Discrepancies in Observed and Predicted Longitudinal Change in Central Hemodynamic Measures: The Framingham Heart Study

Hypertension ◽  
2021 ◽  
Author(s):  
Leroy L. Cooper ◽  
Jian Rong ◽  
Martin G. Larson ◽  
Emelia J. Benjamin ◽  
Naomi M. Hamburg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Framingham Heart Study ◽  
Aortic Stiffness ◽  
Characteristic Impedance ◽  
Longitudinal Change ◽  
Cross Sectional ◽  
Heart Study ◽  
Age Relations

Community-based studies have evaluated cross-sectional age relations of aortic stiffness measures, which are not often recapitulated in longitudinal studies. We examined baseline and longitudinal change in aortic stiffness in 5491 participants (mean age, 49.5±14.5 years; 54% women) who attended 2 sequential examinations (6.0±0.6 years apart) of the Framingham Heart Study. Cross-sectional relations of central hemodynamics (mean arterial pressure, central pulse pressure, carotid-femoral pulse wave velocity, and characteristic impedance) with age and risk factors were assessed at visits 1 and 2 (models 1 and 2). We used model 1 coefficients (M 1 ), visit 1 risk factor levels (R 1 ), and age at each visit (A 1 , A 2 ) to estimate values at visits 1 (M 1 R 1 A 1 ) and 2 (M 1 R 1 A 2 ). While using model 1 coefficients, we accounted for age and risk factor level (R 2 ) changes to predict values at visit 2 (M 1 R 2 A 2 ). Using model 2 coefficients (M 2 ) and visit 2 age and risk factor levels, we predicted visit 2 values (M 2 R 2 A 2 ). We calculated predicted change 3 ways: delta1=M 1 R 1 A 2 −M 1 R 1 A 1 , delta2=M 1 R 2 A 2 −M 1 R 1 A 1 , and delta3=M 2 R 2 A 2 −M 1 R 1 A 1 . Delta1 values were biased and correlated poorly with actual changes ( r =−0.02–0.14). For mean arterial pressure, delta1=1.9±0.8 mm Hg ( r =0.14), observed change=−3.3±10.3 mm Hg, and discrepancy=5.2±10.2 mm Hg ( P <0.0001). For characteristic impedance, delta1=7.2±14.7 dyne×sec/cm 5 ( r =0.07), observed change=20.5±68.2 dyne×sec/cm 5 , and discrepancy=−13.3±68.7 dyne×sec/cm 5 ( P <0.0001). Delta2 values were moderately correlated with change ( r =0.17–0.54) but remained biased whereas delta3 values were moderately correlated with change with no bias. Projected change in hemodynamic measures extrapolated from cross-sectional age relations may differ substantially from actual change, particularly for variables with nonlinear age relations.

Abstract MP74: Long Term Risk-Factor Profiles for Chronic Kidney Disease in the Framingham Heart Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Gearoid M McMahon ◽  
Sarah R Preis ◽  
Shih-Jen Hwang ◽  
Caroline S Fox
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Framingham Heart Study ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Standard Deviation Increase ◽  
Heart Study ◽  
Increased Risk

Background: Chronic Kidney Disease (CKD) is an important public health issue and is associated with an increased risk of cardiovascular disease. Risk factors for CKD are well established, but most are typically assessed at or near the time of CKD diagnosis. Our hypothesis was that risk factors for CKD are present earlier in the course of the disease. We compared the prevalence of risk factors between CKD cases and controls at time points up to 30 years prior to CKD diagnosis. Methods: Participants were drawn from the Framingham Heart Study Offspring cohort. CKD was defined as an estimated glomerular filtration rate of ≤60ml/min/1.73m2. Incident CKD cases occurring at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to controls. Risk factors including systolic blood pressure (SBP), hypertension, lipids, diabetes, smoking status, body mass index (BMI) and dipstick proteinuria were measured at the time of CKD diagnosis and 10, 20 and 30 years prior. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls Results: During follow-up, 441 new cases of CKD were identified and these were matched to 882 controls (mean age 69.2 years, 52.4% women). Up to 30 years prior to CKD diagnosis, those who ultimately developed CKD were more likely to have hypertension (OR 1.74, CI 1.21-2.49), be obese (OR 1.74, CI 1.15-2.63) and have higher triglycerides (OR 1.43, CI 1.12-1.84, p=0.005 per 1 standard deviation increase). Each 10mmHg increase in SBP was associated with an OR of 1.22 for future CKD (95% CI 1.10-1.35) Additionally, cases were more likely to have diabetes (OR 2.90, CI 1.59-5.29) and be on antihypertensive therapy (OR 1.65, CI 1.14-2.40, p=0.009) up to 20 years prior to diagnosis. Increasing HDLc was associated with a lower risk of CKD (OR 0.84, CI 0.81-0.97 per 10mg/dl). Conclusions: As many as 30 years prior to diagnosis, risk factors for CKD are identifiable. In particular, modifiable risk factors such as obesity, hypertension and dyslipidemia are present early in the course of the disease. These findings demonstrate the importance of early identification of risk factors in patients at risk of CKD through a life-course approach.

scholarly journals Hubungan Tingkat Kecemasan Dengan Hemodinamik Pasien Gagal Ginjal Kronik Yang Menjalani Hemodialisa

2019 ◽  
Vol 3 (2) ◽  
pp. 100-111
Author(s):  
Nurlinawati Nurlinawati ◽  
Dini Rudini ◽  
Yuliana Yuliana
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Cross Sectional ◽  
Dialysis Disequilibrium Syndrome

Latar Belakang : Pasien hemodialisis seringkali mengalami kecemasan. Kecemasan ini apabila tidak diatasi akan mempengaruhi aspek fisiologis dan hemodinamik yang dikhawatirkan akan menimbulkan komplikasi yaitu dialysis disequilibrium syndrome. Penelitian ini bertujuan untuk mengetahui  hubungan  tingkat  kecemasan  dengan  kondisi  hemodinamik  pasien  gagal  ginjal kronik yang sedang menjalani hemodialisa. Metode : Jenis penelitian kuantitatif dengan menggunakan cross sectional. Sampel dalam penelitian ini berjumlah 57 responden. Analisis univariat menggunakan distribusi frekuensi dan analisis bivariat menggunakan regresi linier sederhana. Hasil : Hasil penelitian didapat tingkat kecemasan hanya berhubungan dengan Mean Arterial Pressure (MAP) sebelum hemodialisis dengan nilai signifikan 0.023 dan sesudah hemodialisis didapatkan nilai signifikan 0.026. Sedangkan nadi dan respirasi rate tidak terdapat hubungan dengan nilai signifikan >0.05. Kesimpulan : Ada hubungan antara tingkat kecemasan dengan Mean Arterial Pressure (MAP) pasien gagal ginjal kronik yang sedang menjalani hemodialisa di ruang Hemodialisa RSUD Raden Mattaher Jambi Tahun 2018.

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