scholarly journals 4557 Defining the relationship between kidney structure and function in patients with and without diabetes and hypertension

2020 ◽  
Vol 4 (s1) ◽  
pp. 47-47
Author(s):  
Ghazal Zekavat Quinn ◽  
Matthew Palmer ◽  
Jordana Cohen ◽  
Xin Sheng ◽  
Katalin Susztak
Keyword(s):  
Regression Analysis ◽  
Kidney Disease ◽  
Structural Changes ◽  
Polynomial Regression ◽  
Interstitial Fibrosis ◽  
Kidney Tissue ◽  
The United States ◽  
Hypertensive Patients ◽  
Patients With Diabetes ◽  
The Relationship

OBJECTIVES/GOALS: Histopathological descriptions of kidney tissue provide more information about kidney disease severity and prognosis than serum measures, yet most patients with chronic kidney disease do not undergo kidney biopsy. We aim to develop a method to determine the degree of renal injury in patients with diabetes and hypertension without the need for biopsy. METHODS/STUDY POPULATION: Clinical data and renal tissue samples were collected from 864 patients undergoing tumor-associated nephrectomy in seven medical centers in the United States. Exclusion criteria included age < 18, presence of pyelonephritis or non-diabetic or hypertensive renal disease or incomplete clinical or histopathologic data. 19 histologic parameters were scored in a blinded manner by one renal pathologist. We examined the relationship between and functional variables (such as estimated glomerular filtration rate (eGFR)). Polynomial regression analysis was performed to model histopathologic variables and important clinical parameters such as eGFR RESULTS/ANTICIPATED RESULTS: 607 samples met inclusion criteria and were stratified as: control (no history of diabetes or hypertension, n = 160), hypertension alone (n = 224) and both diabetes and hypertension (n = 223). Interstitial fibrosis (IF) and glomerulosclerosis (GS) had the strongest correlations with eGFR. Regression analysis was used to model histopathologic score for a given eGFR. We found that diabetes and hypertension modified the relationship between tubulointerstitial fibrosis and eGFR. For example, while hypertensive patients without diabetes had 33% IF at an eGFR of 30 ml/min/1.73m2 (r2 = 0.64, p<0.01), hypertensive patients with diabetes had 32% IF at an eGFR of 30 ml/min/1.73m2 (r2 = .43, p<0.01) and control patients had approximately 23% IF at an eGFR of 30 ml/min/1.73m2 (r2 = 0.22, p<0.01). DISCUSSION/SIGNIFICANCE OF IMPACT: Here, we describe the relationship between renal structural changes and renal function and show that hypertension significantly modifies the relationship at a given eGFR. These data can be used to reasonably predict renal structural changes given clinical information without the need for renal biopsy and may provide prognostic value.

PSVI-8 Meta-regression Analysis to Determine the Relationship Between Growing Pig Body Weight and Variation

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 218-219
Author(s):  
Andres Fernando T Russi ◽  
Mike D Tokach ◽  
Jason C Woodworth ◽  
Joel M DeRouchey ◽  
Robert D Goodband ◽  
...  
Keyword(s):  
Body Weight ◽  
Regression Analysis ◽  
Sample Size ◽  
Polynomial Regression ◽  
Data Sets ◽  
Regression Equations ◽  
Prediction Equations ◽  
Data Set ◽  
Rate Of Increase ◽  
The Relationship

Abstract The swine industry has been constantly evolving to select animals with improved performance traits and to minimize variation in body weight (BW) in order to meet packer specifications. Therefore, understanding variation presents an opportunity for producers to find strategies that could help reduce, manage, or deal with variation of pigs in a barn. A systematic review and meta-analysis was conducted by collecting data from multiple studies and available data sets in order to develop prediction equations for coefficient of variation (CV) and standard deviation (SD) as a function of BW. Information regarding BW variation from 16 papers was recorded to provide approximately 204 data points. Together, these data included 117,268 individually weighed pigs with a sample size that ranged from 104 to 4,108 pigs. A random-effects model with study used as a random effect was developed. Observations were weighted using sample size as an estimate for precision on the analysis, where larger data sets accounted for increased accuracy in the model. Regression equations were developed using the nlme package of R to determine the relationship between BW and its variation. Polynomial regression analysis was conducted separately for each variation measurement. When CV was reported in the data set, SD was calculated and vice versa. The resulting prediction equations were: CV (%) = 20.04 – 0.135 × (BW) + 0.00043 × (BW)2, R2=0.79; SD = 0.41 + 0.150 × (BW) - 0.00041 × (BW)2, R2 = 0.95. These equations suggest that there is evidence for a decreasing quadratic relationship between mean CV of a population and BW of pigs whereby the rate of decrease is smaller as mean pig BW increases from birth to market. Conversely, the rate of increase of SD of a population of pigs is smaller as mean pig BW increases from birth to market.

scholarly journals Relationship between Plasma Trimethylamine N-Oxide Levels and Renal Dysfunction in Patients with Hypertension

2021 ◽  
pp. 1-12
Author(s):  
Jia Zhou ◽  
Dingkun Wang ◽  
Bingong Li ◽  
Xuelian Li ◽  
Xingjun Lai ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Renal Dysfunction ◽  
High Performance ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Hypertensive Patients ◽  
Ckd Stage ◽  
Liquid Chromatography Tandem Mass ◽  
The Relationship

<b><i>Introduction:</i></b> Trimethylamine N-oxide (TMAO) is a metabolite produced by gut bacteria. Although increased TMAO levels have been linked to hypertension (HTN) and chronic kidney disease (CKD) with poor prognosis, no clinical studies have directly addressed the relationship between them. In this study, we investigated the relationship between TMAO and renal dysfunction in hypertensive patients. <b><i>Methods:</i></b> We included healthy controls (<i>n</i> = 50), hypertensive patients (<i>n</i> = 46), and hypertensive patients with renal dysfunction (<i>n</i> = 143). Their blood pressure values were taken as the highest measured blood pressure. Renal function was evaluated using the estimated glomerular filtration rate. Plasma TMAO levels were measured using high-performance liquid chromatography tandem mass spectrometry. <b><i>Results:</i></b> We found significant differences in plasma TMAO levels among the 3 groups (<i>p</i> &#x3c; 0.01). The plasma TMAO of patients with HTN was significantly higher than that of healthy people, and the plasma TMAO of patients with HTN complicated by renal dysfunction was significantly higher than either of the other groups. Patients in the highest TMAO quartile were at a higher risk of developing CKD stage 5 than those in the lowest quartile. In the receiver operating characteristic curve, the area under the curve of TMAO combined with β 2-macroglobulin for predicting renal dysfunction in patients with HTN was 0.85 (95% confidence interval 0.80–0.90). <b><i>Conclusion:</i></b> An elevated TMAO level reflects higher levels of HTN and more severe renal dysfunction. TMAO, combined with β 2-macroglobulin levels, may assist in diagnosing CKD in hypertensive patients. Plasma TMAO has predictive value for early kidney disease in hypertensive patients.

Abstract 13169: US Prevalence Estimates of Individuals With Diabetes and Chronic Kidney Disease Indicated for SGLT-2 Inhibitor Initiation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rahul Aggarwal ◽  
Kimberly Lu ◽  
Nicholas Chiu ◽  
George Bakris ◽  
Deepak L Bhatt
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
The United States ◽  
Stage Iii ◽  
First Line ◽  
First Line Therapy ◽  
Urine Albumin ◽  
The Us ◽  
Patients With Diabetes

Introduction: Since the CREDENCE trial results, the American Diabetes Association (ADA) recommends SGLT-2 inhibitors as first line therapy for patients with stage III Chronic Kidney Disease (CKD) or proteinuric CKD, regardless of baseline A1C. We project the number of US individuals with diabetes and renal disease that meets inclusion into the CREDENCE trial and that are recommended for SGLT-2 inhibitors based on the guidelines. Methods: Our initial cohort consisted of 48,710 individuals from the 2007-2016 National Health and Nutrition Examination Survey with survey weights designed to estimate the US population. CREDENCE eligible patients were patients with diabetes who had an eGFR of 30-90 and urine albumin-to-creatinine ratio (UACR) of >300 mg/g. Guideline eligible patients were stage III CKD individuals and those with a UACR > 30 mg/g. Results: In the US population, 21,411,059 (+/-708,233) individuals are >=18 years and have diabetes. Of these individuals, 578,514 (+/-72,385) are CREDENCE eligible. Based on the ADA recommendations, 7,504,508 (+/- 342,139) adults with CKD and diabetes are recommended for an SGLT-2 inhibitor, representing 35.0% of individuals with diabetes. The mean age of guideline eligible individuals is 64.4 years, with 3,886,904 males (51.8%) and 3,617,604 females (48.2%). Conclusions: In the United States, a large number of individuals--approximately 35% of adults with diabetes--have renal disease characteristics that give them a first-line indication for SGLT-2 inhibitor initiation.

Middle East Studies for the New Milleniu

2016 ◽  
Keyword(s):  
Middle East ◽  
Structural Changes ◽  
Ways Of Knowing ◽  
The United States ◽  
American University ◽  
The Social ◽  
Big Picture ◽  
The University ◽  
Middle East Studies ◽  
The Relationship

Few world regions today are of more pressing social and political interest than the Middle East: hardly a day has passed in the last decade without events there making global news. Understanding the region has never been more important, yet the field of Middle East studies in the United States is in flux, enmeshed in ongoing controversies about the relationship between knowledge and power, the role of the federal government at universities, and ways of knowing other cultures and places. This book explores the big-picture issues affecting the field, from the geopolitics of knowledge production to structural changes in the university to broader political and public contexts. Tracing the development of the field from the early days of the American university to the Islamophobia of the present day, this book explores Middle East studies as a discipline and, more generally, its impact on the social sciences and academia. Topics include how different disciplines engage with Middle East scholars, how American universities teach Middle East studies and related fields, and the relationship between scholarship and U.S.–Arab relations, among others. This book presents a comprehensive, authoritative overview of how this crucial field of academic inquiry came to be and where it is going next.

scholarly journals Autosomal dominant polycystic kidney disease.

1993 ◽  
Vol 3 (8) ◽  
pp. 1442-1450
Author(s):  
J C Lieske ◽  
F G Toback
Keyword(s):  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Cellular Proliferation ◽  
Autosomal Dominant ◽  
Interstitial Fibrosis ◽  
Family Members ◽  
The United States ◽  
Screening Tests ◽  
Polycystic Kidney ◽  
Autosomal Dominant Polycystic Kidney

Autosomal dominant polycystic kidney disease (ADPKD) is an important cause of medical morbidity in the United States that affects one-half million persons and accounts for ESRD in about 10% of the chronic dialysis population. In addition to its effects on the kidney, the disease has important manifestations in the cardiovascular system (aneurysms, hypertension) and the gastrointestinal tract (hepatic cysts). Clinically important renal complications can develop as the disease progresses that require specialized attention, such as urinary tract infection, pain, and nephrolithiasis. The underlying cellular defect that causes ADPKD has eluded investigators thus far, but abnormalities in cellular proliferation, the tubular basement membrane, and cell fluid secretion appear important in pathogenesis. Factors that mediate progressive interstitial fibrosis and failure of renal function are undefined, although rigorous control of blood pressure appears to be an important therapeutic measure. Recent advances in molecular biology have localized the abnormal gene to chromosome 16 in 90% of families, making early genetic screening of asymptomatic family members possible in many cases. A positive diagnosis may have important effects on employment status, as well as health insurance, so that family members sometimes refuse to be assessed for the presence of the disease. Because of such complex social factors, counseling of an asymptomatic individual by his or her physician is required when considering the use of screening tests for ADPKD. Inadequate patient education may still represent an impediment to early detection, genetic counseling, and timely treatment of disease complications.

scholarly journals Hypoglycemic and Hyperglycemic Crises Among U.S. Adults With Diabetes and End-stage Kidney Disease: Population-Based Study, 2013–2017

2021 ◽  
Author(s):  
Rodolfo J. Galindo ◽  
Mohammed K. Ali ◽  
Shealeigh A. Funni ◽  
Andrew B. Dodge ◽  
Shaheen S. Kurani ◽  
...  
Keyword(s):  
Kidney Disease ◽  
The United States ◽  
Population Based ◽  
Emergency Department Visits ◽  
End Stage Kidney Disease ◽  
Population Based Study ◽  
Hyperglycemic Hyperosmolar State ◽  
Patients With Diabetes ◽  
End Stage ◽  
Event Rates

<b>Objective</b>: We characterized annual trends of severe hypoglycemic and hyperglycemic crises (diabetic ketoacidosis/hyperglycemic hyperosmolar state) in patients with diabetes and end-stage kidney disease (DM/ESKD). <p> </p> <p><b>Design</b>: Nationwide, retrospective study of adults (≥18 years) with DM/ESKD, from the United States Renal Data System registry, 2013 to 2017. Primary outcome was annual rates of emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises, reported as number of events/1000 person-years. Adjusted event rates and risk factors were adjusted for patient age, sex, race/ethnicity, dialysis modality, comorbidities, treatment regimen and U.S. region.</p> <p> </p> <p><b>Results</b>: Among 521,789 adults with DM/ESKD (median age 65 years [IQR 57-73], 56.1% male, and 46% White), overall adjusted rates of hypoglycemic and hyperglycemic crises were 53.64 and 18.24 per 1000 person-years, respectively. For both hypoglycemia and hyperglycemia crises, the risks decreased with age and were lowest in older patients (≥75 vs 18-44 years: IRR 0.35 [95% CI 0.33-0.37] and 0.03 [0.02-0.03], women (IRR 1.09 [1.06-1.12] and 1.44 [1.35-1.54]), and with smoking (IRR 1.36 [1.28-1.43] and 1.71 [1.53-1.91]), substance abuse (IRR 1.27 [1.15-1.42] and 1.53 [1.23-1.9]), retinopathy (IRR 1.10 [1.06-1.15] and 1.36 [1.26-1.47]), and insulin therapy (vs. no therapy; IRR 0.60 [0.59-0.63] and 0.44 [0.39-0.48]), respectively. For hypoglycemia, specifically, additional risk was conferred by Black race (IRR 1.11 [1.08-1.15]) and amputation history (IRR 1.20 [1.13-1.27]).</p> <p> </p> <p><b>Conclusions</b>: In this nationwide study of patients with DM/ESKD, hypoglycemic crises were three-fold more common than hyperglycemic crises, greatly exceeding national reports in non-dialysis patients with chronic kidney disease. Young, Black, and female patients were disproportionately affected. </p>

scholarly journals On the contribution of immune 42 mechanisms to the pathogenesis of diabetic nephropathy

1996 ◽  
Vol 42 (5) ◽  
pp. 42-47
Author(s):  
О. I. Kamayeva ◽  
V. V. Sura
Keyword(s):  
Renal Failure ◽  
Diabetic Nephropathy ◽  
Western Europe ◽  
Kidney Tissue ◽  
The United States ◽  
Chronic Hemodialysis ◽  
Patients With Diabetes ◽  
End Stage ◽  
The Cost

Diabetic nephropathy (NF) came first among all the specified causes of end-stage renal failure. Patients with type 1 diabetes mellitus (DM) make up more than half of all patients treated with chronic hemodialysis in the United States and Western Europe. Among patients with diabetes with terminal renal failure, 60% are people over 50 years old, so hemodialysis is not always prescribed. However, hemodialysis is increasingly used in elderly and senile patients; therefore, the proportion of patients with diabetes, especially type II diabetes, in hemodialysis centers will increase, significantly increasing the cost of treating diabetes. Currently, along with metabolic, hemodynamic and genetic theories, the role of immune disorders in the formation and progression of DNs is being discussed. The prerequisites for the formation of a hypothesis about the immune genesis of DNs were the frequent detection of increased levels of circulating immune complexes (CICs) and immunoglobulins in the blood, as well as deposits of immunoglobulins and complement in the kidney structures of patients with diabetes. However, among researchers there is no unanimity in the explanation of these facts. Many consider indisputably existing immune abnormalities inherent in DN as non-specific epiphenomes. The immune hypothesis of the pathogenesis of DN was formulated back in the 70s. The currently accumulated data suggest the participation of the immunocomplex mechanism in the development of DN. Immunofluorescence examination of the kidney tissue of patients with diabetes almost always reveals a luminescence of IgG, IgM, less often IgA, SZ and other complement fractions along the basal membranes of the glomeruli (BMC) and tubules of focal granular and linear in nature.

scholarly journals Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World

2018 ◽  
Vol 13 (9) ◽  
pp. 1348-1357 ◽  
Author(s):  
Paul E. Drawz ◽  
Roland Brown ◽  
Luca De Nicola ◽  
Naohiko Fujii ◽  
Francis B. Gabbai ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Prevalence Ratio ◽  
The United States ◽  
Adverse Outcomes ◽  
Collaborative Group ◽  
Masked Hypertension ◽  
International Database ◽  
Hypertension Prevalence ◽  
Sustained Hypertension ◽  
Patients With Diabetes

Background and objectivesAmbulatory BP is increasingly recognized as a better measure of the risk for adverse outcomes related to hypertension, an important comorbidity in patients with CKD. Varying definitions of white-coat and masked hypertension have made it difficult to evaluate differences in prevalence of these BP patterns across CKD cohorts.Design, setting, participants, & measurementsThe International Database of Ambulatory BP in Renal Patients collaborative group established a large database of demographic, clinical, and ambulatory BP data from patients with CKD from cohorts in Italy, Spain, the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study of Kidney Disease and Hypertension Cohort Study (AASK) in the United States, and the CKD Japan Cohort (CKD-JAC). Participants (n=7518) with CKD were included in the present analyses. Cutoffs for defining controlled BP were 140/90 mm Hg for clinic and 130/80 mm Hg for 24-hour ambulatory BP.ResultsAmong those with controlled clinic BP, compared with CKD-JAC, AASK participants were more likely to have masked hypertension (prevalence ratio [PR], 1.21; 95% confidence interval [95% CI], 1.04 to 1.41) whereas CRIC (PR, 0.82; 0.72 to 0.94), Italian (PR, 0.73; 0.56 to 0.95), and Spanish participants (PR, 0.75; 0.64 to 0.88) were less likely. Among those with elevated clinic BP, AASK participants were more likely to have sustained hypertension (PR, 1.22; 95% CI, 1.13 to 1.32) whereas Italian (PR, 0.78; 0.70 to 0.87) and Spanish participants (PR, 0.89; 0.82 to 0.96) were less likely, although CRIC participants had similar prevalence as CKD-JAC. Prevalence of masked and sustained hypertension was elevated in males, patients with diabetes, participants on four or more antihypertensives, and those with moderate-to-severe proteinuria.ConclusionsIn a large, multinational database, the prevalence of masked and sustained hypertension varied across cohorts independent of important comorbidities.

scholarly journals Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database

2021 ◽  
Author(s):  
David Alfego ◽  
Jennifer Ennis ◽  
Barbara Gillespie ◽  
Mary Jane Lewis ◽  
Elizabeth Montgomery ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
At Risk ◽  
Kidney Disease ◽  
Clinical Laboratory ◽  
Clinical Care ◽  
National Laboratory ◽  
The United States ◽  
Urine Albumin ◽  
Diagnosis Codes ◽  
Patients With Diabetes

<p><i>Objective:</i> An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at-risk for CKD. This study utilizes data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the United States.</p> <p><i>Research Design and Methods:</i> Patients with Laboratory Corporation of America® Holdings (Labcorp®) testing between 2013 and 2019 were defined as at-risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) testing within the study year.</p> <p><i>Results:</i> We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 y, 53.6% women): 16.2% had diabetes, 63.8% had hypertension and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of hypertensive, and 41.4% of those with both. In a state-by-state comparison, annual testing rates ranged from 5% - 30%. The nationwide rate increased modestly each year between 2013 and 2018 (10.7% to 15.2%).</p> <p><i>Conclusions:</i> Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.</p>

Increased tubulointerstitial recruitment of human CD141hi CLEC9A+ and CD1c+ myeloid dendritic cell subsets in renal fibrosis and chronic kidney disease

2013 ◽  
Vol 305 (10) ◽  
pp. F1391-F1401 ◽  
Author(s):  
Andrew J. Kassianos ◽  
Xiangju Wang ◽  
Sandeep Sampangi ◽  
Kimberly Muczynski ◽  
Helen Healy ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Transforming Growth Factor ◽  
Interstitial Fibrosis ◽  
Kidney Diseases ◽  
Kidney Tissue ◽  
Transforming Growth Factor Β ◽  
Healthy Tissue ◽  
Lectin Domain ◽  
Immune Mediated

Dendritic cells (DCs) play critical roles in immune-mediated kidney diseases. Little is known, however, about DC subsets in human chronic kidney disease, with previous studies restricted to a limited set of pathologies and to using immunohistochemical methods. In this study, we developed novel protocols for extracting renal DC subsets from diseased human kidneys and identified, enumerated, and phenotyped them by multicolor flow cytometry. We detected significantly greater numbers of total DCs as well as CD141hi and CD1c+ myeloid DC (mDCs) subsets in diseased biopsies with interstitial fibrosis than diseased biopsies without fibrosis or healthy kidney tissue. In contrast, plasmacytoid DC numbers were significantly higher in the fibrotic group compared with healthy tissue only. Numbers of all DC subsets correlated with loss of kidney function, recorded as estimated glomerular filtration rate. CD141hi DCs expressed C-type lectin domain family 9 member A (CLEC9A), whereas the majority of CD1c+ DCs lacked the expression of CD1a and DC-specific ICAM-3-grabbing nonintegrin (DC-SIGN), suggesting these mDC subsets may be circulating CD141hi and CD1c+ blood DCs infiltrating kidney tissue. Our analysis revealed CLEC9A+ and CD1c+ cells were restricted to the tubulointerstitium. Notably, DC expression of the costimulatory and maturation molecule CD86 was significantly increased in both diseased cohorts compared with healthy tissue. Transforming growth factor-β levels in dissociated tissue supernatants were significantly elevated in diseased biopsies with fibrosis compared with nonfibrotic biopsies, with mDCs identified as a major source of this profibrotic cytokine. Collectively, our data indicate that activated mDC subsets, likely recruited into the tubulointerstitium, are positioned to play a role in the development of fibrosis and, thus, progression to chronic kidney disease.

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