scholarly journals Pre-ESRD Dementia and Post-ESRD Mortality in a Large Cohort of Incident Dialysis Patients

2017 ◽  
Vol 43 (5-6) ◽  
pp. 281-293 ◽  
Author(s):  
Miklos Z. Molnar ◽  
Keiichi Sumida ◽  
Abduzhappar Gaipov ◽  
Praveen K. Potukuchi ◽  
Tibor Fülöp ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Proportional Hazards ◽  
International Classification Of Diseases ◽  
Cox Proportional Hazards ◽  
Dialysis Initiation ◽  
Entire Cohort ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Stage Renal Disease

Background: Conservative management may be a desirable option for elderly, fragile, or demented patients who reach end-stage renal disease (ESRD), yet some patients with dementia are placed on renal replacement therapy nonetheless. Methods: From a nationwide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (October 1, 2007 to September 30, 2011), we identified 1,336 (3.0%) patients with International Classification of Diseases, Ninth Revision, Clinical Modification code-based dementia diagnosis during the prelude (predialysis) period. We examined the association of prelude dementia with all-cause mortality within the first 6 months following transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. Results: In the entire cohort, the overall mean ± standard deviation age at baseline was 72 ± 11 years, 95% were male, 23% were African-American, and 66% were diabetic. There were 8,080 (18.5%) deaths (mortality rate, 412; 95% confidence interval [CI], 403-421/1,000 patient-years) in the dementia-negative group, and 396 (29.6%) deaths (mortality rate, 708; 95% CI, 642-782/1,000 patient-years) in the dementia-positive group in the entire cohort in the first 6 months after dialysis initiation. Presence of dementia was associated with higher risk of all-cause mortality (adjusted hazard ratio, 1.25; 95% CI, 1.12-1.38) compared to dementia-free patients in the first 6 months after dialysis initiation. Conclusion: Pre-ESRD dementia is associated with increased risk of early post-ESRD mortality in veterans transitioning to dialysis.

Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis

2021 ◽  
pp. 1-11
Author(s):  
Dongying Fu ◽  
Jiani Shen ◽  
Wei Li ◽  
Yating Wang ◽  
Zhong Zhong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Elevated Serum ◽  
Ultra Performance Liquid Chromatography ◽  
Cox Proportional Hazards ◽  
Serum Samples ◽  
Entire Cohort ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Male Patients

Background: Elevated levels of serum trimethylamine N-oxide (TMAO) have been previously linked to adverse cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the clinical significance of serum TMAO levels in patients treated with peritoneal dialysis (PD) is unclear. Methods: A total of 1,032 PD patients with stored serum samples at baseline were enrolled in this prospective study. Serum concentrations of TMAO were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. Cox proportional hazards and competing-risk regression models were performed to examine the association of TMAO levels with all-cause and CV mortality. Results: The median level of serum TMAO in our study population was 34.5 (interquartile range (IQR), 19.8–61.0) μM. During a median follow-up of 63.7 months (IQR, 43.9–87.2), 245 (24%) patients died, with 129 (53%) deaths resulting from CV disease. In the entire cohort, we observed an association between elevated serum TMAO levels and all-cause mortality (adjusted subdistributional hazard ratio [SHR], 1.22; 95% confidence interval [95% CI], 1.01–1.48; p = 0.039) but not CV mortality. Further analysis revealed such association differed by sex; the elevation of serum TMAO levels was independently associated with increased risk of both all-cause (SHR, 1.37; 95% CI, 1.07–1.76; p = 0.013) and CV mortality (SHR, 1.41; 95% CI, 1.02–1.94; p = 0.038) in men but not in women. Conclusions: Higher serum TMAO levels were independently associated with all-cause and CV mortality in male patients treated with PD.

Association of pulse pressure with all-cause mortality in young adults

2019 ◽  
Vol 96 (1138) ◽  
pp. 461-466
Author(s):  
Jie LI ◽  
Jia-Yi Huang ◽  
Kenneth Lo ◽  
Bin Zhang ◽  
Yu-Qing Huang ◽  
...  
Keyword(s):  
Young Adults ◽  
Pulse Pressure ◽  
Subgroup Analysis ◽  
Proportional Hazards ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cox Analysis

BackgroundPulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.ObjectiveTo assess the association of pulse pressure (PP) with all-cause mortality in young adults.MethodsThis cohort from the 1999–2006 National Health and Nutrition Examination Survey included adults aged 18–40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50~60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality.ResultsAfter applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50~60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50–60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants.ConclusionAmong young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.

FC 080VARIABILITY IN SERUM PHOSPHATE ASSESSED BY DIRECTIONAL CHANGE IS ASSOCIATED WITH INCREASED MORTALITY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Xiaoling (Janice) Ye ◽  
Karlien Ter Meulen ◽  
Len A Usvyat ◽  
Frank Van Der Sande ◽  
Constantijn Konings ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Smoothing Splines ◽  
Cox Proportional Hazards ◽  
Serum Phosphate ◽  
P Value ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Directional Change ◽  
Wide Variability

Abstract Background and Aims Prior studies showed that there is a wide variability between serial pre-dialysis measurements of serum phosphate (P). Serum P vary can be due to changes in nutritional intake, underlying bone disorders, medication use or inflammation. Various variability markers have been investigated to study the association between P variability and its association with outcomes, however, the directional trends have not been studied in depth. We aimed to study directional changes and investigated its association with outcomes. Method All adult incident HD patients treated in Fresenius Medical Care North America (FMCNA) clinics between 01/2010 and 10/2018 were included in this retrospective cohort study. Serum P levels were averaged from month 1 to 6 after the initiation of dialysis (baseline). Baseline absolute and directional range (DR) of serum P were calculated. DR of P was calculated as: P min/max (t2) – P max/min (t1), with P (t1) and P (t2) represents the timepoint when either the min P value or max P value was measured, whichever comes first, and with t2 happened after t1. It is positive when the minimum antedates the maximum, otherwise negative. All-cause mortality was recorded between months 7 and 18. Cox proportional hazards models with spline terms were applied to explore the association between absolute and DR of P and all-cause mortality. Additionally, tensor product smoothing splines were computed to study the interactions of P with absolute P and DR of P and their joint associations with outcomes, respectably. Results We studied 353,142 patients. The average age was 62.7 years, 58% were male, 64% were diabetic. Baseline P was 4.98 mg/dL, median absolute range was 2.40 mg/dL, median DR was 1.1 mg/dL. Across different levels of P, both higher levels of absolute range and DR of P were associated with higher risk of mortality (Figure 1, Figure 2). The associations even seemed stronger in patients with lower levels of serum P and with negative DR (Figure 1). Conclusion Lower levels of serum P are independently associated with an increased risk of all-cause mortality. Whereas both a positive and negative DR of P are in general associated with increased mortality, the effects of an increase are most predominant in patients with higher levels of serum P, whereas a negative directional range are most predominant in patients with low serum P. This could be explained by the fact that patients with lower levels of P are generally malnourished or inflamed, where a further reduction indicates nutritional deterioration.

Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

2015 ◽  
Vol 40 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Liping Xiong ◽  
Li Fan ◽  
Qingdong Xu ◽  
Qian Zhou ◽  
Huiyan Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
History Of ◽  
The Relationship

Background: There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. Results: During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. Conclusion: Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.

scholarly journals Women with multiple gestations have an increased risk of development of hypertension in the future

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Geum Joon Cho ◽  
Un Suk Jung ◽  
Ho Yeon Kim ◽  
Soo Bin Lee ◽  
Minjeong Kim ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Smoking Status ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Abnormal Liver Function Test ◽  
Multiple Gestations ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Background Multiple gestations are associated with an increased incidence of preeclampsia. However, there exists no evidence for an association between multiple gestations and development of hypertension(HTN) later in life. This study aimed to determine whether multiple gestations are associated with HTN beyond the peripartum period. Methods In this retrospective nationwide population-based study, women who delivered a baby between January 1, 2007, and December 31, 2008, and underwent a national health screening examination within one year prior to their pregnancy were included. Subsequently, we tracked the occurrence of HTN during follow-up until December 31, 2015, using International Classification of Diseases-10th Revision codes. Results Among 362,821 women who gave birth during the study period, 4,944 (1.36%) women had multiple gestations. The cumulative incidence of HTN was higher in multiple gestations group compared with singleton group (5.95% vs. 3.78%, p < 0.01, respectively). On the Cox proportional hazards models, the risk of HTN was increased in women with multiple gestations (HR 1.35, 95% CI 1.19, 1.54) compared with those with singleton after adjustment for age, primiparity, preeclampsia, atrial fibrillation, body mass index, blood pressure, diabetes mellitus, high total cholesterol, abnormal liver function test, regular exercise, and smoking status. Conclusions Multiple gestations are associated with an increased risk of HTN later in life. Therefore, guidelines for the management of high-risk patients after delivery should be established.

scholarly journals Dexamethasone in hospitalised coronavirus-19 patients not on intensive respiratory support

2021 ◽  
pp. 2102532
Author(s):  
Kristina Crothers ◽  
Rian DeFaccio ◽  
Janet Tate ◽  
Patrick R. Alba ◽  
Matthew Bidwell Goetz ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Respiratory Support ◽  
Low Flow ◽  
Potential Harm ◽  
Cox Proportional Hazards Models ◽  
Veterans Affairs Hospitals ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Mortality Hazard Ratio

IntroductionDexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.MethodsWe included patients admitted to Veterans Affairs hospitals between June 7, 2020-May 31, 2021 within 14-days after SARS-CoV-2 positive test. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weights (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.ResultsOf 19 973 total patients (95% men, median age 71, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514/9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472/5954 (75%) patients on low-flow nasal cannula (NC) received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.47 to 2.12); there was no association with mortality among patients on NC (HR 1.08, 95% CI 0.86 to 1.36).ConclusionIn patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.

scholarly journals A Prospective Study of Persons with the Early Repolarization Normal Variant Electrocardiogram

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1356-1356
Author(s):  
Arthur L. Klatsky ◽  
Mary Anne Armstrong ◽  
Rudolph Oehm ◽  
Robert A. Cooper ◽  
Natalia Udaltsova
Keyword(s):  
Proportional Hazards ◽  
Care Program ◽  
Cox Proportional Hazards ◽  
Normal Variant ◽  
Early Repolarization ◽  
Chi Square ◽  
Entire Cohort ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
A Prospective Study

P30 Sometimes confused with abnormal electrocardiogram (ECG) patterns, especially acute myocardial infarction, the poorly understood “early repolarization normal variant” (VAR) ECG has been considered benign, but, to our knowledge, has not been studied in relationship to later cardiovascular (CV) problems. We collected 2081 possible VAR and normal (NORM) ECG’s from among those done at health examinations of 72,830 members of a pre-paid health care program in 1983-85. All ECG’s were reinterpreted independently as VAR, Borderline, or NORM by 2 cardiologists blinded to all identifying and clinical data; agreement by both was required for categorization as VAR. Comparisons of subsequent hospitalizations and deaths through 1998 among all 72,830 examinees used Cox proportional hazards models with 7 covariates. Outpatient diagnoses were available from 1995 through 1999 among a subset of 45,528 examinees still in the program in 1995; these were compared in sex & age-stratified groups by chi-square tests. The blinded readings yielded 670 VAR ECG s, 330 borderline ECG s, and 1081 NORM ECG s. Comparison of VAR to NORM showed increased VAR proportions of men, persons < 40 years old, and blacks or Asians (all with p<0.001). Among 21,826 persons hospitalized in the entire cohort there were 136 with VAR; among 7974 persons who died there were 37 with VAR; among 15,422 persons with outpatient diagnoses there were 95 with VAR. No significant differences in risk for VAR vs all persons were found for hospitalization or death for all causes, CV causes, or non-CV causes. For outpatient diagnoses, persons with VAR had lower rates/1000 persons than the entire population for any CV diagnosis (339/1000 for all; 256/1000 for VAR; p < 0.001). Diagnosis rates among VAR were significantly lower for hypertension (p < 0.02) arrhythmias (p < 0.01) and non-specific CV symptoms (p < 0.05) and also were nonsignificantly lower among VAR for coronary disease, cardiomyopathy, heart failure, stroke, and valvular disease. These data confirm the benign nature of VAR, suggesting that VAR not only carries no increased risk for development of CV conditions but may be associated with decreased CV risk.

scholarly journals Appendectomy and Non-Typhoidal Salmonella Infection: A Population-Based Matched Cohort Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1466
Author(s):  
Den-Ko Wu ◽  
Kai-Shan Yang ◽  
James Cheng-Chung Wei ◽  
Hei-Tung Yip ◽  
Renin Chang ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Research Database ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

The potential association between appendectomy and non-typhoidal Salmonella (NTS) infection has not been elucidated. We hypothesized that appendectomy may be associated with gut vulnerability to NTS. The data were retrospectively collected from the Taiwan National Health Insurance Research Database to describe the incidence rates of NTS infection requiring hospital admission among patients with and without an appendectomy. A total of 208,585 individuals aged ≥18 years with an appendectomy were enrolled from January 2000 to December 2012, and compared with a control group of 208,585 individuals who had never received an appendectomy matched by propensity score (1:1) by index year, age, sex, occupation, and comorbidities. An appendectomy was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification Procedure Codes. The main outcome was patients who were hospitalized for NTS. Cox proportional hazards models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Two sensitivity analyses were conducted for cross-validation. Of the 417,170 participants (215,221 (51.6%) male), 208,585 individuals (50.0%) had an appendectomy, and 112 individuals developed NTS infection requiring hospitalization. In the fully adjusted multivariable Cox proportional hazards regression model, the appendectomy group had an increased risk of NTS infection (adjusted HR (aHR), 1.61; 95% CI, 1.20–2.17). Females and individuals aged 18 to 30 years with a history of appendectomy had a statistically higher risk of NTS than the control group (aHR, 1.92; 95% CI, 1.26–2.93 and aHR, 2.67; 95% CI, 1.41–5.07). In this study, appendectomy was positively associated with subsequent hospitalization for NTS. The mechanism behind this association remains uncertain and needs further studies to clarify the interactions between appendectomy and NTS.

Abstract 2321: CXCL5 Genotype is Associated with Mortality after Acute Coronary Syndromes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Amber L Beitelshees ◽  
Issam Zineh ◽  
Sharon Cresci ◽  
Jun Wu ◽  
Matthew R Minton ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Proportional Hazards ◽  
Coronary Revascularization ◽  
Recessive Model ◽  
Cox Proportional Hazards ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Coronary Syndromes

BACKGROUND: Epithelial neutrophil activating peptide (ENA-78) is a chemokine implicated in many inflammatory processes and may be involved in cardiovascular disease. We have previously found the −156 G>C variant in the ENA-78 gene ( CXCL5 ) to be associated with elevated plasma ENA-78 concentrations and production from cultured leukocytes. Since leukocytes, including neutrophils, are involved in acute cardiovascular events, we hypothesized that the CXCL5 −156 G>C variant would be associated with worse event-free survival after acute coronary syndromes (ACS). METHODS: A prospective cohort of ACS patients (n=704) with 3-year follow-up was assessed and CXCL5 was genotyped by Taqman. Cox proportional hazards models adjusting for age, race, sex, diabetes, heart failure, ACS type, coronary revascularization, and genotype were constructed in the entire cohort and separately by race. Kaplan Meier curves were estimated. RESULTS: The −156C allele frequency was 0.17, 0.12, and 0.43 in the overall cohort, whites, and blacks, respectively. The −156C allele was associated with an increased risk mortality according to a recessive model of inheritance in the overall cohort (HR 2.8, 95% CI 1.4 –5.9) [Figure ], and in the white (HR 3.7, 95% CI 1.3–11.1) and black (HR 2.6, 95% CI 0.90 –7.3) subgroups. CONCLUSIONS: CXCL5 −156 C/C genotype was associated with 2.8-fold higher mortality relative to other genotypes in ACS patients. The magnitude of risk was similar in both white and black patients. Taken with previous findings, CXCL5 genotype may represent a novel risk-stratification biomarker in ACS.

scholarly journals Circulating ANGPTL8 levels and risk of kidney function decline: Results from the 4C Study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Huajie Zou ◽  
Yongping Xu ◽  
Xiaoyu Meng ◽  
Danpei Li ◽  
Xi Chen ◽  
...  
Keyword(s):  
Kidney Function ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Kidney Function Decline

Abstract Background ANGPTL8, an important regulator of lipid metabolism, was recently proven to have additional intracellular and receptor-mediated functions. This study aimed to investigate circulating levels of ANGPTL8 and its potential association with the risk of kidney function decline in a cohort study. Methods We analysed 2,311 participants aged 40 years old and older from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Kidney function decline was defined as an estimated glomerular filtration rate (eGFR) less than 60 mL per minute per 1.73 m2 of body surface area, a decrease in eGFR of ≥ 30% from baseline, chronic kidney disease (CKD)-related hospitalization or death, or end-stage renal disease. The association between baseline ANGPTL8 levels and kidney function decline was assessed using multivariable-adjusted Cox proportional hazards models, and inverse possibility of treatment weight (IPTW) was utilized to prevent overfitting. Results There were 136 (5.9%) cases of kidney function decline over a median of 3.8 years of follow-up. We found that serum ANGPTL8 levels at baseline were elevated in individuals with kidney function decline compared to those without kidney function decline during follow-up (718.42 ± 378.17 vs. 522.04 ± 283.07 pg/mL, p < 0.001). Compared with the first quartile, multivariable-adjusted hazard ratio (95% confidence intervals [CIs]) for kidney function decline was 2.59 (95% CI, 1.41–4.77) for the fourth ANGPTL8 quartile. Furthermore, compared with patients in the first ANGPTL8 quartile, those in the fourth ANGPTL8 quartile were more likely to report a higher stage of CKD (relative risk: 1.33; 95% CI, 1.01–1.74). The conclusions of the regression analyses were not altered in the IPTW models. Multivariable-adjusted restricted cubic spline analyses suggested a linear relationship of ANGPTL8 with kidney function decline (p for nonlinear trend = 0.66, p for linear trend < 0.001). Conclusions Participants with higher circulating ANGPTL8 levels were at increased risk for kidney function decline, highlighting the importance of future studies addressing the pathophysiological role of ANGPTL8 in CKD.

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