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1.
Am J Transplant ; 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31667990

RESUMO

Using 5-years of US organ procurement organization (OPO) data, we determined the cost of recovering a viable (i.e., transplanted) kidney for each of 51 OPOs. We also examined the effects on OPO costs of the recovery of non-viable (i.e., discarded) kidneys and other OPO metrics. Annual cost reports from 51 independent OPOs were used to determine the cost per recovered kidney for each OPO. A quadratic regression model was employed to estimate the relationship between the cost of kidneys and the number of viable kidneys recovered, as well as other OPO performance indicators. The cost of transplanted kidneys at individual OPOs ranged widely from $24,000 to $56,000, and the average was $36,000. The cost of a viable kidney tended to decline with the number of kidneys procured up to 549 kidneys per year and then increase. Of the total 81,401 kidneys recovered, 66,454 were viable and 14,947 (18.4%) were non-viable. The costs of kidneys varied widely over the OPOs studied, and costs were a function of the recovered number of viable and non-viable organs, local cost levels, donation after cardiac death (DCD), year, and Standardized Donor Rate Ratio (SDRR). Cost increases were 3% per year.

2.
Clin Nephrol ; 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31599226

RESUMO

INTRODUCTION: The United States Renal Data System has collected data on incident hemodialysis (HD) and peritoneal dialysis (PD) patients since 1995, allowing prevalence of chronic diseases over the past 20 years to be measured. MATERIALS AND METHODS: All first-time HD/PD patients 1996 - 2015 were analyzed. Diabetes and cardiovascular diseases were grouped into single variables. Prevalence of each condition was evaluated with logistic regression. Odds ratios (OR) for a 5-year difference in year of dialysis initiation were calculated. Models were adjusted for age, sex, and race, with interactions between modality and year. One- and 5-year mortality were calculated. RESULTS: Age increased among 1,847,212 HD and 156,965 PD patients; PD patients were younger. First-year mortality fell from 24.4 to 21.1% in HD patients and from 17.1 to 8.5% in PD. 5-year mortality fell from 65.9 to 58.6% in HD patients and from 56.3 to 40.4% in PD. Hypertension increased (OR = 1.34 for HD, 1.35 for PD), as did diabetes (OR = 1.16 for HD, 1.06 for PD) and cancer (OR = 1.09 for HD, 1.10 for PD). Cardiovascular disease decreased in PD (OR = 0.87) only. Stroke decreased (OR = 0.98 for HD, 0.90 for PD), as did peripheral vascular disease (OR = 0.91 for HD, 0.82 for PD). Lung disease increased in HD (OR = 1.10) but decreased in PD (OR = 0.97). DISCUSSION: Mortality and cardiovascular disease burden have declined for dialysis patients in the United States despite an aging population that is increasingly hypertensive and diabetic. Comorbid disease burdens among HD and PD patients have diverged over time, with PD patients having fewer comorbid conditions.
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3.
Sci Rep ; 9(1): 9439, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31263163

RESUMO

Type 2 diabetes (T2D) affects the health of millions of people worldwide. The identification of genetic determinants associated with changes in glycemia over time might illuminate biological features that precede the development of T2D. Here we conducted a genome-wide association study of longitudinal fasting glucose changes in up to 13,807 non-diabetic individuals of European descent from nine cohorts. Fasting glucose change over time was defined as the slope of the line defined by multiple fasting glucose measurements obtained over up to 14 years of observation. We tested for associations of genetic variants with inverse-normal transformed fasting glucose change over time adjusting for age at baseline, sex, and principal components of genetic variation. We found no genome-wide significant association (P < 5 × 10-8) with fasting glucose change over time. Seven loci previously associated with T2D, fasting glucose or HbA1c were nominally (P < 0.05) associated with fasting glucose change over time. Limited power influences unambiguous interpretation, but these data suggest that genetic effects on fasting glucose change over time are likely to be small. A public version of the data provides a genomic resource to combine with future studies to evaluate shared genetic links with T2D and other metabolic risk traits.

4.
Kidney Int Rep ; 3(5): 1135-1143, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30197980

RESUMO

Introduction: Chronic kidney disease (CKD) is an important noncommunicable disease globally. Overall prevalence of CKD and distribution of its stages differ between countries. We postulate that these differences may not only be due to variation in prevalence of risk factors but also their differential impact in different populations or settings. Methods: We used nationally representative data on the adult populations from both the United States (US; National Health and Nutrition Examination Survey [NHANES], 2009 to 2010, N = 5557) and China (China National Survey of CKD, 2009 to 2010, N = 46,949). Age, sex, central obesity, cardiovascular disease, diabetes, hypertension, and hyperuricemia were explored as candidate risk factors for CKD. The prevalence of CKD was calculated using survey weights. Results: The prevalence of decreased estimated glomerular filtration rate (eGFR), defined as eGFR < 60 ml/min per 1.73 m2, was 6.5% in the US versus 2.7% in China, whereas the prevalence of albuminuria (defined as urine albumin to creatinine ratio of ≥30 mg/g) was 8.1% in the US versus 9.5% in China. The distribution of eGFR categories differed between the countries (P < 0.001). Stronger associations of diabetes with both indicators were seen in the US participants, whereas stronger associations of male sex with both indicators and of hypertension with albuminuria were observed in the Chinese participants (P < 0.05). After multivariable adjustment, a 65% change in prevalence difference for decreased eGFR was seen between China and the US. Conclusion: People in China and the US share many common risk factors for CKD, but differences in prevalence and the potential impact of these risk factors for CKD were observed.

5.
Am J Prev Med ; 53(3): 300-307, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28410862

RESUMO

INTRODUCTION: This study examined state-level variation in chronic kidney disease (CKD) awareness using national estimates of disease awareness among adults in the U.S. with CKD. METHODS: Data on U.S. adults were obtained from two national, population-based surveys: (1) the Behavioral Risk Factor Surveillance System (BRFSS 2011; n=506,467), a state-level phone survey containing information on self-reported kidney disease; and (2) the National Health and Nutrition Examination Survey (NHANES 2005-2012; n=20,831), containing physical health examination, surveys containing data on self-reported kidney disease, risk factors, and laboratory values. CKD was defined as an estimated glomerular filtration rate of 15-59 mL/minute/1.73 m2 or urinary albumin-to-creatinine ratio >30 mg/g. As BRFSS does not include laboratory data, CKD status for each person was imputed (multiple) based on a logistic regression model predicting NHANES CKD status. CKD awareness in each state was estimated as the weighted proportion of BRFSS participants with imputed CKD who reported having kidney disease. RESULTS: Overall, estimated CKD awareness was 9.0% (95% CI=8.0%, 10.0%), ranging from 5.8% (95% CI=4.8%, 6.8%) in Iowa to 11.7% (95% CI=9.7%, 13.7%) in Arizona. Awareness was greater among adults with hypertension (12.0%) and diabetes (15.3%) than among adults without those conditions, and lower in Hispanics (6.0%) than in non-Hispanic whites (8.8%), non-Hispanic blacks (9.9%), and other racial/ethnic groups (12.7%). CONCLUSIONS: Among individuals with CKD, awareness of their condition was very low and varied approximately twofold among states. This is the first study to estimate awareness of kidney disease by state for the U.S. adult population.


Assuntos
Diabetes Mellitus/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Fatores Etários , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Prevalência , Insuficiência Renal Crônica/prevenção & controle , Fatores de Risco , Autorrelato , Estados Unidos/epidemiologia , Adulto Jovem
6.
Nat Commun ; 7: 13357, 2016 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-27876822

RESUMO

Large consortia have revealed hundreds of genetic loci associated with anthropometric traits, one trait at a time. We examined whether genetic variants affect body shape as a composite phenotype that is represented by a combination of anthropometric traits. We developed an approach that calculates averaged PCs (AvPCs) representing body shape derived from six anthropometric traits (body mass index, height, weight, waist and hip circumference, waist-to-hip ratio). The first four AvPCs explain >99% of the variability, are heritable, and associate with cardiometabolic outcomes. We performed genome-wide association analyses for each body shape composite phenotype across 65 studies and meta-analysed summary statistics. We identify six novel loci: LEMD2 and CD47 for AvPC1, RPS6KA5/C14orf159 and GANAB for AvPC3, and ARL15 and ANP32 for AvPC4. Our findings highlight the value of using multiple traits to define complex phenotypes for discovery, which are not captured by single-trait analyses, and may shed light onto new pathways.


Assuntos
Antropometria , Tamanho Corporal , Modelos Genéticos , Análise de Componente Principal , Estudo de Associação Genômica Ampla , Genótipo , Humanos
7.
Ann Intern Med ; 165(7): 473-481, 2016 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-27479614

RESUMO

Background: Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning. Objective: To update trends in CKD prevalence. Design: Repeated cross-sectional study. Setting: NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012. Participants: Adults aged 20 years or older. Measurements: Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m2, estimated with the Chronic Kidney Disease Epidemiology Collaboration equation from calibrated serum creatinine measurements. An expanded definition of CKD also included persons with an eGFR of at least 60 mL/min/1.73 m2 and a 1-time urine albumin-creatinine ratio of at least 30 mg/g. Results: The unadjusted prevalence of stage 3 and 4 CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD that included persons with higher eGFRs and albuminuria. Limitation: Serum creatinine and albuminuria were measured only once in each person. Conclusion: In a reversal of prior trends, there has been no appreciable increase in the prevalence of stage 3 and 4 CKD in the U.S. population overall during the most recent decade. Primary Funding Source: American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, Centers for Disease Control and Prevention, and National Institutes of Health.


Assuntos
Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Insuficiência Renal Crônica/diagnóstico , Fatores de Tempo , Estados Unidos/epidemiologia
9.
Nat Genet ; 48(2): 134-43, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26691988

RESUMO

Advanced age-related macular degeneration (AMD) is the leading cause of blindness in the elderly, with limited therapeutic options. Here we report on a study of >12 million variants, including 163,714 directly genotyped, mostly rare, protein-altering variants. Analyzing 16,144 patients and 17,832 controls, we identify 52 independently associated common and rare variants (P < 5 × 10(-8)) distributed across 34 loci. Although wet and dry AMD subtypes exhibit predominantly shared genetics, we identify the first genetic association signal specific to wet AMD, near MMP9 (difference P value = 4.1 × 10(-10)). Very rare coding variants (frequency <0.1%) in CFH, CFI and TIMP3 suggest causal roles for these genes, as does a splice variant in SLC16A8. Our results support the hypothesis that rare coding variants can pinpoint causal genes within known genetic loci and illustrate that applying the approach systematically to detect new loci requires extremely large sample sizes.


Assuntos
Estudo de Associação Genômica Ampla , Degeneração Macular/genética , Predisposição Genética para Doença , Humanos , Mutação
10.
PLoS Genet ; 11(10): e1005378, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26426971

RESUMO

Genome-wide association studies (GWAS) have identified more than 100 genetic variants contributing to BMI, a measure of body size, or waist-to-hip ratio (adjusted for BMI, WHRadjBMI), a measure of body shape. Body size and shape change as people grow older and these changes differ substantially between men and women. To systematically screen for age- and/or sex-specific effects of genetic variants on BMI and WHRadjBMI, we performed meta-analyses of 114 studies (up to 320,485 individuals of European descent) with genome-wide chip and/or Metabochip data by the Genetic Investigation of Anthropometric Traits (GIANT) Consortium. Each study tested the association of up to ~2.8M SNPs with BMI and WHRadjBMI in four strata (men ≤50y, men >50y, women ≤50y, women >50y) and summary statistics were combined in stratum-specific meta-analyses. We then screened for variants that showed age-specific effects (G x AGE), sex-specific effects (G x SEX) or age-specific effects that differed between men and women (G x AGE x SEX). For BMI, we identified 15 loci (11 previously established for main effects, four novel) that showed significant (FDR<5%) age-specific effects, of which 11 had larger effects in younger (<50y) than in older adults (≥50y). No sex-dependent effects were identified for BMI. For WHRadjBMI, we identified 44 loci (27 previously established for main effects, 17 novel) with sex-specific effects, of which 28 showed larger effects in women than in men, five showed larger effects in men than in women, and 11 showed opposite effects between sexes. No age-dependent effects were identified for WHRadjBMI. This is the first genome-wide interaction meta-analysis to report convincing evidence of age-dependent genetic effects on BMI. In addition, we confirm the sex-specificity of genetic effects on WHRadjBMI. These results may provide further insights into the biology that underlies weight change with age or the sexually dimorphism of body shape.


Assuntos
Índice de Massa Corporal , Tamanho Corporal/genética , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Adulto , Fatores Etários , Idoso , Mapeamento Cromossômico , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Caracteres Sexuais , Relação Cintura-Quadril
11.
Nature ; 518(7538): 187-196, 2015 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-25673412

RESUMO

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms.


Assuntos
Tecido Adiposo/metabolismo , Distribuição da Gordura Corporal , Estudo de Associação Genômica Ampla , Insulina/metabolismo , Locos de Características Quantitativas/genética , Adipócitos/metabolismo , Adipogenia/genética , Fatores Etários , Índice de Massa Corporal , Grupos de Populações Continentais/genética , Epigênese Genética , Europa (Continente)/etnologia , Feminino , Genoma Humano/genética , Humanos , Resistência à Insulina/genética , Masculino , Modelos Biológicos , Neovascularização Fisiológica/genética , Obesidade/genética , Polimorfismo de Nucleotídeo Único/genética , Caracteres Sexuais , Transcrição Genética/genética , Relação Cintura-Quadril
12.
Nature ; 518(7538): 197-206, 2015 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-25673413

RESUMO

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.


Assuntos
Índice de Massa Corporal , Estudo de Associação Genômica Ampla , Obesidade/genética , Obesidade/metabolismo , Adipogenia/genética , Adiposidade/genética , Fatores Etários , Grupos de Populações Continentais/genética , Metabolismo Energético/genética , Europa (Continente)/etnologia , Feminino , Predisposição Genética para Doença/genética , Ácido Glutâmico/metabolismo , Humanos , Insulina/metabolismo , Masculino , Polimorfismo de Nucleotídeo Único/genética , Locos de Características Quantitativas/genética , Sinapses/metabolismo
13.
Am J Hum Genet ; 95(1): 24-38, 2014 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-24954895

RESUMO

Although age-dependent effects on blood pressure (BP) have been reported, they have not been systematically investigated in large-scale genome-wide association studies (GWASs). We leveraged the infrastructure of three well-established consortia (CHARGE, GBPgen, and ICBP) and a nonstandard approach (age stratification and metaregression) to conduct a genome-wide search of common variants with age-dependent effects on systolic (SBP), diastolic (DBP), mean arterial (MAP), and pulse (PP) pressure. In a two-staged design using 99,241 individuals of European ancestry, we identified 20 genome-wide significant (p ≤ 5 × 10(-8)) loci by using joint tests of the SNP main effect and SNP-age interaction. Nine of the significant loci demonstrated nominal evidence of age-dependent effects on BP by tests of the interactions alone. Index SNPs in the EHBP1L1 (DBP and MAP), CASZ1 (SBP and MAP), and GOSR2 (PP) loci exhibited the largest age interactions, with opposite directions of effect in the young versus the old. The changes in the genetic effects over time were small but nonnegligible (up to 1.58 mm Hg over 60 years). The EHBP1L1 locus was discovered through gene-age interactions only in whites but had DBP main effects replicated (p = 8.3 × 10(-4)) in 8,682 Asians from Singapore, indicating potential interethnic heterogeneity. A secondary analysis revealed 22 loci with evidence of age-specific effects (e.g., only in 20 to 29-year-olds). Age can be used to select samples with larger genetic effect sizes and more homogenous phenotypes, which may increase statistical power. Age-dependent effects identified through novel statistical approaches can provide insight into the biology and temporal regulation underlying BP associations.


Assuntos
Fatores Etários , Pressão Sanguínea/genética , Adolescente , Adulto , Idoso , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Adulto Jovem
14.
Nat Genet ; 45(11): 1345-52, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24097064

RESUMO

Triglycerides are transported in plasma by specific triglyceride-rich lipoproteins; in epidemiological studies, increased triglyceride levels correlate with higher risk for coronary artery disease (CAD). However, it is unclear whether this association reflects causal processes. We used 185 common variants recently mapped for plasma lipids (P < 5 × 10(-8) for each) to examine the role of triglycerides in risk for CAD. First, we highlight loci associated with both low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, and we show that the direction and magnitude of the associations with both traits are factors in determining CAD risk. Second, we consider loci with only a strong association with triglycerides and show that these loci are also associated with CAD. Finally, in a model accounting for effects on LDL-C and/or high-density lipoprotein cholesterol (HDL-C) levels, the strength of a polymorphism's effect on triglyceride levels is correlated with the magnitude of its effect on CAD risk. These results suggest that triglyceride-rich lipoproteins causally influence risk for CAD.


Assuntos
HDL-Colesterol/genética , LDL-Colesterol/genética , Doença da Artéria Coronariana/sangue , Triglicerídeos/sangue , Triglicerídeos/genética , Transporte Biológico , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/genética , Humanos , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Triglicerídeos/metabolismo
15.
Nat Genet ; 45(11): 1274-1283, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24097068

RESUMO

Levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and total cholesterol are heritable, modifiable risk factors for coronary artery disease. To identify new loci and refine known loci influencing these lipids, we examined 188,577 individuals using genome-wide and custom genotyping arrays. We identify and annotate 157 loci associated with lipid levels at P < 5 × 10(-8), including 62 loci not previously associated with lipid levels in humans. Using dense genotyping in individuals of European, East Asian, South Asian and African ancestry, we narrow association signals in 12 loci. We find that loci associated with blood lipid levels are often associated with cardiovascular and metabolic traits, including coronary artery disease, type 2 diabetes, blood pressure, waist-hip ratio and body mass index. Our results demonstrate the value of using genetic data from individuals of diverse ancestry and provide insights into the biological mechanisms regulating blood lipids to guide future genetic, biological and therapeutic research.


Assuntos
Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/genética , Lipídeos/sangue , Lipídeos/genética , Grupo com Ancestrais do Continente Africano/genética , Grupo com Ancestrais do Continente Asiático/genética , HDL-Colesterol/sangue , HDL-Colesterol/genética , LDL-Colesterol/sangue , LDL-Colesterol/genética , Grupo com Ancestrais do Continente Europeu/genética , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Triglicerídeos/sangue , Triglicerídeos/genética
16.
Nat Genet ; 45(5): 501-12, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23563607

RESUMO

Approaches exploiting trait distribution extremes may be used to identify loci associated with common traits, but it is unknown whether these loci are generalizable to the broader population. In a genome-wide search for loci associated with the upper versus the lower 5th percentiles of body mass index, height and waist-to-hip ratio, as well as clinical classes of obesity, including up to 263,407 individuals of European ancestry, we identified 4 new loci (IGFBP4, H6PD, RSRC1 and PPP2R2A) influencing height detected in the distribution tails and 7 new loci (HNF4G, RPTOR, GNAT2, MRPS33P4, ADCY9, HS6ST3 and ZZZ3) for clinical classes of obesity. Further, we find a large overlap in genetic structure and the distribution of variants between traits based on extremes and the general population and little etiological heterogeneity between obesity subgroups.


Assuntos
Antropometria , Estatura/genética , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Obesidade/genética , Polimorfismo de Nucleotídeo Único/genética , Locos de Características Quantitativas , Índice de Massa Corporal , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu/genética , Genótipo , Humanos , Metanálise como Assunto , Fenótipo , Relação Cintura-Quadril
17.
Am J Cardiol ; 111(7): 1034-9, 2013 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-23340032

RESUMO

The clinical expression of hypertrophic cardiomyopathy (HC) is undoubtedly influenced by modifying genetic and environmental factors. Lifestyle practices such as tobacco and alcohol use, poor nutritional intake, and physical inactivity are strongly associated with adverse cardiovascular outcomes and increased mortality in the general population. Before addressing the direct effect of such modifiable factors on the natural history of HC, it is critical to define their prevalence in this population. A voluntary survey, drawing questions in part from the 2007 to 2008 National Health and Nutrition Examination Survey (NHANES), was posted on the HC Association website and administered to patients with HC at the University of Michigan. Propensity score matching to NHANES participants was used. Dichotomous and continuous health behaviors were analyzed using logistic and linear regression, respectively, and adjusted for body mass index and propensity score quintile. Compared to the matched NHANES participants, the patients with HC reported significantly less alcohol and tobacco use but also less time engaged in physical activity at work and for leisure. Time spent participating in vigorous or moderate activity was a strong predictor of self-reported exercise capacity. The body mass index was greater in the HC cohort than in the NHANES cohort. Exercise restrictions negatively affected emotional well-being in most surveyed subjects. In conclusion, patients with HC are less active than the general United States population. The well-established relation of inactivity, obesity, and cardiovascular mortality might be exaggerated in patients with HC. More data are needed on exercise in those with HC to strike a balance between acute risks and the long-term health benefits of exercise.


Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Atividade Motora/fisiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Cardiomiopatia Hipertrófica/epidemiologia , Feminino , Humanos , Estilo de Vida , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Pontuação de Propensão , Análise de Regressão , Fumar/epidemiologia
18.
Kidney Int ; 81(11): 1108-15, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22297673

RESUMO

The risk of death for hemodialysis patients is thought to be highest on the days following the longest interval without dialysis (usually Mondays and Tuesdays); however, existing results are inconclusive. To clarify this we analyzed Dialysis Outcomes and Practice Patterns Study (DOPPS) data of 22,163 hemodialysis patients from the United States, Europe, and Japan. Our study focused on the association between dialysis schedule and day of the week of all-cause, cardiovascular, and noncardiovascular mortality with day-of-week coded as a time-dependent covariate. The models were adjusted for dialysis schedule, age, country, DOPPS phase I or II, and other demographic and clinical covariates, and compared mortality on each day to the 7-day average. Patients on a Monday-Wednesday-Friday (MWF) schedule had elevated all-cause mortality on Mondays, and those on a Tuesday-Thursday-Saturday (TTS) schedule had increased risk of mortality on Tuesdays in all three regions. The association between day-of-week mortality and schedule was generally stronger for cardiovascular than noncardiovascular mortality, and was most pronounced in the United States. Unexpectedly, Japanese patients on a MWF schedule had a higher risk of noncardiovascular mortality on Fridays, and European patients on a TTS schedule experienced an elevated cardiovascular mortality on Saturdays. Thus, future studies are needed to evaluate the influence of practice patterns on schedule-specific mortality and factors that could modulate this effect.


Assuntos
Nefropatias/mortalidade , Nefropatias/terapia , Avaliação de Processos e Resultados (Cuidados de Saúde) , Padrões de Prática Médica/estatística & dados numéricos , Diálise Renal/mortalidade , Idoso , Causas de Morte , Europa (Continente)/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Nephrol Dial Transplant ; 27(5): 2107-13, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22058174

RESUMO

BACKGROUND: Psychosocial factors are associated with clinical outcomes in patients with end-stage renal disease. It is not known if self-reported depression and quality of life influence the likelihood of being wait-listed and receiving a transplant. METHODS: Prevalent cross section of 18- to 65-year-old hemodialysis (HD) patients in the USA (N = 2033) and seven European countries (N = 4350) from the Dialysis Outcomes and Practice Patterns Study phase II and III was analyzed. Wait-listed patients (N = 1838) were followed until kidney transplantation. Self-reported depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression scale, 10-item version (CES-D) and health-related quality of life (HR-QoL) by the Kidney Disease Quality of Life Short Form 12 scale Physical Component Score (PCS). RESULTS: At study entry, 27% (USA) to 53% (UK) of patients were wait-listed in participating countries. Variables associated with lower odds of being on the waiting list included worse HR-QoL, more severe depressive symptoms, older age, fewer years of education, lower serum albumin, lower hemoglobin, shorter time on dialysis and presence of multiple comorbid conditions. Among wait-listed patients, significantly lower transplantation rates were seen for females, blacks, patients having prior transplantation and multiple comorbid conditions but not PCS or CES-D. CONCLUSIONS: Fewer depressive symptoms and better HR-QoL are associated with being on the waiting list in prevalent HD patients but not with receiving a kidney transplant among wait-listed dialysis patients. Regular assessment of subjective well-being may help identify patients with reduced access to wait-listing and kidney transplantation.


Assuntos
Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Transplante de Rim , Diálise Renal , Listas de Espera , Adolescente , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Europa (Continente) , Feminino , Seguimentos , Humanos , Incidência , Falência Renal Crônica/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psicologia , Qualidade de Vida/psicologia , Autorrelato , Estados Unidos , Adulto Jovem
20.
Hemodial Int ; 16(2): 242-51, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22151183

RESUMO

There is variable emphasis on dialysis-specific training among US nephrology fellowship programs. Our study objective was to determine the association between nephrology training experience and subsequent clinical practice. We conducted a national survey of clinical nephrologists using a fax-back survey distributed between March 8, 2010 and April 30, 2010 (N = 629). The survey assessed the time distribution of clinical practice, self-assessment of preparedness to provide care for dialysis patients at the time of certification examination, distribution of dialysis modality among patients, and nephrologists' choice of dialysis modality for themselves if their kidneys failed. While respondents spent 28% of their time caring for dialysis patients, 38% recalled not feeling very well prepared to care for dialysis patients when taking the nephrology certification examination. Sixteen percent obtained additional dialysis training after fellowship completion. Only 8% of US dialysis patients use home dialysis; physicians very well prepared to care for dialysis patients at the time of certification or who obtained additional dialysis training were significantly more likely to provide care to home peritoneal dialysis patients. Even though 92% of US dialysis patients receive thrice weekly in-center hemodialysis, only 6% of nephrologists selected this for themselves; selection of therapy for self was associated with dialysis modalities used by their patients. Nephrology training programs need to ensure that all trainees are very well prepared to care for dialysis patients, as this is central to nephrology practice. Utilization of dialysis therapies other than standard hemodialysis is dependent, in part, on training experience.


Assuntos
Falência Renal Crônica/terapia , Nefrologia/educação , Padrões de Prática Médica , Diálise Renal , Coleta de Dados , Feminino , Humanos , Masculino , Médicos , Inquéritos e Questionários
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