scholarly journals 4577 Resistant hypertension potentiates the risk of End-Stage Kidney Disease among African-Americans independent of APOL1 genotype in the Million Veteran Program

2020 ◽  
Vol 4 (s1) ◽  
pp. 36-36
Author(s):  
Elvis Akwo ◽  
Cassiane Robinson-Cohen ◽  
Cecilia P. Chung ◽  
Peter W.F. Wilson ◽  
Christopher O’Donnell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
African Americans ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Incidence Rates ◽  
Cardiovascular Outcomes ◽  
End Stage Kidney Disease ◽  
Risk Alleles ◽  
End Stage

OBJECTIVES/GOALS: African-Americans have a 3-fold higher risk of end-stage kidney disease (ESKD) compared to Whites due in part to APOL1 risk alleles. Whether resistant hypertension (RH) magnifies the risk of ESKD among African Americans beyond APOL1 is not known. We examined the interaction between RH and race on ESKD risk and the independent effect of RH beyond APOL1. METHODS/STUDY POPULATION: We designed a retrospective cohort of 240,038 veterans with HTN, enrolled in the Million Veteran Program with an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73m2. The primary exposure was incident RH (time-varying). The primary outcome was incident ESKD during a 13.5 year follow up: 2004-2017. Secondary outcomes were myocardial infarction (MI), stroke, and death. Incident RH was defined as failure to achieve outpatient blood pressure (BP) <140/90 mmHg with 3 antihypertensive drugs, including a thiazide, or use of 4 or more drugs. Poisson models were used to estimate incidence rates and test additive interaction with race and APOL1 genotype. Multivariable Cox models (with Fine-Gray competing-risks models as sensitivity analyses) were used to examine independent effects. RESULTS/ANTICIPATED RESULTS: The cohort comprised 235,046 veterans; median age was 60 years; 21% were African-American and 6% were women, with 23,010 incident RH cases observed over a median follow-up time of 10.2 years [interquartile range, 5.6-12.6]. Patients with RH had higher incidence rates [per 1000 person-years] of ESKD (4.5 vs. 1.3), myocardial infarction (6.5 vs. 3.0), stroke (16.4 vs. 7.6) and death (12.0 vs. 6.9) than non-resistant hypertension (NRH). African-Americans with RH had a 2.6-fold higher risk of ESKD compared to African-Americans with NRH; 3-fold the risk of Whites with RH, and 9.6-fold the risk of Whites with NRH [p-interaction<.001]. Among African-Americans, RH was associated with a 2.2-fold (95%CI, 1.86-2.58) higher risk of incident ESKD in models adjusted for APOL1 genotype and in the subset of African-Americans with no APOL1 risk alleles, RH was associated with an adjusted 2.75-fold (95% CI: 2.00-3.50) higher risk of incident ESKD. DISCUSSION/SIGNIFICANCE OF IMPACT: RH was independently associated with a higher risk of ESKD and cardiovascular outcomes, especially among African-Americans. This elevated risk is independent of APOL1 genotype. Interventions that achieve BP targets among patients with RH could curtail the incidence of ESKD and cardiovascular outcomes in this high-risk population. CONFLICT OF INTEREST DESCRIPTION: None.

scholarly journals Association of Apparent Treatment-Resistant Hypertension With Differential Risk of End-Stage Kidney Disease Across Racial Groups in the Million Veteran Program

Hypertension ◽  
2021 ◽  
Author(s):  
Elvis A. Akwo ◽  
Cassianne Robinson-Cohen ◽  
Cecilia P. Chung ◽  
Shailja C. Shah ◽  
Nancy J. Brown ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Disease Incidence ◽  
Treatment Resistant ◽  
End Stage Kidney Disease ◽  
Black Patients ◽  
End Stage ◽  
White Patients

Apparent treatment-resistant hypertension (ATRH) has been linked to end-stage kidney disease (ESKD) and cardiovascular disease. We tested the hypothesis that the effect of ATRH on ESKD is greater in Black patients than in White patients and investigated the effect of ATRH on ESKD independent of APOL1 genotype. In a retrospective cohort of 139 685 hypertensive veterans (22% Black, 5% women) in the Million Veteran Program, ATRH was defined as failure to achieve outpatient blood pressure <140/90 mmHg with 3 antihypertensives including a thiazide or use of ≥4. Outcomes included incident ESKD, myocardial infarction, and stroke. Poisson models were used to test effect modification by race. Over a median follow-up of 10.3 years (interquartile range, 5.8–11.7), 17 521 incident ATRH cases were observed. Compared with nonresistant hypertension, patients with ATRH had higher incidence rates (per 1000-person-years) of ESKD (4.7 versus 1.6), myocardial infarction (6.7 versus 3.4), and stroke (16.7 versus 8.5). A greater attributable risk of ESKD because of ATRH was observed among Black patients (44.4/1000) compared with White patients (25.5/1000). Black patients with ATRH had a 2.3-fold higher risk of ESKD compared with Black patients with nonresistant hypertension; 3-fold the risk of White patients with ATRH, and 9-fold the risk of White patients with nonresistant hypertension ( P -interaction<0.001). Among Black patients, ATRH remained associated with a 98% (95% CI, 1.66–2.75) higher risk of ESKD after adjustment for APOL1 genotype. Patients with ATRH experienced excess ESKD and cardiovascular disease risk. This excess ATRH-related ESKD risk was magnified among Black patients independently of APOL1 genotype. Targeted treatment of ATRH could curtail ESKD and cardiovascular disease incidence.

scholarly journals Dietary Factors and Prevention: Risk of End-Stage Kidney Disease by Fruit and Vegetable Consumption

2021 ◽  
pp. 1-12
Author(s):  
Tanushree Banerjee ◽  
Juan Jesus Carrero ◽  
Charles McCulloch ◽  
Nilka Rios Burrows ◽  
Karen R. Siegel ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Risk Model ◽  
Vegetable Consumption ◽  
Dietary Factors ◽  
Inverse Association ◽  
Fruit And Vegetable ◽  
End Stage Kidney Disease ◽  
Strong Inverse Association ◽  
End Stage

<b><i>Background:</i></b> The association between fruit and vegetable (FV) intake and the risk of end-stage kidney disease (ESKD) has not been examined in the general population and fully explored in chronic kidney disease (CKD). We prospectively evaluated this relationship in US representative sample of adults and evaluated consistency by the presence or absence, and severity, of CKD. <b><i>Methods:</i></b> We used data from the Third National Health and Nutrition Examination Survey (1988–1994) linked with the US Renal Data System, including 14,725 adults aged ≥20 years and with follow-up for ESKD through 2008. Daily FV intake was ascertained using a food frequency questionnaire. We examined the association between selected categories of FV intake and ESKD using a Fine Gray competing risk model adjusting for sociodemographics, lifestyle, clinical and nutritional factors, estimated glomerular filtration rate, and albuminuria. We evaluated whether risk varied in individuals with severe versus any CKD. <b><i>Results:</i></b> 230 participants (1.5%) developed ESKD during follow-up. In the adjusted model, compared to highest intake, those in lowest categories of FV intake had a higher risk of ESKD, for &#x3c;2 times/day (1.45 [1.24–1.68], 2 to &#x3c;3 times/day (1.40 [1.18–1.61]), 3 to &#x3c;4 times/day (1.25 [1.04–1.46]), and 4 to &#x3c;6 times/day (1.14 [0.97–1.31]). There was suggestion of heterogeneity (<i>p</i> for interaction = 0.03) with possible stronger inverse association in patients with CKD than those without CKD. After stratification, we obtained similar strong inverse association when we examined ESKD incidence across intake of FVs in participants with CKD stages 1–4 (<i>n</i> = 5,346) and specifically in those with CKD stages 3–4 (<i>n</i> = 1,084). <b><i>Conclusions:</i></b> Low intake of FVs was associated with higher risk of ESKD in US adults with and without CKD, supporting an emerging body of literature on the potential benefits of plant-rich diets for prevention of ESKD.

Increased Inflammatory Response in Association with the Initiation of Hemodialysis Compared with Peritoneal Dialysis in a Prospective Study of End-Stage Kidney Disease Patients

2018 ◽  
Vol 38 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Kenneth Yong ◽  
Gursharan Dogra ◽  
Neil Boudville ◽  
Wai Lim
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Inflammatory Response ◽  
Prospective Study ◽  
End Stage Kidney Disease ◽  
Cvd Risk ◽  
Ckd Stage ◽  
End Stage

Background Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods We per formed a pilot prospective study on 75 predialysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis Results Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.

scholarly journals An Exome-wide Association Study for Type 2 Diabetes–Attributed End-Stage Kidney Disease in African Americans

2018 ◽  
Vol 3 (4) ◽  
pp. 867-878 ◽  
Author(s):  
Meijian Guan ◽  
Jacob M. Keaton ◽  
Latchezar Dimitrov ◽  
Pamela J. Hicks ◽  
Jianzhao Xu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
African Americans ◽  
Kidney Disease ◽  
Association Study ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals Metabolic Syndrome Severity Score, Comparable to Serum Creatinine, Could Predict the Occurrence of End-Stage Kidney Disease in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

2021 ◽  
Vol 10 (24) ◽  
pp. 5744
Author(s):  
Pil Gyu Park ◽  
Jung Yoon Pyo ◽  
Sung Soo Ahn ◽  
Jason Jungsik Song ◽  
Yong-Beom Park ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Characteristic Curve ◽  
Antineutrophil Cytoplasmic Antibody ◽  
End Stage Kidney Disease ◽  
The Metabolic Syndrome ◽  
Poor Outcomes ◽  
End Stage

This study investigated whether the metabolic syndrome (MetS) severity (MSSS) at diagnosis could predict poor outcomes during follow-up in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with MetS. The equation for the MSSS at diagnosis used in this study was developed and validated in Korean adults aged 20–59 years. The medical records of 261 patients with AAV were retrospectively reviewed, and finally, 36 AAV patients with MetS aged 20–59 years fulfilling the inclusion criteria were included in this study. All-cause mortality, relapse, end-stage kidney disease (ESKD), cerebrovascular accident, and cardiovascular disease were assessed as the poor outcomes of AAV. Their median age was 51.2 years and 36.1% were male. The MSSS was significantly correlated with age and serum albumin but not AAV-specific indices. Among the five poor outcomes, only ESKD showed a relatively significant area under the curve (area 0.696) in receiver operating characteristic curve analysis. In the multivariable Cox hazards model analysis, both serum creatinine (HR 3.033) and MSSS (HR = 2.221) were significantly associated with ESKD occurrence. When the cut-off of the MSSS for ESKD was set at 1.72, ESKD occurred more frequently in patients with MSSS ≥ 1.72 than in those with MSSS < 1.72 (75.0% versus 14.3%, p = 0.002). Furthermore, patients with MSSS ≥ 1.72 exhibited a significantly lower cumulative ESKD-free survival rate than those with MSSS < 1.72 (p = 0.001). MSSS at the time of AAV diagnosis independently predicted the occurrence of ESKD during follow-up in patients with AAV and MetS.

scholarly journals Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252237
Author(s):  
Karumathil M. Murali ◽  
Judy Mullan ◽  
Steven Roodenrys ◽  
Hicham I. Cheikh Hassan ◽  
Maureen Lonergan
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Analysis Of Covariance ◽  
End Stage Kidney Disease ◽  
Change Scores ◽  
Dialysis Vintage ◽  
One Year ◽  
End Stage

Introduction Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. Methods We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression ≥ 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of <1-year and >1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. Results At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage <1-year compared to >1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Conclusion Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.

scholarly journals Relative leucocyte telomere length is associated with incident end-stage kidney disease and rapid decline of kidney function in type 2 diabetes: analysis from the Hong Kong Diabetes Register

Diabetologia ◽  
2021 ◽  
Author(s):  
Feifei Cheng ◽  
Andrea O. Luk ◽  
Hongjiang Wu ◽  
Claudia H. T. Tam ◽  
Cadmon K. P. Lim ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Hong Kong ◽  
Kidney Disease ◽  
Telomere Length ◽  
Rapid Decline ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Diabetes Register

Abstract Aims/hypothesis Few large-scale prospective studies have investigated associations between relative leucocyte telomere length (rLTL) and kidney dysfunction in individuals with type 2 diabetes. We examined relationships between rLTL and incident end-stage kidney disease (ESKD) and the slope of eGFR decline in Chinese individuals with type 2 diabetes. Methods We studied 4085 Chinese individuals with type 2 diabetes observed between 1995 and 2007 in the Hong Kong Diabetes Register with stored baseline DNA and available follow-up data. rLTL was measured using quantitative PCR. ESKD was diagnosed based on the ICD-9 code and eGFR. Results In this cohort (mean ± SD age 54.3 ± 12.6 years) followed up for 14.1 ± 5.3 years, 564 individuals developed incident ESKD and had shorter rLTL at baseline (4.2 ± 1.2 vs 4.7 ± 1.2, p < 0.001) than the non-progressors (n = 3521). On Cox regression analysis, each ∆∆Ct decrease in rLTL was associated with an increased risk of incident ESKD (HR 1.21 [95% CI 1.13, 1.30], p < 0.001); the association remained significant after adjusting for baseline age, sex, HbA1c, lipids, renal function and other risk factors (HR 1.11 [95% CI 1.03, 1.19], p = 0.007). Shorter rLTL at baseline was associated with rapid decline in eGFR (>4% per year) during follow-up (unadjusted OR 1.22 [95% CI 1.15, 1.30], p < 0.001; adjusted OR 1.09 [95% CI 1.01, 1.17], p = 0.024). Conclusions/interpretation rLTL is independently associated with incident ESKD and rapid eGFR loss in individuals with type 2 diabetes. Telomere length may be a useful biomarker for the progression of kidney function and ESKD in type 2 diabetes. Graphical abstract

ENDOVASCULAR RENAL DENERVATION EFFICACY AND FEASIBILITY IN END-STAGE KIDNEY DISEASE WITH RESISTANT HYPERTENSION

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e54-e55
Author(s):  
A. Mazza ◽  
F. Dell’Avvocata ◽  
F. Fiorini ◽  
F. Michielan ◽  
A.F. Compostella ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals Association of kidney structure-related gene variants with type 2 diabetes-attributed end-stage kidney disease in African Americans

2016 ◽  
Vol 135 (11) ◽  
pp. 1251-1262 ◽  
Author(s):  
Meijian Guan ◽  
Jun Ma ◽  
Jacob M. Keaton ◽  
Latchezar Dimitrov ◽  
Poorva Mudgal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
African Americans ◽  
Kidney Disease ◽  
Gene Variants ◽  
Related Gene ◽  
End Stage Kidney Disease ◽  
Kidney Structure ◽  
End Stage

Follow-up of aspirin-resistant patients with end-stage kidney disease

2012 ◽  
Vol 45 (4) ◽  
pp. 1097-1102 ◽  
Author(s):  
Kadriye Orta Kilickesmez ◽  
Cuneyt Kocas ◽  
Okay Abaci ◽  
Baris Okcun ◽  
Bilal Gorcin ◽  
...  
Keyword(s):  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage
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