Nephron Underdosing as a Risk Factor for Impaired Early Kidney Graft Function and Increased Graft Loss During the Long-Term Follow-up Period

2013 ◽  
Vol 45 (4) ◽  
pp. 1639-1643 ◽  
Author(s):  
A. Kolonko ◽  
J. Chudek ◽  
A. Wiecek
Keyword(s):  
Risk Factor ◽  
Graft Loss ◽  
Graft Function ◽  
Kidney Graft ◽  
Long Term Follow Up

Abstract 15934: Higher Midlife Serum Levels of Kidney-injury Molecule-1 (KIM-1) are Associated With Incident Fatal CHD Over Very Long-term Follow-up Among Men

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rachel H Mackey ◽  
Greg G Grandits ◽  
Lewis H Kuller ◽  
Joel Estis ◽  
John A Todd ◽  
...  
Keyword(s):  
Risk Factor ◽  
Limit Of Detection ◽  
Kidney Injury ◽  
Multiple Risk Factor ◽  
Serum Samples ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Kidney Injury Molecule 1

Introduction: Higher levels of kidney-injury molecule-1 (KIM-1) measured in urine are associated with presence and progression of acute renal disease. A recent study reported similar results for KIM-1 measured in blood. Hypothesis: We hypothesized that KIM-1 measured in stored serum from middle-aged men who participated in the Multiple Risk Factor Intervention Trial (MRFIT) would differentiate very long-term risk of fatal CHD vs. survival to a mean age of 80 over approximately 30 year follow-up. Methods: We conducted a nested case-control study within MRFIT, which in 1973-76 randomized 12,866 high risk but CVD free men ages 35-57 to risk factor intervention vs. usual care. Serum samples were collected at baseline and stored for future use. The trial concluded in 1982 but long-term mortality follow-up was ascertained through 2005 using the National Death Index. From MRFIT participants with stored serum from baseline, we sampled 100 men who died of CHD (mean age 47.3 at baseline and 73.9 at death), and 100 men who survived to 2005 (mean age =48.4 at baseline and 80.1 in 2005.) KIM-1 was assayed from stored serum samples using high sensitivity single-molecule counting technology (Erenna ® Immunoassay System, Singulex), with limit of detection (LoD)=0.5 pg/ml, and lower limit of quantification (LLoQ)=2.0 pg/ml. Results were compared between cases and controls using Wilcoxon rank tests and logistic regression. Results: Inter-assay %CVs were 8%. Median KIM-1 was higher for smokers vs. non-smokers and for men with vs. without hypertension, but was not associated with high cholesterol. KIM-1 was significantly higher in cases (183 pg/ml (IQR: 137-239) versus controls, (161 pg/ml (IQR:109-212), p=0.03; OR (95%CI)for Q4 versus Q1 was 2.26 (1.02 - 5.02) Adjusted for age and smoking the OR(95%CI) of fatal CHD for Q4 vs. Q1 was 2.34 (1.02- 5.37), and further adjusted for diastolic BP and serum cholesterol at baseline, was 2.0 (95% CI: 0.8-4.7). Conclusions: Higher serum KIM-1 levels at midlife were associated with a ∼2-fold increased risk of fatal CHD vs. survival over ∼30 years of follow-up. This is the first report of a longitudinal association of circulating KIM-1 levels with fatal CHD in long-term follow-up.

scholarly journals Impact of ventricular arrhythmias on survival in patients after myocardial infarction

2014 ◽  
Vol 1 (1) ◽  
pp. 21 ◽  
Author(s):  
Katarzyna Anna Mitręga ◽  
Agnieszka Kolczyńska ◽  
Joanna Hanzel ◽  
Sylwia Cebula ◽  
Stanisław Morawski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Ventricular Arrhythmias ◽  
Independent Risk Factor ◽  
Premature Ventricular Beats ◽  
Large Numbers ◽  
Ventricular Extrasystoles ◽  
Long Term Follow Up

Introduction: Despite the continuous development of new methods of pharmacological and invasive treatment for patients with acute myocardial infarction (MI) the prognosis of long-term survival is still uncertain. Therefore, there is still need to look for new noninvasive predictors of death in patients after MI. Aim: To analyze the prognostic value of ventricular arrhythmias in predicting mortality following MI in long-term follow-up. Methods: We analyzed 390 consecutive patients (114 females and 276 males, aged 63.9 ± 11.15 years, mean EF: 43.8 ± 7.9%) with MI treated invasively.  On the 5th day after MI 24-hour digital Holter recording was performed to assess the number of premature ventricular beats (VPB) and their sustained forms such as: salvos and nonsustained ventricular tachycardia (nsVT <  30 s). The large numbers of ventricular extrasystoles: ≥ 10 VPB / hour were considered as abnormal. In echocardiography the size of heart cavities and cardiac contractile function were evaluated. Within 30.1 ± 15.1 months of follow-up 38 patients died. Results: In the group of patients with MI the mean value of ventricular ectopy during the day was: 318.8 ± 1447.6. Large numbers of ventricular extrasystoles were observed in 75% patients, while nsVT in 6% patients. Significant differences in the incidence of death after MI were observed in patients with nsVT and ventricular salvos. In the group of patients who died in comparison to the group of patients who survived in long-term follow-up, a significantly less ventricular ectopic incidence was noted (9.83% vs 90.17%, p < 0.01). In patients who died after MI more premature ventricular beats (≥ 10 VPB / h) and a greater nsVT incidence were observed; however not significant. Moreover, in patients with MI the systolic and diastolic LV dimension, decreased values of hemoglobin, salvos and nsVT incidence are the independent risk factors of death. The strongest independent risk factor of death after MI is salvos (HR: 1.32, P < 0.01). Conclusions: In long term follow-up the largest differences in death were observed in patients with ventricular salvos and nsVT. Furthermore, ventricular salvos are the strongest independent risk factor of death in patients with AMI. 

scholarly journals Posttransplant Allosensitization in Low Immunological Risk Kidney and Kidney-Pancreas Graft Recipients

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Jorge Malheiro ◽  
Sandra Tafulo ◽  
Leonídio Dias ◽  
La Salete Martins ◽  
Isabel Fonseca ◽  
...  
Keyword(s):  
Risk Factor ◽  
Graft Loss ◽  
Graft Function ◽  
Kidney Graft ◽  
Hla Antibodies ◽  
Luminex Assay ◽  
Screening Protocol ◽  
Antibody Positivity ◽  
Cox Analysis ◽  
Pancreas Graft

Introduction. Posttransplantation allosensitization prevalence and effect on kidney grafts outcomes remain unsettled.Methods. Between 2007 and 2012, 408 patients received a primary kidney graft (with 68 patients also receiving a pancreas graft) after a negative cytotoxic crossmatch. All patients had a pretransplant negative anti-HLA screening and 0% panel reactive antibodies. We analyzed retrospectively the results of anti-HLA antibodies screening by Luminex assay, performed between 6 and 24 months after transplant, and searched for the risk factors for antibody positivity and its impact on kidney graft outcomes.Results. Anti-HLA antibodies prevalence at 6 months was 17.4%. Previous steroid-insensitive acute rejection was the only risk factor for both anti-HLA classes detected antibodies. Antithymocyte globulin induction was also a risk factor for anti-HLA-I antibodies. Antibody positivity status was associated with reduced graft function at 12 months and graft survival at 5 years (91.5% versus 96.4%,P=0.03). In multivariable Cox analysis, delayed graft function (HR = 6.1,P<0.01), HLA mismatches>3 (HR = 10.2,P=0.03), and antibody positivity for anti-HLA class II (HR = 5.1,P=0.04) or class I/II (HR = 13.8,P<0.01) were independent predictors of graft loss.Conclusions. Allosensitization against HLA classII±Iafter transplant was associated with adverse kidney graft outcomes. A screening protocol seems advisable within the first year in low immunological risk patients.

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