Falls and renal function: a dangerous association

Falls are an important health problem and the risk of falling increases with age. The costs due to falls are related to the progressive decline of patients' clinical conditions, with functional inability inducing increasing social costs, morbidity and mortality. Renal dysfunction is mostly present in elderly people who often have several comorbidities. Risk factors for falls have been classified as intrinsic and extrinsic, and renal dysfunction is included among the former. Chronic kidney disease per se is an important risk factor for falls, and the risk correlates negatively with creatinine clearance. Vitamin D deficiency, dysfunction of muscles and bones, nerve degeneration, cognitive decline, electrolyte imbalance, anemia, and metabolic acidosis have been reported to be associated with falls. Falls seem to be very frequent in dialysis patients: 44% of subjects on hemodialysis fall at least once a year with a 1-year mortality due to fractures of 64%. Male sex, comorbidities, predialysis hypotension, and a history of previous falls are the main risk factors, together with events directly related to renal replacement therapy such as biocompatibility of the dialysis membrane, arrhythmias, fluid overload and length of dialysis treatment. Peripheral nerve degeneration and demyelination as well as altered nerve conduction resulting in muscular weakness and loss of peripheral sensitivity are frequent when the glomerular filtration rate is less than 12 mL/min. Moreover, depression and sleep disorders can also increase the risk of falls. Kidney function is an important parameter to consider when evaluating the risk of falls in the elderly, and the development of specific guidelines for preventing falls in the uremic population should be considered.     

The association between low vision and function

OBJECTIVE: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability. METHODS: Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study. RESULTS: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities. DISCUSSION: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.     

The association between body composition and foot structure and function: a systematic review

The aim of this systematic review was to investigate the relationship between body composition and foot structure and function. Six electronic databases (Ovid MEDLINE, Ovid EMBASE, Ovid AMED, CINAHL, Scopus and The Cochrane Library) and reference lists from relevant papers were searched on 2 September 2013. Sixteen papers that reported on the association between body composition and foot structure and function met our inclusion criteria and were reviewed. The evidence indicates that obesity is strongly associated with planus (low‐arched) foot posture, pronated dynamic foot function and increased plantar pressures when walking. However, there is limited evidence to support an association between other body composition measures, such as fat mass, with foot structure or function.     

The association between hematological parameters and metabolic syndrome in Iranian men: A single center large-scale study

Aims

Some studies have demonstrated that metabolic syndrome is associated with hematological parameters. The present study explores the relationship between hematological parameters and numbers of metabolic syndrome conditions in Iranian men.

正常血压高值与肾功能的相关性研究

目的:观察正常血压高值患者肾功能的变化,以探讨正常血压高值患者是否存在与血压升高相关的靶器官损害,以指导其治疗和预防.方法:根据JNC-7诊断标准筛选病例并分为3组:正常血压组(NT组)56例;正常血压高值组(PH组)51例;高血压组(EH组)54例.留取晨尿,抽取静脉血,离心后采用放免法和酶法测定尿β2-微球蛋白(β2-MG)、尿微量白蛋白(mAIb)及血尿素氮(BUN)、血肌酐(Cr).结果:与NT组相比,PH组和EH组尿β2-MG、mAIb水平明显升高(P＜0.05;P＜0.01);BUN、Cr在EH组明显升高,与NT组比较P＜0.01;在PH组BUN轻度升高,与NT组比较无显著性差异;血Cr明显升高, 与NT组比较P＜0.01.直线相关分析显示:血压水平与尿β2-MG、mAIb及BUN、Cr的水平均呈显著正相关.多因素回归分析显示:校正年龄、体质指数、血糖、胆固醇、TG,血压水平仍与尿β2-MG、mAIb有显著的相关性.结论:PH组患者尿β2- MG 、 mAIb 、 Cr 出现了异常变化.且血压水平与尿β2-MG、mAIb及BUN、Cr的水平均呈显著正相关.提示正常血压高值患者可能存在与血压升高相关的肾损害.血压水平是导致尿β2-MG、尿mAIb增加的独立危险因素.     

The association between anthropometric parameters,the metabolic syndrome and microalbuminuria in black Africans: the SABPA study

Summary

We aimed to determine which surface anthropometric and metabolic syndrome (MS) markers could be associated with the development of microalbuminuria (MA), and assessed 200 urban Africans (25–60 years) stratified into low (≤ 0.90 and ≤ 0.85) and high (> 0.90 and > 0.85) waist-to-hip ratio (WHR) groups from the North-West province. Anthropometric and fasting MS markers, such as systolic and diastolic blood pressure (BP), and glucose, triglyceride (TG) and high-density lipoprotein (HDL) levels, as well as MA markers were measured.Males revealed higher lifestyle risk factors (body mass index, smoking, alcohol consumption, low physical activity), anthropometric and MS markers compared to the females. The same overall trend was seen for high-WHR males but not for high-WHR females compared to their low-WHR counterparts. Both high-WHR groups revealed increased glucose values (males, 6.34 mmol/l; females, 6.13 mmol/l). Multiple linear regression analysis, independent of confounders, showed positive associations between diastolic blood pressure (DBP) (high WHR and all males), TG, waist circumference (WC) and development of MA in all males. In high-WHR females, positive associations existed only between WC and the development of MA, while neck circumference (NC) was associated with MA development in all females. To conclude, vascular BP, TG and WC were associated with risk of renal impairment in males, while in females, NC and WC circumferences were associated with this risk.     

The association between leptin and left ventricular hypertrophy: a population-based cross-sectional study

BACKGROUND AND OBJECTIVES: Plasma leptin levels have been shown to be an independent risk factor for cardiovascular disease. Leptin has been shown to have sympathetic and vascular effects, and may increase cardiovascular risk through increased blood pressure, left ventricular hypertrophy, or atherosclerotic mechanisms. This study examines whether leptin levels, independent of body mass and insulin resistance, are a risk factor for hypertension and left ventricular hypertrophy. METHODS AND PARTICIPANTS: A population-based, cross-sectional sample of 410 adults from rural Spain was studied. The correlations between plasma leptin levels and left ventricular mass index, sum of wall thicknesses, and blood pressure were calculated. Multiple linear regression analysis was used to adjust for other cardiovascular risk factors. RESULTS: After adjusting for age, body mass index, systolic blood pressure, sex, and insulin resistance, leptin was inversely associated with left ventricular mass index (beta = -0.20, P < 0.01). Leptin was also inversely related to the sum of wall thicknesses; however, this association did not reach statistical significance (beta = -0.12, P = 0.063). Leptin was not statistically associated with blood pressure after adjusting for body mass index. CONCLUSIONS: The results do not support the hypothesis that leptin increases cardiovascular risk by increasing left ventricular mass index or blood pressure. Other mechanisms, related to atherosclerosis, could explain the increased risk of cardiovascular diseases observed with high leptin levels.     

The association between peripheral artery and lumbar spine disease: a single-center study

BackgroundWhile intermittent claudication is the hallmark of symptomatic peripheral artery disease, most patients with peripheral artery disease have atypical symptoms. The presence of lumbosacral spine disease, a common cause of nonvascular lower extremity pain, may confound the diagnosis of peripheral artery disease. The goal of this study was to quantify the prevalence of severe lumbar spine degenerative disease in patients referred for lower extremity arterial studies.MethodsAll patients over age 18 years referred for segmental limb pressures and pulse volume recordings at rest and following treadmill exercise testing at a tertiary medical center accredited vascular diagnostic laboratory, who also underwent magnetic resonance imaging or computed tomography of the lumbar spine within 6 months of the arterial studies, were included in the analysis. Frequencies of peripheral artery disease and lumbar spine degenerative disease were determined, and medical records were reviewed for cardiovascular risk factors and prior vascular and spinal interventions.ResultsOne hundred seven subjects (63 men) with a mean age of 70 years (range 35-88 years) were included in the analysis. Lumbar spine disease was present in 81 (75.7%) of the patients referred for vascular testing. The percentage of lumbar spine disease was equivalent in both patients with exercise-induced deterioration in arterial pressure and in those with a physiologic response to exercise. Compared with patients with a normal response to exercise, patients with exercise-induced peripheral artery disease had a lower resting ankle-brachial index (mean 0.79 vs 1.09, P <.001), abnormal pulse volume recordings, and were less likely to use opiate analgesics and more likely to have undergone lower extremity revascularization.ConclusionsSevere lumbar spine degenerative disease is widely prevalent in patients referred for lower extremity arterial studies. Our findings may help explain the high prevalence of atypical limb symptoms among peripheral artery disease patients.     

The association between chronic widespread pain and mental disorder: a population-based study

OBJECTIVE: Patients with chronic widespread pain (CWP) have been reported to have a greater prevalence of mental disorders and somatization than that found in the general population, but the true association between CWP and mental disorders is unknown. In this study, we investigated whether there is an increased prevalence of mental disorder in people with CWP from the general population. We also describe the psychiatric diagnoses associated with CWP. METHODS: In a population-based case-control study, 1,953 subjects (75% of a random sample of individuals age 18-65 years) completed a questionnaire that included a pain assessment and the 12-item General Health Questionnaire (GHQ-12). Of 710 subjects scoring >1 on the GHQ-12, 301 were assessed further using a structured psychiatric interview and detailed assessment of medical records to identify cases of mental disorder, in accordance with criteria of the 10th edition of the International Classification of Diseases. The association between CWP and mental disorder was modeled using logistic regression, adjusting for possible confounders including age, sex, and nonresponders. RESULTS: We estimated the overall population prevalence of mental illness to be 11.9%. The odds of having a mental disorder for subjects with versus those without CWP were 3.18 (95% confidence interval 1.97-5.11). Most subjects with mental disorders were diagnosed as having mood and anxiety disorders. Only 3 cases of somatoform disorders were identified, and all were associated with pain. CONCLUSION: This study, although unable to demonstrate a cause-and-effect relationship, showed that 16.9% of those with CWP were estimated to have a psychiatric diagnosis, suggesting that these disorders should be identified and treated.     

Lupus nephritis: association between serology and renal biopsy measures

The relationship between serologic tests and renal histologic change over time was examined in 55 patients with lupus nephritis. After a median interval of 40 months on various immunosuppressive drug regimens, C3 complement levels were improved in 78% of patients and anti-DNA levels were improved in 85%. Comparison of initial and followup renal pathology showed that the activity index of the biopsy improved in 82%, while the chronicity index worsened in 71% of patients. Normalization of C3, but not anti-DNA levels, was associated with a lowering of the activity index on repeat biopsy. Prolonged depression of serum C3 levels was associated with a trend (p = 0.066) towards worsening of the chronicity index, but the change in chronicity index showed no relationship to the duration of elevated anti-DNA. Our studies indicate that abnormal levels of C3 complement are predictive of the degree of persistently active glomerular disease, but that duration of abnormal C3 or anti-DNA are less consistent predictors of the acquisition of chronic, irreversible renal lesions.     

Absence of relation between nutritional parameters and renal function in non-seminomatous testicular cancer patients

Summary Earlier studies revealed that renal function is reduced in non-cancer patients with a malnutritional status. We have studied the effect of nutritional status on renal function in 46 patients with disseminated non-seminomatous testicular cancer treated with combination chemotherapy including cis-diammine dichloroplatinum (cDDP) according to the Einhorn regimen. The renal function was expressed as glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and filtration fraction (FF) measured by radioisotope infusion methods. Nutritional assessment of the patients was performed by means of three nutritional parameters: weight-for-height index (WHI), creatinine height index (CHI), and serum albumin concentration (Salb). The patients were also divided into two groups: group 1, patients with a sufficient nutritional status, defined as patients with only one abnormal nutritional parameter or none at all (n=30); group 2, patients with an insufficient nutritional status, defined as patients with two or three abnormal nutritional parameters (n=16). Median values of WHI, CHI and Salb in group 2 patients were significantly lower than the median values in group 1. Before treatment no correlation was found between the individual nutritional parameters and GFR, ERPF and FF respectively. The median GFR, ERPF and FF of both group 1 and group 2 did not differ significantly. Although the renal function of the total group of patients was reduced as a result of cDDP, this reduction was not influenced by the individual parameters and not higher in the group with an initially insufficient nutritional status. In this study no relation was found between nutritional status and renal function of patients with disseminated non-seminomatous testicular cancer.     

The association between obesity and migraine in a population of Iranian adults: a case-control study

Aim

To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults.

Absence of association between hypertension and epistaxis: a population-based study

The association between epistaxis and hypertension is still disputed. In a cross-sectional study, we evaluated this association in a sample of 1174 individuals older than 18 years, representative of inhabitants of Porto Alegre, RS, Brazil. Epistaxis was defined as any episode of non-traumatic nosebleeding after 18 years of age. Hypertension was defined as the mean of two blood pressure readings ≥160/95 mmHg or the use of antihypertensive drugs. The prevalence of epistaxis and hypertension were 14.7% (95% confidence interval, CI 12.7-16.7) and 24.1% (95% CI 21.7-26.6), respectively. History of epistaxis in the adulthood (risk ratio = 1.24, 95% CI 0.83-1.85), and in the previous 6 months (risk ratio 0.79, 95% CI 0.40-1.56; p = 0.510) were not associated with hypertension after controlling for gender, age, race, history of allergic rhinitis or nasal abnormalities, alcohol abuse, smoking and years of study. History of epistaxis was positively associated with history of allergic rhinitis and inversely associated with years at school. In conclusion, we demonstrated that hypertension is not associated with history of epistaxis in the adulthood in free-living individuals.     

The association between hyperuricemia and atrioventricular blocks:A retrospective study

Background Atrioventricular block(AVB)is associated with adverse events even cardiac death. Serum uric acid(SUA)might lead to cadiovascular disease including arrhythmia and SUA lowering therapy could lower the risk. But the study of the association between AVB and SUA is rare at present. Method Sixty-four patients with AVB from Sep 2017 to Sep 2018 were enrolled as case group and another 64 patients in the same period were enrolled as control group. The levels of serum uric acid(SUA)and related parameters were compared between the two groups. Results The level of SUA was significantly higher in case group than in control group(402.13±140.08 vs. 351.17±87.81,P=0.015). HUA was associated with AVB significantly(OR 2.863,95%CI1.305～6.279,P=0.009),even after adjustment for confounding factors(OR 2.609,95%CI 1.081～6.296,P=0.033). For the comparison among AVB subgroups,only the association between HUA and Ⅲ-degree subtypes was found significantly(OR 3.411,95%CI 1.452～8.016,P=0.005). Conclusion HUA is positively associated with AVB independent of other potential confounding factors. But further analysis of different subtypes indicated that only the association between HUA and Ⅲ-degree AVB was found significant.