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1.
Clin Chem Lab Med ; 62(3): 421-427, 2024 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-37768854

RESUMEN

OBJECTIVES: To make glomerular filtration rate (GFR) estimating equations applicable across populations with different creatinine generation by using rescaled serum creatinine (sCr/Q) where sCr represents the individual creatinine level and Q the average creatinine value in healthy persons of the same population. METHODS: GFR measurements (mGFR, plasma clearance of 51Cr-EDTA) were conducted in 964 adult Black Europeans. We established the re-expressed Lund-Malmö revised equation (r-LMR) by replacing serum creatinine (sCr) with rescaled creatinine sCr/Q. We evaluated the r-LMR equation based on Q-values of White Europeans (r-LMRQ-white; Q-values females: 62 µmol/L, males: 80 µmol/L) and Black Europeans (r-LMRQ-Black; Q-values females: 65 µmol/L, males: 90 µmol/L), and the European Kidney Function Consortium equation (EKFCQ-White and EKFCQ-Black) regarding bias, precision (interquartile range, IQR) and accuracy (percentage of estimates within ±10 % [P10] and ±30 % [P30] of mGFR). RESULTS: Median bias of r-LMRQ-White/r-LMRQ-Black/EKFCQ-White/EKFCQ-Black were -9.1/-4.5/-6.3/-0.9 mL/min/1.73 m2, IQR 14.7/14.5/14.5/15.6 mL/min/1.73 m2, P10 25.1 %/34.8 %/30.3 %/37.2 % and P30 74.2 %/84.1 %/80.6 %/83.6 %. The improvement of bias and accuracy when using proper Q-values was most pronounced in men. Similar improvements were obtained above and below mGFR 60 mL/min/1.73 m2 and at various age and BMI intervals, except for BMI<20 kg/m2 where bias increased, and accuracy decreased. CONCLUSIONS: GFR estimating equations may be re-expressed to include rescaled creatinine (sCr/Q) and used across populations with different creatinine generation if population-specific average creatinine concentrations (Q-values) for healthy persons are established.


Asunto(s)
Insuficiencia Renal Crónica , Adulto , Masculino , Femenino , Humanos , Tasa de Filtración Glomerular , Creatinina , Cistatina C , África del Sur del Sahara
2.
Biom J ; 66(1): e2300049, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37915123

RESUMEN

During the coronavirus disease 2019 (COVID-19) pandemic, several clinical prognostic scores have been proposed and evaluated in hospitalized patients, relying on variables available at admission. However, capturing data collected from the longitudinal follow-up of patients during hospitalization may improve prediction accuracy of a clinical outcome. To answer this question, 327 patients diagnosed with COVID-19 and hospitalized in an academic French hospital between January and July 2020 are included in the analysis. Up to 59 biomarkers were measured from the patient admission to the time to death or discharge from hospital. We consider a joint model with multiple linear or nonlinear mixed-effects models for biomarkers evolution, and a competing risks model involving subdistribution hazard functions for the risks of death and discharge. The links are modeled by shared random effects, and the selection of the biomarkers is mainly based on the significance of the link between the longitudinal and survival parts. Three biomarkers are retained: the blood neutrophil counts, the arterial pH, and the C-reactive protein. The predictive performances of the model are evaluated with the time-dependent area under the curve (AUC) for different landmark and horizon times, and compared with those obtained from a baseline model that considers only information available at admission. The joint modeling approach helps to improve predictions when sufficient information is available. For landmark 6 days and horizon of 30 days, we obtain AUC [95% CI] 0.73 [0.65, 0.81] and 0.81 [0.73, 0.89] for the baseline and joint model, respectively (p = 0.04). Statistical inference is validated through a simulation study.


Asunto(s)
COVID-19 , Humanos , SARS-CoV-2 , Hospitalización , Biomarcadores , Simulación por Computador
3.
Hypertens Res ; 2024 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-38969804

RESUMEN

Increasing attention has recently been paid to discrepancies between office and ambulatory blood pressure (BP) control in patients with chronic kidney disease (CKD), but information on mechanisms underlying circadian BP variations in CKD remains scarce. We described circadian BP patterns and their predictors in patients with CKD stages 1 to 5 referred for kidney function testing in a French tertiary hospital: 1122 ambulatory BP measurements from 635 participants. Factors associated with daytime and nighttime systolic BP (SBP) as well as with nocturnal SBP dipping (ratio of average nighttime to daytime SBP) were analyzed with linear mixed regression models. Participants (mean age 55 ± 16 years; 36% female, mean GFR 51 ± 22 mL/min/1.73m2) had a mean daytime and nighttime SBP of 130 ± 17 and 118 ± 18 mm Hg, respectively. The prevalence of impaired dipping (nighttime over daytime SBP ratio ≥ 0.9) increased from 32% in CKD stage 1 to 68% in CKD stages 4-5. After multivariable adjustment, measured GFR, diabetes, and sub-Saharan African origin were more strongly associated with nighttime than with daytime SBP, which led to significant associations with altered nocturnal BP dipping. For a 1 SD decrease in measured GFR, nighttime BP was 2.87 mmHg (95%CI, 1.44-4.30) higher and nocturnal SBP dipping ratio was 1.55% higher (95%CI, 0.85-2.26%). In conclusion, the prevalence of impaired nocturnal BP dipping increases substantially across the spectrum of CKD. Along with sub-Saharan African origin and diabetes, lower measured GFR was a robust and specific predictor of higher nighttime BP and blunted nocturnal BP decline.

4.
J Hypertens ; 42(6): 1000-1008, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38647162

RESUMEN

OBJECTIVES: Optimal blood pressure (BP) control is key to prevent cardiovascular complications in patients with chronic kidney disease (CKD). We described the prevalence and factors associated with masked hypertension in CKD. METHODS: We analyzed 1113 ambulatory 24-h BP monitoring (ABPM) records of 632 patients referred for kidney function evaluation. Masked hypertension was defined as office BP less than 140/90 mmHg but daytime BP at least 135/85 mmHg or nighttime BP at least 120/70 mmHg. Factors associated with masked hypertension were assessed with mixed logistic regression models. RESULTS: At inclusion, 424 patients (67%) had controlled office BP, of whom 56% had masked hypertension. In multivariable analysis conducted in all visits with controlled office BP ( n  = 782), masked hypertension was positively associated with male sex [adjusted OR (95% confidence interval) 1.91 (1.16-3.27)], sub-Saharan African origin [2.51 (1.32-4.63)], BMI [1.11 (1.01-1.17) per 1 kg/m 2 ], and albuminuria [1.29 [1.12 - 1.47] per 1 log unit), and was negatively associated with plasma potassium (0.42 [0.29 - 0.71] per 1 mmol/L) and 24-h urinary potassium excretion (0.91 [0.82 - 0.99] per 10 mmol/24 h) as well as the use of renin-angiotensin-aldosterone (RAAS) blockers (0.56 [0.31 - 0.97]) and diuretics (0.41 [0.27 - 0.72]). CONCLUSION: Our findings support the routine use of ABPM in CKD, as more than half of the patients with controlled office BP had masked hypertension. Weight control, higher potassium intake (with caution in advanced CKD), correction of hypokalemia, and larger use of diuretics and RAAS blockers could be potential levers for better out-of-office BP control.


Asunto(s)
Hipertensión Enmascarada , Insuficiencia Renal Crónica , Humanos , Masculino , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Femenino , Persona de Mediana Edad , Hipertensión Enmascarada/epidemiología , Hipertensión Enmascarada/tratamiento farmacológico , Hipertensión Enmascarada/fisiopatología , Prevalencia , Monitoreo Ambulatorio de la Presión Arterial , Anciano , Factores de Riesgo , Presión Sanguínea/efectos de los fármacos , Adulto , Antihipertensivos/uso terapéutico
5.
J Hypertens ; 39(2): 367-375, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33021511

RESUMEN

OBJECTIVE: The role of renin-angiotensin-aldosterone system (RAAS) blockers during the coronavirus disease 2019 (COVID-19) pandemic is a matter of controversies. Studies based on in-hospital exposure have suggested a beneficial effect of these drugs, unlike those based on chronic exposure. We aimed to analyse RAAS blocker prescription before and during hospital stay in patients with COVID-19, and the corresponding outcomes, to explain these discrepant results. METHODS: In a retrospective cohort study conducted in 347 patients hospitalized for COVID-19 (Bichat Hospital, Paris, France, 23 January-29 April 2020), RAAS blocker exposure, as well as timing and reason for treatment modifications, were collected. The association between exposure and mortality within 30 days of hospital admission was analysed using logistic regression analysis adjusted for age, sex, and comorbidities. RESULTS: Median age was 61 [interquartile range, 51-72] years, 209 (60%) were male, 169 (49%) had a history of treated hypertension, and 117 (34%) received a RAAS blocker prior to hospitalization. RAAS blockers were discontinued within the first 7 days of hospital admission in 33% of previously treated patients (mostly driven by severity of the disease), with a corresponding mortality rate of 33%. Mortality was 8% when treatment was maintained or introduced, and 12% in patients never exposed. Adjusted odds ratios for association between exposure and mortality were 0.62 (95% confidence interval 0.25-1.48) based on chronic exposure and 0.25 (0.09-0.65) based on in-hospital exposure. CONCLUSION: A 'healthy user-sick stopper' bias influences RAAS blocker prescription after hospital admission for COVID-19, and explains the seemingly favourable outcome associated with in-hospital treatment.


Asunto(s)
Antagonistas de Receptores de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Tratamiento Farmacológico de COVID-19 , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , COVID-19/mortalidad , Comorbilidad , Femenino , Hospitalización , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Paris , Gravedad del Paciente , Estudios Retrospectivos , SARS-CoV-2
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