Markers of coagulation activation and acute kidney injury in patients after hematopoietic cell transplantation.

Acute kidney injury (AKI) is common after hematopoietic cell transplant (HCT). The etiology of AKI is unknown because biopsies are rarely performed. The pathophysiology of injury is inferred from clinical data. Thrombotic microangiopathy (TMA) is often invoked as the cause of renal injury. Patients >2 years old undergoing their first HCT at Fred Hutchinson Cancer Research Center participated in this study. We prospectively measured plasma markers of coagulation activation, (PAI-1 and tPA) and fibrinolyis (D-dimer) weekly in 149 patients during the first 100 days post transplant. Cox proportional hazards modeling was used to determine associations between these markers and AKI (doubling of baseline serum creatinine). Kruskal-Wallis test was used to determine the associations between day 100 urinary albumin to creatinine ratios and these markers. Thirty one percent of patients developed AKI. Though elevations in these markers occurred frequently, neither PAI-1 nor tPA were associated with the development of AKI. D-dimer was associated with a slightly increased risk of AKI (relative risk=1.76; P-value 0.04). None of these markers were associated with micro- or macroalbuminuria at day 100. The lack of an association with AKI suggests that endothelial injury in the form of TMA is not a common cause of AKI early after transplant.

Urinary cytokines after HCT: evidence for renal inflammation in the pathogenesis of proteinuria and kidney disease.

We compared urinary levels of cytokines in patients with and without albuminuria, proteinuria and kidney disease (glomerular filtration rate<60 mL/min per 1.73 m(2)) after HCT. Plasma and urine were collected at baseline and weekly through day 100 and monthly through year 1, for measurement of IL-6, gp130, sIL6r, IL-10, IL15, MCP-1 and urine albumin-to-creatinine ratios (ACRs). Cox-proportional hazards modeling examined associations between urinary cytokine levels and development of these renal end points. The association of ACR with the hazard of overall mortality was assessed using Cox regression. Increasing urinary IL-6 and IL-15 were associated with an increased risk of developing proteinuria. Urinary MCP-1 during the first 100 days post HCT was associated with kidney disease at 1 year. The degree of albuminuria at any time point in the first 100 days post transplant was related to the subsequent risk of death (for ACR 30-299, hazard ratio (HR)=1.91; 95% confidence interval (CI): 1.27-2.87; for ACR >300, HR=2.82; 95% CI: 1.60-4.98). After HCT, elevated urinary levels of pro-inflammatory cytokines are associated with development of albuminuria and proteinuria, suggesting early intra-renal inflammation as an important pathogenetic mechanism. Albuminuria and proteinuria within the first 100 days post HCT are associated with decreased overall survival.

Dietary intake methodology I. USDA surveys and supporting research.

Nationwide food consumption and dietary surveys have been conducted about every 10 yr by the U.S. Department of Agriculture (USDA) since the mid-1930s to fulfill responsibilities for monitoring dietary patterns among the nation's population. Survey findings have implications for policies and programs related to food production and marketing, food safety, food assistance, and nutrition education. Until 1965, these surveys measured household food consumption only, but subsequent surveys were expanded to include food intakes by individuals in the sample households. Since 1985, small-scale continuing surveys of food intakes by individuals have been conducted during the years between the large decennial surveys. The 1-d recall was used in the first dietary intake survey. Then, to capture day-to-day variation in diets, 3 d of intake data, 1-d recall and 2-d records, were collected in 1977-1978, 1987-1988, and 1989. Prior to the 1977-1978 dietary intake survey, USDA embarked upon an intensive program of extramural research that was designed to improve methodologies for surveying individuals' dietary intakes. Since 1975, many major investigations have been completed and results have been incorporated in current survey procedures. Studies included testing of varied recall and diary methods, approaches for validating survey data, debriefings of survey respondents and interviewers, intersurvey comparisons, and testing of panel approaches with in-person, telephone, and mail contacts.

Dietary patterns of women smokers and non-smokers.

The 1-day food intakes of 1,338 women, aged 19 to 50, who were respondents in the 1985 Continuing Survey of Food Intake by Individuals, were studied. The energy, nutrient, and food intake patterns of smokers, those how had quit smoking, and those who had never smoked cigarettes were compared. Mean energy intakes of smokers (1,627 kcal), those who had never smoked (1,620 kcal), and those who had quit at least 1 year before the interview (1,719 kcal) were not significantly different. Self-reported body weight was significantly different between never-smokers and smokers (p less than .01) and quitters (p less than .05) only for the oldest category of women (ages 41 to 50 years). The consumption of fruits (p less than .001) and vegetables (p less than .01) was significantly lower and the intake of eggs (p less than .01), sugars (p less than .001), regular carbonated soft drinks (p less than .01), coffee (p less than .001), and alcoholic beverages (p less than .001) was significantly higher for women smokers than for non-smokers. After controlling through regression analysis for physical activity, health status, and demographic characteristics, we found that smokers, compared with never-smokers, had significantly lower protein (p less than .04), dietary fiber (p less than .001), vitamin C (p less than .001), and thiamin (p less than .01) intakes and higher cholesterol (p less than .02) intakes per 1,000 kcal.

One-day and 3-day nutrient intakes by individuals--Nationwide Food Consumption Survey findings, Spring 1977.

With the use of data from the Spring 1977 sample of the USDA Nationwide Food Consumption Survey 1977-78, 1- and 3-day nutrient intakes for 8,779 individuals in 22 sex-age groups in the 48 conterminous states were compared. For most nutrients studied, 3-day mean intakes and day 1 mean intakes showed little difference. Mean intakes for day 1 and for days 2 and 3 combined were not significantly different for most sex-age groups for most nutrients. The few statistically significant differences observed for energy, fat, and carbohydrate could have been the result of chance and therefore have little practical significance. Regression analysis indicated that day 1 intake was strongest as a predictor of intake on subsequent days for energy, carbohydrate, calcium, magnesium, and phosphorus; less strong for protein, fat, iron, thiamin, riboflavin, niacin, vitamin B-6, and vitamin C; and poorest for vitamin A.

Milk intakes and feeding patterns of breast-fed infants.

Age and weight were significantly correlated with intake of breast milk for completely but not for partially breast-fed infants (N = 22). The largest mean intakes of breast milk occurred in the early morning of the three days observed, although feedings showed an association with the interval since the previous feeding. Breast milk was the major source of food energy for all partially breast-fed infants, and intakes of breast milk in contiguous periods tended to be correlated. Intakes of protein and calcium averaged higher for partially breast-fed infants than for completely breast-fed infants. However, mean intakes of both groups were below the 1974 Recommended Dietary Allowances, although growth was within normal ranges.