHM, Malhotra R, Berendschot TTJM, Dagnelie PC, Kooman JP, Webers CA, Stehouwer CDA, Ix JH. Serum Phosphate and Microvascular Function in a Population-Based Cohort. Clin J Am Soc Nephrol 2019; 14:1626-1633. [PMID: 31540930 PMCID: PMC6832044 DOI: 10.2215/cjn.02610319] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Higher serum phosphate is associated with cardiovascular events and all-cause mortality. Explanations of this association have focused on large vessel calcification and stiffness. Studies suggest that a higher serum phosphate induces microvascular dysfunction, but relationships in humans with direct measures of microvascular function are lacking. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a cross-sectional analysis of 3189 community-living participants that underwent skin capillaroscopy, laser-Doppler flowmetry, and flicker light-induced retinal vessel responses. We used linear regression to assess the association between serum phosphate and each microvascular outcome. The primary outcome was skin capillary recruitment during postocclusive peak reactive hyperemia by capillaroscopy. Secondary outcomes included capillary recruitment during venous congestion, heat-induced skin hyperemic response, flicker light-induced retinal arteriolar, and venular dilation. RESULTS The mean age of the cohort was 59±8 years, 48% were women, 7% had an eGFR <60 ml/min per 1.73 m2, and the mean serum phosphate concentration was 3.2±0.5 mg/dl. A 1 mg/dl higher serum phosphate was independently associated with a 5.0% lower postocclusive capillary recruitment (95% CI, -10.0% to -0.1%). Results were similar for capillary recruitment with venous congestion (-4.5%; 95% CI, -9.8% to 0.7%). A 1 mg/dl higher serum phosphate was also independently associated with a 0.23% lower retinal venular dilation in response to flicker light (95% CI, -0.44% to -0.02%). A higher serum phosphate was not associated with change in flicker light-induced retinal arteriolar dilation or heat-induced skin hyperemic response, however a higher serum phosphate was associated with a lower heat-induced skin hyperemic response among men (-149% [95% CI, -260 to -38] per 1 mg/dl higher serum phosphate) but not women (P interaction, 0.01). CONCLUSIONS Higher serum phosphate concentrations, even within the normal range, are associated with microvascular dysfunction in community-living individuals. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_09_20_CJN02610319.mp3.
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Affiliation(s)
- Charles Ginsberg
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California; .,Division of Nephrology-Hypertension, University of California San Diego, San Diego, California
| | - Alfons J H M Houben
- Department of Internal Medicine and.,CARIM School for Cardiovascular Diseases and
| | - Rakesh Malhotra
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California.,Imperial Valley Family Care Medical Group, El Centro, California
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine and.,CARIM School for Cardiovascular Diseases and
| | - Jeroen P Kooman
- Department of Internal Medicine and.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; and
| | - Caroll A Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and.,CARIM School for Cardiovascular Diseases and
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California.,Division of Nephrology-Hypertension, University of California San Diego, San Diego, California
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Affiliation(s)
- Pranav S Garimella
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA
| | - Rakesh Malhotra
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA
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Malhotra R, Katz R, Weiner DE, Levey AS, Cheung AK, Bostom AG, Ix JH. Blood Pressure, Chronic Kidney Disease Progression, and Kidney Allograft Failure in Kidney Transplant Recipients: A Secondary Analysis of the FAVORIT Trial. Am J Hypertens 2019; 32:816-823. [PMID: 31179500 DOI: 10.1093/ajh/hpz095] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In chronic kidney disease, intensive systolic blood pressure (SBP) control reduces mortality at a cost of greater acute kidney injury risk. Kidney transplantation involves implantation of denervated kidneys and immunosuppressive medications that increase acute kidney injury risk. The optimal blood pressure (BP) target in kidney transplant recipients (KTRs) is uncertain. Prior observational studies from the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial demonstrate associations of lower SBP levels and reduced mortality risk, but the relationship of BP with kidney allograft function remains unknown. Thus, in FAVORIT, we investigated the relationship of SBP and diastolic blood pressure (DBP) with risk of kidney allograft failure and estimated glomerular filtration rate (eGFR) slope among stable KTRs. METHODS Cox proportional hazards and multivariable linear regression models adjusted for demographics, transplant characteristics, comorbidities, baseline eGFR, and urine albumin-to-creatinine ratio were used to determine associations of SBP and DBP with time to a composite kidney outcome of ≥50% eGFR decline or dialysis dependence, and with annualized eGFR change, respectively. Multivariable restricted cubic spline plots were developed to evaluate the functional form of the relationships. RESULTS Among 3,598 KTRs, mean age was 52 ± 9 years, SBP was 136 ± 20 mm Hg, DBP was 79 ± 12 mm Hg, and eGFR was 49 ± 18 ml/minute/1.73 m2. There were 369 events of ≥50% eGFR decline or dialysis dependence during a mean follow-up of 4.0 ± 1.5 years. There was no association of either SBP (compared with SBP 120 to <130 mm Hg, hazard ratio (HR) for the SBP < 110 was 1.01 (95% confidence interval (CI) 0.60 to 1.70) and 130 to <140 was 0.89 (0.64 to 1.24)) or DBP (compared with DBP 70 to <80 mm Hg, HR for the DBP 60 to <70 was 1.00 (95% CI 0.74 to 1.34) and 80 to <90 was 0.90 (0.68 to 1.18)) with the kidney failure outcome or annualized eGFR slope, and, when examined using restricted cubic splines, there was no evidence of "J"- or "U"-shaped relationships. CONCLUSIONS In a large sample of stable KTRs, we found no evidence of thresholds at which lower BPs were related to higher risk of allograft failure or eGFR decline. In light of prior findings of mortality benefit at low SBP, these observational findings suggest lower BP may be beneficial in KTRs. This important question requires confirmation in future randomized trials in KTRs.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
- Imperial Valley Family Care Medical Group, El Centro, California, USA
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Andrew G Bostom
- Division of Hypertension and Kidney Diseases, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
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Bullen AL, Katz R, Lee AK, Anderson CAM, Cheung AK, Garimella PS, Jotwani V, Haley WE, Ishani A, Lash JP, Neyra JA, Punzi H, Rastogi A, Riessen E, Malhotra R, Parikh CR, Rocco MV, Wall BM, Bhatt UY, Shlipak MG, Ix JH, Estrella MM. The SPRINT trial suggests that markers of tubule cell function in the urine associate with risk of subsequent acute kidney injury while injury markers elevate after the injury. Kidney Int 2019; 96:470-479. [PMID: 31262489 PMCID: PMC6650383 DOI: 10.1016/j.kint.2019.03.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 07/26/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 01/19/2023]
Abstract
Urine markers can quantify tubular function including reabsorption (α-1 microglobulin [α1m]) and β-2-microglobulin [β2m]) and protein synthesis (uromodulin). Individuals with tubular dysfunction may be less able to compensate to insults than those without, despite similar estimated glomerular filtration rate (eGFR) and albuminuria. Among Systolic Blood Pressure Intervention Trial (SPRINT) participants with an eGFR under 60 ml/min/1.73m2, we measured urine markers of tubular function and injury (neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], interleukin-18 [IL-18], monocyte chemoattractant protein-1, and chitinase-3-like protein [YKL-40]) at baseline. Cox models evaluated associations with subsequent acute kidney injury (AKI) risk, adjusting for clinical risk factors, baseline eGFR and albuminuria, and the tubular function and injury markers. In a random subset, we remeasured biomarkers after four years, and compared changes in biomarkers in those with and without intervening AKI. Among 2351 participants, 184 experienced AKI during 3.8 years mean follow-up. Lower uromodulin (hazard ratio per two-fold higher (0.68, 95% confidence interval [0.56, 0.83]) and higher α1m (1.20; [1.01, 1.44]) were associated with subsequent AKI, independent of eGFR and albuminuria. None of the five injury markers were associated with eventual AKI. In the random subset of 947 patients with repeated measurements, the 59 patients with intervening AKI versus without had longitudinal increases in urine NGAL, IL-19, and YKL-40 and only 1 marker of tubule function (α1m). Thus, joint evaluation of tubule function and injury provided novel insights to factors predisposing to AKI, and responses to kidney injury.
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Affiliation(s)
- Alexander L Bullen
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Ronit Katz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alexandra K Lee
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
| | - Cheryl A M Anderson
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California-San Diego, San Diego, California, USA
| | - Alfred K Cheung
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Medical Service, Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - William E Haley
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Areef Ishani
- Division of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - James P Lash
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Javier A Neyra
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, Kentucky, USA; Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern, Dallas, Texas, USA
| | - Henry Punzi
- UT Southwestern Medical Center, Carrollton, Texas, USA
| | - Anjay Rastogi
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Erik Riessen
- Medical Service, Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Chirag R Parikh
- Department of Medicine, Section of Nephrology, Yale University, New Haven, Connecticut, USA
| | - Michael V Rocco
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry M Wall
- Division of Nephrology, Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Udayan Y Bhatt
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA; Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA; Nephrology Section, Veterans Affairs, San Diego Healthcare System, La Jolla, California, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA; Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA.
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Jotwani VK, Lee AK, Estrella MM, Katz R, Garimella PS, Malhotra R, Rifkin DE, Ambrosius W, Freedman BI, Cheung AK, Raphael KL, Drawz P, Neyra JA, Oparil S, Punzi H, Shlipak MG, Ix JH. Urinary Biomarkers of Tubular Damage Are Associated with Mortality but Not Cardiovascular Risk among Systolic Blood Pressure Intervention Trial Participants with Chronic Kidney Disease. Am J Nephrol 2019; 49:346-355. [PMID: 30939472 DOI: 10.1159/000499531] [Citation(s) in RCA: 15] [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: 12/03/2018] [Accepted: 02/11/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Kidney tubulointerstitial fibrosis on biopsy is a strong predictor of chronic kidney disease (CKD) progression, and CKD is associated with elevated risk of cardiovascular disease (CVD). Tubular health is poorly quantified by traditional kidney function measures, including estimated glomerular filtration rate (eGFR) and albuminuria. We hypothesized that urinary biomarkers of tubular injury, inflammation, and repair would be associated with higher risk of CVD and mortality in persons with CKD. METHODS We measured urinary concentrations of interleukin-18 (IL-18), kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and chitinase-3-like protein-1 (YKL-40) at baseline among 2,377 participants of the Systolic Blood Pressure Intervention Trial who had an eGFR < 60 mL/min/1.73 m2. We used Cox proportional hazards models to evaluate biomarker associations with CVD events and all-cause mortality. RESULTS At baseline, the mean age of participants was 72 ± 9 years, and eGFR was 48 ± 11 mL/min/1.73 m2. Over a median follow-up of 3.8 years, 305 CVD events (3.6% per year) and 233 all-cause deaths (2.6% per year) occurred. After multivariable adjustment including eGFR, albuminuria, and urinary creatinine, none of the biomarkers showed statistically significant associations with CVD risk. Urinary IL-18 (hazard ratio [HR] per 2-fold higher value, 1.14; 95% CI 1.01-1.29) and YKL-40 (HR per 2-fold higher value, 1.08; 95% CI 1.02-1.14) concentrations were each incrementally associated with higher mortality risk. Associations were similar when stratified by randomized blood pressure arm. CONCLUSIONS Among hypertensive trial participants with CKD, higher urinary IL-18 and YKL-40 were associated with higher risk of mortality, but not CVD.
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Affiliation(s)
- Vasantha K Jotwani
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, California, USA,
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, California, USA,
| | - Alexandra K Lee
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, California, USA
| | - Michelle M Estrella
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, California, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, California, USA
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Pranav S Garimella
- Department of Medicine, University of California, San Diego, California, USA
| | - Rakesh Malhotra
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Dena E Rifkin
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Walter Ambrosius
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I Freedman
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alfred K Cheung
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kalani L Raphael
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Paul Drawz
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Javier A Neyra
- Department of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Henry Punzi
- Punzi Medical Center, Trinity Hypertension Research Institute, Carollton, Texas, USA
| | - Michael G Shlipak
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, California, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, California, USA
| | - Joachim H Ix
- Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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46
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Pandey R, Soni N, Bhayana H, Malhotra R, Pankaj A, Arora SS. Hand function outcome in closed small bone fractures treated by open reduction and internal fixation by mini plate or closed crossed pinning: a randomized controlled trail. Musculoskelet Surg 2019; 103:99-105. [PMID: 29855782 DOI: 10.1007/s12306-018-0542-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE No study in literature clearly gives advantage of one method of surgical fixation of fracture over the other in metacarpal and phalangeal bones of hand comparing wider outcome measures. MATERIALS AND METHODS A randomized controlled trial between closed reduction and percutaneous Kirschner wire fixation or open reduction and internal fixation with mini fragment plates was conducted. A total of 32 patients with 16 in each group were taken in tertiary-level teaching hospital from 2014 to 2016. Four patients lost to follow-up apart from 32 studied. Inclusion criteria were age group 16-60 years, fresh (3 days) closed shaft fractures of metacarpal and phalanges. Outcome evaluated were time to union of fracture, degree of strength achieved measured with dynamometer, DASH scoring, range of motion of hand and each digit. RESULTS Both groups were comparable in terms of return to full hand function, union and total range of motion. K wire fixation results were slightly better than plating group in terms of early DASH score and grip strength after fixation. CONCLUSION No modality was found to be superior for fixation of small bone fractures of hand. But K wire being cheaper and without inherent complication of plating like scar and tendon irritation, K wire fixation is preferred over plating in shaft fractures of metacarpal and phalanges. LEVEL OF EVIDENCE Level I Therapeutic study.
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Affiliation(s)
- R Pandey
- University College of Medical Sciences, Delhi, India.
| | - N Soni
- Max Health Care, Delhi, India
| | - H Bhayana
- University College of Medical Sciences, Delhi, India
| | - R Malhotra
- University College of Medical Sciences, Delhi, India
| | - A Pankaj
- Fortis Shalimar Bagh, Delhi, India
| | - S S Arora
- Department of Orthopedic, AIIMS Rishikesh, Rishikesh, India
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Mazereeuw‐Hautier J, Hernández‐Martín A, O'Toole E, Bygum A, Amaro C, Aldwin M, Audouze A, Bodemer C, Bourrat E, Diociaiuti A, Dolenc‐Voljč M, Dreyfus I, El Hachem M, Fischer J, Ganemo A, Gouveia C, Gruber R, Hadj‐Rabia S, Hohl D, Jonca N, Ezzedine K, Maier D, Malhotra R, Rodriguez M, Ott H, Paige D, Pietrzak A, Poot F, Schmuth M, Sitek J, Steijlen P, Wehr G, Moreen M, Vahlquist A, Traupe H, Oji V. Congenital ichthyoses: European guidelines of care, part two. Br J Dermatol 2019. [DOI: 10.1111/bjd.17552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Mazereeuw‐Hautier J, Hernandez‐Martin A, O'Toole E, Bygum A, Amaro C, Aldwin M, Audouze A, Bodemer C, Bourrat E, Diociaiuti A, Dolenc‐Voljc M, Dreyfus I, El Hachem M, Fischer J, Ganemo A, Gouveia C, Gruber R, Hadj‐Rabia S, Hohl D, Jonca N, Ezzedine K, Maier D, Malhotra R, Rodriguez M, Ott H, Paige D, Pietrzak A, Poot F, Schmuth M, Sitek J, Steijlen P, Wehr G, Moreen M, Vahlquist A, Traupe H, Oji V. 先天性鱼鳞病 : 欧洲护理指南, 第二部分. Br J Dermatol 2019. [DOI: 10.1111/bjd.17568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Chen C, Lim JT, Chia NC, Wang L, Tysinger B, Zissimopolous J, Chong MZ, Wang Z, Koh GC, Yuan JM, Tan KB, Chia KS, Cook AR, Malhotra R, Chan A, Ma S, Ng TP, Koh WP, Goldman DP, Yoong J. The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore. J Econ Ageing 2019; 14:100193. [PMID: 31857943 PMCID: PMC6922027 DOI: 10.1016/j.jeoa.2019.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.
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Affiliation(s)
- C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - JT Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - NC Chia
- Department of Economics, National University of Singapore, Singapore
| | - L Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - B Tysinger
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Zissimopolous
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - MZ Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Z Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - GC Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - JM Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - KB Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Policy Research and Economics Office, Ministry of Health, Singapore
| | - KS Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - AR Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - R Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - A Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - S Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore
| | - TP Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WP Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - DP Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Yoong
- Center for Economic and Social Research, University of Southern California, USA
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50
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Mazereeuw-Hautier J, Vahlquist A, Traupe H, Bygum A, Amaro C, Aldwin M, Audouze A, Bodemer C, Bourrat E, Diociaiuti A, Dolenc-Voljc M, Dreyfus I, El Hachem M, Fischer J, Gånemo A, Gouveia C, Gruber R, Hadj-Rabia S, Hohl D, Jonca N, Ezzedine K, Maier D, Malhotra R, Rodriguez M, Ott H, Paige DG, Pietrzak A, Poot F, Schmuth M, Sitek JC, Steijlen P, Wehr G, Moreen M, O'Toole EA, Oji V, Hernandez-Martin A. Management of congenital ichthyoses: European guidelines of care, part one. Br J Dermatol 2018; 180:272-281. [PMID: 30216406 DOI: 10.1111/bjd.17203] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
These guidelines for the management of congenital ichthyoses have been developed by a multidisciplinary group of European experts following a systematic review of the current literature, an expert conference held in Toulouse in 2016 and a consensus on the discussions. They summarize evidence and expert-based recommendations and are intended to help clinicians with the management of these rare and often complex diseases. These guidelines comprise two sections. This is part one, covering topical therapies, systemic therapies, psychosocial management, communicating the diagnosis and genetic counselling.
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Affiliation(s)
- J Mazereeuw-Hautier
- Reference Centre for Rare Skin Diseases, Dermatology Department, Larrey Hospital, Toulouse, France
| | - A Vahlquist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Von-Esmarch-Straße 58,, D-48149, Münster, Germany
| | - A Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - C Amaro
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - M Aldwin
- Ichthyosis Support Group, PO Box 1242, Yateley, GU47 7FL, U.K
| | - A Audouze
- Association Ichtyose France, Bellerive sur Allier, France
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France.,Institut Imagine, Université Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - E Bourrat
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France
| | - A Diociaiuti
- Dermatology Division, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - M Dolenc-Voljc
- Department of Dermatovenereology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - I Dreyfus
- Reference Centre for Rare Skin Diseases, Dermatology Department, Larrey Hospital, Toulouse, France
| | - M El Hachem
- Dermatology Division, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Gånemo
- Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Gouveia
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Gruber
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France.,Institut Imagine, Université Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - D Hohl
- Department of Dermatology, Hôpital de Beaumont, Lausanne, Switzerland
| | - N Jonca
- Epithelial Differentiation and Rheumatoid Autoimmunity Unit (UDEAR), UMR 1056 Inserm - Toulouse 3 University, Purpan Hospital, Toulouse, France
| | - K Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, EA EpiDerm, UPEC-Université Paris-Est Créteil, 94010, Créteil, France
| | - D Maier
- Dermatology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, U.K
| | - M Rodriguez
- Department of Ear, Nose and Throat, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - H Ott
- Division of Pediatric Dermatology and Allergology, Auf Der Bult Children's Hospital, Hanover, Germany
| | - D G Paige
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, U.K
| | - A Pietrzak
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - F Poot
- ULB-Erasme Hospital, Department of Dermatology, Brussels, Belgium
| | - M Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - J C Sitek
- Department of Dermatology and Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - P Steijlen
- Department of Dermatology, Maastricht University Medical Centre, GROW Research School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - G Wehr
- Selbsthilfe Ichthyose, Kürten, Germany
| | - M Moreen
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Belgium
| | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Von-Esmarch-Straße 58,, D-48149, Münster, Germany.,Hautarztpraxis am Buddenturm, Rudolf-von-Langen-Straße 55, D-48147, Münster, Germany
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