scholarly journals THU0408 EFFECT OF NEW-ONSET GOUT ON KIDNEY TRANSPLANT OUTCOMES: A RETROSPECTIVE COHORT ANALYSIS OF THE UNITED STATES RENAL DATA SYSTEM

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 441.2-442
Author(s):  
J. LI ◽  
D. Yin ◽  
Z. Wang ◽  
M. Brigham ◽  
B. Lamoreaux ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Retrospective Cohort ◽  
Index Date ◽  
Medication Use ◽  
The United States ◽  
Transplant Proc ◽  
Time Varying ◽  
Increased Risk ◽  
Time Invariant ◽  
New Onset

Background:Gout is a frequent comorbidity in kidney transplant (KT) recipients. However, assessing the independent effect of gout on KT outcomes is difficult because of multiple confounders (e.g., temporal changes in estimated glomerular filtration rate [eGFR], cyclosporine or tacrolimus dose, urate-lowering medication use) that obscure a clear picture of gout’s potential impact.Objectives:This investigation assessed if the development of new-onset gout after KT was an independent risk factor for loss of graft function, as assessed by the need for maintenance hemodialysis following KT.Methods:This retrospective cohort study analyzed data on patients in the United States Renal Data System (USRDS) who received a primary KT between 1/1/2008 and 12/31/2015. The date of transplantation was the ‘index’ date. Eligible patients were required to have ≥24 months of Medicare coverage and no prior history of gout, defined as ≥1 claim with a gout diagnosis code in the 24 months prior to the index date. All patients were also required to have ≥12 months of coverage post index. Patients who died, experienced graft failure, or returned to dialysis <12 months post index were excluded. Because the first year following transplant is associated with the highest frequency of rejections, we evaluated subjects beginning 1 year after transplant. The exposure of interest was new-onset gout, defined as the presence of ≥2 claims for gout post index, and the primary endpoint was return to dialysis >12 months post index. Baseline time-invariant confounders included recipient and donor demographics and clinical characteristics at index. Time-varying confounders included body mass index (BMI) adjusted tacrolimus and cyclosporine dose, eGFR, and urate-lowering medication use post index. Patients who died or lost Medicare coverage >12 months post index were censored; all patients remaining at the end of the study period (12/31/2016) were also censored. A marginal structural model (MSM) was fitted to determine the relative risk of new-onset gout on return to dialysis, while controlling for both time-invariant and time-varying confounders.Results:18,525 of 466,589 KT recipients in the USRDS met study eligibility. Within the observation period, 1,399 (7.6%) developed new-onset gout and 1,420 (7.7%) returned to dialysis >12 months post index. Median time from index to new-onset gout and from index to return to dialysis was 16.2 months (IQR: 33.4) and 32.8 months (IQR: 28.4), respectively. Adjusting for baseline time-invariant and time-varying confounders via the MSM showed new-onset gout was associated with a 51% increased risk of return to dialysis >12 months post index (RR: 1.51, 95% CI: 1.03, 2.20).Conclusion:New-onset gout was independently associated with a 51% increased risk of return to dialysis >12 months after primary KT compared to a control cohort without gout. To our knowledge, this is the first observation of this outcome in an appropriately controlled cohort study of KT recipients with gout. Results from this analysis may have important implications for the monitoring and management of new-onset gout in the kidney transplant population.References:[1]Mandell BF.Cleve Clin J Med2008;75(Suppl 5):S5-8.[2]Forbess LJ, Fields TR.Sem Arthritis Rheum2012;42:146-54.[3]Gibson T.Curr Opin Rheumatol2012;24:127-31.[4]Zhang L, et al.Nephrol Dial Transplant2012;27:1836-9.[5]Clive DM.J Am Soc Nephrol2000;11:974-9.[6]Kalantar E, et al.Transplant Proc2011;43:584-5.[7]Lin HY, et al.N Engl J Med1989;321:287-92.[8]Ben Hmida M, et al.Transplant Proc1995;27:2722-4.[9]Kanbay M, et al.Transplant Proc2005;37:3119-20.[10]Baroletti S, Bencivenga GA.Prog Transplant2004;14:143-7.[11]Kim ED, et al.Am J Transplant2015;15:482-8.[12]Kim DG, et al.PloS One2018;13:e0209156.Disclosure of Interests: :Justin Li: None declared, David Yin: None declared, Zheng Wang: None declared, Mark Brigham: None declared, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Jeffrey Kent Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Richard Johnson Shareholder of: Colorado Research Partners LLC, XORTX Therapeutics, Consultant of: Horizon Therapeutics, Eli Lilly, Speakers bureau: Horizon Therapeutics, Nandini Hadker: None declared, Kevin Francis: None declared, Herman Sanchez: None declared, Gavin Miyasato: None declared

Concussion in adolescence and the risk of multiple sclerosis: A retrospective cohort study

2020 ◽  
pp. 135245852090803
Author(s):  
Christopher A Povolo ◽  
Jennifer N Reid ◽  
Salimah Z Shariff ◽  
Blayne Welk ◽  
Sarah A Morrow
Keyword(s):  
Multiple Sclerosis ◽  
Retrospective Cohort ◽  
Index Date ◽  
Primary Outcome ◽  
Administrative Databases ◽  
Long Term Effects ◽  
Physical Trauma ◽  
Specific Analysis ◽  
Increased Risk

Background: Physical trauma, specifically concussions sustained during adolescence, has been hypothesized to be a risk factor for multiple sclerosis (MS). Objective: To examine the association between adolescent concussions and future MS diagnosis. Methods: This retrospective study using linked administrative databases from Ontario, Canada, identified 97,965 adolescents (age 11–18 years) who sustained ⩾1 concussion and presented to an emergency department between 1992 and 2011. Cases were matched 1:3 with individuals who had not sustained a concussion based on age, sex, address, and index date. The primary outcome was MS diagnosis, using a validated MS diagnosis definition: ⩾1 hospitalization or ⩾5 physician billings within 2 years. Results: A concussion during adolescence was associated with a significantly increased risk of MS (hazard ratio (HR) = 1.29, p = 0.03). Sex-specific analysis revealed that only males who sustained a concussion in adolescence had a raised risk of MS (HR = 1.41, p = 0.04). Conclusion: This study supports an association between concussions in adolescence and future MS diagnoses, highlighting the potentially serious long-term effects of concussions.

Outcomes With Severe Blastomycosis and Respiratory Failure in the United States

2020 ◽  
Author(s):  
Barret Rush ◽  
Sylvain Lother ◽  
Bojan Paunovic ◽  
Owen Mooney ◽  
Anand Kumar
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Ventilatory Support ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
The United States ◽  
Teaching Hospitals ◽  
Historical Case ◽  
Increased Risk

Abstract Background Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50–90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. Methods We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006–2014. Patients aged &gt;18 years with a diagnosis of blastomycosis who received MV were included. Results There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P &lt; .01). The median (IQR) time to death for patients requiring MV was 12 (8–16) days. The median length of hospital stay for survivors of MV was 22 (14–37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06–3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33–2.02; P &lt; .01). Conclusions In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.

scholarly journals Acute Kidney Injury and Long-Term Risk for Cardiovascular Events in Patients after Kidney Transplantation

2019 ◽  
Vol 44 (5) ◽  
pp. 1149-1157
Author(s):  
Ruth Rahamimov ◽  
Tuvia Y. van Dijk ◽  
Maya Molcho ◽  
Itay Vahav ◽  
Eytan Mor ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Time Varying ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cv Disease

Background: Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. Patients after kidney transplantation are prone to AKI events and are also at an increased risk of cardiovascular (CV) disease. The association between AKI and MACE in kidney transplant patients is yet to be studied. Methods: This retrospective single-center cohort study reviewed 416 adult renal allograft recipients transplanted between 2005 and 2010. AKI events were recorded starting 2 weeks after transplantation, or following discharge with a functioning graft. AKI was defined, according to the KDIGO criteria. The primary outcome was the composite of MACE starting 6 months after transplantation and all-cause mortality. For survival analysis, we used univariate and multivariate time varying Cox proportional hazard model. Results: One hundred and twenty-four patients (29.8%) had at least one episode of AKI. During the median follow-up time of 7.2 years (interquartile range 4.3–9.1), 144 outcome events occurred. By time varying Cox regression analysis, AKI was associated with an increased rate of CV outcomes or death (hazard ratio [HR] 1.96, 95% CI 1.36–2.81, p < 0.001), and the association remained significant by multivariate adjusted model (HR 1.76, 95% CI 1.18–2.63, p = 0.005). As for the different components of MACE, all-cause mortality and CV mortality were the only outcomes that were significantly associated with AKI. No interaction between AKI timing and MACE was found. Conclusion: AKI in kidney transplant recipient is associated with an increased risk of CV disease.

scholarly journals Lower-Third SLOE Rankings Impede, But Do Not Prevent, A Match in Emergency Medicine Residency Training

2020 ◽  
Vol 7 ◽  
pp. 238212052098048
Author(s):  
Joseph A Hansroth ◽  
Kristin H Davis ◽  
Kimberly D Quedado ◽  
Stephen M Davis ◽  
Autumn S Kiefer ◽  
...  
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Retrospective Cohort ◽  
Global Assessment ◽  
The United States ◽  
Faculty Advisors ◽  
Increased Risk ◽  
Study Results ◽  
Residency Application ◽  
Secondary Finding

Objective: Emergency medicine program directors (PD) value the standardized letter of evaluation (SLOE) as the most important aspect of a residency application when making both invitation and ranking decisions. This study aims to determine whether the presence of any lower-third in either SLOE global assessment (GA) question impacted the ability of an applicant to match into EM. We hypothesized that any lower-third ranking would be associated with increased odds of not matching into EM. Methods: We conducted a retrospective cohort study evaluating allopathic applicants from medical schools in the United States (US allopathic applicants) to a single EM residency program during the 2018/2019 match cycles. GA SLOE rankings from all applications were tabulated and compared to the applicant’s National Resident Matching Program (NRMP) match outcome. Comparative analyses were conducted between SLOE groupings and odds ratios (OR) were calculated. Results: A total of 2,017 SLOEs from 781 US allopathic applicants were analyzed during the study period. Of the total, 277 (35%) applicants in our sample had any lower-third GA ranking, which significantly decreased an applicant’s odds of matching in EM by 79% (OR 0.21, 95% CI, 0.12-0.34). Having more than one lower-third GA ranking did not further statistically decrease the odds of a successful EM match (OR 0.60, 95% CI 0.31-1.17). As a secondary finding of the study, results demonstrate that those applicants having no lower-third GA rankings had a nearly 5 times increased odds of an EM match (OR 4.84, 95% CI, 2.91-8.03). Conclusion: Having any lower-third GA ranking significantly reduced an applicant’s chances of matching into an EM program. Faculty advisors should be aware of the increased risk of not matching for any applicant with any lower-third GA ranking and advise students appropriately, while maintaining the integrity of the SLOE and not divulging the confidential information contained within.

scholarly journals 2163 Polypharmacy and patterns of prescription medication use among cancer survivors

2018 ◽  
Vol 2 (S1) ◽  
pp. 85-86
Author(s):  
Caitlin Murphy ◽  
Hannah Fullington ◽  
Carlos Alvarez ◽  
Simon C. Lee ◽  
Andrea Betts ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Adverse Drug Events ◽  
Medical Expenditure Panel Survey ◽  
Medication Use ◽  
Prescription Medication ◽  
The United States ◽  
Abuse Potential ◽  
Medical Expenditure ◽  
Adolescent And Young Adult ◽  
Increased Risk

OBJECTIVES/SPECIFIC AIMS: The population of cancer survivors is rapidly growing in the United States. Long term and late effects of cancer, combined with ongoing management of other chronic conditions, make cancer survivors particularly vulnerable to polypharmacy and its adverse effects. We examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors. METHODS/STUDY POPULATION: Using data from the Medical Expenditure Panel Survey (MEPS), we matched cancer survivors (n=5216) to noncancer controls (n=19,588) by age, sex, and survey year. We defined polypharmacy as using 5 or more unique medications. We also estimated proportion of respondents prescribed specific medications within therapeutic classes and total prescription expenditures. RESULTS/ANTICIPATED RESULTS: A higher proportion of cancer survivors were prescribed 5 or more unique medications (64.0%, 95% CI 62.3%–65.8%) compared with noncancer controls (51.5%, 95% CI 50.4%–52.6%), including drugs with abuse potential. Across all therapeutic classes, a higher proportion of newly (≤1 year since diagnosis) and previously (>1 years since diagnosis) diagnosed survivors were prescribed medications compared to controls, with large differences in central nervous system agents (65.8% vs. 57.4% vs. 46.2%), psychotherapeutic agents (25.4% vs. 26.8% vs. 18.3%), and gastrointestinal agents (31.9% vs. 29.6% vs. 22.0%). Specifically, nearly 10% of cancer survivors were prescribed benzodiazepines and/or opioids compared to about 5% of controls. Survivors had more than double prescription expenditures (median $1633 vs. $784 among noncancer controls). Findings persisted similarly across categories of age and comorbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: Cancer survivors were frequently prescribed a higher number of unique medications and inappropriate medications or drugs with abuse potential, increasing risk of adverse drug events, financial toxicity, poor adherence, and drug-drug interactions. Adolescent and young adult survivors appear at increased risk of polypharmacy.

scholarly journals Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study

2019 ◽  
Vol 46 (11) ◽  
pp. 1450-1457 ◽  
Author(s):  
Victor S. Sloan ◽  
Anna Sheahan ◽  
Jeffrey L. Stark ◽  
Robert Y. Suruki
Keyword(s):  
Cohort Study ◽  
Ankylosing Spondylitis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Index Date ◽  
International Classification Of Diseases ◽  
The United States ◽  
Research Database ◽  
Opioid Use ◽  
Chronic Opioid Use

Objective.To assess the prevalence of chronic opioid use in patients with ankylosing spondylitis (AS), and to compare the characteristics of patients with and without chronic opioid use.Methods.This was a retrospective cohort study of patients with AS identified in the Truven Health MarketScan Research database between January 1, 2012, and March 31, 2017. Commercial and Medicaid claims data were examined using both specific (720.0 and M45.x) and broader (720.x and M45.x) International Classification of Diseases (ICD) coding definitions. Patients were aged ≥ 18 years on the date of first qualifying ICD code occurrence (the index date). Demographics and clinical characteristics were assessed in the 12-month period preceding the index date. The 12-month followup period was used to assess prevalence and characteristics of chronic opioid use.Results.Chronic opioid use was common among patients with commercial claims (23.5% of ICD 720.0 patients; 27.3% of ICD 720.x patients), and especially those with Medicaid claims (57.1% and 76.7%, respectively). The proportion of patients with claims for anti–tumor necrosis factor therapies during followup was often low, and for Medicaid patients was lower among those with chronic opioid use (29.6% of ICD 720.0 patients; 2.3% of ICD 720.x patients) than those without (47.1% and 7.1%, respectively). Among chronic opioid users in all cohorts, the cumulative supply of opioids was typically high (≥ 270 days in the followup period); most opioids prescribed were Schedule II.Conclusion.Patients with AS receive opioids with disturbing frequency. The infrequent prescription of recommended therapies to these patients reflects a need to optimize treatment further through education of patients and healthcare professionals alike.

scholarly journals Colorectal Surgery in Kidney Transplant Recipients: A Decade of Trends and Outcomes in the United States

2013 ◽  
Vol 79 (10) ◽  
pp. 1026-1033 ◽  
Author(s):  
Wissam J. Halabi ◽  
Mehraneh D. Jafari ◽  
Vinh Q. Nguyen ◽  
Joseph C. Carmichael ◽  
Steven Mills ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Colorectal Surgery ◽  
Kidney Transplant ◽  
The United States ◽  
Wound Complications ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Colon And Rectal Cancer ◽  
Increased Risk

There is paucity of data evaluating the trends and outcomes of colorectal surgery (CRS) in kidney transplant recipients (KTRs). Using the Nationwide Inpatient Sample 2001 to 2010, a retrospective review of CRS performed in KTRs was performed. Trends, demographics, indications, and outcomes were examined for elective and emergent cases and compared with the general population (GP) on multivariate logistic regression. A total of 2616 KTRs underwent CRS, 50 per cent of which were done emergently. KTRs developed colon and rectal cancer at a younger age and had significantly higher incidence of comorbidities compared with the GP. Diverticular disease was the most common indication for surgery (48%) followed by cancer (30.6%). Compared with the GP, KTRs had higher rates of mortality (6.29 vs 3.64%), wound complications (8.02 vs 5.37%), and acute renal failure (ARF) (17.14 vs 7.10%) (all P < 0.05). No difference was seen in the incidence of anastomotic leak. On multivariate analysis, KTRs had higher associated odds of ARF (odds ratio, 2.02; P < 0.001), whereas the odds of mortality, wound, and anastomotic complications were similar to the GP. Emergency surgery in KTRs was associated with worse outcomes compared with the elective setting. KTRs undergoing CRS have unique characteristics that are different than the GP. They are at an increased risk of complications, especially acute renal failure.

scholarly journals Cardiovascular Safety During and After Use of Phentermine and Topiramate

2018 ◽  
Vol 104 (2) ◽  
pp. 513-522 ◽  
Author(s):  
Mary E Ritchey ◽  
Abenah Harding ◽  
Shannon Hunter ◽  
Craig Peterson ◽  
Philip T Sager ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Medication Use ◽  
Fixed Dose ◽  
Billing Data ◽  
Increased Risk ◽  
Wide Range ◽  
Clinical Program ◽  
Dose Combination

Abstract Context Increases in heart rate were seen during the clinical program for fixed-dose combination phentermine (PHEN) and topiramate (TPM), an oral medication indicated for weight management; however, the effect on cardiovascular (CV) outcomes is uncertain. Objective The aim of the present study was to determine the extent to which the rates of major adverse CV events (MACE) in patients using PHEN and TPM (including fixed dose) differed from the MACE rates during unexposed periods. Design Retrospective cohort study. Setting MarketScan, US insurance billing data. Patients or Other Participants Patients aged &gt;18 years with ≥6 months of continuous enrollment in the database before taking PHEN and/or TPM or after stopping these medications. Interventions PHEN and TPM, taken separately and together (including fixed dose). Main Outcome Measures MACE, a composite of hospitalization for acute myocardial infarction and stroke and in-hospital CV death. Results Because the outcomes are rare and the duration of medication use was brief, few events occurred. The MACE rates among current users of PHEN/TPM, fixed-dose PHEN/TPM, and PHEN were lower than those among unexposed former users. In contrast, the rate of MACE among current users of TPM was greater than among unexposed former users [incidence rate ratio: PHEN/TPM, 0.57; 95% CI, 0.19 to 1.78; fixed-PHEN/TPM, 0.24; 95% CI, 0.03 to 1.70; PHEN, 0.56; 95% CI, 0.34 to 0.91; TPM, 1.58; 95% CI, 1.33 to 1.87). Conclusions Overall, the data indicated no increased risk of MACE for current PHEN/TPM users; however, the 95% CIs for the PHEN/TPM groups were broad, indicating that the data were compatible with a wide range of possible values.

Diabetes in elderly patients with breast cancer in the United States: An analysis of data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 11050-11050
Author(s):  
C. D. O'Malley ◽  
M. Danese ◽  
K. Lindquist ◽  
R. Griffiths ◽  
M. Gleeson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Index Date ◽  
The United States ◽  
Physician Service ◽  
Diabetic Patients ◽  
Diabetes Incidence ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Time Periods

11050 Background: Despite increases in both breast cancer and diabetes, little is known about their co-occurrence. With evidence that cancer and diabetes can reflect related processes such as obesity, understanding the prevalence of diabetes in patients with breast cancer is critical. Methods: Using the SEER-Medicare linked database, 52,977 women newly diagnosed with breast cancer at ages 66+ years during 1998–2002 were identified, and a random sample of Medicare beneficiaries without cancer, matched (1:1) on sex and residence county were selected as a comparison cohort. The occurrence of diabetes was defined as ≥1 hospital or ≥2 physician service claims, and the date of cancer diagnosis served as the index date for the breast cancer patient and her matched cancer-free individual. For both cohorts, diabetes prevalence was measured for the ≥12 months prior to the index date, and incidence was estimated for non-diabetic patients during three time periods after the index date (3 months, 12 months, and overall), with follow-up through 2005. Prevalence and incidence rates (per 1,000 person-years) and their 95% confidence intervals (CI) are standardized to the age and race distribution of the breast cancer group. Results: Rates were higher in breast cancer patients for all time periods, particularly shortly after diagnosis. This pattern of heightened risk immediately following cancer diagnosis held when rates were stratified by age, stage, and race/ethnicity.For both cohorts, diabetes incidence was typically two times greater in Blacks and Hispanics compared to Whites. Conclusions: Older women with breast cancer are at increased risk for diabetes, suggesting that there may be shared biologic pathways such as insulin, INSR, IGF-1, and IGF-1R. [Table: see text] [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document