Impact of diabetes on healthcare utilization and expenditure among older adults in India.

Background and aims: The present study aims to investigate the disparities in healthcare utilization and healthcare burden among individuals with and without diabetes. The prevalence of diabetes is more pronounced among older adults, which can detrimentally influence their health and quality of life while also restricting their capacity to self-manage and giving rise to competing healthcare demands. Thus, it is crucial to understand the implications of diabetes on healthcare demands and expenditures to mitigate its detrimental consequences. Methods: Data was used from the initial round of the Longitudinal Aging Study in India (LASI), conducted in 2017-18. The analytical sample included 65,562 individuals aged 45 or above, and 8429 individuals were identified as having diabetes. The primary outcome variable was the out-of-pocket expenditure (OOPE) in the most recent hospitalization. Descriptive statistics and logistic regression are used to find the trend in the prevalence of morbidities both in diabetic and nondiabetic groups. Additionally, quantile regression was used to study the association between the presence of diabetes and the risk of excess healthcare expenditure calculated through out-of-pocket expenditure for hospitalization and expenditure on medicines. Results: 16% of people with diabetes were hospitalized in the past year, compared to 9% without diabetes. The mean hospitalization length for diabetics was 13.6 days, compared to 6.5 for nondiabetics. Diabetes is significantly associated with higher OOPE for hospitalization across all quintiles, and its effect on hospitalization is weakest in the highest quintile. Having diabetes is also found to be significantly associated with the expenditure on medicines across all quintiles. Conclusion: The study highlights the need for diabetes awareness programs and interventions integrated into national health policies. The quantile regression model provides crucial insights into the association between diabetes and OOPE for hospitalization and medicine The increase of OOPE for hospitalisation and medicine due to the presence of diabetes emphasizes the need to address the financial burden faced by people with diabetes, highlighting the urgency of prioritizing measures to improve access to affordable care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01319-w.

Nocturnal dosing and chronic kidney disease progression: new insights.

PURPOSE OF REVIEW: Several studies have identified the presence of altered diurnal blood pressure patterns, specifically elevated nighttime blood pressure in patients with chronic kidney disease. The lack of nocturnal decline in blood pressure is associated with markers of hypertensive target organ damage and predictive of long-term clinical outcomes. The purpose of this review is to summarize the literature in this area and explore the potential for use of nighttime blood pressure for improving risk stratification and as a therapeutic target. RECENT FINDINGS: The mechanisms of persistent elevation of blood pressure at night in chronic kidney disease are likely to be multifactorial, including altered sodium handling and sympathetic activation among others. Elevated nocturnal blood pressures have been shown to be associated with increased adverse clinical outcomes. Recent studies demonstrate that it is feasible to lower nocturnal blood pressure by modifying the time of administration of antihypertensive medications. SUMMARY: Currently, clinical blood pressure measurements are assessed and targeted for drug therapy. This article shows the importance of measuring ambulatory blood pressures, specifically nocturnal blood pressures to improve risk stratification. More research needs to be done to identify interventions that lower nighttime blood pressure, and test their efficacy in improving clinical outcomes.

Genomic structure and regulation of the rat hepatic CYP4F1 gene by peroxisome proliferators.

The rat hepatic gene CYP4F1 encodes a fatty acid omega hydroxylase P450 that metabolizes proinflammatory eicosanoids and long-chain fatty acids. We have completely sequenced the CYP4F1 gene (Accession Nos. AF200361 and AF181083), identified multiple transcription start sites, and characterized a strong core promoter region, -760/116, induced by retinoic acids and peroxisome proliferators in rat hepatoma McA-RH7777 cells. Three peroxisome proliferator responsive elements (PPRE) bind both PPARalpha/RXRalpha and HNF4alpha. Co-transfection of McA-RH7777 cells with the -760/116 reporter construct and PPARalpha/RXRalpha or HNF4alpha showed that HNF4alpha activated while PPARalpha/RXRalpha inhibited CYP4F1 promoter activity. Treating cells with Wy14,643 reversed all initial effects, indicating co-regulation of CYP4F1 gene transcription by PPARalpha/RXRalpha and HNF4alpha. Chromatin immunoprecipitation analysis of cells treated with Wy14,643 showed association of PPARalpha/RXRalpha with the active transcription of the CYP4F1 gene while in clofibrate treated rats HNF4alpha binds during gene repression, suggesting differential regulation of the CYP4F1 gene in vivo and in cell lines.

A simple tool to predict end-stage renal disease within 1 year in elderly adults with advanced chronic kidney disease.

OBJECTIVES: To develop and validate a model to predict 1-year risk of end-stage renal disease (ESRD) in elderly subjects with advanced chronic kidney disease (CKD). DESIGN: Retrospective. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Individuals aged 65 and older with CKD with an estimated glomerular filtration rate (eGFR) less than 30 mL/min per 1.73 m(2) . MEASUREMENTS: The outcome was ESRD within 1 year of the index eGFR. Cox regression was used to develop a predictive model (Veterans Affairs (VA) risk score) that was validated in a separate cohort. RESULTS: Of the 1,866 participants in the developmental cohort, 77 developed ESRD. Risk factors for ESRD in the final model were age, congestive heart failure, systolic blood pressure, eGFR, potassium, and albumin. In the validation cohort, the C index for the VA risk score was 0.823. The risk for developing ESRD at 1 year from lowest to highest tertile was 0.08%, 2.7%, and 11.3% (P < .001). The C-index for the recently published Tangri model in the validation cohort was 0.780. CONCLUSION: A new model using commonly available clinical measures shows excellent ability to predict the onset of ESRD within the next year in elderly adults. The Tangri model also had good predictive ability. Individuals and physicians can use these risk models to inform decisions regarding preparation for renal replacement therapy in individuals with advanced CKD.