Abstract P036: Little Evidence Of Association Between Kidney Function And Subclinical Arrhythmias Measured By Extended Ambulatory Cardiac Monitoring: The Multi-Ethnic Study Of Atherosclerosis (MESA)

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Kerri L Wiggins ◽  
James S Floyd ◽  
Nisha Bansal ◽  
Bryan Kestenbaum ◽  
Susan R Heckbert
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Ventricular Arrhythmias ◽  
Large Population ◽  
Cardiac Monitoring ◽  
Premature Ventricular Contractions ◽  
Ethnic Study ◽  
Wide Range ◽  
History Of

Introduction: Chronic kidney disease (CKD) patients are at high risk for atrial fibrillation (AF) and ventricular arrhythmias. Arrhythmias are often asymptomatic and not detected clinically, so the true prevalence among CKD patients is unknown. Extended ambulatory cardiac monitoring is a sensitive and unbiased method for detecting arrhythmias. Hypothesis: We assessed the hypothesis that impaired kidney function is associated with atrial and ventricular arrhythmias as measured by extended ambulatory cardiac monitoring. Methods: In the Multi-Ethnic Study of Atherosclerosis (MESA), kidney function was assessed at the 2016-2018 study visit: estimated glomerular filtration rate (eGFR) using the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation and urinary albumin-creatinine ratio (UACR). UACR was log 2 transformed for analysis. At the same visit, extended ambulatory cardiac monitoring was conducted for up to two 14-day periods per participant using the Zio Patch XT (iRhythm Technologies, Inc., San Francisco, CA). Device information was consolidated for participants with 2 devices, and 7 arrhythmia outcomes were studied: presence of monitor-detected AF (>30 seconds), presence of subclinical AF (in those with no history of clinically detected AF), frequency of premature atrial contractions, frequency of runs of ≥ 4 beats of supraventricular tachycardia (SVT), frequency of premature ventricular contractions, presence of runs of ≥ 4 beats of ventricular tachycardia (VT), and frequency of runs of VT. Continuous outcome variables were natural log transformed. Analyses used logistic regression for binary outcomes and linear regression for continuous outcomes, adjusted for demographic and clinical risk factors. Results: A total of 1459 participants had eGFR measures and 1369 had UACR measures; 178 had a history of clinically detected AF. Mean (standard deviation (SD)) age was 74 (8) years; with 52% women. Median (interquartile range) kidney function measures were eGFR 77 (62, 88) ml/min/1.73 m 2 and UACR 6 (3, 18) mg/g, and total monitoring duration was 14 (14, 26) days. AF was detected in 7%, all but one participant had supraventricular ectopy, and 99% had ventricular ectopy. A doubling of UACR was associated with increased odds of monitor-detected AF (odds ratio 1.18; 95% confidence interval (CI): 1.06-1.32) while eGFR was not significantly associated. Neither eGFR nor UACR was associated with subclinical AF or with ventricular arrhythmias. The analysis of eGFR and frequency of runs of SVT yielded results opposite of the expected direction: a 10 ml/min/1.73 m 2 greater eGFR was associated with a 7% greater frequency of SVT (95% CI: 1%-12%). Conclusion: In summary, in a large population of older individuals across a wide range of kidney function, we found little evidence that impaired kidney function was associated with increased monitor-detected arrhythmias.

scholarly journals Hospitalizations among adults with chronic kidney disease in the United States: A cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003470
Author(s):  
Sarah J. Schrauben ◽  
Hsiang-Yu Chen ◽  
Eugene Lin ◽  
Christopher Jepson ◽  
Wei Yang ◽  
...  
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Hospitalization Rate ◽  
Factors Associated ◽  
Hospitalization Rates ◽  
Wide Range

Background Adults with chronic kidney disease (CKD) are hospitalized more frequently than those without CKD, but the magnitude of this excess morbidity and the factors associated with hospitalizations are not well known. Methods and findings Data from 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study between 2003 and 2008 at 7 clinical centers in the United States were used to estimate primary causes of hospitalizations, hospitalization rates, and baseline participant factors associated with all-cause, cardiovascular, and non-cardiovascular hospitalizations during a median follow up of 9.6 years. Multivariable-adjusted Poisson regression was used to identify factors associated with hospitalization rates, including demographics, blood pressure, estimated glomerular filtration rate (eGFR), and proteinuria. Hospitalization rates in CRIC were compared with rates in the Nationwide Inpatient Sample (NIS) from 2012. Of the 3,939 CRIC participants, 45.1% were female, and 41.9% identified as non-Hispanic black, with a mean age of 57.7 years, and the mean eGFR is 44.9 ml/min/1.73m2. CRIC participants had an unadjusted overall hospitalization rate of 35.0 per 100 person-years (PY) [95% CI: 34.3 to 35.6] and 11.1 per 100 PY [95% CI: 10.8 to 11.5] for cardiovascular-related causes. All-cause, non-cardiovascular, and cardiovascular hospitalizations were associated with older age (≥65 versus 45 to 64 years), more proteinuria (≥150 to <500 versus <150 mg/g), higher systolic blood pressure (≥140 versus 120 to <130 mmHg), diabetes (versus no diabetes), and lower eGFR (<60 versus ≥60 ml/min/1.73m2). Non-Hispanic black (versus non-Hispanic white) race/ethnicity was associated with higher risk for cardiovascular hospitalization [rate ratio (RR) 1.25, 95% CI: 1.16 to 1.35, p-value < 0.001], while risk among females was lower [RR 0.89, 95% CI: 0.83 to 0.96, p-value = 0.002]. Rates of cardiovascular hospitalizations were higher among those with ≥500 mg/g of proteinuria irrespective of eGFR. The most common causes of hospitalization were related to cardiovascular (31.8%), genitourinary (8.7%), digestive (8.3%), endocrine, nutritional or metabolic (8.3%), and respiratory (6.7%) causes. Hospitalization rates were higher in CRIC than the NIS, except for non-cardiovascular hospitalizations among individuals aged >65 years. Limitations of the study include possible misclassification by diagnostic codes, residual confounding, and potential bias from healthy volunteer effect due to its observational nature. Conclusions In this study, we observed that adults with CKD had a higher hospitalization rate than the general population that is hospitalized, and even moderate reductions in kidney function were associated with elevated rates of hospitalization. Causes of hospitalization were predominantly related to cardiovascular disease, but other causes contributed, particularly, genitourinary, digestive, and endocrine, nutritional, and metabolic illnesses. High levels of proteinuria were observed to have the largest association with hospitalizations across a wide range of kidney function levels.

scholarly journals Lipocalin 2 stimulates bone fibroblast growth factor 23 production in chronic kidney disease

Bone Research ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Guillaume Courbon ◽  
Connor Francis ◽  
Claire Gerber ◽  
Samantha Neuburg ◽  
Xueyan Wang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Growth Factor ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Fibroblast Growth Factor ◽  
Kidney Function ◽  
Fibroblast Growth Factor 23 ◽  
Left Ventricular ◽  
Fibroblast Growth ◽  
Lipocalin 2

AbstractBone-produced fibroblast growth factor 23 (FGF23) increases in response to inflammation and iron deficiency and contributes to cardiovascular mortality in chronic kidney disease (CKD). Neutrophil gelatinase-associated lipocalin (NGAL or lipocalin 2; LCN2 the murine homolog) is a pro-inflammatory and iron-shuttling molecule that is secreted in response to kidney injury and may promote CKD progression. We investigated bone FGF23 regulation by circulating LCN2. At 23 weeks, Col4a3KO mice showed impaired kidney function, increased levels of kidney and serum LCN2, increased bone and serum FGF23, anemia, and left ventricular hypertrophy (LVH). Deletion of Lcn2 in CKD mice did not improve kidney function or anemia but prevented the development of LVH and improved survival in association with marked reductions in serum FGF23. Lcn2 deletion specifically prevented FGF23 elevations in response to inflammation, but not iron deficiency or phosphate, and administration of LCN2 increased serum FGF23 in healthy and CKD mice by stimulating Fgf23 transcription via activation of cAMP-mediated signaling in bone cells. These results show that kidney-produced LCN2 is an important mediator of increased FGF23 production by bone in response to inflammation and in CKD. LCN2 inhibition might represent a potential therapeutic approach to lower FGF23 and improve outcomes in CKD.

scholarly journals Enteropeptidase inhibitor SCO-792 effectively prevents kidney function decline and fibrosis in a rat model of chronic kidney disease

2020 ◽  
Author(s):  
Yuko Katayama ◽  
Jun Sugama ◽  
Tomohisa Suzuki ◽  
Yoshimasa Ishimura ◽  
Akihiro Kobayashi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Therapeutic Potential ◽  
Renal Plasma Flow ◽  
Production Capacity ◽  
Therapeutic Effects ◽  
Kidney Fibrosis ◽  
Obesity And Diabetes ◽  
Gfr Decline

Abstract Background Inhibiting enteropeptidase, a gut serine protease regulating protein digestion, suppresses food intake and ameliorates obesity and diabetes in mice. However, the effects of enteropeptidase inhibition on the kidney parameters are largely unknown. Here, we evaluated the chronic effects of an enteropeptidase inhibitor, SCO-792, on kidney function, albuminuria, and kidney pathology in spontaneously hypercholesterolaemic (SHC) rats, a rat chronic kidney disease (CKD) model. Methods SCO-792, an orally available enteropeptidase inhibitor, was administered (0.03% and 0.06% (w/w) in the diet) for five weeks to 20-week-old SHC rats showing albuminuria and progressive decline in glomerular filtration rate (GFR). The effects of SCO-792 and the contribution of amino acids to these effects were evaluated. Results SCO-792 increased the faecal protein content, indicating that SCO-792 inhibited enteropeptidase in SHC rats. Chronic treatment with SCO-792 prevented GFR decline and suppressed albuminuria. Moreover, SCO-792 improved glomerulosclerosis and kidney fibrosis. Pair feeding with SCO-792 (0.06%) was less effective in preventing GFR decline, albuminuria, and renal histological damage than SCO-792 treatment, indicating the enteropeptidase-inhibition-dependent therapeutic effects of SCO-792. SCO-792 did not affect the renal plasma flow, suggesting that its effect on GFR was mediated by an improvement in filtration fraction. Moreover, SCO-792 increased hydrogen sulphide production capacity, which has a role in tissue protection. Finally, methionine and cysteine supplementation to the diet abrogated SCO-792-induced therapeutic effects on albuminuria. Conclusions SCO-792-mediated inhibition of enteropeptidase potently prevented GFR decline, albuminuria, and kidney fibrosis; hence, it may have therapeutic potential against CKD.

scholarly journals An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maren Goetz ◽  
Mitho Müller ◽  
Raphael Gutsfeld ◽  
Tjeerd Dijkstra ◽  
Kathrin Hassdenteufel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Preterm Birth ◽  
Kidney Disease ◽  
Preterm Delivery ◽  
Claims Data ◽  
Maternal Risk ◽  
Live Births ◽  
Increased Risk ◽  
History Of

AbstractWomen with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.

scholarly journals Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study

2019 ◽  
Vol 75 (3) ◽  
pp. 517-521
Author(s):  
Ryon J Cobb ◽  
Roland J Thorpe ◽  
Keith C Norris
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Health And Retirement Study ◽  
Disease Epidemiology ◽  
Lower Egfr ◽  
Everyday Discrimination ◽  
Retirement Study

Abstract Background With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults. Methods The data were from 10 973 respondents (ages 52–100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function. Results Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = −1.35, p &lt; .05), and while attenuated, remained significant (B = −0.79, p &lt; .05) after further adjustments for clinical, health behavior, and socioeconomic covariates. Conclusions Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults.

scholarly journals The Accuracy of Emergency Physicians’ Suspicions of Active Pulmonary Tuberculosis

2021 ◽  
Vol 10 (4) ◽  
pp. 860
Author(s):  
Shiang-Jin Chen ◽  
Chun-Yu Lin ◽  
Tzu-Ling Huang ◽  
Ying-Chi Hsu ◽  
Kuan-Ting Liu
Keyword(s):  
Chronic Kidney Disease ◽  
Weight Loss ◽  
Kidney Disease ◽  
Pulmonary Tuberculosis ◽  
General Ward ◽  
Chest Radiographs ◽  
Emergency Physicians ◽  
Active Pulmonary Tuberculosis ◽  
Factors Associated ◽  
History Of

Objective: To investigate factors associated with recognition and delayed isolation of pulmonary tuberculosis (PTB). Background: Precise identification of PTB in the emergency department (ED) remains challenging. Methods: Retrospectively reviewed PTB suspects admitted via the ED were divided into three groups based on the acid-fast bacilli culture report and whether they were isolated initially in the ED or general ward. Factors related to recognition and delayed isolation were statistically compared. Results: Only 24.94% (100/401) of PTB suspects were truly active PTB and 33.77% (51/151) of active PTB were unrecognized in the ED. Weight loss (p = 0.022), absence of dyspnea (p = 0.021), and left upper lobe field (p = 0.024) lesions on chest radiographs were related to truly active PTB. Malignancy (p = 0.015), chronic kidney disease (p = 0.047), absence of a history of PTB (p = 0.013), and lack of right upper lung (p ≤ 0.001) and left upper lung (p = 0.020) lesions were associated with PTB being missed in the ED. Conclusions: Weight loss, absence of dyspnea, and left upper lobe field lesions on chest radiographs were related to truly active PTB. Malignancy, chronic kidney disease, absence of a history of PTB, and absence of right and/or left upper lung lesions on chest radiography were associated with isolation delay.

scholarly journals High prevalence of chronic kidney disease in Iran: a large population-based study

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Farhad Hosseinpanah ◽  
Farshad Kasraei ◽  
Amir A Nassiri ◽  
Fereidoun Azizi
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Large Population ◽  
Population Based ◽  
Population Based Study ◽  
High Prevalence
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