Prevalence, risk factors and clinical characteristics of renal dysfunction in Chinese outpatients with growth simple renal cysts

Background Researchers have proved that simple renal cysts (SRCs) might be correlated with renal dysfunction, but it is still controversial. Thus, we conducted clinical research study with large sample size and long-term follow-up to clarify the relationship between SRCs and renal dysfunction. Methods A total of 571 SRCs patients in outpatients of nephrology department were included, we investigated the clinical characteristics of growth SRCs compared with non-growth SRCs, evaluated the incidence of renal dysfunction in SRCs and explored the risk factors of renal dysfunction in growth SRCs. Results The mean baseline age was 51.31 ± 14.37 years in the whole cohort, ranging from 19 to 79 years, and 57.6% of them were male. The median follow-up duration was 3 years, ranging from 1 to 10 years. In addition, the final maximum diameter increased 1 mm (2.74%) per year. Patients in growth SRCs group tented to have higher percentage of hypertension, hematuria, large cyst and multiple cysts compared with non-growth SRCs group. The prevalence of renal dysfunction was 15.6% after the follow-up, and the prevalence of renal dysfunction was about 10 times higher in growth SRCs group than non-growth SRCs group (23.3% vs. 2.4%). Renal dysfunction was significantly associated with age, female, total cholesterol, diastolic blood pressure, final maximum diameter and yearly change in maximum diameter in growth SRCs. Conclusions SRCs were closely related to the decline of renal function, we recommend close follow-up for growth SRCs.

Modeling the change trajectory of sleep duration and its associated factors: based on an 11-year longitudinal survey in China

Background Sleep duration is a vital public health topic, yet most existing studies have been limited to cross-sectional surveys or inconsistent classifications of sleep duration categories, and few characterized its continuous development process. The current study aimed to depict its change trajectory in the general population and identify associated factors from a dynamic perspective. Methods A total of 3788 subjects (45.4% male, mean age 46.72 ± 14.89 years) from the China Health and Nutrition Survey were recruited, and their daily sleep duration for five consecutive measurements from 2004 to 2015 was recorded. We adopted latent growth modelling to establish systematic relations between sleep duration and time. Participants’ sociodemographic characteristics, lifestyle, and health factors were taken as covariates. Results The change in sleep duration could be depicted by a linear decreasing trajectory with the mean yearly decrease at 2.5 min/day. The trajectory did not differ by residence, BMI category, chronic disease situation, smoking status, or drinking status. Moreover, there were sex and age differences in the trajectory, and females and those under 30 were prone to larger decrease rates. Conclusion The quantified yearly change in sleep duration provided insights for the prediction and early warning of insufficient sleep. Public health interventions focusing on slowing down the decrease rates among females and young individuals are warranted.

Cardiovascular autonomic neuropathy and the impact on progression of diabetic kidney disease in type 1 diabetes

IntroductionWe investigated the association between cardiovascular autonomic neuropathy (CAN) and decline in kidney function in type 1 diabetes.Research design and methodsWe included 329 persons with type 1 diabetes. CAN was assessed by cardiovascular reflex tests (CARTs): heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva maneuvre. Two or more pathological CARTs defined CAN diagnosis. Outcomes were yearly change in albuminuria or yearly change in estimated glomerular filtration rate (eGFR). An endpoint of eGFR decline >30%, development of end-stage kidney disease (ESKD) or death was examined.Associations were assessed by linear and Cox regression.ResultsParticipants were aged 55.2 (9.4) years, 52% were male, with a diabetes duration of 40.1 (8.9) years, HbA1c of 7.9% (62.5 mmol/mol), eGFR 77.9 (27.7) mL/min/1.73 m2, urinary albumin excretion rate of 14.5 (7–58) mg/24 hours, and 31% were diagnosed with CAN.CAN was associated with a 7.8% higher albuminuria increase per year (95% CI: 0.50% to 15.63%, p=0.036) versus no CAN. The endpoint of ESKD, all-cause mortality and ≥30% decline in eGFR was associated with CAN (HR=2.497, p=0.0254).ConclusionCAN and sympathetic dysfunction were associated with increase in albuminuria in individuals with type 1 diabetes suggesting its role as a potential marker of diabetic kidney disease progression.

Prognostic Factors for Radiographic Progression in Patients with Seronegative Rheumatoid Arthritis

(1) Background: It has long been suggested that seronegative rheumatoid arthritis (RA) represents a clinical entity quite distinct from that of seropositive. However, analytical studies of seronegative RA dedicated to clinical outcomes regarding radiographic progression and related risk factors are scarce. The aim of this study is to evaluate radiographic outcome and prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (2) Methods: Subjects included RA patients reported as seronegative for both rheumatoid factor and anti-citrullinated protein antibody, who were treated at Jeju National University Hospital in South Korea between 2003 and 2016, including follow-up of at least 2 years. All patients fulfilled 1987 ACA or 2010 ACR/EULAR RA criteria. Radiographic progression was measured by yearly change in the Sharp van der Heijde (SvdH) score during follow-up periods. Medical records, laboratory and radiographic data were retrospectively analyzed, and linear regression analysis was performed to evaluate prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (3) Results: In total, 116 patients with seronegative RA were observed and 43 (37.1%) patients demonstrated radiographic damage during follow-up period. Mean age at diagnosis was 48 years and 86 (74.1%) patients were female. Symptom duration at diagnosis was 1.3 years and mean follow-up duration was 5.2 years. Patients with radiographic damage at diagnosis were 14 (12.1%) and mean SvdH score was 6.8 at diagnosis. Radiographic damage and SvdH at diagnosis significantly correlated with radiographic progression in patients with seronegative RA after adjusting age, sex, symptom duration, number of active synovitis, and CRP at diagnosis (β-coefficient 6.5 ± 1.84; p = 0.001 and β-coefficient 0.12 ± 0.02; p < 0.001, respectively). (4) Conclusions: This study determined that radiographic damage and SvdH at diagnosis were predictive factors in progression of radiographic damage in patients with seronegative rheumatoid arthritis. A large comparative study dedicated to this issue in seronegative RA is required.

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.

Effect of Statins on Renal Function and Total Kidney Volume in Autosomal Dominant Polycystic Kidney Disease

<b><i>Background:</i></b> Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary nephropathy with few treatments to slow renal progression. The evidence on the effect of lipid-lowering agents (statins) on ADPKD progression remains inconclusive. <b><i>Methods:</i></b> We performed a systematic review and meta-analysis by searching the PubMed, Embase, Web of Science, and Cochrane databases (up to November 2019). Changes in estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) were the primary outcomes. Mean differences (MDs) for continuous outcomes and 95% confidence intervals (CIs) were calculated by a random-effects model. <b><i>Results:</i></b> Five clinical studies with 648 participants were included. Statins did not show significant benefits in the yearly change in eGFR (4 studies, MD = −0.13 mL/min/m², 95% CI: −0.78 to 0.52, <i>p</i> = 0.70) and the yearly change in TKV (3 studies, MD = −1.17%, 95% CI: −3.40 to 1.05, <i>p</i> = 0.30) compared with the control group. However, statins significantly decreased urinary protein excretion (−0.10 g/day, 95% CI: −0.16 to -0.03, <i>p</i> = 0.004) and serum low-density lipoprotein level (−0.34 mmol/L, 95% CI: −0.58 to −0.10, <i>p</i> = 0.006). <b><i>Conclusion:</i></b> Despite these proteinuria and lipid-lowering benefits, the effect of statins on ADPKD progression was uncertain.

SPATIAL-TEMPORAL CHARACTERISTICS OF THE AEROSOL OPTICAL DEPTH (AOD) DERIVED FROM LONGTERM (1980–2018) MERRA-2 OVER GUANGDONG

This paper presents and compares the aerosol optical depth (AOD) spatial-temporal characteristics over five subsets in different locations of Guangdong, as well as Hong Kong and Macau (GDHM) since reform and opening-up. By means of GIS analysis tools and subset the onward MERRA-2 monthly mean value aerosol reanalysis dataset to the size of study area, the results reveal that the yearly mean AOD over the whole GDHM ranged from 0.18 to 0.69 during 1980 to 2018. The field average of AOD in five chosen areas approached to 0.40 and appeared linearly increased at 0.0077 per year. All the five selected areas reached their yearly mean AOD peaks at 2007. The field average AOD increased rapidly at 0.028 per year from 1997 till 2007 then appeared decreasing oscillation in a linear slope −0.0109 per year since 2007. But the average AOD of 2010–2018 is higher than the former three decadal averages. Comparing the former and the latter two decades, the high yearly mean AOD value clusters have moved from northern parts of Guangdong to central north Pearl River Delta, where also appeared more apparent AOD yearly change among the other three parts since late 1990s. Only six yearly mean AOD over southern cities of Pearl River estuary were lower than east or west comparing parts in 1980s. Eastern part of Guangdong stayed the lowest yearly mean AOD region in 21years of the past 39 years. Central, southern and western of GDHM had 36 years while northern and western of GDHM had 37 years their AOD values during February to April were the high values of the year.

Self-Reported Incident Hypertension and Long-Term Kidney Function in Living Kidney Donors Compared with Healthy Nondonors

Background and objectivesThe risk of hypertension attributable to living kidney donation remains unknown as does the effect of developing postdonation hypertension on subsequent eGFR. We sought to understand the association between living kidney donation, hypertension, and long-term eGFR by comparing donors with a cohort of healthy nondonors.Design, setting, participants, & measurementsWe compared 1295 living kidney donors with median 6 years of follow-up with a weighted cohort of 8233 healthy nondonors. We quantified the risk of self-reported hypertension using a parametric survival model. We examined the association of hypertension with yearly change in eGFR using multilevel linear regression and clustering by participant, with an interaction term for race.ResultsKidney donation was independently associated with a 19% higher risk of hypertension (adjusted hazard ratio, 1.19; 95% confidence interval, 1.01 to 1.41; P=0.04); this association did not vary by race (interaction P=0.60). For white and black nondonors, there was a mean decline in eGFR (−0.4 and −0.3 ml/min per year, respectively) that steepened after incident hypertension (−0.8 and −0.9 ml/min per year, respectively; both P<0.001). For white and black kidney donors, there was a mean increase in eGFR after donation (+0.4 and +0.6 ml/min per year, respectively) that plateaued after incident hypertension (0 and −0.2 ml/min per year, respectively; P=0.07 and P=0.01, respectively, after hypertension).ConclusionsKidney donors are at higher risk of hypertension than similar healthy nondonors, regardless of race. Donors who developed hypertension had a plateau in the usual postdonation increase of eGFR.