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Feng L, Bee YM, Fu X, Kwek JL, Chan CM, Jafar TH. Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes. J Diabetes 2024. [PMID: 38169157 DOI: 10.1111/1753-0407.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We examined the trajectory of estimated glomerular filtrate rate (eGFR), associated risk factors, and its relationship with end-stage kidney disease (ESKD) among a multiethnic patient population with type 2 diabetes in Singapore. METHODS A follow-up study included 62 080 individuals with type 2 diabetes aged ≥18 years in a multi-institutional SingHealth Diabetes Registry between 2013 and 2019. eGFR trajectories were analyzed using latent class linear mixed models. Factors associated with eGFR trajectories were evaluated using multinomial logistic regression. The association of eGFR trajectories with ESKD was assessed via competing risk models. RESULTS Trajectory of kidney function, determined by eGFR, was nonlinear. The trajectory pattern was classified as stable initially then gradual decline (75%), progressive decline (21.9%), and rapid decline (3.1%). Younger age, female sex, Malay ethnicity, lower-income housing type, current smoking, higher glycated hemoglobin, lower low-density lipoprotein, higher triglyceride, uncontrolled blood pressure, albuminuria, cardiovascular disease, hypertension, and higher eGFR levels each were associated with progressive or rapid decline. Compared with the trajectory of stable initially then gradual eGFR decline, progressive decline increased the hazard of ESKD by 6.14-fold (95% confidence interval [CI]: 4.96-7.61)) and rapid decline by 82.55 folds (95% CI: 55.90-121.89). CONCLUSIONS Three nonlinear trajectory classes of kidney function were identified among multiethnic individuals with type 2 diabetes in Singapore. About one in four individuals had a progressive or rapid decline in eGFR. Our results suggest that eGFR trajectories are correlated with multiple social and modifiable risk factors and inform the risk of ESKD.
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Affiliation(s)
- Liang Feng
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Xiuju Fu
- Institute of High Performance Computing, A*STAR, Singapore, Singapore
| | - Jia Liang Kwek
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Duke Global Health Institute, Durham, North Carolina, USA
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Zhang JM, Zhong L, Luo T, Lomarda AM, Huo Y, Yap J, Lim ST, Tan RS, Wong ASL, Tan JWC, Yeo KK, Fam JM, Keng FYJ, Wan M, Su B, Zhao X, Allen JC, Kassab GS, Chua TSJ, Tan SY. Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images. PLoS One 2016; 11:e0153070. [PMID: 27187726 PMCID: PMC4871505 DOI: 10.1371/journal.pone.0153070] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/23/2016] [Indexed: 01/10/2023] Open
Abstract
Invasive fractional flow reserve (FFR) is the gold standard to assess the functional coronary stenosis. The non-invasive assessment of diameter stenosis (DS) using coronary computed tomography angiography (CTA) has high false positive rate in contrast to FFR. Combining CTA with computational fluid dynamics (CFD), recent studies have shown promising predictions of FFRCT for superior assessment of lesion severity over CTA alone. The CFD models tend to be computationally expensive, however, and require several hours for completing analysis. Here, we introduce simplified models to predict noninvasive FFR at substantially less computational time. In this retrospective pilot study, 21 patients received coronary CTA. Subsequently a total of 32 vessels underwent invasive FFR measurement. For each vessel, FFR based on steady-state and analytical models (FFRSS and FFRAM, respectively) were calculated non-invasively based on CTA and compared with FFR. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 90.6% (87.5%), 80.0% (80.0%), 95.5% (90.9%), 88.9% (80.0%) and 91.3% (90.9%) respectively for FFRSS (and FFRAM) on a per-vessel basis, and were 75.0%, 50.0%, 86.4%, 62.5% and 79.2% respectively for DS. The area under the receiver operating characteristic curve (AUC) was 0.963, 0.954 and 0.741 for FFRSS, FFRAM and DS respectively, on a per-patient level. The results suggest that the CTA-derived FFRSS performed well in contrast to invasive FFR and they had better diagnostic performance than DS from CTA in the identification of functionally significant lesions. In contrast to FFRCT, FFRSS requires much less computational time.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Liang Zhong
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- * E-mail:
| | - Tong Luo
- California Medical Innovations Institute, San Diego, CA 92121, United States of America
| | - Aileen Mae Lomarda
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Yunlong Huo
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, 100871, China
| | - Jonathan Yap
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Soo Teik Lim
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Ru San Tan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Aaron Sung Lung Wong
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Jack Wei Chieh Tan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Khung Keong Yeo
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Jiang Ming Fam
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Felix Yung Jih Keng
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Min Wan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, 330031, China
| | - Boyang Su
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Xiaodan Zhao
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | | | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, CA 92121, United States of America
| | - Terrance Siang Jin Chua
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Swee Yaw Tan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
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