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1.
Jun Ling Lu Amado X. Freire Miklos Z. Molnar Kamyar Kalantar-Zadeh Csaba P. Kovesdy 《Mayo Clinic proceedings. Mayo Clinic》2018,93(11):1563-1570
Objective
To examine whether chronic insomnia is associated with an increased risk of adverse renal outcomes and all-cause mortality.Patients and Methods
We examined associations of chronic insomnia (defined as the presence of both International Classification of Diseases, Ninth Revision codes 307.42, 307.49, and 780.52 and long-term use of insomnia medications) with adverse renal outcomes (end-stage renal disease, incidence of estimated glomerular filtration rate [eGFR] ≤45 mL/min per 1.73 m2, and eGFR slopes <?3.0 mL/min per 1.73 m2 per year) and all-cause mortality in a national cohort of 1,639,090 US veterans by using Cox proportional hazards and logistic regression models with multivariable adjustments.Results
A total of 36,741 patients (2.24%) had chronic insomnia; 32,985 (89.8%) were male and 28,090 (76.5%) were white, with a mean baseline eGFR of 84.1±16.4 mL/min per 1.73 m2. Chronic insomnia was associated with a significantly higher risk of eGFR 45 mL/min per 1.73 m2 or less (multivariable-adjusted hazard ratio [HR], 1.39; 95% CI, 1.34-1.44; P<.001), and rapid loss of kidney function (odds ratio, 1.07; 95% CI, 1.03-1.12; P=.002), but not end-stage renal disease (HR, 1.25; 95% CI, 0.81-1.93; P=.32). Chronic insomnia was not associated with a higher risk of all-cause mortality (HR, 1.00; 95% CI, 0.97-1.03; P=.99).Conclusion
Chronic insomnia is associated with a higher risk of development and progression of chronic kidney disease, but not ESRD. Further studies are needed to establish the underlying mechanisms of action and to determine whether treatment of insomnia could be beneficial to prevent deteriorating kidney function. 相似文献2.
Yoshitsugu Obi Danh V. Nguyen Hui Zhou Melissa Soohoo Lishi Zhang Yanjun Chen Elani Streja John J. Sim Miklos Z. Molnar Connie M. Rhee Kevin C. Abbott Steven J. Jacobsen Csaba P. Kovesdy Kamyar Kalantar-Zadeh 《Mayo Clinic proceedings. Mayo Clinic》2018,93(9):1224-1235
Objective
To develop and validate a risk prediction model that would help individualize treatment and improve the shared decision-making process between clinicians and patients.Patients and Methods
We developed a risk prediction tool for mortality during the first year of dialysis based on pre–end-stage renal disease characteristics in a cohort of 35,878 US veterans with incident end-stage renal disease who transitioned to dialysis treatment between October 1, 2007, and March 31, 2014 and then externally validated this tool among 4284 patients in the Kaiser Permanente Southern California (KPSC) health care system who transitioned to dialysis treatment between January 1, 2007, and September 30, 2015.Results
To ensure model goodness of fit, 2 separate models were selected for patients whose last estimated glomerular filtration rate (eGFR) before dialysis initiation was less than 15 mL/min per 1.73 m2 or 15 mL/min per 1.73 m2 or higher. Model discrimination in the internal validation cohort of veterans resulted in C statistics of 0.71 (95% CI, 0.70-0.72) and 0.66 (95% CI, 0.65-0.67) among patients with eGFR lower than 15 mL/min per 1.73 m2 and 15 mL/min per 1.73 m2 or higher, respectively. In the KPSC external validation cohort, the developed risk score exhibited C statistics of 0.77 (95% CI, 0.74-0.79) in men and 0.74 (95% CI, 0.71-0.76) in women with eGFR lower than 15 mL/min per 1.73 m2 and 0.71 (95% CI, 0.67-0.74) in men and 0.67 (95% CI, 0.62-0.72) in women with eGFR of 15 mL/min per 1.73 m2 or higher.Conclusion
A new risk prediction tool for mortality during the first year after transition to dialysis (available at www.DialysisScore.com) was developed in the large national Veterans Affairs cohort and validated with good performance in the racially, ethnically, and gender diverse KPSC cohort. This risk prediction tool will help identify high-risk populations and guide management strategies at the transition to dialysis. 相似文献3.
Shannon M. Dunlay Steven J. Lippmann Melissa A. Greiner Emily C. O’Brien Alanna M. Chamberlain Robert J. Mentz Mario Sims 《Mayo Clinic proceedings. Mayo Clinic》2017,92(5):699-709
Objective
To assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study.Patients and Methods
In 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models.Results
Higher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.Conclusion
We found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress. 相似文献4.
Hyung Wook Kim Su-Hyun Kim Young Ok Kim Dong Chan Jin Ho Chul Song Euy Jin Choi Yong-Lim Kim Yon-Su Kim Shin-Wook Kang Nam-Ho Kim Chul Woo Yang Yong Kyun Kim 《Peritoneal dialysis international》2015,35(7):703-711
♦ Background:
The impact of timing of dialysis initiation on mortality is controversial in patients with peritoneal dialysis (PD). In this study, we analyzed the impact of timing of dialysis initiation on mortality in the incident PD population.♦ Methods:
Incident patients with PD were selected from the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD), a prospective cohort study on dialysis in Korea. Patients were categorized into 3 groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD using the Modification of Diet in Renal Disease (MDRD) equation. Group A was defined as eGFR < 5 mL/min/1.73m2, group B as eGFR 5 – 10 mL/min/1.73m2, and group C as eGFR > 10 mL/min/1.73m2. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with group B as the reference. The primary outcome was all-cause mortality.♦ Results:
A total of 495 incident PD patients were included. The number of patients in group A was 109, group B was 279, and group C was 107. The median follow-up period was 23 months. Multivariate Cox regression analysis showed that group A had a significantly higher risk of all-cause mortality compared with group B (HR 4.13, 95% confidence interval [CI], 1.55 – 11.03, p = 0.005) after adjustment for age, gender, cause of ESRD, serum albumin level, diabetes mellitus, and cardiovascular disease. There was no significant difference in mortality between group C and group B (HR 1.50, 95% CI, 0.59 – 3.80, p = 0.398) after adjustment for clinical variables.♦ Conclusion:
An eGFR < 5 mL/min/1.73m2 at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m2 at the initiation of PD was not associated with improved survival compared with an eGFR of 5 – 10 mL/min/1.73m2 at the initiation of PD. 相似文献5.
John J. Sim Simran K. Bhandari Michael Batech Aviv Hever Teresa N. Harrison Yu-Hsiang Shu Dean A. Kujubu Tracy Y. Jonelis Michael H. Kanter Steven J. Jacobsen 《Mayo Clinic proceedings. Mayo Clinic》2018,93(2):167-178
Objective
To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.Patients and Methods
A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders.Results
Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P<.001). The highest ESRD incidence (per 100 person-years) was observed in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69). Compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively. No significant association between glomerulonephropathy types and mortality was detected (P=.24).Conclusion
Our findings from a real-world clinical environment revealed significant differences in eGFR decline and ESRD risk among patients with 5 glomerulonephropathies. These variations in presentation and outcomes warrant different management strategies and expectations. 相似文献6.
Carolina Santiago de Araújo Pio Susan Marzolini Maureen Pakosh Sherry L. Grace 《Mayo Clinic proceedings. Mayo Clinic》2017,92(11):1644-1659
Objective
To ascertain the effect of cardiac rehabilitation (CR) dose (ie, duration × frequency/wk; categorized as low [<12 sessions], medium [12-35 sessions], or high [≥36 sessions]) on mortality and morbidity.Methods
The Cochrane, CINAHL, EMBASE, PsycINFO, and MEDLINE databases were systematically searched from inception through November 30, 2015. Inclusion criteria included randomized or nonrandomized studies with a minimum CR dose of 4 or higher and presence of a control/comparison group. Citations were considered for inclusion, and data were extracted in included studies independently by 2 investigators. Studies were pooled using random-effects meta-analysis and meta-regression where warranted (covariates included study quality, country, publication year, and diagnosis).Results
Of 4630 unique citations, 33 trials were included comparing CR to usual care (ie, no dose). In meta-regression, greater dose was significantly related to lower all-cause mortality (high: ?0.77; SE, 0.22; P<.001; medium: ?0.80; SE, 0.21; P<.001) when compared with low dose. With regard to morbidity, meta-analysis revealed that dose was significantly associated with fewer percutaneous coronary interventions (high: relative risk, 0.65; 95% CI, 0.50-0.84; medium/low: relative risk, 1.04; 95% CI, 0.74-1.48; between subgroup difference P=.03). This reduction was also significant in meta-regression (high vs medium/low: ?0.73; SE, 0.20; P<.001). Publication bias was not evident. No dose-response association was found for cardiovascular mortality, all-cause hospitalization, coronary artery bypass graft surgery, or myocardial infarction.Conclusion
A minimum of 36 CR sessions may be needed to reduce percutaneous coronary interventions. Future studies should examine the effect of actual dose of CR, and trials are needed comparing different doses.7.
Trine Karlsen Javaid Nauman Håvard Dalen Arnulf Langhammer Ulrik Wisløff 《Mayo Clinic proceedings. Mayo Clinic》2017,92(5):710-718
Objective
To assess the isolated and combined associations of leg and arm strength with adherence to current physical activity guidelines with all-cause and cause-specific mortality in healthy elderly women.Patients and Methods
This was a prospective cohort study of 2529 elderly women (72.6±4.8 years) from the Norwegian Healthy survey of Northern Trøndelag (second wave) (HUNT2) between August 15, 1995, and June 18, 1997, with a median of 15.6 years (interquartile range, 10.4-16.3 years) of follow-up. Chair-rise test and handgrip strength performances were assessed, and divided into tertiles. The hazard ratio (HR) of all-cause and cause-specific mortality by tertiles of handgrip strength and chair-rise test performance, and combined associations with physical activity were estimated by using Cox proportional hazard regression models.Results
We observed independent associations of physical activity and the chair-rise test performance with all-cause and cardiovascular mortality, and between handgrip strength and all-cause mortality. Despite following physical activity guidelines, women with low muscle strength had increased risk of all-cause mortality (HR chair test, 1.37; 95% CI, 1.07-1.76; HR handgrip strength, 1.39; 95% CI, 1.05-1.85) and cardiovascular disease mortality (HR chair test, 1.57; 95% CI, 1.01-2.42). Slow chair-test performance was associated with all-cause (HR, 1.32; 95% CI, 1.16-1.51) and cardiovascular disease (HR, 1.41; 95% CI, 1.14-1.76) mortality. The association between handgrip strength and all-cause mortality was dose dependent (P value for trend <.01).Conclusion
Handgrip strength and chair-rise test performance predicted the risk of all-cause and CVD mortality independent of physical activity. Clinically feasible tests of skeletal muscle strength could increase the precision of prognosis, even in elderly women following current physical activity guidelines. 相似文献8.
Moriah P. Bellissimo Karla I. Galaviz Meredith C. Paskert Felipe Lobelo 《Mayo Clinic proceedings. Mayo Clinic》2018,93(10):1375-1396
Objective
To estimate the pooled effects of community-based, recreational-level group sports on cardiometabolic risk factors and fitness parameters among adults.Participants and Methods
We systematically searched PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science electronic databases for English-language articles reporting the effectiveness of recreational-level group sports published between January 1, 1965, and January 17, 2017. We extracted baseline and end of intervention means for cardiometabolic and fitness parameters. Random- or fixed-effects meta-analyses were used to obtain pooled before and after change in outcome means within intervention participants and between groups.Results
From 2491 screened titles, 23 publications were included (902 participants; mean ± SD age, 46.6±11.7 years), comprising 21 soccer and 2 rugby interventions. Intervention participants achieved larger improvements (mean [95% CI]) compared with control subjects in weight (?1.44 kg [?1.79 to ?1.08 kg]), body mass index (?0.88 kg/m2 [?1.73 to ?0.03 kg/m2]), waist circumference (?0.77 cm [?1.21 to ?0.33 cm]), body fat (?1.8% [?3.12% to ?0.49%]), total cholesterol level (?0.33 mmol/L [?0.53 to ?0.13 mmol/L]), low-density lipoprotein cholesterol level (?0.35 mmol/L [?0.54 to ?0.15 mmol/L]), systolic blood pressure (?5.71 mm Hg [?7.98 to ?3.44 mm Hg]), diastolic blood pressure (?3.36 mm Hg [?4.93 to ?1.78 mm Hg]), maximum oxygen consumption (3.93 mL/min per kg [2.96-4.91 mL/min]), and resting heart rate (?5.51 beats/min [?7.37 to ?3.66 beats/min]). Most studies (16) were classified as high quality, and we found no evidence of publication bias.Conclusion
We found significant cardiometabolic and fitness improvements following group sport participation, primarily recreational soccer. These findings suggest that group sport interventions are promising strategies for reducing cardiometabolic risk in adults. 相似文献9.
Daniel K. White Zhichang Li Yuqing Zhang Adam R. Marmon Hiral Master Joseph Zeni Jingbo Niu Long Jiang Shu Zhang Jianhao Lin 《Archives of physical medicine and rehabilitation》2018,99(1):194-197
Objective
To describe physical function before and six months after Total Knee Replacement (TKR) in a small sample of women from China and the United States.Design
Observational.Setting
Community environment.Outcomes
Both groups adhered to the Osteoarthritis Research Society International (OARSI) protocols for the 6-minute walk and 30-second chair stand. We compared physical function prior to TKR and 6 months after using linear regression adjusted for covariates.Participants
Women (N=60) after TKR.Interventions
Not applicable.Results
Age and body mass index in the China group (n=30; 66y and 27.0kg/m2) were similar to those in the U.S. group (n=30; 65y and 29.6kg/m2). Before surgery, the China group walked 263 (95% confidence interval [CI], ?309 to ?219) less meters and had 10.2 (95% CI, ?11.8 to ?8.5) fewer chair stands than the U.S. group. At 6 months when compared with the U.S. group, the China group walked 38 more meters, but this difference did not reach statistical significance (95% CI, ?1.6 to 77.4), and had 3.1 (95% CI, ?4.4 to ?1.7) fewer chair stands. The China group had greater improvement in the 6-minute walk test than did the U.S. group (P<.001).Conclusions
Despite having worse physical function before TKR, the China group had greater gains in walking endurance and similar gains in repeated chair stands than did the U.S. group after surgery. 相似文献10.
Emily Frith Ovuokerie Addoh Joshua R. Mann B. Gwen Windham Paul D. Loprinzi 《Mayo Clinic proceedings. Mayo Clinic》2017,92(10):1494-1501
Objective
To evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all-cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease.Patients and Methods
Data from the 1999 to 2002 National Health and Nutrition Examination Survey were used to identify 1852 adults (age, 60-85 years) with and without mobility and/or cognitive limitations. Hazard ratios (HRs) for mortality risk were calculated for 4 mutually exclusive groups: no limitation (group 1 as reference), mobility limitation only (group 2), cognitive limitation only (group 3), both cognitive and mobility limitations (group 4).Results
Compared with group 1, the adjusted HRs (95% CI) for groups 2, 3, and 4 were 1.72 (1.24-2.38), 2.00 (1.37-2.91), and 2.18 (1.57-3.02), respectively. The mortality risk when comparing group 4 (HR, 2.18) with group 3 (HR, 2.00), however, was not statistically significant (P=.65). Similarly, the mortality risk when comparing group 4 (HR, 2.18) with group 2 (HR, 1.72) was not statistically significant (P=.16).Conclusion
Although the highest mortality risk occurred in those with both limitations (group 4), this point estimate was not statistically significantly different when compared with those with cognitive or mobility limitations alone. 相似文献11.
Tetsuro Tsujimoto Hiroshi Kajio Martin F. Shapiro Takehiro Sugiyama 《Mayo Clinic proceedings. Mayo Clinic》2018,93(4):409-418
Objective
To assess the relationship between use of β-blockers and all-cause mortality in patients with and without diabetes.Patients and Methods
Using data from the US National Health and Nutrition Examination Survey 1999-2010, we conducted a prospective cohort study. The study participants were followed-up from the survey participation date until December 31, 2011. We used a Cox proportional hazards model for all-cause mortality analysis. The multivariate-adjusted hazard ratios (HRs) of the participants taking β-blockers were compared with those of the participants not taking β-blockers.Results
This study included 2840 diabetic participants and 14,684 nondiabetic participants. Compared with diabetic participants not taking a β-blocker, all-cause mortality was significantly higher in diabetic participants taking any β-blocker (HR, 1.49; 95% CI, 1.09-2.04; P=.01), taking a β1-selective β-blocker (HR, 1.60; 95% CI, 1.13-2.24; P=.007), or taking a specific β-blocker (bisoprolol, metoprolol, and carvedilol) (HR, 1.55; 95% CI, 1.09-2.21; P=.01). In addition, all-cause mortality in diabetic participants with coronary heart disease (CHD) was significantly higher in those taking beta-blockers, compared with those not taking beta-blockers (HR, 1.64; 95% CI, 1.08-2.48; P=.02), whereas that in non-diabetic participants with CHD was significantly lower in those taking beta-blockers (HR, 0.68; 95% CI, 0.50-0.94; P=.02). A propensity score–matched Cox proportional hazards model yielded similar results.Conclusion
Use of β-blockers may be associated with an increased risk of mortality for patients with diabetes and among the subset who have CHD. 相似文献12.
Kristina S. Boye Reema Mody Jianmin Wu Maureen J. Lage Fady T. Botros Brad Woodward 《Clinical therapeutics》2018,40(8):1396-1407
Purpose
The aims of this study were to use real-world treatment results to compare changes in estimated glomerular filtration rate (eGFR) and glycosylated hemoglobin (HbA1c) among patients with type 2 diabetes who initiated treatment with dulaglutide or insulin glargine and to determine the proportions of patients with renal impairment who initiate each treatment.Methods
The study used data from the Practice Fusion electronic health records database from October 2013 through June 2017. Adults with type 2 diabetes who initiated dulaglutide or insulin glargine therapy and had multiple recorded serum creatinine and/or HbA1c laboratory test results were included in the study. The dulaglutide cohort (n?=?1222) was matched to the insulin glargine cohort (n?=?13,869) using Mahalanobis distance matching with propensity score calipers. Multivariable analyses of the matched cohorts of individuals with serum creatinine results (n?=?1183 dulaglutide and 1183 insulin glargine) examined the association between intent-to-treat therapy and changes in eGFR. In addition, multivariable analyses were also conducted on a subset of these patients who also had recorded HbA1c tests (n?=?1088 dulaglutide and 1088 insulin glargine) to examine the association between changes in HbA1c during the 1 year postperiod.Findings
Among patients who initiated dulaglutide therapy, only 0.9% of patients had an index eGFR <30 and ≥15 mL/min/1.73 m2 and 0.1% had an index eGFR <15 mL/min/1.73 m2. In contrast, 4.1% of insulin glargine–treated patients had an index eGFR <30 and ≥15 mL/min/1.73 m2 and 1.2% had an index eGFR <15 mL/min/1.73 m2. Compared with patients who initiated therapy with insulin glargine, initiation of dulaglutide therapy was associated with a significantly smaller decrease in eGFR (?0.4 vs ?0.9 mL/min/1.73 m2; P?=?0.0024), a significantly smaller likelihood of having a 30% or greater reduction in eGFR (3.3% vs 4.1%; P < 0.0001), and a significantly larger reduction in HbA1c (?0.5% vs ?0.2%; P < 0.0001).Implications
In clinical practice, the use of dulaglutide was relatively more limited in patients with a higher degree of renal impairment compared with use of insulin glargine. However, initiation of dulaglutide therapy, compared with insulin glargine therapy, was associated with a significantly smaller decrease in eGFR and a larger reduction in HbA1c during the 1 year postperiod. 相似文献13.
Connie M. Rhee Kamyar Kalantar-Zadeh Vanessa Ravel Elani Streja Amy S. You Steven M. Brunelli Danh V. Nguyen Gregory A. Brent Csaba P. Kovesdy 《Mayo Clinic proceedings. Mayo Clinic》2018,93(5):573-585
Objective
Given that patients with non–dialysis-dependent chronic kidney disease (NDD-CKD) have a disproportionately higher prevalence of hypothyroidism compared with their non-CKD counterparts, we sought to determine the association between thyroid status, defined by serum thyrotropin (TSH) levels, and mortality among a national cohort of patients with NDD-CKD.Patients and Methods
Among 227,422 US veterans with stage 3 NDD-CKD with 1 or more TSH measurements during the period October 1, 2004, to September 30, 2012, we first examined the association of thyroid status, defined by TSH categories of less than 0.5, 0.5 to 5.0 (euthyroidism), and more than 5.0 mIU/L, with all-cause mortality. We then evaluated 6 granular TSH categories: less than 0.1, 0.1 to less than 0.5, 0.5 to less than 3.0, 3.0 to 5.0, more than 5.0 to 10.0, and more than 10.0 mIU/L. We concurrently examined thyroid status, thyroid-modulating therapy, and mortality in sensitivity analyses.Results
In expanded case-mix adjusted Cox analyses, compared with euthyroidism, baseline and time-dependent TSH levels of more than 5.0 mIU/L were associated with higher mortality (adjusted hazard ratios [aHRs] [95% CI], 1.19 [1.15-1.24] and 1.23 [1.19-1.28], respectively), as were baseline and time-dependent TSH levels of less than 0.5 mIU/L (aHRs [95% CI], 1.18 [1.15-1.22] and 1.41 [1.37-1.45], respectively). Granular examination of thyroid status showed that incrementally higher TSH levels of 3.0 mIU/L or more were associated with increasingly higher mortality in baseline and time-dependent analyses, and TSH categories of less than 0.5 mIU/L were associated with higher mortality (reference, 0.5-<3.0 mIU/L) in baseline analyses. In time-dependent analyses, untreated and undertreated hypothyroidism and untreated hyperthyroidism were associated with higher mortality (reference, spontaneous euthyroidism), whereas hypothyroidism treated-to-target showed lower mortality.Conclusion
Among US veterans with NDD-CKD, high-normal TSH (≥3.0 mIU/L) and lower TSH (<0.5 mIU/L) levels were associated with higher death risk. Interventional studies identifying the target TSH range associated with the greatest survival in patients with NDD-CKD are warranted. 相似文献14.
Solini A Penno G Bonora E Fondelli C Orsi E Arosio M Trevisan R Vedovato M Cignarelli M Andreozzi F Nicolucci A Pugliese G;Renal Insufficiency Cardiovascular Events 《Diabetes care》2012,35(1):143-149
OBJECTIVE
Although a reduced estimated glomerular filtration rate (eGFR) was shown to be a powerful independent predictor of cardiovascular disease (CVD), other studies suggested that it confers a much lower risk than albuminuria alone, whereas the combination of the two abnormalities is associated with multiplicative risk. This study aimed at assessing the independent association of previous CVD events, either total or by vascular bed, with eGFR and albuminuria and chronic kidney disease (CKD) phenotypes.RESEARCH DESIGN AND METHODS
This cross-sectional study evaluated 15,773 patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study in 19 outpatient diabetes clinics in years 2007–2008. Albuminuria was assessed by immunonephelometry or immunoturbidimetry. GFR was estimated by the simplified Modification of Diet in Renal Disease Study and the Chronic Kidney Disease-Epidemiology Collaboration equation. CKD was defined as an eGFR <60 mL/min/1.73 m2 or micro- or macroalbuminuria. Major acute CVD events were adjudicated based on hospital discharge records or specialist visits.RESULTS
CVD risk increased linearly with eGFR decline and albuminuria and became significant for values <78 mL/min/1.73 m2 and ≥10.5 mg/24 h, respectively. Beyond traditional CVD risk factors, total CVD showed an independent association with albuminuria alone (odds ratio 1.20 [95% CI 1.08–1.33]), reduced eGFR alone (1.52 [1.34–1.73]), and both abnormalities (1.90 [1.66–2.19]). However, coronary events were associated predominantly with reduced eGFR alone, whereas cerebrovascular and peripheral events showed a stronger correlation with the albuminuric CKD phenotypes.CONCLUSIONS
These data, although cross-sectional, show that reduced eGFR, irrespective of albuminuria, is associated with significant CVD, particularly in the coronary district.A large body of evidence suggests that individuals with chronic kidney disease (CKD) are more likely to die, particularly from cardiovascular disease (CVD), than to progress to end-stage renal disease (ESRD) (1), although recent findings seem to favor progression (2). In fact, although CVD risk is particularly increased in patients with ESRD, where CVD mortality accounts for the vast majority of deaths (3), even mild-to-moderate renal impairment is associated with CVD, as shown in the general population (4) and in subjects with type 2 diabetes (5).For clinical and epidemiologic purposes, CKD is currently classified into five stages, according to the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI). Classification is based on the presence or absence of kidney damage, as manifested by pathologic abnormalities or by disease markers such as micro- or macroalbuminuria, and glomerular filtration rate (GFR), as calculated by the use of estimating equations from serum creatinine measurements. Although stages 1–2 CKD are identified by evidence of kidney damage, stages 3–5 CKD are defined solely on the basis of estimated GFR (eGFR), irrespective of albuminuria (6). Because staging systems for disease classification should assign people with worse prognoses to more advanced stages, based on that introduced by the NKF KDOQI, subjects with an eGFR <60 mL/min/1.73 m2 (i.e., stage ≥3 CKD) without albuminuria would carry the same CVD and renal risk as those with albuminuria but a lower risk than individuals with albuminuria and normal or subnormal eGFR, who are assigned to stages 1–2 CKD.In the Third National Health and Nutrition Examination Survey (NHANES III) cohort, increased albuminuria and reduced eGFR were both associated with increased risk of CVD and all-cause mortality overall and within every eGFR and albuminuria category, respectively (7). A recent meta-analysis confirmed that albuminuria, with no threshold, and an eGFR <60 mL/min/1.73 m2 are both independent predictors of death and indicated that these two abnormalities are multiplicatively associated with risk of death without evidence of interaction (8). However, in other samples of the general population, the eGFR cutoff point for optimal discrimination of CVD risk was higher (9,10), whereas more recent reports showed that individuals with reduced eGFR without albuminuria are at much lower CVD risk than subjects with albuminuria without reduced eGFR (11–13). Studies in patients with type 2 diabetes showed that albuminuria and reduced eGFR are associated to the same extent with total CVD events (14,15), whereas albuminuria predicts death from CVD better than reduced eGFR (8,16).Thus, although the independent contribution of albuminuria appears to be relevant, it is unclear whether subnormal eGFR levels (i.e., 60–89 mL/min/1.73 m2) and, particularly, reduced eGFR levels (i.e., <60 mL/min/1.73 m2) in the absence of albuminuria are associated with significant CVD risk. This issue is particularly relevant in patients with type 2 diabetes, because reduced eGFR is more common than previously recognized in these individuals (17), and more importantly, it occurs in the absence of albuminuria in most of them (14,18,19).This study assessed the independent association of previous CVD events, either total or by vascular bed, with eGFR and albuminuria as well as with nonalbuminuric CKD, as defined by an eGFR <60 mL/m/1.73 m2 without albuminuria, compared with albuminuric CKD with either reduced (stage ≥3 CKD) or nonreduced (stages 1–2 CKD) eGFR, in a large Italian cohort of patients with type 2 diabetes. 相似文献15.
Antonio García-Hermoso Iván Cavero-Redondo Robinson Ramírez-Vélez Jonatan R. Ruiz Francisco B. Ortega Duck-Chul Lee Vicente Martínez-Vizcaíno 《Archives of physical medicine and rehabilitation》2018,99(10):2100-2113.e5
Objectives
The aims of the present systematic review and meta-analysis were to determine the relationship between muscular strength and all-cause mortality risk and to examine the sex-specific impact of muscular strength on all-cause mortality in an apparently healthy population.Data Sources
Two authors systematically searched MEDLINE, EMBASE and SPORTDiscus databases and conducted manual searching of reference lists of selected articles.Study Selection
Eligible cohort studies were those that examined the association of muscular strength with all-cause mortality in an apparently healthy population. The hazard ratio (HR) estimates with 95% confidence interval (CI) were pooled by using random effects meta-analysis models after assessing heterogeneity across studies.Data Extraction
Two authors independently extracted data.Data Synthesis
Thirty-eight studies with 1,907,580 participants were included in the meta-analysis. The included studies had a total of 63,087 deaths. Higher levels of handgrip strength were associated with a reduced risk of all-cause mortality (HR=0.69; 95% CI, 0.64-0.74) compared with lower muscular strength, with a slightly stronger association in women (HR=0.60; 95% CI, 0.51-0.69) than men (HR=0.69; 95% CI, 0.62-0.77) (all P<.001). Also, adults with higher levels of muscular strength, as assessed by knee extension strength test, had a 14% lower risk of death (HR=0.86: 95% CI, 0.80-0.93; P<.001) compared with adults with lower muscular strength.Conclusions
Higher levels of upper- and lower-body muscular strength are associated with a lower risk of mortality in adult population, regardless of age and follow-up period. Muscular strength tests can be easily performed to identify people with lower muscular strength and, consequently, with an increased risk of mortality. 相似文献16.
Daniel V. Dudenkov Kristin C. Mara Tanya M. Petterson Julie A. Maxson Tom D. Thacher 《Mayo Clinic proceedings. Mayo Clinic》2018,93(6):721-730
Objective
To determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and all-cause and cause-specific mortality.Patients and Methods
We identified all serum 25(OH)D measurements in adults residing in Olmsted County, Minnesota, between January 1, 2005, and December 31, 2011, through the Rochester Epidemiology Project. All-cause mortality was the primary outcome. Patients were followed up until their last clinical visit as an Olmsted County resident, December 31, 2014, or death. Multivariate analyses were adjusted for age, sex, race/ethnicity, month of measurement, and Charlson comorbidity index score.Results
A total of 11,022 individuals had a 25(OH)D measurement between January 1, 2005, and December 31, 2011, with a mean ± SD value of 30.0±12.9 ng/mL. Mean age was 54.3±17.2 years, and most were female (77.1%) and white (87.6%). There were 723 deaths after a median follow-up of 4.8 years (interquartile range, 3.4-6.2 years). Unadjusted all-cause mortality hazard ratios (HRs) and 95% CIs for 25(OH)D values of less than 12, 12 to 19, and more than 50 ng/mL were 2.6 (95% CI, 2.0-3.2), 1.3 (95% CI, 1.0-1.6), and 1.0 (95% CI, 0.72-1.5), respectively, compared with the reference value of 20 to 50 ng/mL. In a multivariate model, the interaction between the effect of 25(OH)D and race/ethnicity on mortality was significant (P<.001). In white patients, adjusted HRs for 25(OH)D values of less than 12, 12 to 19, 20 to 50, and greater than 50 ng/mL were 2.5 (95% CI, 2.2-2.9), 1.4 (95% CI, 1.2-1.6), 1.0 (referent), and 1.0 (95% CI, 0.81-1.3), respectively. In patients of other race/ethnicity, adjusted HRs were 1.9 (95% CI, 1.5-2.3), 1.7 (95% CI, 1.1-2.6), 1.5 (95% CI, 1.0-2.0), and 2.1 (95% CI, 0.77-5.5).Conclusion
White patients with 25(OH)D values of less than 20 ng/mL had greater all-cause mortality than those with values of 20 to 50 ng/mL, and white patients had greater mortality associated with low 25(OH)D values than patients of other race/ethnicity. Values of 25(OH)D greater than 50 ng/mL were not associated with all-cause mortality. 相似文献17.
Louise de Lannoy Xuemei Sui Carl J. Lavie Steven N. Blair Robert Ross 《Mayo Clinic proceedings. Mayo Clinic》2018,93(2):184-190
Objective
To evaluate the relationship between change in submaximal cardiorespiratory fitness (sCRF) and all-cause mortality risk in adult men and women.Patients and Methods
A prospective study with at least 2 clinical visits (mean follow-up time, 4.2±3.0 years) between April 1974 and January 2002 was conducted to assess the relationship between change in sCRF and mortality risk during follow-up. Participants were 6106 men and women. Submaximal CRF was determined using the heart rate obtained at the 5-minute mark of a graded maximal treadmill test used to determine maximal CRF (mCRF). Change in sCRF from baseline to follow-up was categorized into 3 groups: increased fitness (decreased heart rate, <?4.0 beats/min), stable fitness (heart rate, ?4.0 to 3.0 beats/min), and decreased fitness (increased heart rate, >3.0 beats/min).Results
The mean change in sCRF at follow-up for all 6106 study participants was ?0.5±10.0 beats/min, and the mean change in mCRF was ?0.3±1.4 metabolic equivalents. Change in sCRF was related to change in mCRF, though the variance explained was small (R2=0.21; P<.001). The hazard ratios (95% CIs) for all-cause mortality were 0.60 (0.38-0.96) for stable and 0.59 (0.35-1.00) for increased sCRF compared with decreased sCRF after adjusting for age, change in weight, and other common risk factors for premature mortality. The hazard ratios for changes in sCRF and mCRF were not significant after adjusting for changes in mCRF (P=.29) and sCRF (P=.60), respectively.Conclusion
A simple 5-minute submaximal test of CRF identified that adults who maintained or improved sCRF were less likely to die from all causes during follow-up than were adults whose sCRF decreased. 相似文献18.
More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients 总被引：1，自引：0，他引：1
OBJECTIVE
The current study aimed to investigate whether microalbuminuria or moderately decreased glomerular filtration rate (GFR) is a better predictor for the development and progression of retinopathy in type 2 diabetic patients.RESEARCH DESIGN AND METHODS
Type 2 diabetic patients without cardiovascular diseases, malignancy, pregnancy, and acute intercurrent illness were enrolled between 1 August 2001 and 31 December 2002. All participants provided their detailed medical history and underwent an eye fundus examination. They were followed up in outpatient clinics, and serum creatinine, urinary albumin-to-creatinine ratio (UACR), and retinal photographs were followed up annually until 31 December 2009. The primary outcomes were development and progression of diabetic retinopathy and nephropathy. The secondary outcomes were cardiovascular events and all-cause mortality.RESULTS
Among 487 participants, 81 subjects had normoalbuminuria and moderate renal impairment (baseline eGFR 30–59.9 mL/min/1.73 m2), and 106 subjects had microalbuminuria and baseline eGFR ≥60 mL/min/1.73 m2. Patients with microalbuminuria and eGFR ≥60 mL/min/1.73 m2 had a significantly greater risk for development and progression of diabetic retinopathy (HR 3.34 [95% CI 1.04–10.70]) compared with those with moderate renal impairment and normoalbuminuria after multivariate adjustment. Risks for renal outcome, cardiovascular events, and all-cause mortality were not significantly different between the two groups.CONCLUSIONS
Microalbuminuria has a greater impact on predicting the development and progression of diabetic retinopathy compared with moderate decline in GFR among type 2 diabetic patients.Diabetic retinopathy is a highly specific vascular complication and a sight-threatening problem related to diabetes. Diabetic retinopathy is characterized by gradually progressive alterations in the retinal microvasculature, leading to retinal nonperfusion, increased vascular permeability, and pathologically intraocular proliferation of retinal vessels. Both diabetic retinopathy and nephropathy are microvascular complications of diabetes. With the retina and glomerulus, diabetes-specific microvascular disease is characterized by similar pathophysiologic features. Chronic hyperglycemia is the central initiating factor for all types of diabetic microvascular disease. In exposure to high plasma glucose, hyperglycemic damage is limited to some cell types. Endothelial cells develop intracellular hyperglycemia, since they cannot downregulate glucose transport (1). The common pathologic trait of diabetic microvascular disease is progressive narrowing and eventual occlusion of vascular lumina, subsequently leading to inadequate perfusion of the affected tissues. In the retina, diabetes induces programmed cell death of Muller and ganglion cells (2) and pericytes and endothelial cells (3). In the glomerulus, urinary protein loss and renal function decline are associated with widespread capillary occlusion and podocyte loss.Elevated urinary albumin excretion has been found to increase the risk of proliferative diabetic retinopathy (PDR) and is associated with a higher prevalence of PDR (4–8). Diabetic retinopathy is present in virtually all type 1 diabetic patients with nephropathy, whereas only 50–60% of type 2 diabetic patients with nephropathy have retinopathy (5). Accordingly, nephropathy and retinopathy are not concurrent in type 2 diabetes. Although the prevalence and risk factors for diabetic retinopathy in type 2 diabetes have been extensively investigated (6–8), there are little data addressing the issue of whether microalbuminuria or moderate decline of estimated glomerular filtration rate (eGFR) (30–59.9 mL/min/1.73 m2) is a competing risk factor for the development and progression of diabetic retinopathy. Therefore, the current study strived to investigate whether microalbuminuria or moderately decreased eGFR is a better predictor for the retinal outcome in a type 2 diabetic cohort. 相似文献19.
Chia-Lin Wu Chew-Teng Kor Chia-Chu Chang Ping-Fang Chiu Der-Cherng Tarng Chih-Cheng Hsu 《Mayo Clinic proceedings. Mayo Clinic》2018,93(10):1474-1483
Objective
To investigate the association between statin use and mortality in patients with dialysis-requiring acute kidney injury (AKI-D).Patients and Methods
This nationwide, population-based, retrospective cohort study included 6091 hospitalized patients with AKI-D (1271 statin users and 4820 statin nonusers) retrieved from the National Health Insurance Research Database of Taiwan between January 1, 2000, and December 31, 2012. All the patients were followed up until December 31, 2013. Primary and secondary outcomes were 1-year and in-hospital mortality, respectively. All the primary analyses were performed using the intention-to-treat approach.Results
During 1-year follow-up, 492 of 1271 statin users (38.7%) and 2365 of 4820 statin nonusers (49.1%) died. After propensity score matching, statin use was independently associated with lower risks of 1-year all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.69-0.9; P<.001) and in-hospital all-cause mortality (HR, 0.84; 95% CI, 0.71-0.99; P=.04). The survival benefit of statin treatment was dose-dependent and consistent across subgroups based on sensitivity analyses.Conclusion
Statin use was independently associated with reduced risks of 1-year and in-hospital mortality in patients with AKI-D. Statin therapy may be beneficial in this patient group. However, further clinical trials should be performed to confirm the findings. 相似文献20.
Clément Medrinal Guillaume Prieur Yann Combret Aurora Robledo Quesada David Debeaumont Tristan Bonnevie Francis Edouard Gravier Elise Dupuis Lozeron Jean Quieffin Olivier Contal Bouchra Lamia 《Archives of physical medicine and rehabilitation》2018,99(8):1454-1461