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Pinsino A, Jennings DL, Ladanyi A, Duong P, Sweat AO, Mahoney I, Bohn B, Demmer RT, Takeda K, Sayer GT, Uriel N, Leb JS, Husain SA, Mohan S, Colombo PC, Yuzefpolskaya M. Kidney function assessment using cystatin C and serum creatinine in heart transplantation recipients: Implications for valganciclovir dosing. J Heart Lung Transplant 2024; 43:1963-1972. [PMID: 39069163 DOI: 10.1016/j.healun.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 06/11/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Among heart transplantation (HT) recipients, the accuracy of serum creatinine (sCr)-based estimated glomerular filtration rate (eGFR) may be limited by fluctuations in muscle mass. Cystatin C (cysC) is less influenced by muscle mass, but its levels may increase with obesity and steroid use. Herein, we (1) longitudinally compared eGFRcysC and eGFRsCr among HT recipients; (2) investigated the association of body mass index (BMI), steroid use, and muscle mass with discrepancies between eGFRs; and (3) explored the implications of eGFRcysC use on valganciclovir (VGC) dosing. METHODS cysC and sCr were measured in 294 blood samples obtained from 80 subjects. Intraindividual differences between eGFRs (eGFRdiffcysC-sCr) were calculated with negative values corresponding to eGFRsCr > eGFRcysC and positive values to eGFRcysC > eGFRsCr. In a patient subset (n = 21), pectoralis muscle measures were obtained. RESULTS Marked differences between eGFRcysC and eGFRsCr were observed, particularly early post-HT (1-week post-HT, median eGFRdiffcysC-sCr -28 ml/min/1.73 m2). eGFRcysC demonstrated stability following a transient postoperative decline, while eGFRsCr decreased in the first year post-HT. Lower BMI and higher prednisone dose displayed a modest association with more negative eGFRdiffcysC-sCr values. Pectoralis muscle measures indicative of greater muscle mass and better tissue quality exhibited a stronger association with more positive eGFRdiffcysC-sCr values. The use of eGFRcysC would have led to VGC dose adjustment in 46% of samples, predominantly resulting in dose reduction. CONCLUSIONS Among HT recipients, eGFRcysC and eGFRsCr markedly differ with implications for VGC dosing. The observed discrepancies may reflect changes in body composition and steroid use.
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Affiliation(s)
- Alberto Pinsino
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Douglas L Jennings
- Department of Pharmacy Practice, Long Island University College of Pharmacy, New York, New York; Department of Pharmacy, Columbia University Irving Medical Center, New York, New York
| | - Annamaria Ladanyi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Phuong Duong
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Austin O Sweat
- Department of Medicine, New York University, New York, New York
| | - Ian Mahoney
- Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine, New York University, New York, New York
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota; Division of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jay S Leb
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Syed A Husain
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sumit Mohan
- Division of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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Delanaye P, Derain-Dubourg L, Björk J, Courbebaisse M, Couzi L, Gaillard F, Garrouste C, Grubb A, Jacquemont L, Hansson M, Kamar N, Legendre C, Littmann K, Mariat C, Rostaing L, Rule AD, Sundin PO, Bökenkamp A, Berg U, Åsling-Monemi K, Åkesson A, Larsson A, Nyman U, Pottel H. Estimating glomerular filtration in young people. Clin Kidney J 2024; 17:sfae261. [PMID: 39314869 PMCID: PMC11418036 DOI: 10.1093/ckj/sfae261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Indexed: 09/25/2024] Open
Abstract
Background Creatinine-based equations are the most used to estimate glomerular filtration rate (eGFR). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the re-expressed Lund-Malmö Revised (r-LMR) and the European Kidney Function Consortium (EKFC) equations are the most validated. The EKFC and r-LMR equations have been suggested to have better performances in young adults, but this is debated. Methods We collected data (GFR) measured by clearance of an exogenous marker (reference method), serum creatinine, age and sex from 2366 young adults (aged between 18 and 25 years) both from Europe and the USA. Results In the European cohorts (n = 1892), the bias (in mL/min/1.73 m²) was systematically better for the EKFC and r-LMR equations compared with the CKD-EPI equation [2.28, 95% confidence interval (1.59; 2.91), -2.50 (-3.85; -1.76), 17.41 (16.49; 18.47), respectively]. The percentage of estimated GFR within 30% of measured GFR (P30) was also better for EKFC and r-LMR equations compared with the CKD-EPI equation [84.4% (82.8; 86.0), 87.2% (85.7; 88.7) and 65.4% (63.3; 67.6), respectively]. In the US cohorts (n = 474), the bias for the EKFC and r-LMR equations was better than for the CKD-EPI equation in the non-Black population [0.97 (-1.69; 3.06), -2.62 (-5.14; -1.43) and 7.74 (5.97; 9.63), respectively], whereas the bias was similar in Black US individuals. P30 results were not different between the three equations in US cohorts. Analyses in sub-populations confirmed these results, except in individuals with high GFR levels (GFR ≥120 mL/min/1.73 m²) for whom the CKD-EPI equation might have a lower bias. Conclusions We demonstrated that both the EKFC and r-LMR creatinine-based equations have a better performance than the CKD-EPI equation in a young population. The only exception might be in patients with hyperfiltration.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France
| | - Laurence Derain-Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Marie Courbebaisse
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, INSERM U1151-CNRS UMR8253, Paris, France
| | - Lionel Couzi
- CHU de Bordeaux, Nephrologie – Transplantation – Dialyse, Université de Bordeaux, CNRS-UMR 5164 Immuno ConcEpT, Bordeaux, France
| | - Francois Gaillard
- AURAL, Association pour l'utilisation du rein artificiel dans la région lyonnaise, Lyon, France
| | - Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lola Jacquemont
- Renal Transplantation Department, CHU Nantes, Nantes University, Nantes, France
| | - Magnus Hansson
- Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge and Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR – BMT, University Paul Sabatier, Toulouse, France
| | | | - Karin Littmann
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Hôpital Michallon, CHU Grenoble-Alpes, Grenoble, France
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Per-Ola Sundin
- Karla Healthcare Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Arend Bökenkamp
- Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ulla Berg
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kajsa Åsling-Monemi
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Anna Åkesson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 515] [Impact Index Per Article: 515.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Simon Frances B, Sans-Roselló J, Brugaletta S, Cerrato E, Alfonso F, Gonzalo N, Amat-Santos IJ, Fernández-Peregrina E, Teira Calderón A, Varghese JJ, Garg M, García-García HM. Impact of age on the outcomes of Takotsubo syndrome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:44-51. [PMID: 37949720 DOI: 10.1016/j.carrev.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The impact on age on the short-term and long-term prognosis in patients with Takotsubo syndrome (TTS) is unclear. We aimed to evaluate whether age has prognostic implications during hospital stay and long-term follow-up of TTS patients. METHODS 688 consecutive patients were admitted for TTS in 7 tertiary centers from January-2008 to June-2021. We divided our cohort into two groups (patients <75 years and ≥75 years). Clinical, analytical, and hemodynamic variables as well as in-hospital management were registered and compared between groups. Mortality rates during hospital stay and follow-up were assessed. Adverse cardiovascular events (ACE) were defined as the composite of cardiovascular death, heart failure event, acute myocardial infarction, stroke and symptomatic arrhythmia. RESULTS Median age was 74.7 years and 49.4 % were ≥75 years. 86.9 % were women and 22.3 % were secondary forms of TTS. In-hospital mortality was 3.6 % (1.5 % cardiovascular). Median clinical follow-up was 4.3 years. Mortality during the follow-up period was 23 % (5.0 % cardiovascular) while ACE were 22.5 %, mainly due to heart failure events. Kaplan-Meier curves showed both higher rates of mortality and ACE in ≥75 years group (30.2 % vs 15.8 %; p < 0.001 and 28.3 % vs 16.7 %; p < 0.001). Age was independently associated with higher rates of overall mortality and ACE in patients with TTS. Hypertension, absence of sinus rhythm, Killip class > I and a more impaired coronary microvascular resistance were also associated to ACE in TTS patients. CONCLUSIONS Advanced age was associated with higher rate of overall mortality and ACE during long-term follow-up in TTS patients.
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Affiliation(s)
| | - Jordi Sans-Roselló
- Department of Cardiology, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain.
| | - Salvatore Brugaletta
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Enrico Cerrato
- Interventional Cardiology Unit. San Luigi Gonzaga University Hospital, Orbassano, Italy and Infermi Hospital, Rivoli (Turin), Italy
| | - Fernando Alfonso
- Section of Interventional Cardiology, Department of Cardiology, Hospital Universitario de La Princesa, CIBERCV, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Estefanía Fernández-Peregrina
- Section of Interventional Cardiology, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andrea Teira Calderón
- Section of Interventional Cardiology, Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Mohil Garg
- MedStar Cardiovascular Research Network, NW, Washington, DC, USA
| | - Héctor M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, EB 521, 110 Irving St NW, Washington, DC 20010, USA.
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Delanaye P, Rule AD, Schaeffner E, Cavalier E, Shi J, Hoofnagle AN, Nyman U, Björk J, Pottel H. Performance of the European Kidney Function Consortium (EKFC) creatinine-based equation in United States cohorts. Kidney Int 2024; 105:629-637. [PMID: 38101514 DOI: 10.1016/j.kint.2023.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/28/2023] [Accepted: 11/05/2023] [Indexed: 12/17/2023]
Abstract
Estimating glomerular filtration rate (GFR) is important in daily practice to assess kidney function and adapting the best clinical care of patients with and without chronic kidney disease. The new creatinine-based European Kidney Function Consortium (EKFC) equation is used to estimate GFR. This equation was developed and validated mainly in European individuals and based on a rescaled creatinine, with the rescaling factor (Q-value) defined as the median normal value of serum creatinine in a given population. The validation was limited in Non-Black Americans and absent in Black Americans. Here, our cross-sectional analysis included 12,854 participants from nine studies encompassing large numbers of both non-Black and Black Americans with measured GFR by clearance of an exogenous marker (reference method), serum creatinine, age, sex, and self-reported race available. Two strategies were considered with population-specific Q-values in Black and non-Black men and women (EKFCPS) or a race-free Q-value (EKFCRF). In the whole population, only the EKFCPS equation showed no statistical median bias (0.14, 95% confidence interval [-0.07; 0.35] mL/min/1.73m2), and the bias for the EKFCRF (0.74, [0.51; 0.94] mL/min/1.73m2) was closer to zero than that for the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI2021) equation (1.22, [0.99; 1.47]) mL/min/1.73m2]. The percentage of estimated GFR within 30% of measured GFR was similar for CKD-EPI2021 (79.2% [78.5%; 79.9%]) and EKFCRF (80.1% [79.4%; 80.7%]), but improved for the EKFCPS equation (81.1% [80.5%; 81.8%]). Thus, our EKFC equations can be used to estimate GFR in the United States incorporating either self-reported race or unknown race at the patient's discretion per hospital registration records.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Elke Schaeffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Junyan Shi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA; Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA; Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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de Almeida GS, Toledo NDN, Matos MMM, Martin LC, Franco RJDS. Different methods for assessing glomerular filtration rate in the elderly. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20221101. [PMID: 38294122 PMCID: PMC10830097 DOI: 10.1590/1806-9282.20221101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The objective of this study was to identify the best method to replace cystatin C in the evaluation of glomerular filtration in the elderly. METHODS Individuals over 60 years of age from a primary care center were studied. Blood was collected to determine creatinine and cystatin C and 24-h urine. Three methods were compared to determine glomerular filtration: Creatinine clearance, Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine, considering as a reference the determination of glomerular filtration using the cystatin-based Chronic Kidney Disease Epidemiology Collaboration equation. The statistical methods used were linear regression, Bland-Altman curve, and receiver operating characteristic. RESULTS A total of 180 elderly people were evaluated, but 14 patients were lost from the sample, resulting in a total of 166 patients. The average age of patients was 66.9±6.1 years, and 69.8% were females. Regarding the number of patients eligible for the study, there were 12 black, 108 brown, and 46 white, 42.77% hypertensive, and 38.3% diabetic. Glomerular filtration was less than 60 mL/min in 22.28% of patients. Regarding the evaluation of the different equations, the correlation coefficient was lower for creatinine clearance and progressively higher for Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine. The Bland-Altman diagram and the receiver operating characteristic curve showed similar performance to the correlation coefficient for the different equations evaluated. CONCLUSION Collaboration Epidemiology of Chronic Kidney Disease based on creatinine presented the best performance. Creatinine debug had the worst performance, which reinforces the idea that 24-h urine collection is unnecessary in these patients.
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Affiliation(s)
| | | | | | - Luis Cuadrado Martin
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculty of Medicine – Botucatu (SP), Brazil
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Delanaye P, Cavalier E, Stehlé T, Pottel H. Glomerular Filtration Rate Estimation in Adults: Myths and Promises. Nephron Clin Pract 2024; 148:408-414. [PMID: 38219717 DOI: 10.1159/000536243] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/23/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND In daily practice, glomerular filtration rate (GFR) is estimated with equations including renal biomarkers. Among these biomarkers, serum creatinine remains the most used. However, there are many limitations with serum creatinine, which we will discuss in the current review. We will also discuss how creatinine-based equations have been developed and what we can expect from them in terms of performance to estimate GFR. SUMMARY Different creatinine-based equations have been proposed. We will show the advantages of the recent European Kidney Function Consortium equation. This equation can be used in children and adults. This equation can also be used with some flexibility in different populations. KEY MESSAGES GFR is estimated by creatinine-based equations, but the most important for nephrologists is probably to know the limitations of these equations.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Thomas Stehlé
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Kaya IC, Bulut HI, Lopes L, Ozbayburtlu M, Kocaoglu S. Complete surgical myocardial revascularization in patients with declined renal functions: 12-month outcomes. BMC Cardiovasc Disord 2023; 23:484. [PMID: 37773097 PMCID: PMC10540422 DOI: 10.1186/s12872-023-03507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION This retrospective observational study aimed to evaluate the feasibility and effectiveness of complete revascularization coronary artery bypass grafting (CABG) in patients with multi-vessel disease (MVD)-CAD and declined renal functions, addressing the knowledge gap regarding optimal treatment strategies and outcomes in this specific patient population. METHODS Between 2020 and 2022, a total of 58 patients underwent on-pump coronary artery bypass grafting surgery for complete myocardial revascularization in this study. To assess overall survival, Kaplan-Meier with the log-rank test was conducted for statistical analysis. RESULTS The mean age of cohort was 60.7. The findings showed a high prevalence of medical conditions such as hypertension (50.0%), diabetes (50.0%), and anaemia (41.4%) among the participants. Intraoperatively, low cardiac output syndrome was reported in 5.2% of cases, while perioperative outcomes indicated a need for transfusions in 53.5% of cases and an in-hospital mortality rate of 3.4%. At the 12-month follow-up, no redo revascularization or renal replacement therapy was required, but cardiac mortality was 5.2% and all-cause mortality was 6.9%. CONCLUSIONS The study concluded that complete revascularization is safe for these patients and highlights the potential benefits, emphasizing the need for further research in optimizing revascularization techniques for this population.
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Affiliation(s)
- Ibrahim C Kaya
- Department of Cardiovascular Surgery, Eskisehir City Health Practice and Research Centers, Saglık Bilimleri Universitesi, Eskisehir, Turkey
| | - Halil I Bulut
- Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Leilani Lopes
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, OR, USA
| | - Merih Ozbayburtlu
- Department of Cardiovascular Surgery, Eskisehir City Health Practice and Research Centers, Eskisehir, Turkey
| | - Selim Kocaoglu
- Department of Cardiovascular Surgery, Eskisehir City Health Practice and Research Centers, Eskisehir, Turkey
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9
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Sans-Roselló J, Fernández-Peregrina E, Duran-Cambra A, Carreras-Mora J, Sionis A, Álvarez-García J, Garcia-Garcia HM. Incremental prognostic value of global longitudinal strain to the coronary microvascular resistances in Takotsubo patients. Int J Cardiovasc Imaging 2022; 39:683-693. [PMID: 36471105 DOI: 10.1007/s10554-022-02767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Global longitudinal strain (GLS) allows an accurate assessment of left ventricular function with prognostic value. We aimed to evaluate whether the assessment of GLS in the acute phase of Takotsubo syndrome (TTS) provides incremental prognostic value to the degree of impaired microvascular resistance (MR) in TTS patients at 1-year follow-up. METHODS We recruited patients admitted for TTS who underwent cardiac angiography and echocardiography from January 2017 to June 2020. Left anterior descending coronary artery non-hyperaemic angiography-derived index of microcirculatory resistance (LAD NH-IMRangio) was calculated. NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT), left ventricular ejection fraction (LVEF) and GLS were measured at admission. Major adverse cardiac events (MACE) were defined as the composite of cardiovascular death, repeat hospitalizations for heart failure (HF) and acute myocardial infarctions. RESULTS 67 patients had both GLS and NH-IMRangio available and were included in the study. Median age was 75.2 years and 88% were women. Rate of MACE at 1-year was 13.4%. Kaplan-Meier curves showed higher rates of MACE at 1-year in patients with both higher LAD NH-IMRangio and GLS values compared with those with higher LAD NH-IMRangio and lower GLS values (33.3% vs. 11.1%; p = 0.049). NT-proBNP levels at admission and the recovery of LVEF were correlated with GLS values while MR and hs-cTnT were not. CONCLUSION GLS provides incremental prognostic value to the degree of impaired MR in TTS patients. The combination of a poorer GLS with a higher degree of impaired MR was associated with a higher rate of MACE in these patients.
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Affiliation(s)
- Jordi Sans-Roselló
- Department of Cardiology, Parc Taulí Hospital Universitari, 08208, Sabadell, Barcelona, Spain.
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003, Barcelona, Spain.
- Section of Interventional Cardiology, MedStar Washington Hospital Center, EB 521; 110 Irving St NW, 20010, Washington, DC, United States of America.
| | - Estefanía Fernández-Peregrina
- Interventional Cardiology Unit, Department of Cardiology, Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08041, Barcelona, Spain
- Section of Interventional Cardiology, MedStar Washington Hospital Center, EB 521; 110 Irving St NW, 20010, Washington, DC, United States of America
| | - Albert Duran-Cambra
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08041, Barcelona, Spain
| | - Jose Carreras-Mora
- Acute and Intensive Cardiovascular Care Unit, Cardiology Department, Hospital del Mar, 08003, Barcelona, Spain
| | - Alessandro Sionis
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08041, Barcelona, Spain
| | - Jesús Álvarez-García
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003, Barcelona, Spain
- Advanced Heart Failure Unit, Department of Cardiology, IRYCIS. Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, EB 521; 110 Irving St NW, 20010, Washington, DC, United States of America.
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10
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Lin MT, Hsu CN, Lee CT, Cheng SH. Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan. Int J Health Policy Manag 2022; 11:1307-1315. [PMID: 33906336 PMCID: PMC9808322 DOI: 10.34172/ijhpm.2021.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression. METHODS We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray's test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs. RESULTS The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P<.0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58-0.64, P<.0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54-0.67, P<.0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs. CONCLUSION The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD.
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Affiliation(s)
- Min-Ting Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Te Lee
- Division of Nephrology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
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11
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Wang J, Liu J, Wu W, Yang S, Liu L, Fu Q, Li J, Chen X, Deng R, Wu C, Long S, Zhang W, Zhang H, Mao H, Chen W. Combining Clinical Parameters and Acute Tubular Injury Grading Is Superior in Predicting the Prognosis of Deceased-Donor Kidney Transplantation: A 7-Year Observational Study. Front Immunol 2022; 13:912749. [PMID: 35844570 PMCID: PMC9279653 DOI: 10.3389/fimmu.2022.912749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWe developed a pragmatic dichotomous grading criterion to stratify the acute tubular injury (ATI) of deceased-donor kidneys. We intended to verify the predictive value of this criterion for the prognosis of deceased-donor kidney transplantation.MethodsThe allografts with ATI were classified into severe and mild groups. Severe ATI was defined as the presence of extreme and diffuse flattening of the tubular epithelial cells, or denudement of the tubular basement membrane. The clinical delayed graft function (DGF) risk index was calculated based on a regression model for posttransplant DGF using 17 clinical parameters related to donor–recipient characteristics.ResultsA total of 140 recipients were enrolled: 18 severe and 122 mild ATI. Compared with the mild ATI group, the severe ATI group had more donors after cardiac death, higher median donor terminal serum creatinine level (dScr), and longer median cold ischemia time. Severe ATI had a higher DGF rate (55.6% vs 14.6%, p < 0.001), longer DGF recovery time (49.6 vs 26.3 days, p < 0.001), and a lower estimated glomerular filtration rate (eGFR) at 1 month (23.5 vs 54.0 ml/min/1.73 m2, p < 0.001), 3 months (40.4 vs 59.0, p = 0.001), and 6 months after transplant (46.8 vs 60.3, p = 0.033). However, there was no significant difference in eGFR at 1 year or beyond, graft, and patient survival. The predictive value of combined dScr with ATI severity for DGF rate and DGF recovery time was superior to that of dScr alone. The predictive value of the combined DGF risk index with ATI severity for DGF was also better than that of the DGF risk index alone; however, the association of the DGF risk index with DGF recovery time was not identified. Chronic lesions including glomerulosclerosis, interstitial fibrosis, arterial intimal fibrosis, and arteriolar hyalinosis were associated with declined posttransplant 1-year eGFR.ConclusionBased on our pragmatic dichotomous grading criterion for ATI in a preimplantation biopsy, donor kidneys with severe ATI increased DGF risk, prolonged DGF recovery, and decreased short-term graft function but demonstrated favorable long-term graft function. Our grading method can offer additive valuable information for assessing donor kidneys with acute kidney injury and may act as an effective supplementary index of the Banff criteria.
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Affiliation(s)
- Jiali Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Jinqi Liu
- Department of Pediatrics, Guangzhou Women and Children’s Medical Centre, Guangzhou, China
| | - Wenrui Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shicong Yang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xutao Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sizhe Long
- Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wujun Zhang
- Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenfang Chen, ; Haiping Mao, ; Huanxi Zhang,
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
- *Correspondence: Wenfang Chen, ; Haiping Mao, ; Huanxi Zhang,
| | - Wenfang Chen
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenfang Chen, ; Haiping Mao, ; Huanxi Zhang,
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12
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Sans Roselló J, Vidal-Burdeus M, Loma-Osorio P, Pons Riverola A, Bonet Pineda G, El Ouaddi N, Aboal J, Ariza Solé A, Scardino C, García-García C, Fernández-Peregrina E, Sionis A. “Impact of age on management and prognosis of resuscitated sudden cardiac death patients”. IJC HEART & VASCULATURE 2022; 40:101036. [PMID: 35514873 PMCID: PMC9062668 DOI: 10.1016/j.ijcha.2022.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Background Sudden cardiac death (SCD) has a great impact on healthcare due to cardiologic and neurological complications. Admissions of elderly people in Cardiology Intensive Care Units have increased. We assessed the impact of age in presentation, therapeutic management and in vital and neurological prognosis of SCD patients. Methods We carried out a retrospective, observational, multicenter registry of patients who were admitted with a SCD in 5 tertiary hospitals from January 2013 to December 2020. We divided our cohort into two groups (patients < 80 years and ≥ 80 years). Clinical, analytical and hemodynamic variables as well as in-hospital management were registered and compared between groups. The degree of neurological dysfunction, vital status at discharge and the influence of age on them were also reviewed. Results We reviewed 1160 patients admitted with a SCD. 11.3% were ≥ 80 years. Use of new antiplatelet agents, performance of a coronary angiography, use of pulmonary artery catheter and temperature control were less carried out in the elderly. Age, non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min, time to ROSC > 20 min and lactate > 2 mmol/L were independent predictors for in-hospital mortality. Non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min and time to ROSC > 20 min but not age were independent predictors for poor neurological outcomes. Conclusions Age determined a less aggressive management and it was associated with a worse vital prognosis in patients admitted with a SCD. Nevertheless, age was not associated with worse neurological outcomes.
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Affiliation(s)
- Jordi Sans Roselló
- Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain
- Corresponding autor at: Intensive Cardiac Care Unit. Cardiology Department. Hospital de la Santa Creu i Sant Pau, C/Santa Maria Claret 167, Barcelona 08025, Spain (Alessandro Sionis) Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain. Parc Taulí, 1, 08208 Sabadell, Barcelona (Jordi Sans-Roselló).
| | - Maria Vidal-Burdeus
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitari Vall d’Hebrón. Barcelona, Spain
| | - Pablo Loma-Osorio
- Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Alexandra Pons Riverola
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Gil Bonet Pineda
- Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain
| | - Nabil El Ouaddi
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jaime Aboal
- Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Albert Ariza Solé
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Claudia Scardino
- Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain
| | - Cosme García-García
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Estefanía Fernández-Peregrina
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Alessandro Sionis
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
- Corresponding autor at: Intensive Cardiac Care Unit. Cardiology Department. Hospital de la Santa Creu i Sant Pau, C/Santa Maria Claret 167, Barcelona 08025, Spain (Alessandro Sionis) Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain. Parc Taulí, 1, 08208 Sabadell, Barcelona (Jordi Sans-Roselló).
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Prognostic Value of Microvascular Resistance at Rest in Patients With Takotsubo Syndrome. JACC Cardiovasc Imaging 2022; 15:1784-1795. [DOI: 10.1016/j.jcmg.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/15/2022] [Accepted: 03/31/2022] [Indexed: 01/10/2023]
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Laham G, Ponti JP, Soler Pujol G. Assessing Renal Function for Kidney Donation. How Low Is Too Low? Front Med (Lausanne) 2022; 8:784435. [PMID: 35186970 PMCID: PMC8847393 DOI: 10.3389/fmed.2021.784435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Kidney transplantation (KT) is the treatment of choice for patients with end-stage kidney disease (ESKD) with decreased morbi-mortality, improved life quality, and reduced cost. However, the shortage of organs from deceased donors led to an increase in KT from living donors. Some stipulate that living donors have a higher risk of ESKD after donation compared with healthy non-donors. The reason for this is not clear. It is possible that ESKD is due to the nephrectomy-related reduction in glomerular filtration rate (GFR), followed by an age-related decline that may be more rapid in related donors. It is essential to assess donors properly to avoid rejecting suitable ones and not accepting those with a higher risk of ESKD. GFR is a central aspect of the evaluation of potential donors since there is an association between low GFR and ESKD. The methods for assessing GFR are in continuous debate, and the kidney function thresholds for accepting a donor may vary according to the guidelines. While direct measurements of GFR (mGFR) provide the most accurate evaluation of kidney function, guidelines do not systematically use this measurement as a reference. Also, some studies have shown that the GFR decreases with age and may vary with gender and race, therefore, the lower limit of GFR in patients eligible to donate may vary based on these demographic factors. Finally, it is known that CrCl overestimates mGFR while eGFR underestimates it, therefore, another way to have a reliable GFR could be the combination of two measurement methods.
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Affiliation(s)
- Gustavo Laham
- Internal Medicine Department, Nephrology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
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15
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Zhu C, Zhang H, Shen Z, Chen J, Gu Y, Lv S, Li Y, Zhu B, Ding X, Zhang X. OUP accepted manuscript. Clin Kidney J 2022; 15:1322-1332. [PMID: 35756734 PMCID: PMC9217656 DOI: 10.1093/ckj/sfac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
| | | | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney Disease, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
| | - Jing Chen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney Disease, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yulu Gu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney Disease, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Shiqi Lv
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney Disease, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney Disease, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Bowen Zhu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney Disease, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
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Szymala-Pędzik M, Żórawska J, Ciach J. Drugs Dosing in Geriatric Patients Depending on Kidney Function Estimated by MDRD and Cockroft-Gault Formulas. Clin Interv Aging 2021; 16:2057-2067. [PMID: 34916788 PMCID: PMC8672121 DOI: 10.2147/cia.s313196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION According to the current data, regardless of the method used to estimate GFR, the differences between the obtained results should be insignificant and do not imply therapeutic decisions. The aim of this study was to analyze and compare the eGFR results with the estimated creatinine clearance score calculated according to the Cockroft-Gault equation, and to assess the significance of the difference between these two results. SAMPLE AND METHODS A study group was constituted of 115 patients, of whom 76 were women and 39 men at the age range of 55-93 years, with a median of 79 years. The study analyzed differences in the assessment of kidney function by comparing the results of eGFR assessed by MDRD method obtained from the laboratory with the calculated values of creatinine clearance using the Cockroft-Gault formula, and examining the correlation between the difference D = eGFR -eClCr and BMI and body surface. RESULTS In the entire group of patients (N = 115), the significant statistical difference was found between eGFR and eClCr. In the subgroup of patients (N = 45) with the lower baseline eGFR <60, there was no significant difference between eGFR and eClCr, while in the subgroup of patients with baseline eGFR ≥60 (N = 75), there was a significant difference between eGFR and eClCr. The study showed that based on the estimated GFR using both methods (C-G and MDRD), 29.2% and 32.4% of patients, respectively, were incorrectly assigned to given stage of chronic kidney disease. CONCLUSION Proper assessment of kidney function is very important in order to properly drugs dosing, especially to adjust the doses of drugs metabolized by the kidneys in order to avoid or minimize their nephrotoxic effects.
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Affiliation(s)
| | - Joanna Żórawska
- Department of Geriatrics, Wroclaw Medical University, Wrocław, Poland
| | - Jacek Ciach
- Department of Human Morphology and Embryology, Wroclaw Medical University, Wrocław, Poland
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Busse D, Borghardt JM, Petroff D, Pevzner A, Dorn C, El-Najjar N, Huisinga W, Wrigge H, Simon P, Kloft C. Evaluating prediction methods for glomerular filtration to optimise drug doses in obese and nonobese patients. Br J Clin Pharmacol 2021; 88:2973-2981. [PMID: 34688225 DOI: 10.1111/bcp.15115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/19/2021] [Accepted: 10/03/2021] [Indexed: 01/02/2023] Open
Abstract
AIMS The most suitable method for predicting the glomerular filtration rate (GFR) in obesity is currently debated. Therefore, multiple GFR/creatinine clearance prediction methods were applied to (morbidly) obese and nonobese patients ranging from moderate renal impairment to glomerular hyperfiltration and their predictions were rated based on observed fosfomycin pharmacokinetics, as this model drug is exclusively eliminated via glomerular filtration. METHODS The GFR/creatinine clearance predictions via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD; indexed and de-indexed by body surface area) and creatinine clearance via the Cockcroft-Gault formula (CLCRCG ) using different body size descriptors were compared to the fosfomycin clearance (CLFOF ) from 30 surgical patients (body mass index = 20.1-52.0 kg m-2 ), receiving 8000 mg as intravenous infusion. RESULTS The concordance between CLFOF and creatinine clearance predictions was highest for CLCRCG employing either ideal body weight or adjusted body weight (if body mass >1.3 ideal body weight; CLCRCG_ABW-Schwartz , concordance-correlation coefficient [95% confidence interval] = 0.474 [0.156; 0.703], CCC) and GFR predictions via the de-indexed MDRD equation (concordance-correlation coefficient = 0.452 [0.137; 0.685]). The proportion of predicted GFR values within ±30% of the observed CLFOF (P30 = 72.3-76.7%) was only marginally lower than the reported P30 in the original CKD-EPI and MDRD publications (P30 = 84.1-90.0%). CONCLUSION This analysis represents a successful proof-of-concept for evaluating GFR/creatinine clearance prediction methods: Across all body mass index classes CLCRCG_ABW-Schwartz or the de-indexed MDRD were most suitable for predicting creatinine clearance/GFR also in (morbidly) obese, CKD stage <3B individuals in therapeutic use. Their application is proposed in optimising doses for vital therapies in obese patients requiring monitoring of renal function (e.g. methotrexate dosing).
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Affiliation(s)
- David Busse
- Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Berlin, Germany.,Graduate Research Training program PharMetrX, Berlin/Potsdam, Germany
| | - Jens Markus Borghardt
- Drug Discovery Sciences, Research DMPK, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Alice Pevzner
- Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Berlin, Germany
| | - Christoph Dorn
- University of Regensburg, Institute of Pharmacy, Regensburg, Germany
| | - Nahed El-Najjar
- Institute of Clinical Microbiology and Hygiene, Faculty of Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Wilhelm Huisinga
- University of Potsdam, Institute of Mathematics, Potsdam, Germany
| | - Hermann Wrigge
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany.,Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany
| | - Philipp Simon
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Charlotte Kloft
- Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Berlin, Germany
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Coronary Microvascular Dysfunction in Takotsubo Syndrome Assessed by Angiography-Derived Index of Microcirculatory Resistance: A Pressure-Wire-Free Tool. J Clin Med 2021; 10:jcm10194331. [PMID: 34640350 PMCID: PMC8509411 DOI: 10.3390/jcm10194331] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/30/2021] [Accepted: 09/17/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Coronary microvascular dysfunction (CMD) has been proposed as a key mechanism in Takotsubo syndrome (TTS). The non-hyperaemic angiography-derived index of microcirculatory resistance (NH-IMRangio) has been validated as a pressure-wire-free tool for the assessment of coronary microvasculature. We aimed to study the presence of CMD in TTS patients and its association with levels of cardiac biomarkers and systolic dysfunction patterns. Methods: We recruited 181 consecutive patients admitted for TTS who underwent cardiac angiography at a tertiary center from January 2014 to January 2021. CMD was defined as an NH-IMRangio ≥ 25. Plasma levels of NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT) and the left ventricular ejection fraction (LVEF) by echocardiography were measured at admission. Results: Mean age was 75.3 years, 83% were women and median LVEF was 45%. All patients presented CMD (NH-IMRangio ≥ 25) in at least one epicardial coronary artery. The left anterior descending artery (LAD) showed higher median NH-IMRangio values than left circumflex (LCx) and right coronary arteries (RCA) (44.6 vs. 31.3 vs. 36.1, respectively; p < 0.001). NH-IMRangio values differed among ventricular contractility patterns in the LAD and RCA (p = 0.0152 and 0.0189, respectively) with the highest values in the mid-ventricular + apical and mid-ventricular + basal patterns. NT-proBNP levels, but not high-sensitive cardiac troponin T (hs-cTnT), were correlated with both the degree and the extent of CMD in patients with TTS. Lower LVEF was also associated with higher NH-IMRangio values. Conclusions: CMD is highly prevalent in patients admitted for TTS and is associated with both a higher degree of systolic dysfunction and higher BNP levels, but not troponin.
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Jeong TD, Cho EJ, Lee K, Lee W, Yun YM, Chun S, Song J, Min WK. Recent Trends in Creatinine Assays in Korea: Long-Term Accuracy-Based Proficiency Testing Survey Data by the Korean Association of External Quality Assessment Service (2011-2019). Ann Lab Med 2021; 41:372-379. [PMID: 33536355 PMCID: PMC7884186 DOI: 10.3343/alm.2021.41.4.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background Accurate serum creatinine (Cr) concentration measurement is essential for evaluating kidney function. In 2011, the Korean Association of External Quality Assessment Service (KEQAS) launched an accuracy-based Cr proficiency testing (ABCr PT) survey. We analyzed long-term data of the KEQAS ABCr PT survey collected between 2011 and 2019 to assess recent trends in Cr assays in Korea. Methods The ABCr PT survey including three commutable fresh-frozen serum samples was performed twice a year. The target Cr concentration was assigned using isotope-dilution mass spectrometry. We analyzed data obtained from the participating laboratories, calculated the yearly bias, and evaluated bias trends for the major reagents and instruments. Outliers were excluded from all analysis. Results The mean percentage bias based on the total data of all participating laboratories was 10.8% in the 2011-A survey and 0.2% in 2019-B survey. Bias for the major reagents and instruments differed depending on the manufacturer. Enzymatic assays generally showed desirable bias ranging from –3.9% to 3.2% at all Cr concentrations and lower interlaboratory variability than non-enzymatic assays (enzymatic vs. non-enzymatic, 3.3%–7.2% vs. 6.3%–9.1%). Conclusions Although the mean percentage bias of Cr assays tends to decrease over time, it is necessary to continuously strive to improve Cr assay accuracy, especially at low concentrations.
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Affiliation(s)
- Tae-Dong Jeong
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun-Jung Cho
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyunghoon Lee
- Department of Laboratory Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Korea
| | - Woochang Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Sail Chun
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Junghan Song
- Department of Laboratory Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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20
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Wang PC, Gussekloo J, Arai Y, Abe Y, Blom JW, Duncan R, Jagger C, Kerse N, Martin-Ruiz C, Palapar L, den Elzen WPJ. The effects of single and a combination of determinants of anaemia in the very old: results from the TULIPS consortium. BMC Geriatr 2021; 21:457. [PMID: 34372781 PMCID: PMC8351428 DOI: 10.1186/s12877-021-02389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 07/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of these determinants, singly and in combination, on anaemia in the very old. Method The TULIPS Consortium consists of four population-based studies in oldest-old individuals: Leiden 85-plus Study, LiLACS NZ, Newcastle 85+ study, and TOOTH. Five selected determinants (iron, vitamin B12, and folate deficiency; low estimated glomerular filtration rate (eGFR); and high C-reactive protein (CRP)) were summed. This sum score was used to investigate the association with the presence and onset of anaemia (WHO definition). The individual study results were pooled using random-effects models. Results In the 2216 participants (59% female, 30% anaemia) at baseline, iron deficiency, low eGFR and high CRP were individually associated with the presence of anaemia. Low eGFR and high CRP were individually associated with the onset of anaemia. In the cross-sectional analyses, an increase per additional determinant (adjusted OR 2.10 (95% CI 1.85–2.38)) and a combination of ≥2 determinants (OR 3.44 (95% CI 2.70–4.38)) were associated with the presence of anaemia. In the prospective analyses, an increase per additional determinant (adjusted HR 1.46 (95% CI 1.24–1.71)) and the presence of ≥2 determinants (HR 1.95 (95% CI 1.40–2.71)) were associated with the onset of anaemia. Conclusion Very old adults with a combination of determinants of anaemia have a higher risk of having, and of developing, anaemia. Further research is recommended to explore causality and clinical relevance. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02389-2.
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Affiliation(s)
- Pin-Chun Wang
- Leiden University Medical Center, Master's Vitality and Ageing, PO Box 9600, 2300 RC, Leiden, the Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.,Department of Internal Medicine, Gerontology and Geriatrics Section, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Rachel Duncan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, 1072, New Zealand
| | - Carmen Martin-Ruiz
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Leah Palapar
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, 1072, New Zealand
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands. .,Atalmedial Diagnostics Centre, Amsterdam, The Netherlands. .,Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, The Netherlands.
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21
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Real-world renal function among patients with multiple myeloma in the United States. Blood Cancer J 2021; 11:99. [PMID: 34021119 PMCID: PMC8140071 DOI: 10.1038/s41408-021-00492-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
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22
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Zong M, Zhou L, Guan Q, Lin D, Zhao J, Qi H, Harriman D, Fan L, Zeng H, Du C. Comparison of Surface-Enhanced Raman Scattering Properties of Serum and Urine for the Detection of Chronic Kidney Disease in Patients. APPLIED SPECTROSCOPY 2021; 75:412-421. [PMID: 33031004 PMCID: PMC8027936 DOI: 10.1177/0003702820966322] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Chronic kidney disease (CKD) affects more than 10% of the global population and is associated with significant morbidity and mortality. In most cases, this disease is developed silently, and it can progress to the end-stage renal failure. Therefore, early detection becomes critical for initiating effective interventions. Routine diagnosis of CKD requires both blood test and urinalyses in a clinical laboratory, which are time-consuming and have low sensitivity and specificity. Surface-enhanced Raman scattering (SERS) is an emerging method for rapidly assessing kidney function or injury. This study was designed to compare the differences between the SERS properties of the serum and urine for easy and simple detection of CKD. Enrolled for this study were 126 CKD patients (Stages 2-5) and 97 healthy individuals. SERS spectra of both the serum and urine samples were acquired using a Raman spectrometer (785 nm excitation). The correlation of chemical parameters of kidney function with the spectra was examined using prinicpal component analysis (PCA) combined with linear discriminant analysis (LDA) and partial least squares (PLS) analysis. Here, we showed that CKD was discriminated from non-CKD controls using PCA-LDA with a sensitivity of 74.6% and a specificity of 93.8% for the serum spectra, and 78.0% and 86.0 % for the urine spectra. The integration area under the receiver operating characteristic curve was 0.937 ± 0.015 (p < 0.0001) for the serum and 0.886 ± 0.025 (p < 0.0001) for the urine. The different stages of CKD were separated with the accuracy of 78.0% and 75.4% by the serum and urine spectra, respectively. PLS prediction (R2) of the serum spectra was 0.8540 for the serum urea (p < 0.001), 0.8536 for the serum creatinine (p < 0.001), 0.7500 for the estimated glomerular filtration rate (eGFR) (p < 0.001), whereas the prediction (R2) of urine spectra was 0.7335 for the urine urea (p < 0.001), 0.7901 for the urine creatinine (p < 0.001), 0.4644 for the eGFR (p < 0.001) and 0.6579 for the urine microalbumin (p < 0.001). In conclusion, the accuracy of associations between SERS findings of the serum and urine samples with clinical conclusions of CKD diagnosis in this limited number of patients is similar, suggesting that SERS may be used as a rapid and easy-to-use method for early screening of CKD, which however needs further evaluation in a large cohort study.
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Affiliation(s)
- Ming Zong
- Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Lan Zhou
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiunong Guan
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Duo Lin
- Imaging Unit, Integrative Oncology Department, BC Cancer Research Center, Vancouver, Canada
| | - Jianhua Zhao
- Imaging Unit, Integrative Oncology Department, BC Cancer Research Center, Vancouver, Canada
| | - Hualin Qi
- Department of Nephrology, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - David Harriman
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Lieying Fan
- Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Lieying Fan, Tongji University School of Medicine, Shanghai East Hospital, Shanghai 200092, China. Haishan Zeng, Imaging Unit, Integrative Oncology Department, BC Cancer Research Center, 675 W 10th Ave, Vancouver V5Z 1L3, Canada. Caigan Du, The University of British Columbia Jack Bell Research Centre, Vancouver, V6T 1Z4 Canada.
| | - Haishan Zeng
- Imaging Unit, Integrative Oncology Department, BC Cancer Research Center, Vancouver, Canada
| | - Caigan Du
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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23
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Williams EH, Flint TR, Connell CM, Giglio D, Lee H, Ha T, Gablenz E, Bird NJ, Weaver JMJ, Potts H, Whitley CT, Bookman MA, Lynch AG, Meyer HV, Tavaré S, Janowitz T. CamGFR v2: A New Model for Estimating the Glomerular Filtration Rate from Standardized or Non-standardized Creatinine in Patients with Cancer. Clin Cancer Res 2021; 27:1381-1390. [PMID: 33303580 PMCID: PMC9097346 DOI: 10.1158/1078-0432.ccr-20-3201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Management of patients with cancer, specifically carboplatin dosing, requires accurate knowledge of glomerular filtration rate (GFR). Direct measurement of GFR is resource limited. Available models for estimated GFR (eGFR) are optimized for patients without cancer and either isotope dilution mass spectrometry (IDMS)- or non-IDMS-standardized creatinine measurements. We present an eGFR model for patients with cancer compatible with both creatinine measurement methods. EXPERIMENTAL DESIGN GFR measurements, biometrics, and IDMS- or non-IDMS-standardized creatinine values were collected for adult patients from three cancer centers. Using statistical modeling, an IDMS and non-IDMS creatinine-compatible eGFR model (CamGFR v2) was developed. Its performance was compared with that of the existing models Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Full Age Spectrum (FAS), Lund-Malmö revised, and CamGFR v1, using statistics for bias, precision, accuracy, and clinical robustness. RESULTS A total of 3,083 IDMS- and 4,612 non-IDMS-standardized creatinine measurements were obtained from 7,240 patients. IDMS-standardized creatinine values were lower than non-IDMS-standardized values in within-center comparisons (13.8% lower in Cambridge; P < 0.0001 and 19.3% lower in Manchester; P < 0.0001), and more consistent between centers. CamGFR v2 was the most accurate [root-mean-squared error for IDMS, 14.97 mL/minute (95% confidence interval, 13.84-16.13) and non-IDMS, 15.74 mL/minute (14.86-16.63)], most clinically robust [proportion with >20% error of calculated carboplatin dose for IDMS, 0.12 (0.09-0.14) and non-IDMS, 0.17 (0.15-0.2)], and least biased [median residual for IDMS, 0.73 mL/minute (-0.68 to 2.2) and non-IDMS, -0.43 mL/minute (-1.48 to 0.91)] eGFR model, particularly when eGFR was larger than 60 ml/minute. CONCLUSIONS CamGFR v2 can utilize IDMS- and non-IDMS-standardized creatinine measurements and outperforms previous models. CamGFR v2 should be examined prospectively as a practice-changing standard of care for eGFR-based carboplatin dosing.
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Affiliation(s)
- Edward H Williams
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, England, United Kingdom
| | - Thomas R Flint
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Claire M Connell
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, England, United Kingdom
- University of Cambridge, Cambridge, England, United Kingdom
| | - Daniel Giglio
- Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Hassal Lee
- University of Cambridge School of Clinical Medicine, Cambridge, England, United Kingdom
| | - Taehoon Ha
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York
| | - Eva Gablenz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York
| | - Nicholas J Bird
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - James M J Weaver
- The Christie NHS Foundation Trust, Manchester, England, United Kingdom
- University of Manchester, Manchester, England, United Kingdom
| | - Harry Potts
- University of Cambridge School of Clinical Medicine, Cambridge, England, United Kingdom
| | - Cameron T Whitley
- University of Cambridge School of Clinical Medicine, Cambridge, England, United Kingdom
| | - Michael A Bookman
- Gynecologic Oncology Therapeutics, Kaiser Permanente, San Francisco, California
| | - Andy G Lynch
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, England, United Kingdom
- School of Medicine, University of St Andrews, St Andrews, Scotland, United Kingdom
- School of Mathematics and Statistics, University of St Andrews, St Andrews, Scotland, United Kingdom
| | - Hannah V Meyer
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York
| | - Simon Tavaré
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, England, United Kingdom
- Columbia University, New York, New York
| | - Tobias Janowitz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York.
- Northwell Health, New York, New York
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24
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AbdElhalim MS, Kenawy AS, Demellawy HHE, Azouz AA, Alghanem SS, Al-Otaibi T, Gheith O, ElMonem MA, Afifi MK, Hussein RRS. The impact of omeprazole on mycophenolate pharmacokinetics in kidney transplant recipients. Kidney Res Clin Pract 2020; 39:479-486. [PMID: 33214342 PMCID: PMC7770995 DOI: 10.23876/j.krcp.20.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The absorption rates of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) may be influenced by the concomitant use of omeprazole. METHODS One hundred kidney transplant patients were recruited during their outpatient visits, including 50 on MMF and 50 on EC-MPS. At the clinic, a predose mycophenolic acid (MPA) sample (C0) was collected; subsequently, the participants received the proton-pump inhibitor omeprazole along with either MMF or EC-MPS. Two more blood samples were collected at 1.5 and 3.5 hours and used to estimate an area under the curve (AUC) from zero to 12 hours [AUC (0-12)]. RESULTS The mean number of months after transplant was 92 months. The median AUC (0-12) and C0 results were 62.2 mg·h/L and 2.0 mg/L for the MMF group and 71.9 mg·h/L and 1.8 mg/L for the EC-MPS group (P = 0.160 and 0.225, respectively). Interestingly, 54% of the MMF group and 62% of the EC-MPS group showed AUCs above the target values. The correlation between MPA C0 and the predicted AUC was poor in both groups. CONCLUSION Omeprazole can be safely co-administered with either MMF or EC-MPS, as it did not compromise the MPA exposure. Unexpectedly, however, a high percentage of patients presented MPA AUCs exceeding the target value, highlighting the importance of periodically assessing MPA level.
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Affiliation(s)
| | - Ahmed S. Kenawy
- Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Heba H. El Demellawy
- Department of Nephrology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Amany A. Azouz
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Sarah S. Alghanem
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Torki Al-Otaibi
- Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Osama Gheith
- Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Abd ElMonem
- Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Mohammed K. Afifi
- Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Raghda R. S. Hussein
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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25
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Drug dosing in cancer patients with decreased kidney function: A practical approach. Cancer Treat Rev 2020; 93:102139. [PMID: 33370636 DOI: 10.1016/j.ctrv.2020.102139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Correct drug dosing of anticancer agents is essential to obtain optimal outcomes. Overdosing will result in increased toxicity, treatment interruption and possible cessation of anticancer treatment. Underdosing may result in suboptimal anti-cancer effects and may increase the risk of cancer-related mortality. As it is practical nor feasible to perform therapeutic drug monitoring for all anti-cancer drugs, kidney function is used to guide drug dosing for those drugs whose primary mode of excretion is through the kidney. However, it is not well-established what method should be utilized to measure or estimate kidney function and the choice of method does influence treatment decisions regarding eligibility for anti-cancer drugs and their dose. In this review, we will provide an overview regarding the importance of drug dosing, the preferred method to determine kidney function and a practical approach to drug dosing of anticancer drugs.
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26
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Benoit SW, Kathman T, Patel J, Stegman M, Cobb C, Hoehn J, Devarajan P, Nehus EJ. GFR Estimation After Cystatin C Reference Material Change. Kidney Int Rep 2020; 6:429-436. [PMID: 33615068 PMCID: PMC7879112 DOI: 10.1016/j.ekir.2020.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Glomerular filtration rate (GFR) is routinely estimated with cystatin C. In June 2010, the International Federation of Clinical Chemistry (IFCC) released a certified cystatin C reference material (ERM-DA471/IFCC), and new cystatin C glomerular filtration rate estimation (eGFR) equations were developed with the IFCC standard. Early in 2018, Siemens discontinued their nonstandardized cystatin C reagent kits and replaced them with IFCC-calibrated kits in the US market. The aim of the current study was to assess the effect of IFCC calibration on cystatin C values and corresponding GFR estimations. Methods Cystatin C concentration was measured in 81 pediatric patients using a plasma sample from their nuclear GFR measurement with 99mTc-diethylenetriaminepentaaccetic acid. Calibration curves were generated using Siemens nonstandardized and IFCC-standardized kits to measure paired cystatin C concentrations in each sample. GFR-estimating equations using pre-IFCC and IFCC cystatin C values were compared using Bland-Altman analyses. Results The IFCC-standardized assay resulted in a mean increase in the measured cystatin C value of 24%. Estimating equations consistently overestimated GFR prior to IFCC standardization. Following incorporation of the IFCC standard, the Full Age Spectrum equation demonstrated the best overall performance, whereas the Chronic Kidney Disease in Children (CKiD) equation was more accurate in children with decreased GFR. Conclusion Incorporation of the IFCC standard significantly increased cystatin C values and affected the performance of GFR estimating equations. Clinical laboratories and providers may need to update the equation used for cystatin C-based estimation of GFR following adoption of the IFCC reference standard.
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Affiliation(s)
- Stefanie W Benoit
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Thelma Kathman
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jay Patel
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Melinda Stegman
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cristina Cobb
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jonathan Hoehn
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Prasad Devarajan
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Edward J Nehus
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
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27
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Chen CH, Grollman AP, Huang CY, Shun CT, Sidorenko VS, Hashimoto K, Moriya M, Turesky RJ, Yun BH, Tsai K, Wu S, Chuang PY, Tang CH, Yang WH, Tzai TS, Tsai YS, Dickman KG, Pu YS. Additive Effects of Arsenic and Aristolochic Acid in Chemical Carcinogenesis of Upper Urinary Tract Urothelium. Cancer Epidemiol Biomarkers Prev 2020; 30:317-325. [PMID: 33277322 DOI: 10.1158/1055-9965.epi-20-1090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/21/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aristolochic acids (AA) and arsenic are chemical carcinogens associated with urothelial carcinogenesis. Here we investigate the combined effects of AA and arsenic toward the risk of developing upper tract urothelial carcinoma (UTUC). METHODS Hospital-based (n = 89) and population-based (2,921 cases and 11,684 controls) Taiwanese UTUC cohorts were used to investigate the association between exposure to AA and/or arsenic and the risk of developing UTUC. In the hospital cohort, AA exposure was evaluated by measuring aristolactam-DNA adducts in the renal cortex and by identifying A>T TP53 mutations in tumors. In the population cohort, AA exposure was determined from prescription health insurance records. Arsenic levels were graded from 0 to 3 based on concentrations in well water and the presence of arseniasis-related diseases. RESULTS In the hospital cohort, 43, 26, and 20 patients resided in grade 0, 1+2, and 3 arseniasis-endemic areas, respectively. Aristolactam-DNA adducts were present in >90% of these patients, indicating widespread AA exposure. A>T mutations in TP53 were detected in 28%, 44%, and 22% of patients residing in grade 0, 1+2, and 3 arseniasis-endemic areas, respectively. Population studies revealed that individuals who consumed more AA-containing herbs had a higher risk of developing UTUC in both arseniasis-endemic and nonendemic areas. Logistic regression showed an additive effect of AA and arsenic exposure on the risk of developing UTUC. CONCLUSIONS Exposure to both AA and arsenic acts additively to increase the UTUC risk in Taiwan. IMPACT This is the first study to investigate the combined effect of AA and arsenic exposure on UTUC.
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Affiliation(s)
- Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Arthur P Grollman
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York.,Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Forensic Medicine and Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Viktoriya S Sidorenko
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
| | - Keiji Hashimoto
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
| | - Masaaki Moriya
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
| | - Robert J Turesky
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Medicinal Chemistry, University of Minnesota, Minneapolis, Minnesota
| | - Byeong Hwa Yun
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Medicinal Chemistry, University of Minnesota, Minneapolis, Minnesota
| | - Karen Tsai
- School of Medicine, Stony Brook University, Stony Brook, New York
| | - Stephanie Wu
- School of Medicine, Stony Brook University, Stony Brook, New York
| | - Po-Ya Chuang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Wen-Horng Yang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzong-Shin Tzai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuh-Shyan Tsai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Kathleen G Dickman
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York. .,Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
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Karger AB, Eckfeldt JH, Rynders GP, Chaudhari J, Miao S, Van Lente F, Coresh J, Levey AS, Inker LA. Long-Term Longitudinal Stability of Kidney Filtration Marker Measurements: Implications for Epidemiological Studies and Clinical Care. Clin Chem 2020; 67:425-433. [PMID: 33257944 DOI: 10.1093/clinchem/hvaa237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Establishment and improvement of glomerular filtration rate estimating equations requires accurate and precise laboratory measurement procedures (MPs) for filtration markers. The Advanced Research and Diagnostic Laboratory (ARDL) at the University of Minnesota, which has served as the central laboratory for the Chronic Kidney Disease Epidemiology Collaboration since 2009, has implemented several quality assurance measures to monitor the accuracy and stability of filtration marker assays over time. METHODS To assess longitudinal stability for filtration marker assays, a 40-sample calibration panel was created using pooled serum, divided into multiple frozen aliquots stored at -80 °C. ARDL monitored 4 markers-creatinine, cystatin C, beta-2-microglobulin (B2M) and beta-trace protein-measuring 15 calibration panel aliquots from 2009 to 2019. Initial target values were established using the mean of the first 3 measurements performed in 2009-10, and differences from target were monitored over time. New MPs for cystatin C and B2M were added in 2012, with target values established using the first measurement. RESULTS The mean percentage difference from mean target values across time was <2% for all original MPs (-0.59% for creatinine; -0.94% for cystatin C; -0.82% for B2M; 1.24% for beta-trace protein). CONCLUSIONS Close monitoring of filtration marker trends with a calibration panel at ARDL demonstrates remarkable long-term stability of the MPs. Routine use of a calibration panel for both research studies and clinical care is recommended for filtration markers where longitudinal monitoring is important to detect analytical biases, which can mask or confound true clinical trends in patients.
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Affiliation(s)
- Amy B Karger
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN
| | - John H Eckfeldt
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN
| | - Gregory P Rynders
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN
| | - Juhi Chaudhari
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Shiyuan Miao
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Frederick Van Lente
- Preventive Research Laboratory and Laboratory Diagnostic Core, Cleveland Clinic, Cleveland, OH
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Andrew S Levey
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, MA
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Mróz J, Białek Ł, Gozdowska J, Sadowska-Jakubowicz A, Czerwińska K, Durlik M. Formulas Estimating Glomerular Filtration Rate in the Evaluation of Living Kidney Donor Candidates: Comparison of Different Formulas With Scintigraphy-Measured Glomerular Filtration Rate. Transplant Proc 2020; 53:773-778. [PMID: 33248721 DOI: 10.1016/j.transproceed.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Estimation of kidney function is crucial in the evaluation of living kidney donor candidates. Despite the multitude of glomerular filtration rate (GFR) formulas, no equation is universal, and none were validated in the population of kidney donors. Novel biomarkers, including beta trace protein (BTP) and cystatin C, are studied to help estimate GFR and improve the safe qualification of living kidney donors. AIM This study compares the accuracy of different formulas that estimate GFR with reference scintigraphy-measured GFR in the population of living kidney donor candidates. MATERIAL AND METHODS This study enrolled 30 healthy living kidney donor candidates. GFR was measured using the following 11 different formulas. For reference, GFR was assessed using 99m-Technetium-diethylenetriaminepentaacetic acid. RESULTS The accuracy of estimation was generally low in all formulas. The strongest correlation between measured GFR (mGFR) and estimated GFR (eGFR) was achieved by the Nankivell formula (R = 0.47, P = .009); however, in the group of patients with a body mass index of >25 kg/m2, only the equations based on BTP had a statistically significant correlation with mGFR: White (R = 0.59; P = .016) and Poge (R = 0.53; P = .035). Bland-Altman plots revealed wide limits of agreement between eGFRs and mGFR in all groups of patients. CONCLUSION In living kidney donor candidates, GFR estimation formulas should be chosen individually. White formula, which is based on BTP, may be a promising tool in estimating GFR in overweight potential living kidney donor candidates. More than 1 formula and personalized choice of GFR estimation method regarding the given patient should be performed in qualification of kidney donors.
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Affiliation(s)
- Julia Mróz
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Łukasz Białek
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland.
| | - Anna Sadowska-Jakubowicz
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Katarzyna Czerwińska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland
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Franks CE, Scott MG. On the Basis of Race: The Utility of a Race Factor in Estimating Glomerular Filtration. J Appl Lab Med 2020; 6:155-166. [PMID: 33236055 DOI: 10.1093/jalm/jfaa128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glomerular filtration rate (GFR) is a measure of the combined rate of filtration of all functional nephrons in the kidney. Measurement of GFR is used in the clinic to detect, stratify, and monitor progression of kidney dysfunction, and also serves as a prognostic tool for staging chronic kidney disease (CKD). The gold standard method for measuring GFR is by plasma or urine clearance of exogenous filtration markers, but this is not feasible in routine clinical practice. The most commonly used method to assess GFR is using equations for estimated GFR (eGFR). CONTENT Addition of a race factor to eGFR equations has been recommended to optimize performance for Black individuals. Here, we review the basis of the race-based equation and assess its utility and widespread applicability. SUMMARY Although evidence supporting the performance of a race factor exists in the unique populations in which these estimation equations were derived, more studies are needed to assess the need, or lack thereof, for race factors for all ethnicities. Furthermore, ethnicity is complex and likely cannot be qualified with a 2-level descriptor.
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Affiliation(s)
- Caroline E Franks
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology, Washington University School of Medicine, Saint Louis, MO
| | - Mitchell G Scott
- Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology, Washington University School of Medicine, Saint Louis, MO
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Ahmed MB, Salman Ul Islam, Lee YS. Concomitant Drug Treatment and Elimination in the RCC-affected Kidneys: Can We Kill Two Birds with One Stone? Curr Drug Metab 2020; 21:1009-1021. [PMID: 33183198 DOI: 10.2174/1389200221666201112112707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The kidneys are vital organs acting as the body's filters that eliminate drugs and other waste products from the body. For effective cancer therapy, a delicate balance is required in the drug treatment and its elimination, which is critical for drug accumulation, toxicity, and kidney malfunction. However, how renal cell carcinoma (RCC) affects the kidneys in safely eliminating the byproducts of drug treatments in patients with severely dysregulated kidney functions had remained elusive. Recent advancements in dose adjustment have added to our understanding regarding how drug treatments could be effectively regulated in aberrant kidney cells, driving safe elimination and reducing drug accumulation and toxicity at the right time and space. Dose adjustment is the only standard systemic way applicable; however, it presents certain limitations. There is significant room for developing new strategies and alternatives to improve it. OBJECTIVES Our analysis of the available treatments in literature discusses the treatment and their safe eliminations. In this study, we give an overview of the measures that could be taken to maintain the elimination gradient of anti-cancer drugs and restore normal kidney function in RCC. Differential therapeutics of RCC/mRCC in various clinical phase trials and the interaction of targeted therapeutics in response to vascular endothelial growth factor (VEGF) were also discussed. CONCLUSION Such information might suggest a new direction in controlling treatment with safe elimination through dose adjustment and its associated alternatives in a judicious manner. A strategy to systematically focus on the safe elimination of anti-cancer drugs in RCC strongly needs advocating.
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Affiliation(s)
- Muhammad Bilal Ahmed
- School of Life Sciences, College of Natural Sciences, Kyungpook National University, Daegu, 41566, Korea
| | - Salman Ul Islam
- School of Life Sciences, College of Natural Sciences, Kyungpook National University, Daegu, 41566, Korea
| | - Young Sup Lee
- School of Life Sciences, College of Natural Sciences, Kyungpook National University, Daegu, 41566, Korea
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Chen X, Wang Y, Gao L, Song J, Wang JY, Wang DD, Ma JX, Zhang ZQ, Bi LK, Xie DD, Yu DX. Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys. World J Clin Cases 2020; 8:4753-4762. [PMID: 33195643 PMCID: PMC7642540 DOI: 10.12998/wjcc.v8.i20.4753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.
AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.
METHODS This was a retrospective study of 12 patients with HK and a limited number (n ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).
RESULTS No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min vs 151.40 ± 39.54 min, P = 0.399), estimated blood loss (48.57 ± 31.85 mL vs 72.00 ± 41.47 mL, P = 0.292) and length of hospital stay (12.14 ± 2.61 d vs 12.40 ± 3.21 d, P = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m2), respectively (P = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m2), respectively (P = 0.581).
CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Jin Song
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jin-You Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Deng-Dian Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jia-Xing Ma
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Zhi-Qiang Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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Augmented Renal Clearance and How to Augment Antibiotic Dosing. Antibiotics (Basel) 2020; 9:antibiotics9070393. [PMID: 32659898 PMCID: PMC7399877 DOI: 10.3390/antibiotics9070393] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/02/2023] Open
Abstract
Augmented renal clearance (ARC) refers to the state of heightened renal filtration commonly observed in the critically ill. Its prevalence in this patient population is a consequence of the body’s natural response to serious disease, as well as the administration of fluids and pharmacologic therapies necessary to maintain sufficient blood pressure. ARC is objectively defined as a creatinine clearance of more than 130 mL/min/1.73 m2 and is thus a crucial condition to consider when administering antibiotics, many of which are cleared renally. Using conventional dosing regimens risks the possibility of subtherapeutic concentrations or clinical failure. Over the past decade, research has been conducted in patients with ARC who received a number of antibacterials frequently used in the critically ill, such as piperacillin-tazobactam or vancomycin. Strategies to contend with this condition have also been explored, though further investigations remain necessary.
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Rasała J, Szczot M, Kościelska-Kasprzak K, Szczurowska A, Poznański P, Mazanowska O, Małkiewicz B, Dębiński P, Krajewska M, Kamińska D. Computed Tomography Parameters and Estimated Glomerular Filtration Rate Formulas for Peridonation Living Kidney Donor Assessment. Transplant Proc 2020; 52:2278-2283. [PMID: 32505497 DOI: 10.1016/j.transproceed.2020.03.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/02/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal function is usually described by the estimated glomerular filtration rate (eGFR). The standard method used for living kidney donor evaluation in our center is the 24-hour urine creatinine clearance (CrCl) and kidney morphology assessment with computed tomography (CT). The aim of the study was the analysis of the correlation of CrCl with 15 published eGFR formulas and morphologic CT parameters to choose the most accurate kidney function estimation method before and after donation. METHODS The study included 39 living donors (18 male and 21 female, aged 32-69 years; mean age, 51.4 [SD, 9.7] years). The eGFR was estimated using Cockcroft-Gault, Modification of Diet in Renal Disease 7, Modification of Diet in Renal Disease 4, Chronic Kidney Disease Epidemiology Collaboration, Mayo Clinic, Nankivell, Bjornsson, Davis-Chandler, Edward-Whyte, Walser, Gates, Hull, Jelliffe-1, Jelliffe-2, or Mawer formulas and correlated with CrCl. CT parameters (kidney dimensions, volume, vascularization) were compared with eGFR formulas. RESULTS The 25% to 34% (mean, 28.5% [SD, 2.3%]) decrease in eGFR after donation and its 1.5% to 5.0% (mean, 3.2% [SD, 1.0%]) increase over a year were observed. Cockcroft-Gault, Bjornsson, Hull, and Mawer equations (all including serum creatinine, age, sex, and body mass) correlated with predonation CrCl (r = 0.54, 0.53, 0.53, and 0.56, respectively; P < .001). From CT parameters, renal cortex volume correlated with CrCl (r = 0.48, P = .002) as well as the 4 abovementioned equations before donation (r = 0.65, 0.61, 0.64, and 0.74, respectively; P < .001) and during the postdonation period (12-month r = 0.59, 0.54, 0.57, and 0.70 respectively; P < .002). CONCLUSIONS The eGFR calculated with equations combining serum creatinine, age, sex, and body mass as well as renal cortex volume are predictive of pre- and postdonation kidney function.
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Affiliation(s)
- Julia Rasała
- Faculty of Medicine Wroclaw Medical University, Wrocław, Poland.
| | - Mikołaj Szczot
- Faculty of Medicine Wroclaw Medical University, Wrocław, Poland
| | | | - Agata Szczurowska
- Department of General Radiology, Interventional Radiology, and Neuroradiology, Wroclaw Medical University, Wrocław, Poland
| | - Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wrocław, Poland
| | - Paweł Dębiński
- Department of Urology and Oncological Urology, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
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Laszczyńska O, Azevedo A, Ferreira-Almeida M, Guimarães JT, Severo M. Conversion methods for modified Jaffe reaction assays of serum creatinine. Porto Biomed J 2020; 5:e72. [PMID: 33299949 PMCID: PMC7722398 DOI: 10.1097/j.pbj.0000000000000072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Modifications in Jaffe serum creatinine (sCr) assays question the suitability of the results for direct comparison. METHODS sCr in adult in-patients was routinely measured either by SRM 909-standardized/noncompensated (method A) or isotope dilution mass spectrometry traceable/compensated method (reference). We converted values by method A into values by the reference using a formula provided by the manufacturer [Beckman Coulter (BC)] and traditional equating methods. RESULTS The BC-based conversion and linear equating resulted in underestimated sCr values, whereas equipercentile equating (EE) provided sCr with not significantly different distribution from the reference values. Proportions of patients with renal impairment did not differ between the reference and EE-converted sCr, as opposed to BC-recalculated values. Three percent of patients were classified into better renal function category when applying BC versus EE conversion. CONCLUSIONS Equipercentile equation was a more accurate method for recalculation of sCr obtained from different Jaffe reaction assays than the linear equating or the BC linear formula. This study emphasizes the importance of the derivation sample specificity when applying research results to other real-world populations.
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Affiliation(s)
| | - Ana Azevedo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto
- Centro de Epidemiologia Hospitalar, Centro Hospitalar Universitário de São João
| | | | - João T Guimarães
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto
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Porrini E, Ruggenenti P, Luis-Lima S, Carrara F, Jiménez A, de Vries APJ, Torres A, Gaspari F, Remuzzi G. Reply to 'Strengths and limitations of estimated and measured GFR'. Nat Rev Nephrol 2020; 15:785-786. [PMID: 31578496 DOI: 10.1038/s41581-019-0214-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Esteban Porrini
- Hospital Universitario de Canarias, Tenerife, Spain. .,University of La Laguna, Instituto de Tecnologías Biomédicas (ITB), Tenerife, Spain.
| | - Piero Ruggenenti
- Nephrology and Dialysis Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica, Bergamo, Italy
| | - Sergio Luis-Lima
- Hospital Universitario de Canarias, Tenerife, Spain.,University of La Laguna, Instituto de Tecnologías Biomédicas (ITB), Tenerife, Spain
| | - Fabiola Carrara
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica, Bergamo, Italy
| | | | - Aiko P J de Vries
- Division of Nephrology, Department of Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Armando Torres
- Hospital Universitario de Canarias, Tenerife, Spain.,University of La Laguna, Instituto de Tecnologías Biomédicas (ITB), Tenerife, Spain
| | - Flavio Gaspari
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica, Bergamo, Italy.,Department of Biochemical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
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Kalyesubula R, Fabian J, Nakanga W, Newton R, Ssebunnya B, Prynn J, George J, Wade AN, Seeley J, Nitsch D, Hansen C, Nyirenda M, Smeeth L, Naicker S, Crampin AC, Tomlinson LA. How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study. BMC Nephrol 2020; 21:20. [PMID: 31941441 PMCID: PMC6964098 DOI: 10.1186/s12882-020-1688-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/08/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a substantial cause of morbidity and mortality worldwide with disproportionate effects in sub-Saharan Africa (SSA). The optimal methods to estimate glomerular filtration rate (GFR) and therefore to determine the presence of CKD in SSA are uncertain. We plan to measure iohexol excretion to accurately determine GFR in Malawi, South Africa and Uganda. We will then assess the performance of existing equations to estimate GFR and determine whether a modified equation can better improve estimation of GFR in sub-Saharan Africa. METHODS The African Research on Kidney Disease (ARK) study is a three-country study embedded within existing cohorts. We seek to enrol 3000 adults > 18 years based on baseline serum creatinine. Study procedures include questionnaires on socio-demographics and established risk factors for kidney disease along with anthropometry, body composition, blood pressure, blood chemistry and urine microscopy and albuminuria. We will measure GFR (mGFR) by plasma clearance of iohexol at 120, 180 and 240 min. We will compare eGFR determined by established equations with mGFR using Bland-Altman plots. We will use regression methods to estimate GFR and compare the newly derived model with existing equations. DISCUSSION Through the ARK study, we aim to establish the optimal approach to estimate GFR in SSA. The study has the advantage of drawing participants from three countries, which will increase the applicability of the findings across the region. It is also embedded within established cohorts that have longitudinal information and serial measures that can be used to characterize kidney disease over a period of time. This will help to overcome the limitations of previous research, including small numbers, selected population sub-groups, and lack of data on proteinuria. The ARK collaboration provides an opportunity for close working partnerships across different centres, using standardized protocols and measurements, and shared bio-repositories. We plan to build on the collaboration for this study for future work on kidney disease in sub-Saharan Africa, and welcome additional partners from across the continent.
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Affiliation(s)
- Robert Kalyesubula
- Medical Research Council/ UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda. .,Makerere University College of Health Sciences, Kampala, Uganda. .,London School of Hygiene & Tropical Medicine, London, UK.
| | - June Fabian
- Wits Donald Gordon Medical Centre, Parktown, Johannesburg, South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wisdom Nakanga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Newton
- Medical Research Council/ UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Billy Ssebunnya
- Medical Research Council/ UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Josephine Prynn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Jaya George
- Department of Chemical Pathology, National Health Laboratory Services, University of Witwatersrand, Johannesburg, South Africa
| | - Alisha N Wade
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Seeley
- Medical Research Council/ UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - Christian Hansen
- Medical Research Council/ UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, UK
| | - Moffat Nyirenda
- Medical Research Council/ UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, UK.,Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Liam Smeeth
- London School of Hygiene & Tropical Medicine, London, UK
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Amelia C Crampin
- London School of Hygiene & Tropical Medicine, London, UK.,Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
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Willey JZ, Moon YP, Husain SA, Elkind MSV, Sacco RL, Wolf M, Cheung K, Wright CB, Mohan S. Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study. PLoS One 2020; 15:e0226509. [PMID: 31940363 PMCID: PMC6961921 DOI: 10.1371/journal.pone.0226509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022] Open
Abstract
Background Estimated glomerular filtration rate (eGFR) is routinely utilized as a measure of renal function. While creatinine-based eGFR (eGFRcr) is widely used in clinical practice, the use of cystatin-C to estimate GFR (eGFRcys) has demonstrated superior risk prediction in various populations. Prior studies that derived eGFR formulas have infrequently included high proportions of elderly, African-Americans, and Hispanics. Objective Our objective as to compare mortality risk prediction using eGFRcr and eGFRcys in an elderly, race/ethnically diverse population. Design The Northern Manhattan Study (NOMAS) is a multiethnic prospective cohort of elderly stroke-free individuals consisting of a total of 3,298 participants recruited between 1993 and 2001, with a median follow-up of 18 years. Participants We included all Northern Manhattan Study (NOMAS) participants with concurrent measured creatinine and cystatin-C. Main measures The eGFRcr was calculated using the CKD-EPI 2009 equation. eGFRcys was calculated using the CKD-EPI 2012 equations. The performance of each eGFR formula in predicting mortality risk was tested using receiver-operating characteristics, calibration and reclassification. Net reclassification improvement (NRI) was calculated based on the Reynolds 10 year risk score from adjusted Cox models with mortality as an outcome. The primary hypothesis was that eGFRcys would better predict mortality than eGFRcr. Results Participants (n = 2988) had a mean age of 69±10.2 years and were predominantly Hispanic (53%), overweight (69%), and current or former smokers (53% combined). The mean eGFRcr (74.68±18.8 ml/min/1.73m2) was higher than eGFRcys (51.72±17.2 ml/min/1.73m2). During a mean of 13.0±5.6 years of follow-up, 53% of the cohort had died. The AUC of eGFRcys (0.73) was greater than for eGFRcr (0.67, p for difference<0.0001). The proportions of correct reclassification (NRI) based on 10 year mortality for the model with eGFRcys compared to the model with eGFRcr were 4.2% (p = 0.002). Conclusions In an elderly, race/ethnically diverse cohort low eGFR is associated with risk of all-cause mortality. Estimated GFR based on serum cystatin-C, in comparison to serum creatinine, was a better predictor of all-cause mortality.
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Affiliation(s)
- Joshua Z. Willey
- Division of Nephrology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
| | - Yeseon Park Moon
- Division of Nephrology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States of America
| | - S. Ali Husain
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Mitchell S. V. Elkind
- Division of Nephrology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ralph L. Sacco
- Departments of Neurology and Public Health Sciences, Leonard M. Miller School of Medicine, the McKnight Brain Institute and the Neuroscience Program, University of Miami, Miami, FL, United States of America
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Ken Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Clinton B. Wright
- Departments of Neurology and Public Health Sciences, Leonard M. Miller School of Medicine, the McKnight Brain Institute and the Neuroscience Program, University of Miami, Miami, FL, United States of America
| | - Sumit Mohan
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Ostojic SM, Stajer V, Vranes M, Ostojic J. Searching for a better formulation to enhance muscle bioenergetics: A randomized controlled trial of creatine nitrate plus creatinine vs. creatine nitrate vs. creatine monohydrate in healthy men. Food Sci Nutr 2019; 7:3766-3773. [PMID: 31763026 PMCID: PMC6848817 DOI: 10.1002/fsn3.1237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/05/2019] [Accepted: 09/14/2019] [Indexed: 11/18/2022] Open
Abstract
A novel creatine blend (creatine nitrate mixed with creatinine, CN-CRN) has been anecdotally suggested to be superior to traditional creatine formulations for bioavailability and performance. However, does CN-CRN supremely affects creatine levels in the blood and skeletal muscle of healthy humans remain currently unknown. This randomized, controlled, double-blind, crossover trial evaluated the acute effects of single-dose CN-CRN on serum creatine levels, and 5-days intervention with CN-CRN on skeletal muscle creatine and safety biomarkers in healthy men. Ten healthy young men (23.6 ± 2.9 years) were allocated to receive either CN-CRN (3 grams of creatine nitrate mixed with 3 grams of creatinine), pure creatine nitrate (3 grams, CN), or regular creatine monohydrate (3 grams, CRM) by oral administration. We found that CN-CRN resulted in a more powerful rise in serum creatine levels comparing to either CN or CRM after a single-dose intervention, as evaluated with the area under the concentration-time curve calculation (701.1 ± 62.1 (µmol/L) × min versus 622.7 ± 62.9 (µmol/L) × min versus 466.3 ± 47.9 (µmol/L) × min; p < .001). The peak serum creatine levels at 60-min sampling interval were significantly higher in CN-CRN group (183.7 ± 15.5 µmol/L), as compared to CN group (163.8 ± 12.9 µmol/L) and CRM group (118.6 ± 12.9 µmol/L) (p < .001). This was accompanied by a significantly superior increase in muscle creatine levels after CN-CRN administration at 5-days follow-up, as compared to CN and CRM, respectively (9.6% versus 8.0% versus 2.1%; p = .01). While 2 out of 10 participants were found to be nonresponsive to CN intervention (20.0%) (e.g., no amplification in muscle creatine levels found at 5-days follow-up), and 3 participants out of 10 were nonresponsive in CRM trial (30%), no nonresponders were found after CN-CRN administration, with individual upswing in total muscle creatine varied in this group from 2.0% (lowest increment) to 16.8% (highest increment). Supplemental CN-CRN significantly decreased estimated glomerular filtration rate (eGFR) at 5-days follow-up, as compared to other interventions (p = .004), with the average reduction was 14.8 ± 7.7% (95% confidence interval; from 9.3 to 20.3). Nevertheless, no single participant experienced a clinically relevant reduction in eGFR (< 60 ml/min/1.73 m2) throughout the course of the trial. Liver enzymes remained in reference ranges throughout the study, with no participant experienced high liver blood tests (e.g., AST > 40 units per L or ALT >56 units per L). Besides, no participant reported any major side effects during the trial, while the odors of CN-CRN and CN formulations were considered somewhat unpleasant in 8 out of 10 participants (80.0%). Our results suggest that CN-CRN is a preferred and relatively safe alternative to traditional creatine formulations for improved creatine bioavailability in the blood and skeletal muscle after single-dose and 5-days interventions.
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Affiliation(s)
- Sergej M. Ostojic
- Applied Bioenergetics LabFaculty of Sport and PEUniversity of Novi SadNovi SadSerbia
- Faculty of Health SciencesUniversity of PecsPecsHungary
| | - Valdemar Stajer
- Applied Bioenergetics LabFaculty of Sport and PEUniversity of Novi SadNovi SadSerbia
| | - Milan Vranes
- Faculty of SciencesUniversity of Novi SadNovi SadSerbia
| | - Jelena Ostojic
- Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
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Levey AS, Coresh J, Tighiouart H, Greene T, Inker LA. Measured and estimated glomerular filtration rate: current status and future directions. Nat Rev Nephrol 2019; 16:51-64. [DOI: 10.1038/s41581-019-0191-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 12/28/2022]
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Long term renal function in Asian HIV-1 infected adults receiving tenofovir disoproxil fumarate without protease inhibitors. J Infect 2019; 79:454-461. [PMID: 31401085 DOI: 10.1016/j.jinf.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/19/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The risk of kidney dysfunction on the WHO recommended first line regimens containing tenofovir disoproxil fumarate (TDF) without protease inhibitors (PI) remains unclear in Asian patients, especially those with low body weight. METHODS Using data collected in a multicenter clinical trial in Thailand and proportional hazard regression models, we compared the risk of a >25% estimated glomerular filtration rate (eGFR) reduction in HIV naïve patients initiating TDF or zidovudine (AZT) containing non-PI regimen. RESULTS Of 640 patients included in the analysis, 461 (72%) received a TDF-containing regimen for a median 6.7 years and 179 (28%) an AZT-containing regimen for 6.5 years. The risk of a >25% eGFR reduction was not associated with treatment (HR 1.11, 95% CI 0.84-1.47, P = 0.46). In multivariate analysis, the risk of >25% eGFR reduction form baseline was associated with body weight at baseline (HR 2.12, 95% CI 1.48-3.02 for <48 kg patients and HR 1.64, 95% CI 1.20-2.25 for 48-59.9 kg patients, compared to those with >60 kg, P < 0.001) and hypertension (HR 4.03, 95% CI 2.0-8.0, P < 0.001). The effect of baseline weight on >25% eGFR reduction did not significantly vary with treatment (P = 0.27). CONCLUSIONS The risk of eGFR reduction was not higher on TDF- versus AZT-based non-PI regimens. Although the risk of eGFR reduction was greater for patients of lower body weight, this risk was not significantly increased by TDF.
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Glatard A, Guidi M, Dobrinas M, Cornuz J, Csajka C, Eap CB. Influence of body weight and UGT2B7 polymorphism on varenicline exposure in a cohort of smokers from the general population. Eur J Clin Pharmacol 2019; 75:939-949. [PMID: 30868192 DOI: 10.1007/s00228-019-02662-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/06/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The abstinence rate to tobacco after varenicline treatment is moderate and might be partially affected by variability in varenicline concentrations. This study aimed at characterizing the sources of variability in varenicline pharmacokinetics and to relate varenicline exposure to abstinence. METHODS The population pharmacokinetic analysis (NONMEM®) included 121 varenicline concentrations from 82 individuals and tested the influence of genetic and non-genetic characteristics on apparent clearance (CL/F) and volume of distribution (V/F). Model-based average concentrations over 24 h (Cav) were used to test the impact of varenicline exposure on the input rate (Kin) expressed as a function of the number of cigarettes per day in a turnover model of 373 expired carbon monoxide levels. RESULTS A one-compartment model with first-order absorption and elimination appropriately described varenicline concentrations. CL/F was 8.5 L/h (coefficient of variation, 26%), V/F was 228 L, and the absorption rate (ka) was fixed to 0.98 h-1. CL/F increased by 46% in 100-kg individuals compared to 60-kg individuals and was found to be 21% higher in UGT2B7 rs7439366 TT individuals. These covariates explained 14% and 9% of the interindividual variability in CL/F, respectively. No influence of varenicline Cav was found on Kin in addition to the number of cigarettes. CONCLUSIONS Body weight mostly and to a smaller extent genetic polymorphisms of UGT2B7 can influence varenicline exposure. Dose adjustment based on body weight and, if available, on UGT2B7 genotype might be useful to improve clinical efficacy and tolerability of varenicline.
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Affiliation(s)
- Anaïs Glatard
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Hospital of Cery, University of Lausanne, Prilly, Switzerland
- Service of Clinical Pharmacology, Department of Laboratories, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Monia Guidi
- Service of Clinical Pharmacology, Department of Laboratories, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Maria Dobrinas
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Hospital of Cery, University of Lausanne, Prilly, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Chantal Csajka
- Service of Clinical Pharmacology, Department of Laboratories, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Hospital of Cery, University of Lausanne, Prilly, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Assessment of treatment efficacy using surface-enhanced Raman spectroscopy analysis of urine in rats with kidney transplantation or kidney disease. Clin Exp Nephrol 2019; 23:880-889. [PMID: 30830549 DOI: 10.1007/s10157-019-01721-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/21/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Individuals who have kidney disease or kidney transplants need routine assessment of their kidney damage and function, which are largely measured based on histological examination of kidney biopsies, blood test, and urinalysis. These methods are practically difficult or inconvenient, and expensive. The objective of this study was to develop a model to estimate the kidney damage and function by surface-enhanced Raman spectroscopy (SERS). METHODS Urine samples were collected from two previous studies: renal allograft recipient Lewis rats receiving anti-TGF-β antibody or control antibody treatment and obese diabetic ZSF1 rats with kidney disease fed with whole grape powder-containing chow or control chow. Silver nanoparticle-based SERS spectra of urine were measured. SERS spectra were analyzed using principal component analysis (PCA) combined with linear discriminant analysis (LDA) and partial least squires (PLS) analysis. RESULTS PCA/LDA separated anti-TGF-β antibody-treated group from control group with 90% sensitivity and 70% specificity in kidney transplants, and grape-fed group from controls with 72.7% sensitivity and 60% specificity in diabetic kidneys. The receiver operating characteristic curves showed that the integration area under the curve was 0.850 ± 0.095 (p = 0.008) in kidney transplant groups and 0.800 ± 0.097 (p = 0.02) in diabetic kidney groups. PLS predicted the biochemical parameters of kidney function using the SERS spectra, resulting in R2 = 0.8246 (p < 0.001,urine protein), R2 = 0.8438 (p < 0.001, urine creatinine), R2 = 0.9265 (p < 0.001, urea), R2 = 0.8719 (p < 0.001, serum creatinine), and R2 = 0.6014 (p < 0.001, urine protein to creatinine ratio). CONCLUSION Urine SERS spectral analysis suggesting that it may become a convenient method for rapid assessment of renal impairment.
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Husain SA, Willey JZ, Park Moon Y, Elkind MSV, Sacco RL, Wolf M, Cheung K, Wright CB, Mohan S. Creatinine- versus cystatin C-based renal function assessment in the Northern Manhattan Study. PLoS One 2018; 13:e0206839. [PMID: 30427947 PMCID: PMC6235352 DOI: 10.1371/journal.pone.0206839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Accurate glomerular filtration rate estimation informs drug dosing and risk stratification. Body composition heterogeneity influences creatinine production and the precision of creatinine-based estimated glomerular filtration rate (eGFRcr) in the elderly. We compared chronic kidney disease (CKD) categorization using eGFRcr and cystatin C-based estimated GFR (eGFRcys) in an elderly, racially/ethnically diverse cohort to determine their concordance. METHODS The Northern Manhattan Study (NOMAS) is a predominantly elderly, multi-ethnic cohort with a primary aim to study cardiovascular disease epidemiology. We included participants with concurrently measured creatinine and cystatin C. eGFRcr was calculated using the CKD-EPI 2009 equation. eGFRcys was calculated using the CKD-EPI 2012 equation. Logistic regression was used to estimate odds ratios and 95% confidence intervals of factors associated with reclassification from eGFRcr≥60ml/min/1.73m2 to eGFRcys<60ml/min/1.73m2. RESULTS Participants (n = 2988, mean age 69±10yrs) were predominantly Hispanic, female, and overweight/obese. eGFRcys was lower than eGFRcr by mean 23mL/min/1.73m2. 51% of participants' CKD status was discordant, and only 28% maintained the same CKD stage by both measures. Most participants (78%) had eGFRcr≥60mL/min/1.73m2; among these, 64% had eGFRcys<60mL/min/1.73m2. Among participants with eGFRcr≥60mL/min/1.73m2, eGFRcys-based reclassification was more likely in those with age >65 years, obesity, current smoking, white race, and female sex. CONCLUSIONS In a large, multiethnic, elderly cohort, we found a highly discrepant prevalence of CKD with eGFRcys versus eGFRcr. Determining the optimal method to estimate GFR in elderly populations needs urgent further study to improve risk stratification and drug dosing.
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Affiliation(s)
- S. Ali Husain
- Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, United States of America
| | - Joshua Z. Willey
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Yeseon Park Moon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Mitchell S. V. Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Ralph L. Sacco
- Departments of Neurology and Public Health Sciences, Leonard M. Miller School of Medicine, the McKnight Brain Institute and the Neuroscience Program, University of Miami, Miami, Florida, United States of America
| | - Myles Wolf
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Ken Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Clinton B. Wright
- Departments of Neurology and Public Health Sciences, Leonard M. Miller School of Medicine, the McKnight Brain Institute and the Neuroscience Program, University of Miami, Miami, Florida, United States of America
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
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Crass RL, Pai MP. Estimating Renal Function in Drug Development: Time to Take the Fork in the Road. J Clin Pharmacol 2018; 59:159-167. [PMID: 30184267 DOI: 10.1002/jcph.1314] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/15/2018] [Indexed: 01/29/2023]
Abstract
Renal function is the most commonly applied patient-specific quantitative variable used to determine drug doses. Measurement of renal function is not practical in most clinical settings; therefore, clinicians often rely on estimates when making dosing decisions. Similarly, renal function estimates are used to assign subjects in phase 1 pharmacokinetic studies, which inform dosing in late-phase clinical trials and ultimately the product label. The Cockcroft-Gault estimate of creatinine clearance has been the standard renal function metric; however, this paradigm is shifting toward the Modification of Diet in Renal Diseases (MDRD) estimate of the glomerular filtration rate (GFR). The proportion of approved new drug labels with dosing recommendations based on the MDRD equation was 16.7% in 2015, 70.0% in 2016, and 46.7% in 2017. Disharmonious recommendations from the United States Food and Drug Administration and the European Medicines Agency will continue to increase this heterogeneity in the assessment of renal function in drug development and negatively impact industry, health systems, and clinicians. In this review, we discuss the current regulatory guidance for the conduct of renal impairment pharmacokinetic studies and review the implications of this guidance across the medication use system with 3 recently approved antibiotics: ceftazidime/avibactam, delafloxacin, and meropenem/vaborbactam. Finally, we suggest measuring GFR in phase 1 studies and employing the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to integrate data across clinical trials. This will help to harmonize CKD staging, population pharmacokinetic analyses, and dosing by estimated renal function.
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Affiliation(s)
- Ryan L Crass
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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Abstract
: The burden of chronic kidney disease (CKD) is rising both in this country and worldwide. An estimated 10% to 15% of U.S. adults are currently living with CKD. Reducing the CKD burden requires a systematic, interdisciplinary approach to care. The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease. Nurses are well positioned to facilitate the implementation of collaborative care. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1 offers an overview of the disease, describes identification and etiology, and discusses ways to slow disease progression. Part 2, which will appear next month, addresses disease complications and treatment of kidney failure.
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Mendonça N, Granic A, Mathers JC, Martin-Ruiz C, Wesnes KA, Seal CJ, Jagger C, Hill TR. One-Carbon Metabolism Biomarkers and Cognitive Decline in the Very Old: The Newcastle 85+ Study. J Am Med Dir Assoc 2017; 18:806.e19-806.e27. [PMID: 28647580 PMCID: PMC5576913 DOI: 10.1016/j.jamda.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Although the biological rationale for the association between folate, vitamin B12, and homocysteine with cognitive function seems plausible, conflicting results have been reported. This study aimed to determine the associations between 1-carbon (1-C) metabolism biomarkers (folate, vitamin B12, and homocysteine), and cognitive impairment at baseline and the rate of cognitive decline over 5 years in the very old. DESIGN The Newcastle 85+ Study was a prospective longitudinal study of people 85 years old and followed over 5 years in Northeast England. SETTING Community-dwelling and institutionalized. PARTICIPANTS The analytical sample included 765 very old participants with 1-C metabolism biomarkers and cognitive measures. MEASUREMENTS Global cognition was measured by the Standardized Mini-Mental State Examination (SMMSE) at baseline, and at 3 and 5 years of follow-up and, attention-specific cognition with the Cognitive Drug Research (CDR) System at baseline, and at 1.5 and 3.0 years of follow-up. Baseline red blood cell folate (RBC folate), plasma vitamin B12, and total homocysteine (tHcy) concentrations were determined by immunoassay. Linear mixed models were used to estimate the associations between quartiles of 1-C metabolism biomarkers and cognition over 3 (CDR) and 5 years (SMMSE). RESULTS Compared with participants in the lowest quartile of RBC folate concentrations (<612 nmol/L), those in the highest quartile of RBC folate concentrations (>1280 nmol/L) had 1 more point on the SMMSE at baseline (β = +1.02, SE = 0.43, P = .02). Those in quartile 4 of tHcy (>21.4 μmol/L) had 1 point less in the SMMSE at baseline than those in the lowest quartile (<13.5 μmol/L) (β = -1.05, SE = 0.46, P = .02). Plasma vitamin B12 was not predictive of global or attention-specific cognition at baseline and at follow-up. None of the 1-C metabolism biomarkers except tHcy was associated with the rate of decline in attention scores over 3 years. CONCLUSION RBC folate and tHcy, but not plasma vitamin B12, were associated with better global cognition in the very old at baseline but were not predictive of rate of decline over 5 years.
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Affiliation(s)
- Nuno Mendonça
- School of Agriculture, Food, and Rural Development, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
| | - Antoneta Granic
- Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK; NIHR Newcastle Biomedical Research Centre in Ageing and Chronic Disease, Newcastle University and Newcastle-upon-Tyne NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - John C Mathers
- Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Keith A Wesnes
- Wesnes Cognition Ltd, Streatley-on-Thames, UK; Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK; Medical School, University of Exeter, Exeter, UK
| | - Chris J Seal
- School of Agriculture, Food, and Rural Development, Newcastle University, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Carol Jagger
- Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Tom R Hill
- School of Agriculture, Food, and Rural Development, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK; Human Nutrition Research Centre, Newcastle University, Newcastle-upon-Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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Levey AS, Inker LA. Assessment of Glomerular Filtration Rate in Health and Disease: A State of the Art Review. Clin Pharmacol Ther 2017; 102:405-419. [DOI: 10.1002/cpt.729] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- AS Levey
- Division of Nephrology, Tufts Medical Center; Boston Massachusetts USA
| | - LA Inker
- Division of Nephrology, Tufts Medical Center; Boston Massachusetts USA
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Huang Y, Tilea A, Gillespie B, Shahinian V, Banerjee T, Grubbs V, Powe N, Rios-Burrows N, Pavkov M, Saran R. Understanding Trends in Kidney Function 1 Year after Kidney Transplant in the United States. J Am Soc Nephrol 2017; 28:2498-2510. [PMID: 28270413 DOI: 10.1681/asn.2016050543] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
Lower eGFR 1 year after kidney transplant is associated with shorter allograft and patient survival. We examined how practice changes in the past decade correlated with time trends in average eGFR at 1 year after kidney transplant in the United States in a cohort of 189,944 patients who received a kidney transplant between 2001 and 2013. We calculated the average eGFR at 1 year after transplant for the recipient cohort of each year using the appropriate Modification of Diet in Renal Disease equation depending on the prevailing methodology of creatinine measurement, and used linear regression to model the effects of practice changes on the national post-transplant eGFR trend. Between the 2001-2005 period and the 2011-2013 period, average 1-year post-transplant eGFR remained essentially unchanged, with differences of 1.34 (95% confidence interval, 1.03 to 1.65) ml/min per 1.73 m2 and 0.66 (95% confidence interval, 0.32 to 1.01) ml/min per 1.73 m2 among deceased and living donor kidney transplant recipients, respectively. Over time, the mean age of recipients increased and more marginal organs were used; adjusting for these trends unmasked a larger temporal improvement in post-transplant eGFR. However, changes in immunosuppression practice had a positive effect on average post-transplant eGFR and balanced out the negative effect of recipient/donor characteristics. In conclusion, average 1-year post-transplant eGFR remained stable, despite increasingly unfavorable attributes in recipients and donors. With an aging ESRD population and continued organ shortage, preservation of average post-transplant eGFR will require sustained improvement in immunosuppression and other aspects of post-transplant care.
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Affiliation(s)
- Yihung Huang
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anca Tilea
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brenda Gillespie
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Vahakn Shahinian
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Tanushree Banerjee
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California; and
| | - Vanessa Grubbs
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California; and
| | - Neil Powe
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California; and
| | | | - Meda Pavkov
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rajiv Saran
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan;
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Nyman U, Grubb A, Lindström V, Björk J. Accuracy of GFR estimating equations in a large Swedish cohort: implications for radiologists in daily routine and research. Acta Radiol 2017; 58:367-375. [PMID: 27166345 DOI: 10.1177/0284185116646143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Guidelines recommend estimation of glomerular filtration rate (eGFR) prior to iodine contrast media (CM) examinations. It is also recommended that absolute eGFR in mL/min, not commonly used relative GFR (adjusted to body surface area; mL/min/1.73 m2), should be preferred when dosing and evaluating toxicity of renally excreted drugs. Purpose To validate the absolute Lund-Malmö equation (LM-ABS) in comparison with the absolute Cockcroft-Gault (CG) equation and the relative equations, revised Lund-Malmö (LM-REV), MDRD, and CKD-EPI, after converting relative estimates to absolute values, and to analyze change in eGFR classification when absolute instead of relative eGFR was used. Material and Methods A total of 3495 plasma clearance of iohexol to measure GFR (mGFR) served as reference test. Bias, precision, and accuracy (percentage of estimates ±30% of mGFR; P30) were compared overall and after stratification for various mGFR, eGFR, age, and BMI subgroups. Results The overall P30 results of CG/LM-ABS/LM-REV/MDRD/CKD-EPI were 62.8%/84.9%/83.7%/75.3%/75.6%, respectively. LM-ABS was the most stable equations across subgroups and the only equation that did not exhibit marked overestimation in underweight patients. For patients with relative eGFR 30-44 and 45-59 mL/min/1.73 m2, 36% and 58% of men, respectively, and 24% and 32% of women, respectively, will have absolute eGFR values outside these relative eGFR intervals. Conclusion Choosing one equation to estimate GFR prior to contrast medium examinations, LM-ABS may be preferable. Unless absolute instead of relative eGFR are used, systematic inaccuracies in assessment of renal function may occur in daily routine and research on CM nephrotoxicity may be flawed.
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Affiliation(s)
- Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden
| | - Veronica Lindström
- Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden
| | - Jonas Björk
- R&D Centre Skåne, Skåne University Hospital, Lund, Sweden
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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