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1.
The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes
Anna R. Kahkoska Scott Isom Jasmin Divers Elizabeth J. Mayer-Davis Lawrence Dolan Amy S. Shah Maryam Afkarian David J. Pettitt Jean M. Lawrence Santica Marcovina Sharon H. Saydah Dana Dabelea David M. Maahs Amy K. Mottl 《Journal of diabetes and its complications》2018,32(12):1160-1168
Aims
To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression.Methods
Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N?=?1316) and type 2 diabetes (N?=?143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7?years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ≥30?μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30?μg/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression).Results
Albuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR)?=?1.3, 95% CI 1.1–1.6) and lack of private health insurance (aOR?=?2.7, 95%CI 1.1–6.5) in type 1 diabetes; and African American race (OR?=?4.6, 95% CI 1.2–14.2), lower estimated insulin sensitivity score (aOR?=?2.1, 95% CI 1.4–3.3), baseline UACR (aOR?=?3.2, 95% CI 1.7–5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR?=?1.3, 95% CI 1.0, 1.5) in type 2 diabetes.Conclusions
In the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Early interventions may help reduce long-term kidney complications. 相似文献2.
Idris Guessous William McClellan David Kleinbaum Viola Vaccarino Henry Hugues Olivier Boulat Pedro Marques-Vidal Fred Paccaud Jean-Marc Theler Jean-Michel Gaspoz Michel Burnier Gérard Waeber Peter Vollenweider Murielle Bochud 《Clinical journal of the American Society of Nephrology》2015,10(7):1162-1169
Background and objectives
Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria.Design, setting, participants, & measurements
Baseline (2003–2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m2), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography–tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors.Results
Among the 4280 people included in the analysis, the mean±SD annual eGFR change was −0.57±1.78 ml/min per 1.73 m2, and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was −0.005 ml/min per 1.73 m2 (95% confidence interval, −0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria.Conclusions
The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR. 相似文献3.
Bixia Gao Shouling Wu Jinwei Wang Chao Yang Shuohua Chen Jinhong Hou Junjuan Li Yaozheng Yang Kevin He Minghui Zhao Min Chen Luxia Zhang 《Journal of diabetes and its complications》2019,33(1):39-45
Background
Information regarding the clinical phenotypes of diabetic kidney disease (DKD) might guide better practice for clinicians. We aim to compare the clinical features and long-term outcomes of proteinuric and non-proteinuric phenotypes of DKD, based on a prospective cohort of Chinese population.Methods
Altogether 8811 Chinese participants with diabetes were included. Kidney function decline was defined as estimated glomerular filtration rate <60?mL/min·1.73?m?2. The presence of proteinuria by urine dipstick test was further divided into micro-proteinuria (trace or 1+) and overt-proteinuria (≥2+). Participants were then stratified into 5 groups: no DKD, isolated kidney function decline, isolated micro-proteinuria, isolated overt-proteinuria, and proteinuria combined with kidney function decline. Outcomes include the first occurrence of composite cardiovascular events, end-stage renal disease (ESRD), and all-cause mortality.Main findings
After a median follow-up of 6.9?years, there were 646 composite cardiovascular events, 31 ESRD events, and 718 deaths. Isolated kidney function decline was only associated with the higher risk of ESRD (HRs 31.33 (95% CI 3.65–269.27)). Participants of overt-proteinuria and proteinuria combined with kidney function decline phenotypes were associated with increased risk of all predefined adverse outcomes.Conclusions
Proteinuric and non-proteinuric DKD phenotypes might follow different pathophysiological pathways, and result in heterogeneous clinical features and prognosis. 相似文献4.
Jose Kuzhively Bettina Tahsin Peter Hart Leon Fogelfeld 《Journal of diabetes and its complications》2018,32(5):474-479
Aim
Evaluate legacy effect on renal outcomes after the end of a multifactorial-multidisciplinary intervention in patients with advanced diabetic nephropathy (ADN trial) CKD 3–4.Methods
A retrospective electronic review was conducted of 72 patients who completed the ADN trial ESRD-free with subsequent follow-up of two years or until ESRD development.Results
At baseline, reflecting ADN trial end, 38 post-intervention and 34 post-control patients were similar except for lower HbA1c, SBP and age in the post-intervention group. In post-trial follow-up, ESRD developed in both groups at similar rates (23 vs 20%). ESRD occurred mainly in baseline CKD 4 (75%). In CKD 3, only those in post-control developed ESRD (28.6%, p?=?0.067). A significant decline in eGFR occurred within both groups. In multivariate analyses, ESRD was associated with baseline yearly eGFR decline. Greater yearly eGFR decline was associated with higher albumin/creatinine ratio at follow-up, lower age, and baseline SBP not being at target (p?=?0.005, with an R2 of 0.197).Conclusions
There was no significant post-intervention effect on ESRD progression in the two groups. Minimal legacy effect was observed in less advanced nephropathy (CKD 3). These renal and risk outcomes emphasize the importance and potential benefits of continuous and long-term multifactorial care. 相似文献5.
Gregory A. Nichols Anouk Déruaz-Luyet Sibylle J. Hauske Kimberly G. Brodovicz 《Journal of diabetes and its complications》2018,32(3):291-297
Aims
We evaluated the simultaneous effects of all clinically recognized categories of albuminuria and estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) and mortalityMethods
We conducted a longitudinal observational study of 16,678 type 2 diabetes (T2D) patients. From the first serum creatinine value from 2006 to 2012 and a urine-albumin creatinine ratio (UACR) recorded within 6 months, we applied baseline Kidney Disease: Improving Global Outcomes (KDIGO) categories of eGFR and albuminuria. We followed patients for up to 11 years to calculate adjusted incidence per 1000 person-years (p-y) of first CVD hospitalization and all-cause mortality.Results
Over 98,069 p-y of follow-up, CVD hospitalization risk was greater for each higher eGFR and albuminuria category. In eGFR category G2 (60-89 mL/min/1.73 m2), adjusted incidence per 1000 p-y was 14.1 (95% CI 12.9-15.5), 19.8 (17.2-22.8), and 22.8 (17.4-30.0) for normoalbuminuria, microalbuminuria and macroalbuminuria, respectively. For eGFR category G3a (45-59), rates were 26.7 (22.3-32.0), 40.3 (32.2-50.5), and 44.1 (28.8-67.4), respectively. Adjusted risk of all-cause mortality followed a similar pattern.Conclusions
Our data underscore the importance of including detailed eGFR and UACR values in assessing CVD risk. High albuminuria and low eGFR is a potent predictor of CVD and death. 相似文献6.
S. Pilemann-Lyberg M. Lindhardt Frederik Persson S. Andersen P. Rossing 《Journal of diabetes and its complications》2018,32(5):470-473
Aims
Uric acid (UA) is a risk factor for CKD. We evaluated UA in relation to change in GFR in patients with type 1 diabetes.Methods
Post hoc analysis of a trial of losartan in diabetic nephropathy, mean follow-up 3?years (IQR 1.5–3.5). UA was measured at baseline. Primary end-point was change in measured GFR. UA was tested in a linear regression model adjusted for known progression factors (gender, HbA1c, systolic blood pressure, cholesterol, baseline GFR and baseline urinary albumin excretion rate (UAER)).Results
Baseline UA was 0.339?mmol/l (SD ±0.107), GFR 87?ml/min/1.73?m2 (±23), geometric mean UAER 1023?mg/24?h (IQR, 631 – 1995). Mean rate of decline in GFR was 4.6 (3.7) ml/min/year. In the upper quartile of baseline UA the mean decline in GFR from baseline to the end of the study was 6.2 (4.9) ml/min/1.73?m2 and 4.1 (3.1) ml/min/1.73?m2 in the three lower quartiles of UA, (p?=?0.088). In a linear model including baseline covariates (UAER, GFR, total cholesterol, HDL cholesterol) UA was associated with decline in GFR (r2?=?0.45, p?<?0.001).Conclusion
Uric acid was weakly associated with decline in GFR in type 1 diabetic patients with overt nephropathy. 相似文献7.
Kevin Damman Serge Masson Donata Lucci Marco Gorini Renato Urso Aldo P. Maggioni Luigi Tavazzi Luigi Tarantini Gianni Tognoni Adriaan Voors Roberto Latini 《Journal of cardiac failure》2017,23(1):2-9
Background
Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.Methods and Results
Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68?mL???min?1???1.73?m?2. Change in eGFR in the 1st year was ?1.5?±?16?mL???min?1???1.73?m?2, and over 36 months it was ?3.7?±?18?mL???min?1???1.73?m?2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15?mL???min?1???1.73?m?2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08–1.10 (P?<?.001) per 10?mL???min?1???1.73?m?2 decrease, as well as every 10?mL???min?1???1.73?m?2 decrease over the 1st year (HR 1.10, 95% CI 1.04–1.17; P?<?.001). A deterioration in eGFR >15?mL???min?1???1.73?m?2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10–1.36; P?<?.001).Conclusions
Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates. 相似文献8.
Marina Pontello Cristelli Joan Carles Trullàs Federico Cofán Naira Rico Christian Manzardo Juan Ambrosioni Josep Lluis Bedini Asunción Moreno Fritz Diekmann Jose Maria Miro 《The Brazilian journal of infectious diseases》2018,22(3):193-201
Background
In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60–89 mL/min).Objective
The present study aims to assess the influence of sex, antiretroviral therapy, and classical risk factors on the occurrence of mild decreased renal function in a large Spanish cohort of HIV-infected patients.Methods
Cross-sectional, single center study, including all adult HIV-1-infected patients under antiretroviral treatment with at least two serum creatinine measures during 2014, describing the occurrence of and the risk factors for mildly decreased renal function (eGFR by CKD-EPI creatinine equation of 60–89 mL/min).Results
Among the 4337 patients included, the prevalence rate of mildly reduced renal function was 25%. Independent risk factors for this outcome were age older than 50 years (OR 3.03, 95% CI 2.58–3.55), female sex (OR 1.23, 95% CI 1.02–1.48), baseline hypertension (OR 1.57, 95% CI 1.25–1.97) or dyslipidemia (OR 1.48, 95% CI 1.17–1.87), virologic suppression (OR 1.88, 95% CI 1.39–2.53), and exposure to tenofovir disoproxil-fumarate (OR 1.67, 95% CI 1.33–2.08) or ritonavir-boosted protease-inhibitors (OR 1.19, 95% CI 1.03–1.39).Conclusions
Females and patients over 50 seem to be more vulnerable to renal impairment. Potentially modifiable risk factors and exposure to tenofovir disoproxil-fumarate or ritonavir-boosted protease-inhibitors are present even in earlier stages of chronic kidney dysfunction. It remains to be determined whether early interventions including antiretroviral therapy changes (tenofovir alafenamide, cobicistat) or improving comorbidities management will improve the course of chronic kidney disease. 相似文献9.
Betlem Salvador-González Neus Gil-Terrón M. Jesús Cerain-Herrero Isaac Subirana Roser Güell-Miró Luisa M. Rodríguez-Latre Oriol Cunillera-Puértolas Roberto Elosua Maria Grau Joan Vila Luisa Pascual-Benito Jordi Mestre-Ferrer Rafel Ramos José Miguel Baena-Díez Maria Soler-Vila Eva Alonso-Bes Laura Ruipérez-Guijarro Virtudes Álvarez-Funes Alberto Martínez-Castelao 《Revista espa?ola de cardiología》2018,71(6):450-457
Introduction and objectives
Individuals with a decreased estimated glomerular filtration rate (eGFR) are at increased risk of all-cause (ACM) and cardiovascular mortality; there is ongoing debate about whether older individuals with eGFR 45 to 59 mL/min/1.73 m2 are also at increased risk. We evaluated the association between eGFR and ACM and cardiovascular events (CVE) in people aged 60 to 74 and ≥ 75 years in a population with a low coronary disease incidence.Methods
We conducted a retrospective cohort study by using primary care and hospital electronic records. We included 130 233 individuals aged ≥ 60 years with creatinine measurement between January 1, 2010 and December 31, 2011; eGFR was estimated by using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. The independent association between eGFR and the risk of ACM and hospital admission due to CVE were determined with Cox and Fine-Gray regressions, respectively.Results
The median was age 70 years, and 56.1% were women; 13.5% had eGFR < 60 (69.7% eGFR 45-59). During a median follow-up of 38.2 months, 6474 participants died and 3746 had a CVE. For ACM and CVE, the HR in older individuals became significant at eGFR < 60. Fully adjusted HR for ACM in the eGFR 45 to 59 category were 1.61; 95%CI, 1.37-1.89 and 1.19; 95%CI, 1.10-1.28 in 60- to 74-year-olds and ≥ 75-year-olds, respectively; for CVE HR were 1.28; 95%CI, 1.08-1.51 and 1.12; 95%CI, 0.99-1.26.Conclusions
In a region with low coronary disease incidence, the risk of death and CVE increased with decreasing eGFR. In ≥ 75-year-olds, the eGFR 45 to 59 category, which had borderline risk for CVE, included many individuals without significant additional risk.Full English text available from: www.revespcardiol.org/en 相似文献10.
Chutatip Limkunakul Ian H. de Boer Bryan R. Kestenbaum Jonathan Himmelfarb T. Alp Ikizler Cassianne Robinson-Cohen 《Journal of diabetes and its complications》2019,33(4):296-301
Context
Diabetic kidney disease (DKD) is the leading cause of end stage kidney disease (ESKD) and is associated with a considerably shortened lifespan. While glucose-lowering therapy targeting glycated hemoglobin (HbA1c) <7% is proven to reduce the risk of developing DKD, its effects on complications of DKD are unclear.Objective
We examined the associations of HbA1c with risks of progression to ESKD and death within a clinic-based study of CKD. We hypothesized that higher HbA1c concentrations would be associated with increased risks of ESKD and death.Design and setting
We studied 618 participants from the Seattle Kidney Study (mean eGFR 42?ml/min), 308 of whom had diabetes, and tested associations of baseline HbA1c with time to a composite outcome of initiation of renal replacement therapy or death.Results
During a median follow-up of 4.2?years, there were 343 instances of the composite outcome (11.5 per 100 person-years). Among participants with diabetes, in both crude and adjusted analyses, higher HbA1c levels (examined continuously or categorically) were not associated with the risk of the composite outcome (HR (95% CI): 0.99 (0.88, 1.10) per 1% additional HbA1c, p?=?0.79). HbA1c was not associated with ESKD or mortality when the outcomes were examined separately, nor when stratified between insulin users and non-users.Conclusion
In a referred population of established DKD, higher HbA1c was not associated with higher risk of ESKD or death. These data support current recommendations to be conservative with glycemic control among patients with advanced diabetes complications, such as CKD. 相似文献11.
Glenn M. Chertow Gerald B. Appel Geoffrey A. Block Melanie P. Chin Daniel W. Coyne Angie Goldsberry Kamyar Kalantar-Zadeh Colin J. Meyer Mark E. Molitch Pablo E. Pergola Philip Raskin Arnold L. Silva Bruce Spinowitz Stuart M. Sprague Peter Rossing 《Journal of diabetes and its complications》2018,32(12):1113-1117
Aims
Obesity is associated with progression of chronic kidney disease (CKD). Treatment with bardoxolone methyl in a multinational phase 3 trial, Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), resulted in increases in estimated glomerular filtration rate (eGFR) with concurrent reductions in body weight. We performed post-hoc analyses to further characterize reductions in body weight with bardoxolone methyl.Methods
Eligible patients with type 2 diabetes (T2DM) and CKD stage 4 (eGFR 15 to <30?mL/min/1.73?m2) were randomized 1:1 to receive once-daily oral dose of bardoxolone methyl (20?mg) or placebo.Results
BEACON enrolled 2185 patients. Patients randomized to bardoxolone methyl experienced significant reductions in body weight from baseline relative to patients randomized to placebo (?5.7?kg; 95% CI: ?6.0 to ?5.3?kg; p?<?0.001). In patients randomized to bardoxolone methyl, rate and magnitude of body weight loss were proportional to baseline BMI. Bardoxolone methyl resulted in significant reductions in waist circumference and improved glycemic control.Conclusions
Bardoxolone methyl resulted in significant weight loss in a generally obese patient population with T2DM and stage 4 CKD, with the magnitude and rate dependent on baseline BMI. 相似文献12.
N. Vallianou T. Stratigou A. Paikopoulou T. Apostolou B. Vlassopoulou S. Tsagarakis G. Ioannidis 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(5):689-692
Background
The purpose of this study was to evaluate the outcome of DM2 patients with nephropathy when they are under surveillance of a joined clinic run by endocrinologists & nephrologists.Patients and methods
A cohort of 106 patients with DM2, 42–83 years of age, and eGFR?<?60?ml/min/m2 were included. Age, sex, duration of diabetes, duration of attending our clinic, smoking habits, BMI, data regarding ischemic heart disease and induction of hemodialysis, urine albumin excretion (UAE) levels, eGFR (MDRD equation) and values of various biochemical parameters were recorded too. Follow-up period ranged from one to 25 years. Paired samples t-test and non-parametrical Kruskal–Wallis test were used for the analyses of the data.Results
Fifty percent of patients had no further progression, 25.9% improvement, while 24.1% had worsening of the UAE levels. During the follow-up in the joined clinic, there was a smaller than the expected from the medical literature decrease in median eGFR, i.e. 2,3?ml/min/m2 and a statistically significant improvement in glycosylated hemoglobin levels from 8.0% to 7.4% (p?=?0.016). Time in years of follow-up in the joined clinic of our hospital appeared to be the most significant factor in the improvement or stabilization against deterioration of the UAE levels (p?=?0.018).Conclusions
Close follow-up of DM2 patients with eGFR?<?60?ml/min/m2 has resulted in a minor annual eGFR decrease. Monitoring of these patients in a specialized diabetic nephropathy clinic is beneficial for this group of patients for delaying the occurrence of end-stage renal disease. 相似文献13.
Jinbo Hu Chuan Peng Jiayu Li Rufei Gao Aipin Zhang Linqiang Ma Linkun Zhang Yi Yang Qingfeng Cheng Yue Wang Ting Luo Zhihong Wang Hua Qing Shumin Yang Qifu Li 《Seminars in arthritis and rheumatism》2019,48(4):644-648
Objective
This study aims to evaluate whether serum Bisphenol A (BPA) is a risk factor for hyperuricemia.Methods
In this prospective study, a total of 482 participants without hyperuricemia were enrolled at baseline and followed up for 6 years. Clinical characteristics were recorded, and serum levels of uric acid and BPA were measured. Participants were stratified into tertiles according to low, median, and high baseline serum BPA levels. Regression models were used to analyze associations of serum BPA with the change in uric acid and the risk of developing hyperuricemia.Results
At baseline, serum concentrations of BPA was 0.51 (0.24–2.37) ng/mL. After 6 years of follow-up, the change in serum uric acid concentration from baseline to the 6-year mark was significantly higher in subjects with higher baseline BPA concentration (0.03 ± 0.19, 0.07 ± 0.21, and 0.11 ± 0.25 mg/dL for low, median, and high tertiles, respectively, P = 0.006). When adjusted for potential confounders, such as age, renal function, and history of diabetes and hypertension, multivariable logistic analyses showed that subjects in the median or high baseline BPA tertiles exhibited a twofold higher risk of 6-year hyperuricemia incidence compared to subjects in the low baseline BPA tertile [odds ratio (OR) = 2.28 (95% CI: 1.05–4.95) for the median tertile; 2.42 (1.07–5.48) for the high tertile, Pfor Trend = 0.043].Conclusion
In conclusion, serum BPA is an independent risk factor for hyperuricemia. 相似文献14.
Sangheun Lee Jun Yong Park Kijun Song Do Young Kim Beom Kyung Kim Seung Up Kim Hye Jin Ku Kwang-Hyub Han Sang Hoon Ahn 《Gut and liver》2015,9(6):776-783
Background/Aims
The aim of this study was to evaluate the estimated glomerular filtration rate (eGFR) during telbivudine (LdT) versus entecavir (ETV) treatment in chronic hepatitis B (CHB) patients with underlying comorbidities such as diabetes mellitus (DM), hypertension, and cirrhosis.Methods
From 2010 to 2012, 116 CHB patients treated with LdT and 578 treated with ETV were compared in this real-practice cohort. The mean changes in eGFR (Modification of Diet in Renal Disease [MDRD] formula) from baseline to months 6, 12, and 18 were analyzed using a linear mixed model.Results
In LdT-treated patients, the mean eGFR increased by 7.6% at month 18 compared with the eGFR at baseline (MDRD formula in mL/min/1.73 m2). However, in ETV-treated patients, the mean eGFR decreased by 4.1% at month 18 compared with the eGFR at baseline. In the LdT-treated patients with DM, hypertension, cirrhosis or low eGFR <90 mL/min/1.73 m2, the mean eGFR showed a steady improvement, whereas the mean eGFR was reduced in the same subgroups of ETV-treated patients.Conclusions
The eGFR gradually increased over time during LdT treatment, especially in patients with mild abnormal eGFR at baseline, and in those with DM, hypertension, and cirrhosis, whereas a reduction in eGFR was seen with ETV treatment. 相似文献15.
Tsai-Chung Li Tzu-Yun Yu Chia-Ing Li Chiu-Shong Liu Wen-Yuan Lin Chih-Hsueh Lin Sing-Yu Yang Jen-Huai Chiang Cheng-Chieh Lin 《Journal of diabetes and its complications》2018,32(8):784-790
Aims
The study evaluated associations between 3-year eGFR trajectory patterns and adverse renal event in diabetic patients.Methods
Adverse renal event was defined as sustained eGFR <60 or one ACR >300?mg/g creatinine. Cox proportional hazards models evaluated association between eGFR trajectory patterns and adverse renal event.Results
We detected six clusters. Cluster 1 had a stable but relatively low baseline eGFR level (n?=?823, 20.52%), cluster 2 had a high baseline eGFR level, but slightly decreased afterwards (n?=?1708, 42.59%), cluster 3 had an increasing eGFR during the first 15-month follow-up and then a decline rate (n?=?505, 12.59%), cluster 4 decreased during the first 9-month follow-up and then remained stable (n?=?774, 19.30%), cluster 5 had a sharp decline and then was elevated after 21?months until the end of follow-up (n?=?135, 3.37%), and cluster 6 had an extremely fluctuating eGFR and then a sharp increase at the last 12-month period (n?=?65, 1.62%). Clusters 1, 3, and 4 show increased adverse renal risks compared with cluster 2 (2.24, 1.69–2.97; 2.70, 2.02–3.61; and 2.15, 1.64–2.83, respectively).Conclusions
Patients with sustained low-level renal function, renal decline, or increasing trend in eGFR trajectory encountered an increased CKD risk. 相似文献16.
Drug eluting stents are superior to bare metal stents to reduce clinical outcome and stent‐related complications in CKD patients,a systematic review,meta‐analysis and network meta‐analysis 
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下载免费PDF全文 Gabriele Crimi MD Valeria Gritti MD Vincenzo Alessandro Galiffa MD Valeria Scotti MD Sergio Leonardi MD MHS FESC Maurizio Ferrario MD Marco Ferlini MD Gaetano Maria De Ferrari MD Luigi Oltrona Visconti MD Catherine Klersy MD MScEpid 《Journal of interventional cardiology》2018,31(3):319-329
Aims
To compare clinical outcome in Chronic kidney disease (CKD) patients receiving coronary stents according to stent type BMS versus DES and 1st generation versus 2nd generation DES.Methods and Results
PubMed, Cinhal, Cochrane, Embase, and Web of Science were searched for studies including CKD patients. CKD was defined as eGFR < 60 mL/min. We selected n = 35 articles leading to 376 169 patients, of which 76 557 CKD patients receiving BMS n = 35,807, 1st generation DES n = 37,650, or 2nd generation DES n = 3100. Patient receiving DES, compared to BMS, had a 18% lower all‐cause mortality (RR 0.82, 95%CI 0.71‐0.94). The composite of death or myocardial infarction (MI) was lower in DES patients (RR 0.78, 95%CI 0.67‐0.91), as was stent thrombosis (ST) (RR 0.57, 95%CI 0.34‐0.95), target vessel/lesion revascularization (TVR/TLR) (RR 0.69, 95%CI 0.57‐0.84) and death for cardiovascular cause (RR 0.43, 95%CI 0.25‐0.74). We also found a gradient between 1st and 2nd generation DES, through BMS. Second, compared to 1st generation DES, were associated with further relative risk (RR) reduction of ?18% in of all‐cause death, and lower incidence of stent‐related clinical events: ?39% RR of ST risk; ?27 RR of TVR/TLR risk.Conclusions
DES in CKD patients undergoing PCI were superior to BMS in reducing major adverse clinical events. This was possibly explained, by a lower risk of stent‐related events as ST and TVR or TLR. Second, compared to 1st generation DES may furtherly reduce clinical events.17.
Masaki Ohsawa Tomoaki Fujioka Kuniaki Ogasawara Kozo Tanno Tomonori Okamura Tanvir Chowdhury Turin Kazuyoshi Itai Akira Ogawa Yuki Yoshida Shinichi Omama Toshiyuki Onoda Motoyuki Nakamura Shinji Makita Yasuhiro Ishibashi Fumitaka Tanaka Toru Kuribayashi Mutsuko Ohta Kiyomi Sakata Akira Okayama 《International journal of cardiology》2013
Background
The reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated.Methods
A total of 16,759 participants aged 40 to 69 years with normal or mildly reduced eGFR (45–119 ml/min/1.73 m2) were enrolled and divided into six groups (group 1, eGFR: 90–119 without albuminuria; group 2, eGFR: 90–119 with albuminuria; group 3, eGFR: 60–89 without albuminuria (reference); group 4, eGFR: 60–89 with albuminuria; group 5, eGFR: 45–59 without albuminuria; group 6, eGFR: 45–59 with albuminuria) based on GFR estimated by using the CKD-EPI study equation modified by a Japanese coefficient and albuminuria (urine albumin–creatinine ratio ≥ 30 mg/g). Outcomes included all-cause death (ACD), cardiovascular death (CVD) and neoplasm-related death (NPD). Multivariable-adjusted mortality rate ratios (RR) and their 95% confidence intervals (CIs) in the groups were estimated by Poisson's regression analysis.Results
The highest risk of ACD (RR (95% CIs): 3.95 (2.08–7.52)), CVD (7.15 (2.25–22.7)) and NPB (3.25 (1.26–8.38)) was observed in group 2. Subjects in group 2 were relatively young and had the highest levels of body mass index, blood pressure and HbA1c and the highest prevalence of diabetes and metabolic syndrome.Conclusion
Coexistence of preserved eGFR and albuminuria increases risks for ACD, CVD and NPD. Relatively young metabolic persons having both preserved eGFR and albuminuria should be considered as a very high-risk population. 相似文献18.
Carlos K.H. Wong Colman S.C. Fung S.C. Siu Yvonne Y.C. Lo K.W. Wong Daniel Y.T. Fong Cindy L.K. Lam 《Diabetes research and clinical practice》2013
Aim
To determine the efficacy of delivering short-message service (SMS) to provide diabetes-related information in reducing the risk of developing diabetes in Chinese professional drivers with pre-diabetes.Methods
A pilot single-blinded randomized controlled trial was conducted in Hong Kong between 05/2009 and 04/2012. Professional drivers with impaired glucose tolerance (IGT) were randomly allocated to either a SMS group receiving messages comprising knowledge and lifestyle modification on diabetes or to a control group with usual care. Primary outcomes were the incidence rate of diabetes mellitus over 12 and 24 months period.Results
Fifty-four, out of 104 professional drivers recruited, were randomly allocated to intervention group. Fewer subjects developed diabetes at 12 months in intervention group (5.56%) compared to control group (16.00%). Relative risk (RR) of diabetes onset was 0.35 (95%CI: 0.10–1.24) and the number needed to treat (NNT) for preventing one diabetes was 9.57. At 24 months, RR increased to 0.62 (95%CI: 0.24–1.61) with a NNT of 10.58. Logistic regression showed a significant odds ratio of 0.04 (P = 0.021) for intervention group compared to control group at 12-month follow-up for completers and a non-significant odds ratio of 0.34 (P = 0.303) at 24-month follow-up.Conclusions
The SMS program proved to have potential to reduce the risk of developing diabetes at 12 months but additional measures should be integrated to prevent or delay disease progression. 相似文献19.
G.-M. Kouli D.B. Panagiotakos I. Kyrou E.N. Georgousopoulou C. Chrysohoou C. Tsigos D. Tousoulis C. Pitsavos 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2017,27(10):881-889
Background and aims
Visceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue accumulation/dysfunction. Our aim was to evaluate potential associations between the VAI and the 10-year cardiovascular disease (CVD) incidence.Methods and results
During 2001–2002, 3042 Greek adults (1514 men; age: ≥18 years) without previous CVD were recruited into the ATTICA study, whilst the 10-year study follow-up was performed in 2011–2012, recording the fatal/non-fatal CVD incidence in 2020 (1010 men) participants. The baseline VAI scores for these participants were calculated based on anthropometric and lipid variables, while VAI tertiles were extracted for further analyses. During the study follow-up a total of 317 CVD events (15.7%) were observed. At baseline, the participants' age and the prevalence of hypertension, diabetes, hypercholesterolemia and metabolic syndrome increased significantly across the VAI tertiles. After adjusting for multiple confounders, VAI exhibited a significantly independent positive association with the 10-year CVD incidence (OR = 1.05, 95%CI: 1.01, 1.10), whereas the association of the body mass index (HR = 1.03, 95%CI: 0.99, 1.08), or the waist circumference (HR = 1.01, 95%CI: 0.99, 1.02) was less prominent. Sex-specific analysis further showed that VAI remained significantly predictive of CVD in men alone (HR = 1.06, 95%CI: 1.00, 1.11) but not in women (HR = 1.06, 95%CI: 0.96, 1.10).Conclusions
Our findings show for the first time in a large-sample, long-term, prospective study in Europe that the VAI is independently associated with elevated 10-year CVD risk, particularly in men. This suggests that the VAI may be utilized as an additional indicator of long-term CVD risk for Caucasian/Mediterranean men without previous CVD. 相似文献20.
Emily C. Zabor Helena Furberg Joseph Mashni Byron Lee Edgar A. Jaimes Paul Russo 《Clinical journal of the American Society of Nephrology》2016,11(1):101-107