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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 55(1): 176-182, 2024 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-38322533

RESUMO

Objective: To analyze the prevalence of hyperuricemia (HUA) among the Tibetan population in Nagqu City, Tibet and to uncover the relevant influencing factors. Methods: From July 2020 to August 2021, 763 Tibetan natives from Bangor County (specifically Xinji Township and Jiaqiong Township) and Seni District (specificially Sexiong Township), Nagqu City were investigated by multi-stage cluster random sampling method and the prevalence of HUA was studied by retrospective analysis. Chi-square test and multiple logistic regression were used to analyze the influencing factors of HUA prevalence. Results: The overall prevalence of HUA among the Tibetan population in the three townships of Nagqu City was 19.66% (150/763). In particular, the prevalence in men was 35.00%, while that in women was 8.58%, showing significant difference (P<0.05). According to the results of univariate analysis, there were significant differences in the distribution of sex, abnormal liver function, abnormal hemoglobin, hyperlipidemia, high level of low-density lipoprotein, hypertriglyceridemia, hypercholesterolemia, abnormal creatinine, hyperhomocysteinemia, obesity, and hypertension between HUA and non-HUA patients (P<0.05). Multiple logistic regression showed that female sex (odds ratio [OR]=0.195, 95% confidence interval [CI]: 0.120-0.315) was a protective factor for HUA, while abnormal liver function (OR=2.812, 95% CI: 1.685-4.692), abnormal creatinine (OR=7.374, 95% CI: 1.446-37.620), high level of low-density lipoprotein (OR=2.357, 95% CI: 1.011-5.492), and hyperlipidemia (OR=3.056, 95% CI: 1.886-4.951) were independent risk factors. Conclusion: The prevalence of HUA is relatively high in Nagqu city and the prevalence of HUA is much higher in men than that in women. Male sex, abnormal liver function, abnormal creatinine, elevated low-density lipoprotein, and hyperlipidemia may be the risk factors for HUA in the local Tibetan population.


Assuntos
Hiperlipidemias , Hiperuricemia , Humanos , Masculino , Feminino , Hiperuricemia/epidemiologia , Tibet , Estudos Retrospectivos , Creatinina , Ácido Úrico , Fatores de Risco , Lipoproteínas LDL , Prevalência , China/epidemiologia
2.
Transpl Int ; 37: 12192, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38328616

RESUMO

Pneumocystis pneumonia (PcP) remains life-threatening in kidney transplant recipients (KTR). Our study investigated risk factors one-year before PcP. We conducted a monocentric, case-control study including all KTR at the Dijon University Hospital (France) with a diagnosis of PcP between 2005 and 2022 (cases), and matched control KTR with no history of PcP (3 controls/case). Among all 1,135 KTR, 57 cases (5%) and 169 matched-controls were included. PcP was associated with 18% mortality. Compared to controls, cases were older, with a higher immunological risk, and CMV infection was more frequent in the year preceding the occurrence of PcP (23% vs. 4%; p < 0.001). As early as 1 year before PcP, lymphocyte counts were lower and serum creatinine levels were higher in cases, but immunosuppressive regimens were not significantly different. Multivariable analysis identified lymphocyte count, serum creatinine level, being treated by immunosuppressive therapy other than anti-rejection drugs, and CMV infection in the year preceding the time PcP as independently associated with the occurrence of PcP. PcP was associated with an increased risk of subsequent chronic rejection (27% vs. 3%; p = 0.001) and return to dialysis (20% vs. 3%; p = 0.002). The occurrence of CMV infection and a low lymphocyte count could redefine the indications for continuation or reinitiation of anti-Pneumocystis prophylaxis.


Assuntos
Infecções por Citomegalovirus , Transplante de Rim , Linfopenia , Pneumocystis carinii , Pneumonia por Pneumocystis , Trombocitopenia , Humanos , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/tratamento farmacológico , Estudos de Casos e Controles , Transplante de Rim/efeitos adversos , Creatinina , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Fatores de Risco , Linfopenia/complicações , Trombocitopenia/complicações , Transplantados , Estudos Retrospectivos
3.
Sci Rep ; 14(1): 2761, 2024 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-38307949

RESUMO

Resistance training is an exercise against resistance designed to train the endurance and strength of muscle. To observe the effect of intervention of periodic resistance training on obese patients with type 2 diabetic nephropathy. A total of 60 obese patients with type 2 diabetic nephropathy were randomized into resistance training group and aerobic exercise group (30 patients each group) for observing the changes of blood glucose, body weight, blood lipid, insulin resistance, serum creatinine (Scr), urinary microalbumin, urinary albumin excretion rate (UAER) calculated by urinary creatinine, and glomerular filtration rate (GFR) after 12 weeks of intervention, and relevant significance as well. The number of patients with hypoglycemia during the intervention was also recorded. After 12 weeks of intervention, the weight, Body mass index (BMI), Waist, Triglyceride (TG), Cholesterol (TC), Low-density lipoprotein cholesterol (LDL), Fasting glucose (FBG), Fasting insulin (FINS), Glycosylated hemoglobin (HbA1c) and urine Albumin-Creatinine Ratio (uACR) were decreased and GFR was increased in both groups (P < 0.05), but the effect was more significant in the resistance training group. GFR was increased from 92.21 ± 10.67 mL/(min·1.73 m2) to 100.13 ± 12.99 mL/(min·1.73 m2) in resistance training group (P < 0.05). In the aerobic exercise group, GFR was increased from 89.98 ± 9.48 mL/(min·1.73 m2) to 92.51 ± 11.35 mL/(min·1.73 m2) (P > 0.05). Periodic resistance training can not only control the weight, blood sugar and blood lipid of obese patients with type 2 diabetic nephropathy, but also improve the urinary albumin excretion rate and glomerular filtration rate of early obese patients with type 2 diabetic nephropathy, and delay the progression of diabetic nephropathy. It is an effective non-drug intervention.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Treinamento de Força , Humanos , Creatinina , Obesidade/complicações , Obesidade/terapia , Glicemia , Colesterol , Lipídeos , Diabetes Mellitus Tipo 2/complicações , Albuminas
4.
BMC Cardiovasc Disord ; 24(1): 87, 2024 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-38310219

RESUMO

BACKGROUND: The Shock Index Creatinine (SIC) scoring is a recently developed tool for risk stratification patients. These updated scoring was already used in ST-Elevation Myocardial Infarction (STEMI) patients. However its utility in predicting outcomes for patients with Acute Coronary Syndrome (ACS) remains unclear. This study aims to evaluate and update the current SIC score to predict in-hospital mortality among patients with ACS. PATIENTS AND METHODS: A retrospective cohort, Single-centered study enrolled 1349 ACS patients aged ≥ 18 years old diagnosed with ACS was conducted between January 2018 to January 2022 who met for inclusion and exclusion criteria. Study subjects were analyzed for in-hospital mortality and evaluated using binary linear regression analysis. The area under the curve (AUC) of SIC score was obtain to predict the sensitivity and specificity. RESULTS: Multivariate analysis showed that SIC score was significantly associated with in-hospital mortality. High SIC score (SIC ≥ 25) had significantly higher in-hospital mortality (p < 0.001) with odds ratio for (95% CIs) were 2.655 (1.6-4.31). Receiver operating characteristics (ROC) curve analysis determine the predictive power of SIC score for in-hospital mortality. SIC had an acceptable predictive value for in-hospital mortality (AUC = 0.789, 95% CI: 0.748-0.831, p < 0.001). The SIC score for sensitivity and specificity were, respectively, 71.5% and 74.4%, with optimal cutoff of SIC ≥ 25. CONCLUSION: SIC had acceptable predictive value for in-hospital mortality in patients with all ACS spectrums. SIC was a useful parameter for predicting in-hospital mortality, particularly with a score ≥ 25. This is the first study to evaluate SIC in all spectrums of ACS.


Assuntos
Síndrome Coronariana Aguda , Humanos , Adolescente , Medição de Risco , Fatores de Risco , Creatinina , Estudos Retrospectivos , Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar , Prognóstico
5.
Iran J Kidney Dis ; 1(1): 27-35, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38308548

RESUMO

INTRODUCTION: This study was an attempt to detect the relationship between chronic kidney disease (CKD) and anthropometric indices in presence of confounding variables. METHODS: A cross-sectional study of 3375 participants was designed in Isfahan city. Waist-height ratio (WHtR), waist-hip ratio (WHR), body mass index (BMI) and waist circumference (WC) were measured. Participants were divided into CKD and non-CKD groups according to the calculated albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Then, the groups were subdivided into sub-groups of high and normal anthropometric indices. RESULTS: To evaluate CKD in relation to anthropometric indices, odds ratio was calculated; in the female group, no association was observed (P ˃ .05). However, in the male group high levels of WHtR and BMI were associated with CKD (P value of .002 and .015, respectively). To evaluate the association between ACR and eGFR with anthropometric indices linear regression analysis was performed. There was no significant relation between ACR and eGFR with anthropometric indices in both sexes in a fully adjusted state (P ˃ .05). CONCLUSION: High WHtR and BMI probably are associated with CKD in male. WHR and WC have no relation to the occurrence of CKD. There are no significant changes in regard to ACR and eGFR.  DOI: 10.52547/ijkd.7685.


Assuntos
Insuficiência Renal Crônica , Humanos , Masculino , Feminino , Taxa de Filtração Glomerular , Creatinina , Estudos Transversais , Índice de Massa Corporal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Albuminas , Fatores de Risco
6.
Clin Chem ; 70(2): 382-391, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38321881

RESUMO

BACKGROUND: Measurement of urine albumin is critical for diagnosis, risk classification, and monitoring of chronic kidney disease (CKD). Guidelines recommend clinical decision cutoffs for the urine albumin-to-creatinine ratio (ACR) of 30 and 300 mg/g (3 and 30 mg/mmol). However, differences among manufacturers' routine urine albumin measurement procedures have been found to exceed 40%, suggesting CKD diagnosis and risk classification may vary depending upon the specific measurement procedure implemented in the laboratory. CONTENT: This review discusses urine albumin pathophysiology and clinical practice guideline recommendations for CKD. The review also provides recommendations for urine specimen collection and storage, and results reporting for the ACR. Recent advances in measurement techniques and development of reference systems intended to facilitate standardization of urine albumin measurements are reviewed. SUMMARY: Urine albumin is an important measurement procedure used for diagnosis, risk classification, and management of CKD. Urine albumin results should be reported as the ACR using quantitative measurement procedures. Random urine collections used for albuminuria screening should be followed by confirmation with first morning void collections to reduce variation and increase diagnostic accuracy for urine albumin measurement. Most measurement procedures utilize immunoturbidimetric or immunonephelometric techniques. However, results vary significantly among measurement procedures, potentially resulting in differences in classification or risk assessment for CKD. The National Institute for Standards and Technology (NIST) and other laboratories are developing reference systems, including liquid chromatography-tandem mass spectrometry candidate reference measurement procedures and reference materials, to enable standardization of routine measurement procedures.


Assuntos
Insuficiência Renal Crônica , Urinálise , Humanos , Creatinina/urina , Albuminúria/urina , Insuficiência Renal Crônica/diagnóstico , Albuminas/análise
7.
Pediatr Int ; 66(1): e15722, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38299706

RESUMO

BACKGROUND: The urine protein to creatinine ratio (UPCR) correlates well with the 24-h urine protein test (24-h UPT) and is a reliable indicator of proteinuria. However, in nephrotic syndrome, the correlation between the UPCR and the 24-h UPT tends to decrease. To address this, we introduced the fractional excretion of total protein (FETP), which reflects serum total protein and creatinine levels because severe hypoproteinemia and/or elevated serum creatinine levels tend to occur under these conditions. The 24-h UPT corrected for body surface area (BSA) (24-h UPT/BSA) was used to take body size into consideration. The correlation coefficients for 24-h UPT/BSA and FETP and 24-h UPT/BSA and UPCR were calculated. The statistical significance of the differences between these coefficients was also calculated. METHODS: Thirty-six pediatric patients with nephrotic syndrome were included in this study. The FETP was calculated as total protein clearance/creatinine clearance (%). Correlation coefficients were calculated for 24-h UPT/BSA and FETP and 24-h UPT/BSA and UPCR. The statistical significance of the differences between these coefficients was also calculated. RESULTS: The mean ± standard error of FETP was 0.11% ± 0.013%. The correlation coefficients of FETP and UPCR with 24-h UPT/BSA were 0.91 and 0.81, respectively. The FETP demonstrated a significantly stronger correlation with 24-h UPT/BSA than with UPCR (p = 0.01). CONCLUSIONS: The FETP correlated more strongly with 24-h UPT/BSA than with UPCR in patients with nephrotic syndrome. The FETP is a reliable indicator of proteinuria in nephrotic syndrome, especially in patients with severe hypoproteinemia or elevated serum creatinine levels.


Assuntos
Hipoproteinemia , Síndrome Nefrótica , Humanos , Criança , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/urina , Creatinina/urina , Proteinúria/diagnóstico , Proteinúria/urina , Urinálise
8.
Mikrochim Acta ; 191(3): 128, 2024 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-38334814

RESUMO

A paper-based analytical device (PAD) with an integrated composite electrode has been designed and fabricated for non-enzymatic creatinine sensing. Reduced graphene oxide (rGO) was employed to modify the PAD so that it could function as a solid-contact transducer. A new macrocyclic pyrido-hexapeptide derivative was made and used as a special ionophore in the creatinine membrane sensor. The synthesized PAD showed a detection limit of 1.0 µM (S/N = 3) and a potentiometric response towards creatinine throughout a log-linear range of 2.0 µM-10 mM (R2 = 0.9998). The sensor shows significant selectivity for a few related substances, including ephedrine, codeine, ketamine, caffeine, urea, urate, carbinoxamine, and dextromethorphan. It has been established that the testing method is appropriate for the direct potentiometric detection of creatinine in a variety of human urine sample types. When an indicating electrode and a reference electrode are put on the same flexible disposable, this lets applications with a small sample volume be done. For point-of-care creatinine measurement, the developed paper-based analytical equipment is a good choice because it is affordable, easily accessible, and self-pumping (especially when combined with potentiometric detection).


Assuntos
Urinálise , Humanos , Creatinina , Potenciometria , Eletrodos
9.
J Coll Physicians Surg Pak ; 34(2): 151-155, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38342863

RESUMO

OBJECTIVE: To determine the frequency of parenteral Acyclovir-induced Acute Kidney Injury (AKI) in patients with viral encephalitis. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Neurology, Liaquat National Hospital, Karachi, from January to December 2021. METHODOLOGY: A total of 89 suspected and proven cases of encephalitis receiving IV Acyclovir were collated. All had extensive medical histories and underwent CSF studies with +/- brain imaging. CSF routine and viral PCR were done. Acyclovir-induced AKI was defined as a rise in serum creatinine of >0.3 mg/dl in 48 h or by ≥1.5 times the baseline value, and its severity was staged into 1 (risk), 2 (injury), and 3 (failure) according to the KDIGO guidelines (Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group, 2012). Patients' variables, including age, gender, presenting features, comorbid conditions, and CSF findings, were divided into two groups, i.e. with and without AKI. RESULTS: This research included 89 patients with a mean age of 48 years. AKI occurred in 34 patients (38.2%). The frequency of AKI with Stage 1 was 24%, Stage 2 was 44%, and Stage 3 was 32%; approximately two-thirds of cases were in Stage 2 and 3 (p >0.05). Five patients (5.6%) from Stage 3, required dialysis. CONCLUSION: AKI is an important adverse effect of parenteral acyclovir, which necessitates its early identification and timely management. Renal function monitoring is essential for patients on Acyclovir treatment as they are at risk for AKI. KEY WORDS: Acyclovir, Acute kidney injury, Viral encephalitis, Creatinine, Kidney Disease Improving Global Outcomes.


Assuntos
Injúria Renal Aguda , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Encefalite Viral , Adulto , Humanos , Pessoa de Meia-Idade , Aciclovir/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/terapia , Encefalite Viral/tratamento farmacológico , Encefalite Viral/induzido quimicamente , Creatinina
10.
Arq Bras Cardiol ; 121(1): e20230229, 2024 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38324858

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) and Fabry disease (FD) are genetically inherited diseases with left ventricular hypertrophy (LVH) phenotype characteristics that cause adverse cardiac outcomes. OBJECTIVES: To investigate the demographic, clinical, biochemical, electrocardiographic (ECG), and echocardiographic (ECHO) differences between HCM and FD. METHODS: 60 HCM and 40 FD patients were analyzed retrospectively as a subanalysis of the 'LVH-TR study' after excluding patients with atrial fibrillation, pace rhythm, bundle branch blocks, and second and third-degree atrioventricular (AV) blocks. The significance level was accepted as <0.05. RESULTS: Male gender (p=0.048) and creatinine (p=0.010) are significantly higher in favor of FD; however, ST depression (p=0.028), QT duration (p=0.041), interventricular septum thickness (IVSd) (p=0.003), posterior wall thickness (PWd) (p=0.009), moderate-severe mitral regurgitation (MR) (p=0.013), and LV mass index (LVMI) (p=0.041) are significantly higher in favor of HCM in the univariate analyses. In multivariate analysis, statistical significance only continues in creatinine (p=0.018) and QT duration (0.045). FD was positively correlated with creatinine (rho=0.287, p=0.004) and HCM was positively correlated with PWd (rho=0.306, p=0.002), IVSd (rho=0.395, p<0.001), moderate-severe MR (rho=0.276, p<0.005), LVMI (rho=0.300, p=0.002), relative wall thickness (RWT) (rho=0.271, p=0.006), QT duration (rho=0.213, p=0.034) and ST depression (rho=0.222, p=0.026). CONCLUSION: Specific biochemical, ECG, and ECHO characteristics can aid in the differentiation and early diagnosis of HCM and FD.


FUNDAMENTO: A cardiomiopatia hipertrófica (CMH) e a doença de Fabry (DF) são doenças herdadas geneticamente com características fenotípicas de hipertrofia ventricular esquerda (HVE) que causam resultados cardíacos adversos. OBJETIVOS: Investigar as diferenças demográficas, clínicas, bioquímicas, eletrocardiográficas (ECG) e ecocardiográficas (ECO) entre CMH e DF. MÉTODOS: 60 pacientes com CMH e 40 pacientes com DF foram analisados retrospectivamente como uma subanálise do "estudo LVH-TR" após exclusão de pacientes com fibrilação atrial, ritmo de estimulação, bloqueios de ramo e bloqueios atrioventriculares (AV) de segundo e terceiro graus. O nível de significância foi aceito como <0,05. RESULTADOS: O sexo masculino (p=0,048) e a creatinina (p=0,010) são significativamente maiores a favor da DF; entretanto, infradesnivelamento do segmento ST (p=0,028), duração do QT (p=0,041), espessura do septo interventricular (SIVd) (p=0,003), espessura da parede posterior (PWd) (p=0,009), insuficiência mitral moderada a grave (IM) (p=0,013) e o índice de massa ventricular esquerda (IMVE) (p=0,041) são significativamente maiores a favor da CMH nas análises univariadas. Na análise multivariada, a significância estatística apenas permanece na creatinina (p=0,018) e na duração do intervalo QT (0,045). A DF foi positivamente correlacionada com a creatinina (rho=0,287, p=0,004) e a CMH foi positivamente correlacionada com o PWd (rho=0,306, p=0,002), IVSd (rho=0,395, p<0,001), IM moderada-grave (rho= 0,276, p<0,005), IMVE (rho=0,300, p=0,002), espessura relativa da parede (ERP) (rho=0,271, p=0,006), duração do QT (rho=0,213, p=0,034) e depressão do segmento ST (rho =0,222, p=0,026). CONCLUSÃO: Características bioquímicas, ECG e ECO específicas podem auxiliar na diferenciação e no diagnóstico precoce da CMH e da DF.


Assuntos
Cardiomiopatia Hipertrófica , Doença de Fabry , Humanos , Masculino , Doença de Fabry/complicações , Doença de Fabry/diagnóstico , Estudos Retrospectivos , Creatinina , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etiologia
11.
Medicine (Baltimore) ; 103(6): e37051, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38335416

RESUMO

This study was to investigate the improvement value of Niaoduqing particles in the outcome of non-diabetic patients with stage IV chronic kidney disease (CKD). The non-diabetic patients with stage IV CKD who were to receive Niaoduqing particles were set as the study group (252 cases), and the patients with the same disease who only received Western medicine in the public database were set as the control group (220 cases). The follow-up visits were 3 months/time for 1 year. Deaths due to various causes, doubling of creatinine levels, and end-stage renal disease were used as hard end points to stop follow-up. The clinical indexes of the 2 groups were observed and compared. The results showed that the rate of compound outcome was significantly lower in the study group (28.17%) than in the control group (36.82%), the glomerular filtration rate was significantly higher than that in the control group, and the levels of uric acid and urea were significantly lower than that in the control group (P < .05). Niaoduqing particles can reduce creatinine and urea nitrogen, stabilize renal function, delay dialysis time, and improve the incidence of compound outcome in patients with non-diabetic stage IV CKD, which is worthy of clinical promotion.


Assuntos
Diálise Renal , Insuficiência Renal Crônica , Humanos , Estudos Retrospectivos , Creatinina , Progressão da Doença , Insuficiência Renal Crônica/epidemiologia , Taxa de Filtração Glomerular , Ureia
12.
Biopharm Drug Dispos ; 45(1): 58-68, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38319316

RESUMO

Renal function is an important factor affecting the pharmacokinetics of vancomycin. The renal function in elderly patients gradually decreases with age. An accurate estimated glomerular filtration rate (GFR) is essential in drug dosing. The study aimed to determine the most appropriate renal function estimation equations to describe vancomycin pharmacokinetics in elderly patients using population pharmacokinetic analysis. Data were obtained retrospectively from elderly patients aged ≥65 years who received vancomycin for infection from September 2016 to January 2022. Renal function was estimated using the Cockcroft-Gault equation (CG), Modification of Diet in Renal Disease equation (MDRD), three Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPIcys-scr , CKD-EPIscr , and CKD-EPIcys ) and two Berlin Initiative Study equations (BIS-1 and BIS-2). The CKD-EPIcys-scr and BIS-2 equations were based on cystatin C (Cys C) and serum creatinine (Scr). The others were based on Cys C or Scr. A nonlinear mixed effects model (NONMEM) was used to develop the population pharmacokinetic model. A total of 471 serum concentrations from 313 elderly patients were used to develop the population pharmacokinetic model. Weight and GFR were identified as significant covariates affecting the pharmacokinetics of vancomycin. Cys C and Scr-based GFR (CKD-EPIcys-scr and BIS-2) yielded significant improvement performance compared with the other equations in model building. The interindividual variability of CL was reduced from 49.4% to 23.6% and 49.4% to 23.7% in CKD-EPIcys-scr and BIS-2 based models, respectively. However, greater interindividual variabilities of CL (from 26.6% to 29.0%) were represented in the other five models which were based on either Cys C or Scr. The GFR estimated by EPIcys-scr and BIS-2 equations and vancomycin CL exhibited a good correlation (r = 0.834 and 0.833). In the external validation with 124 serum concentrations, the predictive performances of the CKD-EPIcys-scr and BIS-2 based models (the mean relative prediction errors were less than 1%, the mean relative absolute prediction errors were about 23%) were also superior to the other five models (the mean relative prediction errors were about 2%, the mean relative absolute prediction errors were greater than 25%) which are based on either Cys C or Scr. In this study, we determined that the equation used to estimate GFR can affect the population pharmacokinetic model fitting result. Population pharmacokinetics model with CKD-EPIcys-scr or BIS-2 can be used to optimize vancomycin dosage in elderly Chinese patients.


Assuntos
Taxa de Filtração Glomerular , Insuficiência Renal Crônica , Vancomicina , Idoso , Humanos , China , Creatinina , Cistatina C , Insuficiência Renal Crônica/metabolismo , Estudos Retrospectivos , Vancomicina/farmacocinética
13.
J Cardiothorac Surg ; 19(1): 96, 2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38360763

RESUMO

BACKGROUND: Ulinastatin, an anti-inflammatory and antioxidant trypsin inhibitor, has shown potential in mitigating acute kidney injury (AKI) and reducing serum creatinine levels after various surgeries. This retrospective study aimed to evaluate the effects of ulinastatin on AKI in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. METHODS: We hypothesized that the administration of ulinastatin could prevent AKI in OPCAB. Electrical medical records were reviewed to identify OPCAB patients between January 2015 and June 2020. The utilization of ulinastatin was randomly determined and applied during this period. Acute kidney injury was defined according to the KDIGO guideline, and its incidence was compared between the ulinastatin administration group and the control group. To investigate the effect of ulinastatin on renal function, multivariate logistic regression analysis was used to calculate propensity scores for each group. RESULTS: A total 454 OPCAB were performed, and after following inclusion and exclusion process, 100 patients were identified in the ulinastatin group and 303 patients in the control group. Using 1:2 propensity score matching, we analyzed 100 and 200 patients in the ulinastatin and control groups. The incidence of AKI was similar between the groups (2.5% for the control group, 2.0% for the ulinastatin group, p > 0.999). However, the serum creatinine value on the first post-operative day were significantly lower in the ulinastatin group compared to the control group (0.774 ± 0.179 mg/dL vs 0.823 ± 0.216 mg/dL, P = 0.040), while no significant differences were observed for the other time points (P > 0.05). The length of ICU stay day was significantly shorter in the ulinastatin group (2.91 ± 2.81 day vs 5.22 ± 7.45 day, respectively, P < 0.001). CONCLUSIONS: Ulinastatin did not have a significant effect on the incidence of AKI; it demonstrated the ability to reduce post-operative serum creatine levels at first post-operative day and shorten the length of ICU stay.


Assuntos
Injúria Renal Aguda , Ponte de Artéria Coronária , Glicoproteínas , Humanos , Estudos Retrospectivos , Creatinina , Ponte de Artéria Coronária/efeitos adversos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle
14.
Hum Genet ; 143(2): 151-157, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38349571

RESUMO

Experimental models suggest an important role for mitochondrial dysfunction in the pathogenesis of chronic kidney disease (CKD) and acute kidney injury (AKI), but little is known regarding the impact of common mitochondrial genetic variation on kidney health. We sought to evaluate associations of inherited mitochondrial DNA (mtDNA) variation with risk of CKD and AKI in a large population-based cohort. We categorized UK Biobank participants who self-identified as white into eight distinct mtDNA haplotypes, which were previously identified based on their associations with phenotypes associated with mitochondrial DNA copy number, a measure of mitochondrial function. We used linear and logistic regression models to evaluate associations of these mtDNA haplotypes with estimated glomerular filtration rate by serum creatinine and cystatin C (eGFRCr-CysC, N = 362,802), prevalent (N = 416 cases) and incident (N = 405 cases) end-stage kidney disease (ESKD), AKI defined by diagnostic codes (N = 14,170 cases), and urine albumin/creatinine ratio (ACR, N = 114,662). The mean age was 57 ± 8 years and the mean eGFR was 90 ± 14 ml/min/1.73 m2. MtDNA haplotype was significantly associated with eGFR (p = 2.8E-12), but not with prevalent ESKD (p = 5.9E-2), incident ESKD (p = 0.93), AKI (p = 0.26), or urine ACR (p = 0.54). The association of mtDNA haplotype with eGFR remained significant after adjustment for diabetes mellitus and hypertension (p = 1.2E-10). When compared to the reference haplotype, mtDNA haplotypes I (ß = 0.402, standard error (SE) = 0.111; p = 2.7E-4), IV (ß = 0.430, SE = 0.073; p = 4.2E-9), and V (ß = 0.233, SE = 0.050; p = 2.7E-6) were each associated with higher eGFR. Among self-identified white UK Biobank participants, mtDNA haplotype was associated with eGFR, but not with ESKD, AKI or albuminuria.


Assuntos
Injúria Renal Aguda , Falência Renal Crônica , Insuficiência Renal Crônica , Humanos , Pessoa de Meia-Idade , Idoso , Bancos de Espécimes Biológicos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/genética , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/genética , Injúria Renal Aguda/diagnóstico , Taxa de Filtração Glomerular/genética , Mitocôndrias/genética , DNA Mitocondrial/genética , Variação Genética , Creatinina
15.
J Am Heart Assoc ; 13(4): e032463, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38362889

RESUMO

BACKGROUND: Prior research suggests clinical effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are mediated by changes in glycated hemoglobin, body weight, systolic blood pressure, hematocrit, and urine albumin-creatinine ratio. We aimed to confirm these findings using a meta-analytic approach. METHODS AND RESULTS: We updated a systematic review of 9 GLP-1RA and 13 SGLT2i trials and summarized longitudinal mediator data. We obtained hazard ratios (HRs) for cardiovascular, renal, and mortality outcomes. We performed linear mixed-effects modeling of LogHRs versus changes in potential mediators and investigated differences in meta-regression associations among drug classes using interaction terms. HRs generally became more protective with greater glycated hemoglobin reduction among GLP-1RA trials, with average HR improvements of 20% to 30%, reaching statistical significance for major adverse cardiovascular events (ΔHR, 23%; P=0.02). Among SGLT2i trials, associations with HRs were not significant and differed from GLP1-RA trials for major adverse cardiovascular events (Pinteraction=0.04). HRs for major adverse cardiovascular events, myocardial infarction, and stroke became less efficacious (ΔHR, -15% to -34%), with more weight loss for SGLT2i but not for GLP-1RA trials (ΔHR, 4%-7%; Pinteraction<0.05). Among 5 SGLT2i trials with available data, HRs for stroke became less efficacious with larger increases in hematocrit (ΔHR, 123%; P=0.09). No changes in HRs by systolic blood pressure (ΔHR, -11% to 9%) and urine albumin-creatinine ratio (ΔHR, -1% to 4%) were found for any outcome. CONCLUSIONS: We confirmed increased efficacy findings for major adverse cardiovascular events with reduction in glycated hemoglobin for GLP1-RAs. Further research is needed on the potential loss of cardiovascular benefits with increased weight loss and hematocrit for SGLT2i.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Inibidores do Transportador 2 de Sódio-Glicose , Acidente Vascular Cerebral , Humanos , Albuminas/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Creatinina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Hemoglobinas Glicadas , Hipoglicemiantes/efeitos adversos , Modelos de Riscos Proporcionais , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Redução de Peso
16.
Clin Cardiol ; 47(2): e24238, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38400562

RESUMO

To date, the predictive role of laboratory indicators for the phenomenon of no flow is unclear. Hence, our objective was to conduct a meta-analysis to investigate the association between laboratory parameters and the risk of the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI). This, in turn, aims to offer valuable insights for early clinical prediction of no-reflow. We searched Pubmed, Embase, and Cochrane Library from the establishment of the database to October 2023. We included case-control or cohort study that patients with STEMI following primary PCI. We excluded repeated publication, research without full text, incomplete information or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. The pooled results indicated that elevated white blood cell (WBC) count (odds ratio [OR] = 1.061, 95% confidence interval [CI]: 1.013-1.112), neutrophil count (OR = 1.324, 95% CI: 1.128-1.553), platelet (PLT) (OR = 1.002, 95% CI: 1.000-1.005), blood glucose (OR = 1.005, 95% CI: 1.002-1.009), creatinine (OR = 1.290, 95% CI: 1.070-1.555), total cholesterol (TC) (OR = 1.022, 95% CI: 1.012-1.032), d-dimer (OR = 1.002, 95% CI: 1.001-1.004), and fibrinogen (OR = 1.010, 95% CI: 1.005-1.015) were significantly associated with increased risk of no-reflow. However, elevated hemoglobin was significantly associated with decreased risk of no-reflow. In conclusion, our comprehensive analysis highlights the predictive potential of various parameters in assessing the risk of no-reflow among STEMI patients undergoing PCI. Specifically, WBC count, neutrophil count, PLT, blood glucose, hemoglobin, creatinine, TC,  d-dimer, and fibrinogen emerged as significant predictors. This refined risk prediction may guide clinical decision-making, allowing for more targeted and effective preventive measures to mitigate the occurrence of no-reflow in this patient population.


Assuntos
Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Animais , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos de Coortes , Fenômeno de não Refluxo/diagnóstico , Fenômeno de não Refluxo/etiologia , Glicemia , Creatinina , Fibrinogênio , Hemoglobinas , Angiografia Coronária/efeitos adversos
17.
Clin Interv Aging ; 19: 303-311, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38404478

RESUMO

Background: Contrast-associated acute kidney injury (CA-AKI) is a prevalent complication following coronary angiography (CAG). However, there is ongoing controversy surrounding its precise definition. Although previous studies have demonstrated the successful application of appropriate definitions in managing high-risk CA-AKI patients, there remains limited research on the association between different definitions and prognosis specifically in patients with chronic kidney disease (CKD). Methods: A total of 4197 CKD patients undergoing coronary angiography (CAG) were included in this study. Two definitions of contrast-associated acute kidney injury (CA-AKI) were used: CA-AKIA, which was defined as an increase of ≥0.5 mg/dL or >25% in serum creatinine (SCr) from baseline within 72 hours after CAG, and CA-AKIB, which was defined as an increase of ≥0.3 mg/dL or >50% in SCr from baseline within 48 hours after CAG. Cox regression analysis was employed to assess the association between these two definitions and long-term mortality. Additionally, population attributable risks (PARs) were calculated to evaluate the impact of CA-AKI definitions on long-term prognosis. Results: During the median follow-up period of 4.70 (2.50-7.78) years, the overall long-term mortality was 23.6%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 33.5% and 33.8%, respectively. We found that CA-AKIA (HR: 1.45, 95% CI: 1.23-1.70, p<0.001) and CA-AKIB (HR: 1.44, 95% CI: 1.23-1.69, p<0.001) were associated with long-term mortality. The PARs were the highest for CA-AKIA (5.87%), followed by CA-AKIB (5.70%). Conclusion: Contrast-associated acute kidney injury (CA-AKI) is a frequently observed complication in CKD patients undergoing coronary angiography (CAG), and both definitions of CA-AKI are significantly correlated with a poor long-term prognosis. Consequently, in the clinical management of CKD patients, it is crucial to prioritize CA-AKI, irrespective of the specific CA-AKI definition used.


Assuntos
Injúria Renal Aguda , Insuficiência Renal Crônica , Humanos , Angiografia Coronária/efeitos adversos , Meios de Contraste/efeitos adversos , Fatores de Risco , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/complicações , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico por imagem , Creatinina
18.
J Chromatogr A ; 1718: 464735, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38364619

RESUMO

Hyperandrogenism is one of the most pronounced symptoms of Polycystic Ovary Syndrome (PCOS) and seems to play a key role in the pathogenesis of this complex disorder. Nevertheless, there is still a lack of consistent results regarding common steroid predictors of PCOS. Therefore, a liquid chromatography tandem mass spectrometry (HPLC-QqQ/MS) method was developed and validated to determine the concentrations of four classic androgens: androstenedione (An-dione), testosterone (T), 5α-dihydrotestosterone (DHT) and androsterone (An) in urine samples obtained from women with PCOS and healthy controls. The limits of detection were between 0.04 and 0.09 ng/mL, while the limits of quantification ranged from 0.1 to 0.3 ng/mL respectively. As a pre-treatment procedure prior to analysis, hydrolysis using ß-glucuronidase and thin film solid-phase microextraction (TF-SPME) was applied. The methodology was employed to perform targeted metabolomics of urinary steroids in women with PCOS and healthy controls. All measured androgens: An-dione (p < 0.0001), T (p = 0.0001), DHT (p < 0.0001) and An (p = 0.0002) showed significantly higher concentrations in the urine of women with PCOS. The largest difference in the mean concentration was found for DHT, which was 2.8 times higher in the PCOS group (13.9 ± 14.1 ng/mg creatinine) in comparison to healthy controls (4.9 ± 3.4 ng/mg creatinine). The results of receiver operating characteristic curve indicated that determination of the panel of three urinary androgens: T+DHT+An-dione with, under the study assumptions, was the best predictor of PCOS diagnosis (AUC of ROC curve = 0.91 (95 % CI: 0.8212-0.9905). The application of an LC-MS/MS-based analysis, together with highly sensitive extraction techniques like TF-SPME, is a suitable approach to perform fast assays and obtain reliable results - crucial in the search for valuable and significant steroids predictors of PCOS.


Assuntos
Androgênios , Síndrome do Ovário Policístico , Feminino , Humanos , Síndrome do Ovário Policístico/diagnóstico , Cromatografia Líquida , Creatinina , Microextração em Fase Sólida , Espectrometria de Massas em Tandem , Testosterona , Di-Hidrotestosterona , Esteroides
19.
Arthritis Res Ther ; 26(1): 54, 2024 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-38378664

RESUMO

BACKGROUND: Leveraging the Accelerating Medicines Partnership (AMP) Lupus Nephritis (LN) dataset, we evaluated longitudinal patterns, rates, and predictors of response to standard-of-care therapy in patients with lupus nephritis. METHODS: Patients from US academic medical centers with class III, IV, and/or V LN and a baseline urine protein/creatinine (UPCR) ratio ≥ 1.0 (n = 180) were eligible for this analysis. Complete response (CR) required the following: (1) UPCR < 0.5; (2) normal serum creatinine (≤ 1.3 mg/dL) or, if abnormal, ≤ 125% of baseline; and (3) prednisone ≤ 10 mg/day. Partial response (PR) required the following: (1) > 50% reduction in UPCR; (2) normal serum creatinine or, if abnormal, ≤ 125% of baseline; and (3) prednisone dose ≤ 15 mg/day. RESULTS: Response rates to the standard of care at week 52 were CR = 22.2%; PR = 21.7%; non-responder (NR) = 41.7%, and not determined (ND) = 14.4%. Only 8/180 (4.4%) patients had a week 12 CR sustained through week 52. Eighteen (10%) patients attained a week 12 PR or CR and sustained their responses through week 52 and 47 (26.1%) patients achieved sustained PR or CR at weeks 26 and 52. Week 52 CR or PR attainment was associated with baseline UPCR > 3 (ORadj = 3.71 [95%CI = 1.34-10.24]; p = 0.012), > 25% decrease in UPCR from baseline to week 12 (ORadj = 2.61 [95%CI = 1.07-6.41]; p = 0.036), lower chronicity index (ORadj = 1.33 per unit decrease [95%CI = 1.10-1.62]; p = 0.003), and positive anti-dsDNA antibody (ORadj = 2.61 [95%CI = 0.93-7.33]; p = 0.069). CONCLUSIONS: CR and PR rates at week 52 were consistent with the standard-of-care response rates observed in prospective registrational LN trials. Low sustained response rates underscore the need for more efficacious therapies and highlight how critically important it is to understand the molecular pathways associated with response and non-response.


Assuntos
Nefrite Lúpica , Humanos , Nefrite Lúpica/tratamento farmacológico , Imunossupressores/uso terapêutico , Estudos Prospectivos , Creatinina , Prednisona/uso terapêutico , Resultado do Tratamento , Indução de Remissão , Estudos Retrospectivos , Rim
20.
Zhonghua Yu Fang Yi Xue Za Zhi ; 58(2): 227-234, 2024 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-38387955

RESUMO

Objective: To investigate the association of urinary cadmium level with body mass index (BMI) and body circumferences among the older adults over 65 years old in 9 longevity areas of China. Methods: Subjects were older adults over 65 years old from the Healthy Aging and Biomarkers Cohort Study (HABCS) between 2017 and 2018 conducted in 9 longevity areas in China. A total of 1 968 older adults were included in this study. Information including socio-demographic characteristics, lifestyles, diet intake, and health status was collected by using questionnaires and physical examinations. Urine samples were collected to detect urinary cadmium and creatinine levels. Body circumferences included waist circumference, hip circumference and calf circumference. Subjects were divided into three groups (low:<0.77 µg/g·creatinine, middle:0.77-1.69 µg/g·creatinine, high:≥1.69 µg/g·creatinine) by tertiles of creatinine-adjusted urinary cadmium concentration. Multiple linear regression models were used to analyze the association of creatinine-adjusted urinary cadmium level with BMI and body circumferences. The dose-response relationship of creatinine-adjusted urinary cadmium concentration with BMI and body circumferences was analyzed by using restrictive cubic splines fitting multiple linear regression model. Results: The mean age of subjects was (83.34±11.14) years old. The median (Q1, Q3) concentration of creatinine-adjusted urinary cadmium was 1.13 (0.63, 2.09) µg/g·creatinine, and the BMI was (22.70±3.82) kg/m2. The mean values of waist circumference, hip circumference, and calf circumference were (85.42±10.68) cm, (92.67±8.90) cm, and (31.08±4.76) cm, respectively. After controlling confounding factors, the results of the multiple linear regression model showed that for each increment of 1 µg/g·creatinine in creatinine-adjusted urinary cadmium, the change of BMI, waist circumference, hip circumference, and calf circumference in the high-level group was -0.28 (-0.37, -0.19) kg/m2, -0.74 (-0.96, -0.52) cm, -0.78 (-0.96, -0.61) cm, and -0.20 (-0.30, -0.11) cm, respectively. The restrictive cubic splines curve showed a negative nonlinear association of creatinine-adjusted urinary cadmium with BMI (Pnonlinear<0.001) and negative linear associations of creatinine-adjusted urinary cadmium with waist circumference (Plinear<0.001), hip circumference (Plinear<0.001), and calf circumference (Plinear<0.001). Conclusion: Urinary cadmium level is significantly associated with decreased BMI, waist circumference, hip circumference and calf circumference among older adults over 65 years old in 9 longevity areas of China.


Assuntos
Cádmio , Humanos , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Creatinina , Circunferência da Cintura , China/epidemiologia
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