scholarly journals Low Serum Bicarbonate and CKD Progression in Children

2020 ◽  
Vol 15 (6) ◽  
pp. 755-765 ◽  
Author(s):  
Denver D. Brown ◽  
Jennifer Roem ◽  
Derek K. Ng ◽  
Kimberly J. Reidy ◽  
Juhi Kumar ◽  
...  
Keyword(s):  
Lower Risk ◽  
Glomerular Disease ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Ckd Progression ◽  
Hazard Ratios ◽  
Alkali Therapy ◽  
Therapy Treatment ◽  
Low Serum

Background and objectivesStudies of adults have demonstrated an association between metabolic acidosis, as measured by low serum bicarbonate levels, and CKD progression. We evaluated this relationship in children using data from the Chronic Kidney Disease in Children study.Design, setting, participants, & measurementsThe relationship between serum bicarbonate and a composite end point, defined as 50% decline in eGFR or KRT, was described using parametric and semiparametric survival methods. Analyses were stratified by underlying nonglomerular and glomerular diagnoses, and adjusted for demographic characteristics, eGFR, proteinuria, anemia, phosphate, hypertension, and alkali therapy.ResultsSix hundred and three participants with nonglomerular disease contributed 2673 person-years of follow-up, and 255 with a glomerular diagnosis contributed 808 person-years of follow-up. At baseline, 39% (237 of 603) of participants with nonglomerular disease had a bicarbonate level of ≤22 meq/L and 36% (85 of 237) of those participants reported alkali therapy treatment. In participants with glomerular disease, 31% (79 of 255) had a bicarbonate of ≤22 meq/L, 18% (14 of 79) of those participants reported alkali therapy treatment. In adjusted longitudinal analyses, compared with participants with a bicarbonate level >22 meq/L, hazard ratios associated with a bicarbonate level of <18 meq/L and 19–22 meq/L were 1.28 [95% confidence interval (95% CI), 0.84 to 1.94] and 0.91 (95% CI, 0.65 to 1.26), respectively, in children with nonglomerular disease. In children with glomerular disease, adjusted hazard ratios associated with bicarbonate level ≤18 meq/L and bicarbonate 19–22 meq/L were 2.16 (95% CI, 1.05 to 4.44) and 1.74 (95% CI, 1.07 to 2.85), respectively. Resolution of low bicarbonate was associated with a lower risk of CKD progression compared with persistently low bicarbonate (≤22 meq/L).ConclusionsIn children with glomerular disease, low bicarbonate was linked to a higher risk of CKD progression. Resolution of low bicarbonate was associated with a lower risk of CKD progression. Fewer than one half of all children with low bicarbonate reported treatment with alkali therapy. Long-term studies of alkali therapy’s effect in patients with pediatric CKD are needed.

Consumption of flavonoid-rich fruits, flavonoids from fruits, and stroke risk: a prospective cohort study

2021 ◽  
pp. 1-26
Author(s):  
Qi Gao ◽  
Jia-Yi Dong ◽  
Renzhe Cui ◽  
Isao Muraki ◽  
Kazumasa Yamagishi ◽  
...  
Keyword(s):  
Lower Risk ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dietary Factors ◽  
Citrus Fruits ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Index Study

Abstract We sought to examine the prospective associations of specific fruit consumption, in particular flavonoid-rich fruit (FRF) consumption, with the risk of stroke and subtypes of stroke in a Japanese population. A study followed a total of 39,843 men and 47,334 women aged 44-76 years, and free of cardiovascular disease, diabetes, and cancer at baseline since 1995 and 1998 to the end of 2009 and 2012, respectively. Data on total and specific FRF consumption for each participant were obtained using a self-administrated food frequency questionnaire. The hazard ratios (HRs) of stroke in relation to total and specific FRF consumption were estimated through Cox proportional hazards regression models. During a median follow-up of 13.1 years, 4092 incident stroke cases (2557 cerebral infarctions and 1516 hemorrhagic strokes) were documented. After adjustment for age, body mass index, study area, lifestyles, dietary factors, and other risk factors, it was found that total FRF consumption was associated with a significantly lower risk of stroke in women (HR= 0.70; 95% CI, 0.58-0.84), while the association in men was not significant (HR= 0.93; 95% CI, 0.79-1.09). As for specific FRFs, consumptions of citrus fruits, strawberries, and grapes were found associated with a lower stroke risk in women. Higher consumptions of FRFs, in particular citrus fruits, strawberries, and grapes, were associated with a lower risk of developing stroke in Japanese women.

scholarly journals Short-term and long-term effects of low serum bicarbonate level at admission in hospitalised patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Sung Yoon Lim ◽  
Youngmi Park ◽  
Ho Jun Chin ◽  
Ki Young Na ◽  
Dong-Wan Chae ◽  
...  
Keyword(s):  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Long Term Effects ◽  
Short Term ◽  
Hospitalised Patients ◽  
Serum Bicarbonate Level ◽  
Low Serum

scholarly journals Association between the intake of α-linolenic acid and the risk of CHD

2014 ◽  
Vol 112 (5) ◽  
pp. 735-743 ◽  
Author(s):  
Mia Sadowa Vedtofte ◽  
Marianne U. Jakobsen ◽  
Lotte Lauritzen ◽  
Eilis J. O'Reilly ◽  
Jarmo Virtamo ◽  
...  
Keyword(s):  
Linolenic Acid ◽  
Lower Risk ◽  
Outcome Measure ◽  
Potential Effect ◽  
Effect Modification ◽  
Inverse Association ◽  
Prospective Cohort Studies ◽  
Hazard Ratios ◽  
Long Chain

The intake of the mainly plant-derived n-3 PUFA α-linolenic acid (ALA) has been reported to be associated with a lower risk of CHD. However, the results have been inconsistent. Therefore, the objective of the present study was to examine the association between the intake of ALA and the risk of CHD. Potential effect modification by the intake of long-chain n-3 PUFA (n-3 LCPUFA) was also investigated. Data from eight American and European prospective cohort studies including 148 675 women and 80 368 men were used. The outcome measure was incident CHD (CHD event and death). During 4–10 years of follow-up, 4493 CHD events and 1751 CHD deaths occurred. Among men, an inverse association (not significant) between the intake of ALA and the risk of CHD events and deaths was observed. For each additional gram of ALA consumed, a 15 % lower risk of CHD events (hazard ratios (HR) 0·85, 95 % CI 0·72, 1·01) and a 23 % lower risk of CHD deaths (HR 0·77, 95 % CI 0·58, 1·01) were observed. No consistent association was observed among women. No effect modification by the intake of n-3 LCPUFA was observed.

scholarly journals Metformin use is associated with a lower risk of uterine leiomyoma in female type 2 diabetes patients

2019 ◽  
Vol 10 ◽  
pp. 204201881989515 ◽  
Author(s):  
Chin-Hsiao Tseng
Keyword(s):  
Type 2 Diabetes ◽  
Lower Risk ◽  
Uterine Leiomyoma ◽  
Sensitivity Analyses ◽  
Matched Pair ◽  
Diagnostic Code ◽  
Hazard Ratios ◽  
Diabetes Patients

Background: Whether metformin may reduce the risk of uterine leiomyoma in type 2 diabetes patients has not been investigated. This retrospective cohort study compared the risk of uterine leiomyoma in ever versus never users of metformin. Methods: Female patients with new-onset type 2 diabetes during 1999–2005 were enrolled from the reimbursement database of Taiwan’s National Health Insurance and followed up from 1 January 2006 until 31 December 2011. Analyses were conducted in a propensity score (PS) matched-pair cohort of 10,998 ever users and 10,998 never users of metformin. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the PS. Results: A total of 321 never users and 162 ever users developed uterine leiomyoma during follow up, with respective incidence of 704.65 and 329.82 per 100,000 person-years. The overall hazard ratio was 0.467 (95% confidence interval: 0.387–0.564). The hazard ratios for the first (<23.3 months), second (23.3–53.1 months), and third (>53.1 months) tertiles of cumulative duration were 0.881 (0.685–1.132), 0.485 (0.367–0.642), and 0.198 (0.134–0.291), respectively; and were 0.751 (0.576–0.980), 0.477 (0.360–0.632), and 0.277 (0.198–0.386), respectively, for the first (<655,000 mg), second 655,000–1,725,500 mg), and third (>1,725,500) tertiles of cumulative dose. Sensitivity analyses after excluding users of sulfonylurea, users of estrogen, users of insulin, users of incretin-based therapies during follow up, patients with irregular drug refills, patients who discontinued the use of metformin, patients who received metformin prescription less than four times, or redefining uterine leiomyoma by using ‘diagnostic code’ plus ‘procedure codes’ consistently supported a lower risk of uterine leiomyoma in ever users of metformin. Conclusion: Metformin use is associated with a lower risk of uterine leiomyoma.

scholarly journals Metformin Reduces the Risk of Diverticula of Intestine in Taiwanese Patients with Type 2 Diabetes Mellitus

2021 ◽  
Vol 12 ◽  
Author(s):  
Chin-Hsiao Tseng
Keyword(s):  
Incidence Rate ◽  
Lower Risk ◽  
Cox Regression ◽  
Age Groups ◽  
Confounding By Indication ◽  
Hazard Ratios ◽  
Cumulative Duration ◽  
Insurance Database

Aim: To investigate the risk of diverticula of intestine associated with metformin use.Methods: This retrospective cohort study used the Taiwan’s National Health Insurance database to enroll 307,548 ever users and 18,839 never users of metformin. The patients were followed up starting on January 1, 2006 and ending on a date up to December 31, 2011. To address confounding by indication, hazard ratios were derived from Cox regression based on the inverse probability of treatment weighting using propensity score.Results: During follow-up, newly diagnosed cases of diverticula were identified in 1,828 ever users (incidence rate: 125.59 per 100,000 person-years) and 223 never users (incidence rate: 268.17 per 100,000 person-years). Ever users had an approximately 54% lower risk, as shown by the overall hazard ratio of 0.464 (95% confidence interval 0.404–0.534). While patients categorized in each tertile of cumulative duration of metformin therapy were compared to never users, a dose-response pattern was observed with hazard ratios of 0.847 (0.730–0.983), 0.455 (0.391–0.531) and 0.216 (0.183–0.255) for the first (&lt;27.37 months), second (27.37–59.70 months) and third (&gt;59.70 months) tertiles, respectively. The findings were similar when the diagnosis of diverticula was restricted to the small intestine or to the colon. Subgroup analyses suggested that the lower risk of diverticula of intestine associated with metformin use was significant in all age groups of &lt;50, 50–64 and ≥65 years, but the magnitude of risk reduction attenuated with increasing age.Conclusion: Metformin treatment is associated with a significantly reduced risk of diverticula of intestine.

Abstract P413: Chocolate Consumption is Associated with a Lower Risk of Heart Failure in Lean US Male Physicians

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Andrew B Petrone ◽  
J. Michael Gaziano ◽  
Luc Djousse
Keyword(s):  
Heart Failure ◽  
Lower Risk ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Health Study ◽  
Adjusted Relative Risk ◽  
Hazard Ratios ◽  
Lower Blood ◽  
History Of

Background: Previous studies have suggested that dark chocolate consumption may lower blood pressure, a major risk factor for heart failure. However, limited and inconsistent data are available on the association of chocolate consumption with the incidence rate of heart failure. Objective: To test the hypothesis that chocolate consumption is associated with a lower risk of heart failure. Methods: We prospectively studied 20,278 men from the Physicians’ Health Study. Chocolate consumption was assessed between 1999 and 2002 via a food frequency questionnaire and heart failure was ascertained through annual follow-up questionnaires with validation in a subsample. We used Cox regression to estimate multivariable adjusted relative risk of heart failure. Results: During a median follow-up of 9.3 years, there were 876 new cases of heart failure. The mean age at baseline was 66.4 ± 9.2 years. Median chocolate consumption was 1-3 times per month. Hazard ratios (95% CI) for heart failure were 1.0 (ref), 0.87 (0.73-1.04), 0.80 (0.66-0.98), and 0.87 (0.72-1.04), for chocolate consumption of less than 1/month, 1-3/month, 1/week, and 2+/week, respectively, after adjusting for age, body mass index (BMI), smoking, alcohol intake, exercise, and history of atrial fibrillation. In a secondary analysis, chocolate consumption was inversely associated with risk of heart failure in men whose BMI was <25 kg/m 2 but not in those with BMI of 25+ kg/m 2 ( Figure 1 ), p for interaction=0.0895. Conclusions: Our data suggest that moderate consumption of chocolate might be associated with a lower risk of heart failure, especially in lean individuals.

scholarly journals A Leukocyte Score to Improve Clinical Outcome Predictions in Bacteremic Pneumococcal Pneumonia in Adults

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Mathieu Blot ◽  
Delphine Croisier ◽  
André Péchinot ◽  
Ameline Vagner ◽  
Alain Putot ◽  
...  
Keyword(s):  
Pneumococcal Pneumonia ◽  
Pneumonia Severity Index ◽  
Adult Patients ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Risk Of Death ◽  
Pneumonia Severity Index Score ◽  
Serum Bicarbonate Level ◽  
Bacteremic Pneumococcal Pneumonia ◽  
Low Serum

Abstract Background.  Bacteremic pneumococcal pneumonia (BPP) is associated with high and early mortality. A simple procedure to predict mortality is crucial. Methods.  All adult patients with BPP admitted from 2005 through 2013 to the University Hospital of Dijon, France, were enrolled to study 30-day mortality and associated factors, particularly leukocyte counts. A simple leukocyte score was created by adding 1 point each for neutropenia (&lt;1500 cells/mm3), lymphopenia (&lt;400), and monocytopenia (&lt;200). Results.  One hundred and ninety-two adult patients (mean age, 69 years; standard deviation [SD], 19 years) who had developed and were hospitalized for BPP (58% community-acquired) were included. The 30-day crude mortality rate was 21%. The mean Pneumonia Severity Index score was high at 127.3 (SD = 41.3). Among the 182 patients who had a white blood cell count, 34 (19%) had a high leukocyte score (≥2). Multivariate analysis revealed that mortality was significantly associated with a high leukocyte score (odds ratio, 6.28; 95% confidence interval, 2.35–16.78), a high respiratory rate, a low serum bicarbonate level, and an altered mental status (all P &lt; .05). The leukocyte score was not significantly dependent on the previous state of immunosuppression, alcoholism, or viral coinfection, but it did correlate with an acute respiratory distress syndrome and a low serum bicarbonate level. Conclusions.  This new leukocyte score, in combination with the well known predictive factors, seems of interest in predicting the risk of death in BPP. A high score correlated with organ dysfunction and probably reflects the level of immunoparalysis. Its predictive value has to be confirmed in other cohorts.

scholarly journals Diet quality and risk and severity of COVID-19: a prospective cohort study

2021 ◽  
Author(s):  
Jordi Merino ◽  
Amit D Joshi ◽  
Long Nguyen ◽  
Emily Leeming ◽  
David Alden Drew ◽  
...  
Keyword(s):  
Diet Quality ◽  
Lower Risk ◽  
Socioeconomic Deprivation ◽  
Healthy Plant ◽  
Cox Models ◽  
Plant Foods ◽  
Hazard Ratios ◽  
High Deprivation ◽  
Diet Score

Objective: Poor metabolic health and certain lifestyle factors have been associated with risk and severity of coronavirus disease 2019 (COVID-19), but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its intersection with socioeconomic deprivation. Design: We used data from 592,571 participants of the smartphone-based COVID Symptom Study. Diet quality was assessed using a healthful plant-based diet score, which emphasizes healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalization with oxygen support, respectively. Results: Over 3,886,274 person-months of follow-up, 31,815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR, 0.91; 95% CI, 0.88-0.94) and severe COVID-19 (HR, 0.59; 95% CI, 0.47-0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate for lowest vs highest quartile of diet score was 22.5 (95% CI, 18.8-26.3) and 40.8 (95% CI, 31.7-49.8; 10,000 person-months) among persons living in areas with low and high deprivation, respectively. Conclusions: A dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19. These association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.

scholarly journals MO072LONGITUDINAL SERUM BICARBONATE MEASUREMENTS AND RISK OF CHRONIC KIDNEY DISEASE PROGRESSION AND MORTALITY: INSIGHTS FROM THE CKD-REIN COHORT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mathilde Prezelin-Reydit ◽  
Christian Combe ◽  
Jerome Harambat ◽  
Ziad Massy ◽  
Marie Metzger ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Random Effect ◽  
Random Effect Model ◽  
Current Level ◽  
Joint Analysis ◽  
Serum Bicarbonate ◽  
Ckd Progression ◽  
Longitudinal Measurements ◽  
Ckd Stage

Abstract Background and Aims Metabolic acidosis is a common complication of CKD and may contribute to CKD progression. However, the association between serum bicarbonate and CKD progression has not yet been investigated using longitudinal measurements. Method We used data from CKD-REIN, a prospective cohort study conducted in 40 representative French nephrology clinics which included 3033 patients with CKD stages 3 to 5 between 2013 and 2016. Patients who had no serum bicarbonate or no creatinine measure at within 6 months of their inclusion date in the CKD-REIN study were excluded. All serum bicarbonate measurements were taken into account, from inclusion to the occurrence of renal replacement therapy (RRT), death, or end of follow-up, whichever came first. We used a shared random-effect model for the joint analysis of individual trajectories of serum bicarbonate and the hazard of the composite outcome (RRT or death before RRT) and each specific event separately. Hazard ratio were adjusted (aHR) for age, sex, primary kidney disease, metabolic syndrome, cardiovascular disease, proteinuria (&lt; 30, 30-300, &gt; 300 mg/day), and the CKD-EPI estimated glomerular filtration rate (eGFR) at baseline. Results A total of 2977 patients (65.4% men, median age 69 years) were included. At baseline, the median eGFR was 31.8 mL/min/1.73m2 and the median bicarbonate concentration was 25 mmol/L. During a median follow-up of 4.5 years, 615 patients received RRT and 378 died before RRT. At any time of follow-up, a decrease of 1 mmol/l of the current level of serum bicarbonate was associated with a significantly increased hazard of RRT or death before RRT (aHR 1.05, 95%CI 1.02-1.08). The estimated effect was stronger on death before RRT (aHR 1.05, 95% CI 1.00-1.09) than on RRT (aHR 1.02, 95% CI 0.99-1.06). Conclusion A lower current level of serum bicarbonate is associated with an increased mortality in patients with CKD stage 3 to 5.

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