48 results on '"Teo, Boon Wee"'
Search Results
2. Unravelling complex choices: multi-stakeholder perceptions on dialysis withdrawal and end-of-life care in kidney disease.
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Ramakrishnan, Chandrika, Widjaja, Nathan, Malhotra, Chetna, Finkelstein, Eric, Khan, Behram Ali, Ozdemir, Semra, Choo, Jason Chon Jun, Teo, Boon Wee, Yee, Althea Chung Pheng, Yan, Hua, and See, Vincent Wei Xiong
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TERMINAL care ,HEMODIALYSIS facilities ,DIALYSIS (Chemistry) ,KIDNEY diseases ,MEDICAL personnel ,HEMODIALYSIS - Abstract
Background: For patients on dialysis with poor quality of life and prognosis, dialysis withdrawal and subsequent transition to palliative care is recommended. This study aims to understand multi-stakeholder perspectives regarding dialysis withdrawal and identify their information needs and support for decision-making regarding withdrawing from dialysis and end-of-life care. Methods: Participants were recruited through purposive sampling from eight dialysis centers and two public hospitals in Singapore. Semi-structured in-depth interviews were conducted with 10 patients on dialysis, 8 family caregivers, and 16 renal healthcare providers. They were held in-person at dialysis clinics with patients and caregivers, and virtually via video-conferencing with healthcare providers. Interviews were audio-recorded, transcribed, and thematically analyzed. The Ottawa Decision Support Framework's decisional-needs manual was used as a guide for data collection and analysis, with two independent team members coding the data. Results: Four themes reflecting perceptions and support for decision-making were identified: a) poor knowledge and fatalistic perceptions; b) inadequate resources and support for decision-making; c) complexity of decision-making, unclear timing, and unpreparedness; and d) internal emotions of decisional conflict and regret. Participants displayed limited awareness of dialysis withdrawal and palliative care, often perceiving dialysis withdrawal as medical abandonment. Patient preferences regarding decision-making ranged from autonomous control to physician or family-delegated choices. Cultural factors contributed to hesitancy and reluctance to discuss end-of-life matters, resulting in a lack of conversations between patients and providers, as well as between patients and their caregivers. Conclusions: Decision-making for dialysis withdrawal is complicated, exacerbated by a lack of awareness and conversations on end-of-life care among patients, caregivers, and providers. These findings emphasize the need for a culturally-sensitive tool that informs and prepares patients and their caregivers to navigate decisions about dialysis withdrawal and the transition to palliative care. Such a tool could bridge information gaps and stimulate meaningful conversations, fostering informed and culturally aligned decisions during this critical juncture of care. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Home blood pressure-centered approach – from digital health to medical practice: HOPE Asia Network consensus statement 2023.
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Kario, Kazuomi, Tomitani, Naoko, Wang, Tzung-Dau, Park, Sungha, Li, Yan, Shin, Jinho, Tsoi, Kelvin, Chen, Chen-Huan, Cheng, Hao-Min, Siddique, Saulat, Turana, Yuda, Buranakitjaroen, Peera, Van Huynh, Minh, Nailes, Jennifer, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Tay, Jam Chin, and Teo, Boon Wee
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- 2023
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4. Agreement regarding overcoming hypertension in the Asian Hypertension Society Network 2022.
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Hoshide, Satoshi, Yamamoto, Koichi, Katsurada, Kenichi, Yano, Yuichiro, Nishiyama, Akira, Wang, Ji-Guang, Narasingan, S. N., Verma, Narsingh, Erwinanto, Erwinanto, Turana, Yuda, Ihm, Sang Hyun, Park, Sungha, Hanafi, Nik Sherina, Chia, Yook-Chin, Unurjargal, Tsolmon, Siddique, Saulat, Ona, Deborah Ignacia D., Venketasubramanian, Narayanaswamy, Teo, Boon Wee, and Constantine, Godwin
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- 2023
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5. Non-pharmacological management of hypertension.
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Verma, Narsingh, Rastogi, Smriti, Chia, Yook‐Chin, Siddique, Saulat, Turana, Yuda, Cheng, Hao‐min, Sogunuru, Guru Prasad, Tay, Jam Chin, Teo, Boon Wee, Wang, Tzung‐Dau, TSOI, Kelvin Kam Fai, Kario, Kazuomi, Chia, Yook-Chin, Cheng, Hao-Min, and Wang, Tzung-Dau
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Hypertension is an insidious disease which predisposes to cardiovascular complications and if not treated properly can lead to various serious complications. Economic limitations, having additional benefits with few or almost no side effects have made non-pharmacological management of hypertension an attractive approach for dealing with hypertension, in developed and developing countries alike. A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials, and meta-analyses for this review paper. Lifestyle modifications including changes in the dietary pattern, adopting special diets with low sodium, saturated fat and high calcium, magnesium and potassium and trying the new methods like time restricted meal intake which work in tandem with the circadian rhythm are opening new vistas in the field of non-pharmacological management of hypertension. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of Yoga, Acupuncture, Tai chi, mindfulness-based stress-reduction program, and Transcendental Meditation. Air pollution of the surrounding air is linked with poor health outcomes and is a major contributor to the global burden of disease. Fine particulate matter <2.5 μm in diameter (PM2.5) is strongly associated with cardiovascular morbidity and mortality. Short-term PM exposure (hours to weeks) increases the likelihood of adverse cardiovascular events including myocardial infarction, stroke, and heart failure, and longer-term exposure multiplies that risk. Non-pharmacological methods should be initiated early phase of disease and should be continued with medication. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Cumulative iodinated contrast exposure for computed tomography during acute kidney injury and major adverse kidney events.
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Chua, Horng-Ruey, Low, Sanmay, Murali, Tanusya Murali, Wong, Emmett Tsz-Yeung, He, Hai-Dong, Teo, Boon-Wee, Thian, Yee-Liang, Akalya, K., and Vathsala, Anantharaman
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ACUTE kidney failure ,COMPUTED tomography ,RENAL replacement therapy ,BIVARIATE analysis ,PATIENTS' attitudes - Abstract
Objectives: To determine if contrast-enhanced CT imaging performed in patients during their episode of AKI contributes to major adverse kidney events (MAKE).Methods: A propensity score-matched analysis of 1127 patients with AKI defined by KDIGO criteria was done. Their mean age was 63 ± 16 years with 56% males. A total of 419 cases exposed to CT contrast peri-AKI were matched with 798 non-exposed controls for 14 covariates including comorbidities, acute illnesses, and initial AKI severity; outcomes including MAKE and renal recovery in hospital were compared using bivariate analysis and logistic regression. MAKE was a composite of mortality, renal replacement therapy, and doubling of serum creatinine on discharge over baseline; renal recovery was classified as early versus late based on a 7-day timeline from AKI onset to nadir creatinine or cessation of renal replacement therapy in survivors.Results: Sixty-two patients received cumulatively > 100 mL of CT contrast, 143 patients had > 50-100 mL, and 214 patients had 50 mL or less; MAKE occurred in 34%, 17%, and 21%, respectively, as compared with 20% in non-exposed controls (p = 0.008 for patients with > 100 mL contrast versus none). More contrast-exposed patients experienced late renal recovery (27% versus 20%) and longer hospital days (median 10 versus 8) than non-exposed patients (all p < 0.01). On multivariate analysis, cumulative CT contrast > 100 mL was independently associated with MAKE (odds ratio 2.39 versus non-contrast, adjusted for all confounders, p = 0.005); cumulative CT contrast under 100 mL was not associated with MAKE.Conclusions: High cumulative volume of CT contrast administered to patients with AKI is associated with worse short-term renal outcomes and delayed renal recovery.Key Points: • Cumulative intravenous iodinated contrast for CT imaging of more than 100 mL, during an episode of acute kidney injury, was independently associated with worse renal outcomes and less renal recovery. • These adverse outcomes including renal replacement therapy were not more frequent in similar patients who received cumulatively 100 mL or less of CT contrast, compared with non-exposed patients. • More patients with CT contrast exposure during acute kidney injury experienced delayed renal recovery. [ABSTRACT FROM AUTHOR]- Published
- 2021
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7. Tackling Dialysis Burden around the World: A Global Challenge.
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Li, Philip Kam-Tao, Chan, Gordon Chun-Kau, Chen, Jianghua, Chen, Hung-Chun, Cheng, Yuk-Lun, Fan, Stanley L.-S., He, John Cijiang, Hu, Weixin, Lim, Wai-Hon, Pei, York, Teo, Boon Wee, Zhang, Ping, Yu, Xueqing, and Liu, Zhi-Hong
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- 2021
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8. Hypertension in a multi-ethnic Asian population of Singapore.
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Gek Cher Chan, Boon Wee Teo, Jam Chin Tay, Chen-Huan Chen, Hao-Min Cheng, Tzung-Dau Wang, Turana, Yuda, Kazuomi Kario, Yook-Chin Chia, Kelvin Tsoi, Sogunuru, Guru Prasad, Nailes, Jennifer, Chan, Gek Cher, Teo, Boon Wee, Tay, Jam Chin, Chen, Chen-Huan, Cheng, Hao-Min, Wang, Tzung-Dau, Kario, Kazuomi, and Chia, Yook-Chin
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The prevalence of hypertension varies by country and region, but it remains a leading yet modifiable risk factor of cardiovascular disease. There are many factors that contribute to the burden of hypertension in Asia, a region with diverse ethnicity. It has been shown that sociodemographic variability is related to ethnic differences, thereby emphasizing the importance of hypertension screening and educating at-risk or vulnerable groups. In this review, we describe the ethnic differences in genetic variants, dietary choice, and lifestyle habits, as well as its association with sociodemographic differences, hypertension awareness, and treatment control. [ABSTRACT FROM AUTHOR]
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- 2021
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9. Myocardial ischemia by radionuclide imaging and long-term outcomes after kidney transplantation.
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Low, Sanmay, Chua, Horng-Ruey, Wong, Raymond, Goh, Angeline, Ng, Yue-Harn, Teo, Boon-Wee, and Vathsala, Anantharaman
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Purpose: We examined the incidence of myocardial ischemia (MI) in kidney transplant recipients (KTR) using myocardial perfusion imaging (MPI), and its association with long-term outcomes after transplantation. Methods: A retrospective observational study was conducted of asymptomatic KTRs who underwent post-transplant MPI screening for MI, as defined by moderate to severe myocardial perfusion defects, post-stress myocardial stunning or balanced ischemia. A composite outcome of all-cause mortality, graft loss, and major adverse cardiovascular events (MACE) was examined over minimum 5 years. Results: We studied 135 KTRs who underwent 226 MPIs, with follow-up duration of 10 (7–13) years. 110 (81%) patients had normal MPIs, 11 (8%) had mild perfusion defects, and 14 (10%) had MI. Correspondingly, composite outcome developed in 6%, 27%, and 43% (p = 0.04), and MACE occurred in 7%, 0%, and 21% (p = 0.11), of the respective subgroups. Twenty-six patients developed the composite outcome after 5 (3–7) years post-transplantation, including 11 patients with MACE. On multivariate analysis, MI, higher low-density lipoprotein levels, and proteinuria > 0.3 g/day independently predicted the composite outcome; only MI predicted MACE (all p < 0.05). Ninety-one patients had two serial MPIs, which increased the positive predictive value for MACE from 17 to 25%. Absence of MI had negative predictive value of 83% for MACE and 93% for the composite outcome. Conclusion: MI that is detected early post-kidney transplantation predicts long-term mortality, graft loss, and MACE in KTRs, with excellent negative but poor positive predictive values. [ABSTRACT FROM AUTHOR]
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- 2020
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10. What is new in the 2018 Chinese hypertension guideline and the implication for the management of hypertension in Asia?
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Wang, Ji‐Guang, Chia, Yook‐Chin, Chen, Chen‐Huan, Park, Sungha, Hoshide, Satoshi, Tomitani, Naoko, Kabutoya, Tomoyuki, Shin, Jinho, Turana, Yuda, Soenarta, Arieska Ann, Tay, Jam Chin, Buranakitjaroen, Peera, Nailes, Jennifer, Van Minh, Huynh, Siddique, Saulat, Sison, Jorge, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Teo, Boon Wee, and Verma, Narsingh
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The new Chinese hypertension guideline comprehensively covers almost all major aspects in the management of hypertension. In this new guideline, hypertension remains defined as a systolic/diastolic blood pressure of at least 140/90 mm Hg. For risk assessment, a qualitative approach is used similarly as in previous Chinese guidelines according to the blood pressure level and the presence or absence of other risk factors, target organ damage, cardiovascular complications, and comorbid diseases. The therapeutic target is 140/90 mm Hg in general, and if tolerated, especially in high-risk patients, can be more stringent, that is, 130/80 mm Hg. However, a less stringent target, that is, 150/90 mm Hg, is used in the younger (65-79 years, if tolerated, 140/90 mm Hg) and older elderly (≥80 years). Five classes of antihypertensive drugs, including β-blockers, can be used either in initial monotherapy or combination. The guideline also provided information on the management of hypertension in several special groups of patients and in the presence of secondary causes of hypertension. To implement the guideline recommendations, several nationwide hypertension control initiatives are being undertaken with new technology. The new technological platforms hopefully will help improve the management of hypertension and generate scientific evidence for future hypertension guidelines, including a possible Asian hypertension guideline in the near future. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Highlights of the 2019 Japanese Society of Hypertension Guidelines and perspectives on the management of Asian hypertensive patients.
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Hoshide, Satoshi, Kario, Kazuomi, Tomitani, Naoko, Kabutoya, Tomoyuki, Chia, Yook‐Chin, Park, Sungha, Shin, Jinho, Turana, Yuda, Tay, Jam Chin, Buranakitjaroen, Peera, Chen, Chen‐Huan, Nailes, Jennifer, Minh, Huynh Van, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Teo, Boon Wee, and Verma, Narsingh
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Unlike other international guidelines but in accord with the earlier Japanese Society of Hypertension (JSH) guidelines, the 2019 JSH guidelines ("JSH 2019") continue to emphasize the importance of out-of-office blood pressure (BP) measurements obtained with a home BP device. Another unique characteristic of JSH 2019 is that it sets clinical questions about the management of hypertension that are based on systematic reviews of updated evidence. JSH 2019 states that individuals with office BP < 140/90 mm Hg do not have normal BP. The final decisions regarding the diagnosis and treatment of hypertension should be performed based on out-of-office BP values together with office BP measurements. For hypertensive adults with comorbidities, the office BP goal is usually <130/80 mm Hg and the home BP goal is <125/75 mm Hg. Recommendations of JSH 2019 would be valuable for not only Japanese hypertensive patients but also Asian hypertensive patients, who share the same features including higher incidence of stroke compared with that of myocardial infarction and a steeper blood pressure-vascular event relationship. [ABSTRACT FROM AUTHOR]
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- 2020
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12. The influence of the ambient temperature on blood pressure and how it will affect the epidemiology of hypertension in Asia.
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Park, Sungha, Kario, Kazuomi, Chia, Yook‐Chin, Turana, Yuda, Chen, Chen‐Huan, Buranakitjaroen, Peera, Nailes, Jennifer, Hoshide, Satoshi, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Tay, Jam Chin, Teo, Boon Wee, Zhang, Yu‐Qing, Shin, Jinho, Minh, Huynh, Tomitani, Naoko, Kabutoya, Tomoyuki, and Sukonthasarn, Apichard
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Epidemiologic studies have consistently demonstrated an increased risk of cardiovascular disease during colder temperatures. Hemodynamic changes associated with cold temperature and an increase in thrombogenicity may both account for the increase in cardiovascular risk and mortality. Studies using both in-office and out-of-office BP measurements have consistently shown an elevation in BP during the colder seasons. The large difference in BP between cold and warm months may increase the incidence of hypertension and reduce the hypertension control rate, potentially resulting in increased cardiovascular risk, especially among those at risk of cardiovascular disease. The current trends in global warming and climate change may have a profound impact on the epidemiology of hypertension and cardiovascular disease, as changes in the climate may significantly affect both BP variability and cardiovascular disease, especially in those with high cardiovascular risk and the elderly. Furthermore, climate change could have a significant influence on hypertension in Asia, considering the unique characteristics of hypertensive patients in Asia. As an increase in ambient temperature decreases the mean daytime average and morning surge in BP, but increases the nocturnal BP, it is difficult to predict how environmental changes will affect the epidemiology and prognosis of hypertension in the Asian-Pacific region. However, these seasonal variations in BP could be minimized by adjusting the housing conditions and using anticipation medicine. In this review, we discuss the impact of seasonal variation in the ambient temperature on hypertension and cardiovascular disease and discuss how this may impact the epidemiology of hypertension and cardiovascular disease. [ABSTRACT FROM AUTHOR]
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- 2020
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13. Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice?
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Cheng, Hao‐Min, Chuang, Shao‐Yuan, Wang, Tzung‐Dau, Kario, Kazuomi, Buranakitjaroen, Peera, Chia, Yook‐Chin, Divinagracia, Romeo, Hoshide, Satoshi, Minh, Huynh Van, Nailes, Jennifer, Park, Sungha, Shin, Jinho, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Tay, Jam Chin, Teo, Boon Wee, and Turana, Yuda
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Since noninvasive central blood pressure (BP) measuring devices are readily available, central BP has gained growing attention regarding its clinical application in the management of hypertension. The disagreement between central and peripheral BP has long been recognized. Some previous studies showed that noninvasive central BP may be better than the conventional brachial BP in association with target organ damages and long-term cardiovascular outcomes. Recent studies further suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control. Despite the use of central BP being promising, more randomized controlled studies comparing central BP-guided therapeutic strategies with conventional care for cardiovascular events reduction are required because noninvasive central and brachial BP measures are conveniently available. In this brief review, the rationale supporting the utility of central BP in clinical practice and relating challenges are summarized. [ABSTRACT FROM AUTHOR]
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- 2020
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14. An overview of hypertension and cardiac involvement in Asia: Focus on heart failure.
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Soenarta, Arieska Ann, Buranakitjaroen, Peera, Chia, Yook‐Chin, Chen, Chen‐Huan, Nailes, Jennifer, Hoshide, Satoshi, Minh, Huynh Van, Park, Sungha, Shin, Jinho, Siddique, Saulat, Sison, Jorge, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Tay, Jam Chin, Teo, Boon Wee, Turana, Yuda, Verma, Narsingh, Wang, Tzung‐Dau, Zhang, Yu‐Qing, and Wang, Ji‐Guang
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Cardiovascular Disease (CVD) is the leading cause of deaths worldwide, contributing to about 30% of all deaths. Half of the cases of CVD are estimated in Asia, the world's most populous continent. Hypertension, a major modifiable risk factor for CVD, results in more deaths than any other CV risk factors in the Asian regions. The total number of patients with hypertension is likely to grow as the population ages. The proportion of the elderly population aged 65 years or more in Asia is expected to increase from 7.4% in 2015 to 10.9% in 2030. It is important to note that more than half (54%) of the world's population live in Asia. Aside of being the biggest single risk factor for global deaths, hypertension is also an important precursor and most common risk factor of heart failure (HF). An increase in HF prevalence is clearly related to the rapid epidemiological transition caused by changes in lifestyle in Asian countries. However, the availability of data on HF burden and health care delivery is limited in Asia compared with Europe and North America. This reality has driven the working group of Asian experts for example the HOPE Asia Network to concentrate on hypertension as risk factors for CVD, with the mission to improve the management of hypertension resulting in organ protection toward a goal of achieving "ZERO" CV event in Asia. This paper aims to give an overview regarding the heart problems caused by hypertension in Asia, focus on HF. [ABSTRACT FROM AUTHOR]
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- 2020
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15. High blood pressure in dementia: How low can we go?
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Turana, Yuda, Tengkawan, Jeslyn, Chia, Yook‐Chin, Teo, Boon Wee, Shin, Jinho, Sogunuru, Guru Prasad, Soenarta, Arieska Ann, Minh, Huynh Van, Buranakitjaroen, Peera, Chen, Chen‐Huan, Nailes, Jennifer, Hoshide, Satoshi, Park, Sungha, Siddique, Saulat, Sison, Jorge, Sukonthasarn, Apichard, Tay, Jam Chin, Wang, Tzung‐Dau, Verma, Narsingh, and Zhang, Yu‐Qing
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Hypertension is an important public health concern. The prevalence keeps increasing, and it is a risk factor for several adverse health outcomes including a decline in cognitive function. Recent data also show that the prevalence of hypertension and age-related dementia is rising in Asian countries, including in the oldest old group. This study aims to discuss possible treatments for high blood pressure in the elderly and propose an optimal target for BP relative to cognitive outcomes. This review discusses several studies on related blood pressure treatments that remain controversial and the consequences if the treatment target is too low or aggressive. Longitudinal, cross-sectional, and RCT studies were included in this review. An optimum systolic blood pressure of 120-130 mm Hg is recommended, especially in nondiabetic hypertensive patients with significant risk factors. In the oldest old group of patients, hypertension might have a protective effect. The use of calcium channel blockers (CCB) and angiotensin receptor blocker (ARB) is independently associated with a decreased risk of dementia in older people. However, personalized care for patients with hypertension, especially for patients who are frail or very old, is encouraged. [ABSTRACT FROM AUTHOR]
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- 2020
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16. 2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network.
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Kario, Kazuomi, Park, Sungha, Chia, Yook‐Chin, Sukonthasarn, Apichard, Turana, Yuda, Shin, Jinho, Chen, Chen‐Huan, Buranakitjaroen, Peera, Divinagracia, Romeo, Nailes, Jennifer, Hoshide, Satoshi, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Tay, Jam Chin, Teo, Boon Wee, Zhang, Yu‐Qing, Van Minh, Huynh, and Tomitani, Naoko
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Hypertension professionals from Asia have been meeting together for the last decade to discuss how to improve the management of hypertension. Based on these education and research activities, the Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network was officially established in June 2018 and includes experts from 12 countries/regions across Asia. Among the numerous research and review papers published by members of the HOPE Asia Network since 2017, publications in three key areas provide important guidance on the management of hypertension in Asia. This article highlights key consensus documents, which relate to the Asian characteristics of hypertension, home blood pressure monitoring (HBPM), and ambulatory blood pressure monitoring (ABPM). Hypertension and hypertension-related diseases are common in Asia, and their characteristics differ from those in other populations. It is essential that these are taken into consideration to provide the best opportunity for achieving "perfect 24-hour blood pressure control", guided by out-of-office (home and ambulatory) blood pressure monitoring. These region-specific consensus documents should contribute to optimizing individual and population-based hypertension management strategies in Asian country. In addition, the HOPE Asia Network model provides a good example of the local interpretation, modification, and dissemination of international best practice to benefit specific populations. [ABSTRACT FROM AUTHOR]
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- 2020
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17. Diversity of and initiatives for hypertension management in Asia-Why we need the HOPE Asia Network.
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Kario, Kazuomi, Chia, Yook‐Chin, Sukonthasarn, Apichard, Turana, Yuda, Shin, Jinho, Chen, Chen‐Huan, Buranakitjaroen, Peera, Nailes, Jennifer, Hoshide, Satoshi, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Tay, Jam Chin, Teo, Boon Wee, Zhang, Yu‐Qing, Park, Sungha, Minh, Huynh Van, Tomitani, Naoko, and Kabutoya, Tomoyuki
- Abstract
The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries. Identifying and treating masked hypertension is important to reduce cardiovascular risk. Abnormal patterns of blood pressure (BP) variability common in Asia include exaggerated early morning BP surge and nocturnal hypertension. These are also important cardiovascular risk factors that need to be managed. Home blood pressure monitoring (HBPM) is an important tool for detecting white-coat and masked hypertension, and monitoring BP variability, and practices in Asia are variable. Use of HBPM is important given the Asia-specific features of hypertension, and strategies are needed to improve and standardize HBPM usage. Development of HBPM devices capable of measuring nocturnal BP along with other information and communication technology-based strategies are key developments in the widespread implementation of anticipation medicine strategies to detect and prevent cardiovascular events in patients with hypertension. Region-wide differences in hypertension prevalence, control, and management practices in Asia highlight the importance of information sharing to facilitate best practices. [ABSTRACT FROM AUTHOR]
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- 2020
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18. Current status of ambulatory blood pressure monitoring in Asian countries: A report from the HOPE Asia Network.
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Shin, Jinho, Kario, Kazuomi, Chia, Yook‐Chin, Turana, Yuda, Chen, Chen‐Huan, Buranakitjaroen, Peera, Divinagracia, Romeo, Nailes, Jennifer, Hoshide, Satoshi, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Tay, Jam Chin, Teo, Boon Wee, Zhang, Yu‐Qing, Park, Sungha, Van Minh, Huynh, Kabutoya, Tomoyuki, and Verma, Narsingh
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Ambulatory blood pressure monitoring (ABPM) can measure 24-hour blood pressure (BP), including nocturnal BP and diurnal variations. This feature of ABPM could be of value in Asian populations for preventing cardiovascular events. However, no study has yet investigated regarding the use of ABPM in actual clinical settings in Asian countries/regions. In this study, 11 experts from 11 countries/regions were asked to answer questionnaires regarding the use of ABPM. We found that its use was very limited in primary care settings and almost exclusively available in referral settings. The indications of ABPM in actual clinical settings were largely similar to those of home BP monitoring (HBPM), that is, diagnosis of white-coat or masked hypertension and more accurate BP measurement for borderline clinic BP. Other interesting indications, such as nighttime BP patterns, including non-dipper BP, morning BP surge, and BP variability, were hardly adopted in daily clinical practice. The use of ABPM as treatment guidance for detecting treated but uncontrolled hypertension in the Asian countries/regions didn't seem to be common. The barrier to the use of ABPM was primarily its availability; in referral centers, patient reluctance owing to discomfort or sleep disturbance was the most frequent barrier. ABPM use was significantly more economical when it was reimbursed by public insurance. To facilitate ABPM use, more simplified indications and protocols to minimize discomfort should be sought. For the time being, HBPM could be a reasonable alternative. [ABSTRACT FROM AUTHOR]
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- 2020
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19. Comparison of day-to-day blood pressure variability in hypertensive patients with type 2 diabetes mellitus to those without diabetes: Asia BP@Home Study.
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Chia, Yook‐Chin, Kario, Kazuomi, Tomitani, Naoko, Park, Sungha, Shin, Jinho, Turana, Yuda, Tay, Jam Chin, Buranakitjaroen, Peera, Chen, Chen‐Huan, Hoshide, Satoshi, Nailes, Jennifer, Minh, Huynh Van, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Teo, Boon Wee, Verma, Narsingh, and Zhang, Yuqing
- Abstract
Blood pressure variability (BPV) has been shown to be independently associated with cardiovascular (CV) mortality and morbidity. Patients with type 2 diabetes mellitus (T2DM) have also been shown to have increased BPV. We aimed to compare BPV in hypertensive patients with diabetes with those without diabetes. A total of 1443 hypertensive patients measured their blood pressure (BP) twice in the morning and twice before bed at home for a week. Demographic data, history of T2DM, and anti-hypertensive use were captured. Clinic BP was measured twice in the clinic. Control of BP was defined as clinic systolic BP (SBP) <140 mm Hg and home SBP < 135 mm Hg. BPV was based on home SBP measurements. A total of 362(25.1%) hypertensives had diabetes and 47.4% were male. Mean age was 62.3 ± 12.1 years. There was no difference in the mean clinic SBP in both groups (139.9 mm Hg vs 138.4 mm Hg P = .188). However, the mean morning home SBP was significantly higher and control rate lower in hypertensives with diabetes than those without (132.3 ± 15 mm Hg vs 129.7 ± 14.4 mm Hg P = .005, 39.4% vs 47.6% P = .007), respectively. Masked uncontrolled morning hypertension was higher in those with diabetes versus those without (12.8% vs 8.4%, respectively). There was no statistically significant difference in BPV between those with and without diabetes. In summary, clinic SBP was similar in hypertensives with or without diabetes. However, control of BP based on both clinic and home SBP thresholds was poorer in hypertensives with diabetes compared to those without. Masked uncontrolled morning hypertension was higher in those with diabetes than those without. There was no difference in BPV between the two groups. [ABSTRACT FROM AUTHOR]
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- 2020
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20. Target blood pressure and control status in Asia.
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Chia, Yook‐Chin, Kario, Kazuomi, Turana, Yuda, Nailes, Jennifer, Tay, Jam Chin, Siddique, Saulat, Park, Sungha, Shin, Jinho, Buranakitjaroen, Peera, Chen, Chen‐Huan, Divinagracia, Romeo, Hoshide, Satoshi, Minh, Huynh Van, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Sukonthasarn, Apichard, Teo, Boon Wee, Verma, Narsingh, and Zhang, Yuqing
- Abstract
It is widely accepted that hypertension constitutes a significant cardiovascular risk factor and that treating high blood pressure (BP) effectively reduces cardiovascular risk. An important issue in Asia is not just the high prevalence of hypertension, particularly in some countries, but also the low level of awareness and treatment rates in many regions. The 2017 update of the American College of Cardiology/American Heart Association hypertension guidelines raised the question about which BP threshold should be used to diagnose and treat hypertension. Although there is a theoretical rationale for a stricter BP criterion in Asia given the ethnic-specific features of hypertension in the region, the majority of countries in Asia have retained a diagnostic BP threshold of ≥140/90 mm Hg. Although lowering thresholds might make theoretical sense, this would increase the prevalence of hypertension and also markedly reduce BP control rates. In addition, there are currently no data from robust randomized clinical trials of the benefits of the lower targets in preventing cardiovascular disease and reducing cardiovascular risk, particularly in high-risk patients and especially for Asian populations. There is also no defined home BP treatment target level for an office BP treatment target of 130/80 mm Hg. However, in this regard, in the interim, lifestyle modifications, including reducing body weight and salt intake, should form an important part of hypertension management strategies in Asia, while studies on treating at lower BP threshold level in Asians and getting to lower BP targets will be helpful to inform and optimize the management of hypertension in the region. [ABSTRACT FROM AUTHOR]
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- 2020
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21. High-sensitivity Troponin I Predicts Galectin-3 in Chronic Kidney Disease Patients.
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Chan, Gek Cher, Ho, Peh Joo, Li, Jialiang, Lee, Evan Jon Choon, Chua, Horng Ruey, Lau, Titus, Sethi, Sunil, and Teo, Boon Wee
- Abstract
Purpose: Plasma galectin-3 (pG3) regulates inflammation. B-type natriuretic peptide (BNP), high-sensitivity Troponin I (hsTnI), and pG3 concentrations are elevated in chronic kidney disease (CKD) patients. The associations of pG3 with hsTnI/BNP are unclear. We explored the relationship of hsTnI and BNP with pG3 in Asian CKD patients and healthy controls. Methods: We retrieved prospectively collected frozen plasma samples from 163 stable CKD patients and 105 healthy controls. BNP, hsTnI and pG3 were assayed. pG3 was assessed for associations with age, gender, ethnicity, blood pressures; height, weight, body mass index (BMI), previously diagnosed CKD, diabetes, hypertension, coronary artery disease, estimated glomerular filtration rate (eGFR); C-reactive protein, beta-trace protein, 24 h urine protein, serum albumin, uric acid and cystatin C. We created two models predicting pG3 using multiple linear regression. Akaike Information Criterion (AIC) was used for comparison. Significance was taken at P < 0.05. Results: CKD versus healthy participants: mean BMI (28.2 vs. 24.9 kg/m
2 ), median serum creatinine (159 vs. 69 µmol/L; 1.8 vs. 0.78 mg/dL), median eGFR (49 vs. 104 mL/min/1.73m2 ), median pG3 (29.4 vs. 15.4 ng/mL), median BNP (136 vs. 23 pg/mL), and median hsTnI (12.5 vs. 2.6 pg/mL). By univariate analysis, all variables are associated with pG3 except weight, gender and diagnosis of cerebrovascular or peripheral vascular diseases. A parsimonious model selected for hsTnI, BMI, serum albumin, cystatin C and eGFR (AIC = 77.6). Conclusion: BNP and hsTnI are associated with pG3 in Asian CKD patients. hsTnI is a better predictor of pG3. [ABSTRACT FROM AUTHOR]- Published
- 2020
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22. Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy.
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Pek, Gregory Xiang Wen, Ngoh, Clara Lee Ying, Teo, Boon Wee, Vathsala, Anantharaman, Goh, Benjamin Yen Seow, Yong, Clement Hsiang Rong, Raman, Lata, and Tiong, Ho Yee
- Subjects
NEPHRECTOMY ,OBESITY ,CHRONIC kidney failure ,KIDNEYS ,CROSS-sectional imaging ,BODY mass index - Abstract
Introduction: Obesity may be a risk factor for kidney donors to develop reduced renal function. The Framingham heart study suggested that visceral adipose tissue (VAT) confers a more adverse metabolic profile compared with subcutaneous adipose tissue (SAT). Asians tend to have a higher VAT composition and it is unclear if their kidney function is affected differently. We hypothesized that Asian living kidney donors who have visceral obesity are at a higher risk of renal function deterioration 1 year after donation. Methods: Between 2011 and 2014, we retrospectively evaluated data from 73 consecutive patients (52% male; mean age 44.9 ± 11.7 years) before they underwent donor nephrectomy and at their 1 year routine follow-up. VAT and SAT were measured at the level of the umbilicus on pre-operative computerized tomography (CT). Visceral obesity (VO) was defined as a VAT > 100 cm [2] and patients were then further divided and compared in two subgroups: VAT > 100 and < 100 cm [2]. Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m [2]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation pre-operatively and 1 year post-operatively. Results: Both subgroups had similar baseline kidney function (P = NS) pre-operatively. At the 1 year follow-up, patients with VO experienced a more significant decline of renal function (109 ± 9 to 89 ± 8 mL/min per 1.73 m
2 ), compared to those without VO (111 ± 12 to 96 ± 11 mL/min per 1.73 m2 , P = 0.013). VO was associated with a body mass index (BMI) > 25 kg/m2 (P < 0.001), male gender (P < 0.001) and older age at the time of donor nephrectomy (48.0 vs 39.5 years, P = 0.01). The presence of hypertension or hyperlipidaemia pre-operatively, choice of surgical approach, and post-operative complication rates, did not differ significantly between the subgroups. Conclusions: Visceral obesity as defined by VAT > 100 cm2 at the level of the umbilicus on cross-sectional imaging, may have a significant impact on early renal function after donor nephrectomy. Adiposity markers, as measured by cross-sectional CT imaging, may be incorporated into routine pre-operative kidney donor workup. [ABSTRACT FROM AUTHOR]- Published
- 2019
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23. Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network.
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Kario, Kazuomi, Shin, Jinho, Chen, Chen‐Huan, Buranakitjaroen, Peera, Chia, Yook‐Chin, Divinagracia, Romeo, Nailes, Jennifer, Hoshide, Satoshi, Siddique, Saulat, Sison, Jorge, Soenarta, Arieska Ann, Sogunuru, Guru Prasad, Tay, Jam Chin, Teo, Boon Wee, Turana, Yuda, Zhang, Yuqing, Park, Sungha, Van Minh, Huynh, Wang, Ji‐Guang, and Chen, Chen-Huan
- Abstract
Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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24. Asian management of hypertension: Current status, home blood pressure, and specific concerns in Singapore.
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Tay, Jam Chin and Teo, Boon Wee
- Abstract
Despite reductions in hypertension prevalence and improvements in control rates in recent years, almost one-third of all deaths in Singapore are due to cardiovascular disease and that proportion is growing. Ischemic heart disease is the most common cause of cardiovascular death, ahead of stroke. Local data suggest that awareness and support for home blood pressure monitoring (HBPM) is good, but there are reservations about the accuracy of HBPM devices and physicians cited a lack of time and resources to educate patients about HBPM. In addition, there was a knowledge gap around use of HBPM for evaluating treatment response. This is consistent with the emphasis of using HBPM for the diagnosis, rather than monitoring, of hypertension in the Singapore hypertension guidelines. In the absence of specific HBPM thresholds and targets, it is suggested that HOPE Asia Network consensus documents provide the most locally relevant guidance of the use of HBPM. Calcium channel blockers and angiotensin receptor blockers are the most commonly used antihypertensive agents in Singapore, and monotherapy was relatively uncommon (24%) of patients. Overall, more needs to be done in detecting and managing hypertension in Singapore to address rates of cardiovascular disease and cardiovascular disease mortality. Use of HBPM needs to be encouraged to improve adherence to treatment and optimize BP targets according to Asian perspectives and data. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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25. Hypertension and blood pressure variability management practices among physicians in Singapore.
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Setia, Sajita, Subramaniam, Kannan, Jam Chin Tay, Boon Wee Teo, Tay, Jam Chin, and Teo, Boon Wee
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HYPERTENSION ,BLOOD pressure ,KIDNEY diseases ,DIABETES ,DIAGNOSIS ,ANTIHYPERTENSIVE agents ,AMBULATORY blood pressure monitoring ,EMPLOYEE orientation ,MEDICAL protocols ,GENERAL practitioners ,SURVEYS ,CONTINUING medical education ,TREATMENT effectiveness ,CROSS-sectional method ,EDUCATION - Abstract
Purpose: There are limited data on blood pressure variability (BPV) in Singapore. The absence of updated local guidelines might contribute to variations in diagnosis, treatment and control of hypertension and BPV between physicians. This study evaluated BPV awareness, hypertension management and associated training needs in physicians from Singapore.Materials and Methods: Physicians from Singapore were surveyed between September 8, 2016, and October 5, 2016. Those included were in public or private practice for ≥3 years, cared directly for patients ≥70% of the time and treated ≥30 patients for hypertension each month. The questionnaire covered 6 main categories: general blood pressure (BP) management, BPV awareness/diagnosis, home BP monitoring (HBPM), ambulatory BP monitoring (ABPM), BPV management and associated training needs.Results: Responses from 60 physicians (30 general practitioners [GPs], 20 cardiologists, 10 nephrologists) were analyzed (77% male, 85% aged 31-60 years, mean 22 years of practice). Approximately 63% of physicians considered white-coat hypertension as part of BPV. The most common diagnostic tool was HBPM (overall 77%, GPs 63%, cardiologists 65%, nephrologists 70%), but ABPM was rated as the tool most valued by physicians (80% overall), especially specialists (97%). Withdrawn Singapore guidelines were still being used by 73% of GPs. Approximately 48% of physicians surveyed did not adhere to the BP cutoff recommended by most guidelines for diagnosing hypertension using HBPM (>135/85 mmHg). Hypertension treatment practices also varied from available guideline recommendations, although physicians did tend to use a lower BP target for patients with diabetes or kidney disease. There were a number of challenges to estimating BPV, the most common of which was patient refusal of ABPM/HBPM. The majority of physicians (82%) had no training on BPV, but stated that this would be useful.Conclusion: There appear to be gaps in knowledge and guideline adherence relating to the assessment and management of BPV among physicians in Singapore. [ABSTRACT FROM AUTHOR]- Published
- 2017
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26. PS-C27-8: ELIGIBILITY OF FINERENONE INITIATION IN ASIAN CHRONIC KIDNEY DISEASE PATIENTS BY KIDNEY FUNCTION AND DIABETES STATUS.
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Teo, Boon Wee
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- 2023
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27. JS-HOPE ASIA-4: TELEMEDICINE IN HYPERTENSION.
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Teo, Boon Wee
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- 2023
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28. S-41-3: HYPERTENSION AND KIDNEY DISEASE IN SINGAPORE.
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Teo, Boon Wee
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- 2023
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29. Cystatin C, chronic kidney disease and retinopathy in adults without diabetes.
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Ng, Wei Yan, Teo, Boon Wee, Tai, E Shyong, Sethi, Sunil, Lamoureux, Ecosse, Tien Yin, Wong, and Sabanayagam, Charumathi
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- 2016
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30. Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients.
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Boon Wee Teo, Horng Ruey Chua, Weng Kin Wong, Haroon, Sabrina, Subramanian, Srinivas, Ping Tyug Loh, Sethi, Sunil, Lau, Titus, Teo, Boon Wee, Chua, Horng Ruey, Wong, Weng Kin, and Loh, Ping Tyug
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REGULATION of blood pressure ,CHRONIC kidney failure complications ,ANTIHYPERTENSIVE agents ,CREATININE ,GLOMERULAR filtration rate ,ASIANS ,BLOOD pressure ,BLOOD pressure measurement ,CHRONIC kidney failure ,DIASTOLE (Cardiac cycle) ,CARDIAC contraction ,HYPERTENSION ,MEDICAL protocols ,STATISTICS - Abstract
Introduction: Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD.Methods: Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses.Results: 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m(2). At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020).Conclusion: Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients. [ABSTRACT FROM AUTHOR]- Published
- 2016
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31. Elevated Serum Leptin, Adiponectin and Leptin to Adiponectin Ratio Is Associated with Chronic Kidney Disease in Asian Adults.
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Lim, Cynthia Ciwei, Teo, Boon Wee, Tai, E. Shyong, Lim, Su Chi, Chan, Choong Meng, Sethi, Sunil, Wong, Tien Y., and Sabanayagam, Charumathi
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ADIPONECTIN ,KIDNEY diseases ,CARDIOVASCULAR diseases ,CASE-control method ,GLOMERULAR filtration rate ,LOGISTIC regression analysis - Abstract
Background: Adiponectin and leptin, two of the key cytokines secreted by adipocytes, have been shown to be associated with cardiovascular disease. However, the association of these adipocytokines with chronic kidney disease (CKD) is not clear. We examined the association of serum adiponectin, leptin levels and leptin to adiponectin ratio (LAR) with CKD in a population-based sample of Asian adults. Methods: We conducted a case-control study (450 CKD cases and 920 controls matched for age, sex and ethnicity) involving Chinese and Indian adults aged 40–80 years who participated in the Singapore Epidemiology of Eye Diseases Study (2007–2011). CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73m
2 from serum creatinine. Serum adiponectin and leptin levels were measured using commercially available ELISA. Odds ratio of CKD associated with elevated adiponectin and leptin levels were estimated using logistic regression models adjusted for age, gender, ethnicity, education, smoking, body mass index, diabetes, blood pressure, total and HDL cholesterol. Results: CKD cases had higher levels of leptin (mean [SD] 9.7 [11.5] vs.16.9 [20.2] ng/mL, p<0.0001) and adiponectin (10.4 [7.4] vs. 9.2 [4.2], p = 0.001) compared to controls. In multi-variable models, compared to those in the lowest quartile, the OR (95% confidence interval) of CKD among those in the highest quartile were: 6.46 (3.84, 10.88), 1.94 (1.32–2.85) and 2.88 (1.78–4.64) for leptin, adiponectin and LAR. Similar associations were also observed when adiponectin and leptin were analyzed as continuous variables. This positive association of serum adiponectin, leptin and LAR with CKD was consistently present in subgroups of gender, ethnicity, diabetes, hypertension and overweight status (all P-interaction >0.1). Conclusions: Higher levels of serum adiponectin, leptin and LAR were positively associated with CKD independent of traditional risk factors in this Asian population. [ABSTRACT FROM AUTHOR]- Published
- 2015
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32. Retinal Microvascular Abnormalities and Risk of Renal Failure in Asian Populations.
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Yip, WanFen, Sabanayagam, Charumathi, Teo, Boon Wee, Tay, Wan Ting, Ikram, M. Kamran, Tai, E. Shyong, Chow, Khuan Yew, Wong, Tien Y., and Cheung, Carol Y.
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MICROCIRCULATION disorders ,KIDNEY failure ,ASIANS ,COMPUTERS in medicine ,FOLLOW-up studies (Medicine) ,DISEASES ,DISEASE risk factors - Abstract
Background: Retinal microvascular signs may provide insights into the structure and function of small vessels that are associated with renal disease. We examined the relationship of retinal microvascular signs with both prevalent and incident end-stage renal disease (ESRD) in a multi-ethnic Asian population. Methods: A total of 5763 subjects (aged ≥40 years) from two prospective population-based studies (the Singapore Malay Eye Study and the Singapore Prospective Study) were included for the current analysis. Retinopathy was graded using the modified Airlie House classification system. Retinal vascular parameters were measured using computer-assisted programs to quantify the retinal vessel widths (arteriolar and venular caliber) and retinal vascular network (fractal dimension). Data on ESRD was obtained by record linkage with the ESRD cases registered by National Registry of Diseases Office, Singapore. Multi-variable adjusted regression analyses were performed to assess the associations of baseline retinal vascular parameters and prevalent and incident ESRD. Results: At baseline, 21(0.36%) persons had prevalent ESRD. During a median follow-up of 4.3 years, 33 (0.57%) subjects developed ESRD. In our analyses, retinopathy was associated with prevalent ESRD (multi-variable adjusted odds ratio [OR], 3.21, 95% confidence interval [CI]: 1.28–8.05) and incident ESRD (multi-variable adjusted hazard ratio [HR], 2.51, 95%CI: 1.14–5.54). This association was largely seen in person with diabetes (HR, 2.60, 95%CI: 1.01–6.66) and not present in persons without diabetes (HR, 1.65, 95%CI: 0.14–18.98). Retinal arteriolar caliber, retinal venular caliber and retinal vascular fractal dimension were not associated with ESRD. Conclusion: Retinopathy signs in persons with diabetes are related to an increased risk of ESRD; however, other microvascular changes in the retina are not associated with ESRD. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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33. Spot Urine Estimations Are Equivalent to 24-Hour Urine Assessments of Urine Protein Excretion for Predicting Clinical Outcomes.
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Teo, Boon Wee, Loh, Ping Tyug, Wong, Weng Kin, Ho, Peh Joo, Choi, Kwok Pui, Toh, Qi Chun, Xu, Hui, Saw, Sharon, Lau, Titus, Sethi, Sunil, and Lee, Evan J. C.
- Subjects
EVALUATION of medical care ,ASIANS ,CHRONIC kidney failure ,CREATININE ,GLOMERULAR filtration rate ,KIDNEY diseases ,MORTALITY ,PROTEINS ,REGRESSION analysis ,RESEARCH funding ,STATISTICS ,DATA analysis ,PROPORTIONAL hazards models ,URINE collection & preservation - Abstract
Background. The use of spot urine protein to creatinine ratios in estimating 24 hr urine protein excretion rates for diagnosing and managing chronic kidney disease (CKD) predated the standardization of creatinine assays. The comparative predictive performance of spot urine ratios and 24 hr urine collections (of albumin or protein) for the clinical outcomes of CKD progression, end-stage renal disease (ESRD), and mortality in Asians is unclear. We compared 4 methods of assessing urine protein excretion in a multiethnic population of CKD patients. Methods. Patients with CKD (n=232) provided 24 hr urine collections followed by spot urine samples the next morning. We created multiple linear regression models to assess the factors associated with GFR decline (median follow-up: 37 months, IQR 26–41) and constructed Cox proportional-hazards models for predicting the combined outcome of ESRD and death. Results. The linear regression models showed that 24 hr urine protein excretion was most predictive of GFR decline but all other methods were similar. For the combined outcomes of ESRD and death, the proportional hazards models had similar predictive performance. Conclusions. We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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34. Predicting First-Year Mortality in Incident Dialysis Patients with End-Stage Renal Disease - The UREA5 Study.
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Chua, Horng-Ruey, Lau, Titus, Luo, Nan, Ma, Valerie, Teo, Boon-Wee, Haroon, Sabrina, Choy, Kwan-Loong, Lim, Yoke-Ching, Chng, Wei-Qiang, Ong, Li-Zhen, Wong, Tsz-Yeung, and Lee, Evan J.
- Subjects
ALKALINE phosphatase ,CARDIOVASCULAR diseases ,CEREBROVASCULAR disease ,CHRONIC kidney failure ,HYPERURICEMIA ,PERIPHERAL vascular diseases ,LEFT heart ventricle diseases - Abstract
We aimed to develop a risk prediction model for first-year mortality (FYM) in incident dialysis patients with end-stage renal disease. We retrospectively examined patient comorbidities and biochemistry, prior to dialysis initiation, using a single-center, prospectively maintained database from 2005-2010, and analyzed these variables in relation to FYM. A total of 983 patients were studied. 22% had left ventricular ejection fraction (LVEF) <45%. FYM was 17%, and independent predictors included URate <500 or >600 μmol/l, LVEF <45% (higher odds ratio if <30%), Age >70 years, Arteriopathies (cerebrovascular and/or peripheral-vascular diseases), serum Albumin <30 g/l, and Alkaline phosphatase >80 U/l (p < 0.05, C-statistic 0.74), and these constitute the acronym UREA5. Using linear modeling, risk weightage/integer of 3 was assigned to LVEF <30%, 2 to age >70 years, and 1 to each remaining variable. Cumulative UREA5 scores of ≤1, 2, 3, 4, and ≥5 were associated with FYM of 6, 8, 22, 31, and 46%, respectively (p < 0.0001). Increasing UREA5 scores were strongly associated with stepwise worsening of FYM after dialysis initiation. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Published
- 2014
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35. Glomerular filtration rates in healthy Asians without kidney disease.
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Teo, Boon Wee, Xu, Hui, Koh, Yun Yin, Li, Jialiang, Subramanian, Srinivas, Sinha, Arvind Kumar, Shuter, Borys, Toh, Qi Chun, Sethi, Sunil, and Lee, Evan JC
- Subjects
ENDOCRINE diseases ,INFECTIOUS disease transmission ,KIDNEY diseases ,GLOMERULAR filtration rate ,CREATININE ,ETHNOLOGY ,ASIANS - Abstract
Aim The Chronic Kidney Disease Collaboration - Epidemiology ( CKD-EPI) glomerular filtration rates ( GFR) estimation equation is believed to estimate GFR more accurately in healthy people but this has not been validated in Asians. We studied the distribution of GFR in a multi-ethnic Asian population without CKD, and compared the performance of measures of GFR estimation, including the CKD-EPI equation, Cockroft- Gault equation, and 24-hour urine creatinine clearances. Materials and Methods A total of 103 healthy volunteers without a history of kidney disease, hypertension, or diabetes underwent GFR measurement using 3-sample plasma clearance of
99m Tc- DTPA. Cockroft- Gault estimated GFR and 24-hour urine creatinine clearances were normalized to body surface area. Results The mean measured GFR was 101 ± 15.8 m L/min per 1.73 m2 and was lowest in Indians (93 ± 12.3 m L/min per 1.73 m2 ; P < 0.001). The CKD-EPI equation appears to be more accurate for healthy participants. Estimated GFR correlated with measured GFR ( r = 0.57, P < 0.001), and the mean difference is 3.72 ± 14.43 m L/min per 1.73 m2 ( P < 0.001). However, estimating GFR using self-directed 24-hour urine creatinine clearances is poorer than using the CKD-EPI equation. Conclusions GFR estimation using self-directed 24-hour urine collection for creatinine clearance is less accurate than using the CKD-EPI equation. A larger study is required to clarify GFR in healthy Asians, and the association of health outcomes of Asian kidney donors with lower GFR thresholds. [ABSTRACT FROM AUTHOR]- Published
- 2014
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36. Comparison of Creatinine Based and Kidney Volume Based Methods of Estimating Glomerular Filtration Rates in Potential Living Kidney Donors.
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Goh, Yen Seow Benjamin, Wu, Mei Wen Fiona, Tai, Bee Choo, Lee, King Chien Joe, Raman, Lata, Teo, Boon Wee, Vathsala, Anatharaman, and Tiong, Ho Yee
- Published
- 2013
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37. An elevated pro-inflammatory cytokine response is linked to development of amphotericin B-induced nephrotoxicity.
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Chai, Louis Y A, Netea, Mihai G, Tai, Bee Choo, Khin, Lay Wai, Vonk, Alieke G, Teo, Boon Wee, Schlamm, Haran T, Herbrecht, Raoul, Donnelly, J Peter, Troke, Peter F, and Kullberg, Bart-Jan
- Published
- 2013
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38. An elevated pro-inflammatory cytokine response is linked to development of amphotericin B-induced nephrotoxicity.
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Chai, Louis Y. A., Netea, Mihai G., Tai, Bee Choo, Khin, Lay Wai, Vonk, Alieke G., Teo, Boon Wee, Schlamm, Haran T., Herbrecht, Raoul, Donnelly, J. Peter, Troke, Peter F., and Kullberg, Bart-Jan
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CYTOKINES ,CELLULAR immunity ,AMPHOTERICIN B ,AMPHOTERICINS ,NEPHROTOXICOLOGY - Abstract
Objectives The underlying mechanism for amphotericin B-induced acute kidney injury (AKI) remains poorly understood and may be immunologically mediated. We assessed whether the development of nephrotoxicity is linked to a distinct cytokine profile in patients receiving amphotericin B deoxycholate (AmBD). Patients and methods In 58 patients who received AmBD, circulating serum interleukin (IL)-6, IL-8 and IL-10 were measured at baseline, week 1 and week 2 of antifungal treatment and correlated to the development of renal impairment. The Cox proportional hazards model approach was adopted for analysis. Results The P value was 0.026 for the overall effect of IL-6 on time to development of AKI. An increasing or non-receding IL-6 trend by week 1 of AmBD treatment (followed by a decreasing or non-receding IL-6 trend from week 1 to week 2) correlated with an increased likelihood of nephrotoxicity [hazard ratio (HR) 6.93, P value 0.005 and HR 3.46, P value 0.035, respectively]. Similarly, persistently increasing IL-8 levels were linked to a 3.84-fold increased likelihood of AKI. Conclusions In patients receiving AmBD, persistence of an elevated pro-inflammatory cytokine milieu is associated with a predisposition to drug-related kidney injury. [ABSTRACT FROM PUBLISHER]
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- 2013
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39. Quantifying acute changes in volume and nutritional status during haemodialysis using bioimpedance analysis.
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CHUA, HORNG-RUEY, XIANG, LING, CHOW, PEK-YEE, XU, HUI, SHEN, LIANG, LEE, EVAN, and TEO, BOON-WEE
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NUTRITIONAL status ,HEMODIALYSIS patients ,BIOELECTRIC impedance measurement ,CHRONIC kidney failure ,WATER in the body ,LEAN body mass ,PHYSIOLOGY ,PATIENTS - Abstract
ABSTRACT: Aim: To determine the precision of multi-frequency bioimpedance analysis (MFBIA) in quantifying acute changes in volume and nutritional status during haemodialysis, in patients with end-stage renal disease (ESRD). Methods: Using whole-body MFBIA, we prospectively studied changes in total body water (TBW), extracellular volume (ECV), intracellular volume (ICV), lean body mass (LBM), body cell mass (BCM) and fat mass (FM), pre- and post-haemodialysis and tested the agreement of volume changes with corresponding acute weight change and ultrafiltration volume (UF) using Bland-Altman analysis. Results: Forty-four prevalent and 17 incident haemodialysis patients were studied (median age 55 years, 56% males). MFBIA-derived TBW, ECV, ICV, LBM and BCM were significantly reduced after haemodialysis ( P < 0.001), but FM remained constant. TBW change estimated weight change with mean bias of −0.52 L, with 56/61 (91.8%) data points within limits of agreement (−2.74 L, 1.69 L). TBW change estimated UF with mean bias of −0.62 L, with 55/61 (90.2%) data points within limits of agreement (−2.68 L, 1.43 L). ECV change underestimated weight change and UF with mean bias of −1.17 L and −1.27 L respectively. Similarly, ICV change underestimated both clinical measures with corresponding mean bias of −1.34 L and −1.44 L. Comparing incidents versus prevalent haemodialysis patients, TBW change estimated weight change with smaller mean bias (−0.10 L vs−0.69 L, respectively) and narrower limits of agreement. Conclusion: Multi-frequency bioimpedance analysis-derived TBW change has the best agreement with acute clinical volume change during haemodialysis compared to ECV or ICV change alone, but overall degree of precision remains poor. Nutritional assessment using LBM and BCM measurements is significantly confounded by hydration status. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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40. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury.
- Author
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Demirjian, Sevag, Teo, Boon Wee, Guzman, Jorge A., Heyka, Robert J., Paganini, Emil P., Fissell, William H., Schold, Jesse D., and Schreiber, Martin J.
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FAMILIAL hypophosphatemia ,HEMODIALYSIS ,RESPIRATORY insufficiency ,ACUTE kidney failure ,VASOCONSTRICTORS ,CREATININE ,PHOSPHATES ,TRACHEOTOMY - Abstract
Background. Hypophosphatemia is common in critically ill patients and has been associated with generalized muscle weakness, ventilatory failure and myocardial dysfunction. Continuous renal replacement therapy causes phosphate depletion, particularly with prolonged and intensive therapy. In a prospective observational cohort of critically ill patients with acute kidney injury (AKI), we examined the incidence of hypophosphatemia during dialysis, associated risk factors and its relationship with prolonged respiratory failure and 28-day mortality.Methods. This is a single-center prospective observational study. Included in the study were 321 patients with AKI on continuous dialysis as initial treatment modality.Results. Four per cent of the patients had a phosphate level <2 mg/dL at initiation and 27% during dialysis. Low baseline phosphate was associated with older age, female gender, parenteral nutrition, vasopressor support, low calcium, and high urea, bilirubin and creatinine, whereas hypophosphatemia during dialysis correlated with the ischemic acute tubular necrosis etiology of renal failure, intensive dose and longer therapy. Serum phosphate decline during dialysis was associated with higher incidence of prolonged respiratory failure requiring tracheostomy [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.07–3.08], but not 28-day mortality (OR = 1.16; 95% CI = 0.76–1.77) in multivariable analysis.Conclusions. Hypophosphatemia occurs frequently during dialysis, particularly with long and intensive treatment. Decline in serum phosphate levels during dialysis is associated with higher incidence of prolonged respiratory failure requiring tracheostomy, but not 28-day mortality. [ABSTRACT FROM AUTHOR]
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- 2011
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41. Asian chronic kidney disease best practice recommendations: Positional statements for early detection of chronic kidney disease from Asian Forum for Chronic Kidney Disease Initiatives (AFCKDI).
- Author
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PHILIP KAM-TAO LI, KAI MING CHOW, MATSUO, SEIICHI, CHIH WEI YANG, VIVEKANAND JHA, BECKER, GAVIN, NAN CHEN, SHARMA, SANJIB KUMAR, CHITTINANDANA, ANUTRA, CHOWDHURY, SHAFIQUL, HARRIS, DAVID C.H., HOOI, LAI SEONG, IMAI, ENYU, KIM, SUHNGGWON, KIM, SUNG GYUN, LANGHAM, ROBYN, PADILLA, BENITA S., TEO, BOON WEE, TOGTOKH, ARIUNAA, and WALKER, ROWAN G.
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KIDNEY disease diagnosis ,EARLY diagnosis ,PEOPLE with diabetes ,FAMILY history (Medicine) ,GLOMERULAR filtration rate ,ASIANS ,HEALTH ,DISEASE risk factors - Abstract
AFCKDI RECOMMENDATIONS FOR EARLY DETECTION OF CHRONIC KIDNEY DISEASE 1. Targets Patients with diabetes, hypertension Those with family history of chronic kidney disease (CKD) Individuals receiving potentially nephrotoxic drugs, herbs or substances or taking indigenous medicine Patients with past history of acute kidney injury Individuals older than 65 years 2. Tools Spot urine sample for protein with standard urine Dipstick test (need a repeat confirmatory test if positive) Dipstick for red blood cells (need confirmation by urine microscopy) An estimate of glomerular filtration rate based on serum creatinine concentration 3. Frequency of screening Screening frequency for targeted individuals should be yearly if no abnormality is detected on initial evaluation. 4. Who should perform the screening Doctors, nurses, paramedical staff and other trained healthcare professionals 5. Intervention after screening Patients detected to have CKD should be referred to primary care physicians with experience in management of kidney disease for follow up. A management protocol should be provided to the primary care physicians. Further referral to nephrologists for management will be based on the protocol together with clinical judgment of the primary care physicians with their assessment of the severity of CKD and the likelihood of progression. 6. Screening for cardiovascular disease risk It is recommended that cardiovascular disease risk factors should be screened in all patients with CKD. [ABSTRACT FROM AUTHOR]
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- 2011
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42. Serum high-sensitivity troponin concentrations in a multi-ethnic Asian population of stable chronic kidney disease patients.
- Author
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Teo, Boon Wee, Lau, Titus, Toh, Qi Chun, Chua, Horng Ruey, Wong, Weng Kin, Haroon, Sabrina, Subramanian, Srinivas, Saw, Sharon, Sethi, Sunil, and on behalf of the NUHS Nephrology Clinical Research Group
- Subjects
TROPONIN ,MICROFILAMENT proteins ,KIDNEY diseases ,IMMUNOASSAY ,IMMUNOLOGICAL blood tests ,PATIENTS - Abstract
The article discusses a study which examined serum high-sensitivity troponin concentrations in a multi-ethnic Asian population with stable chronic kidney disease. Topics covered include the cardiac effect of elevated troponins in CKD, the use of a high-sensitivity assay in the study, and basic characteristics of the study participants.
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- 2015
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43. Case of disseminated tuberculosis in a patient on peritoneal dialysis and discussion on latent tuberculosis screening.
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Chhabra, Srishti, Chua, Yan Ting, Lee, Martin Beng Huat, Teo, Boon Wee, and Tok, Pei Loo
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TUBERCULOSIS patients ,PERITONEAL dialysis ,TUBERCULOSIS ,HEMODIALYSIS patients ,INTERFERON gamma release tests - Published
- 2020
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44. The Relationship between Generalized and Abdominal Obesity with Diabetic Kidney Disease in Type 2 Diabetes: A Multiethnic Asian Study and Meta-Analysis.
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Man, Ryan Eyn Kidd, Gan, Alfred Tau Liang, Fenwick, Eva Katie, Gupta, Preeti, Wong, Mark Yu Zheng, Wong, Tien Yin, Tan, Gavin Siew Wei, Teo, Boon Wee, Sabanayagam, Charumathi, and Lamoureux, Ecosse Luc
- Abstract
This study examined the associations of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) with diabetic kidney disease (DKD) in a clinical sample of Asian patients with type 2 diabetes (T2DM); substantiated with a meta-analysis of the above associations. We recruited 405 patients with T2DM (mean (standard deviation (SD)) age: 58 (7.5) years; 277 (68.4%) male; 203 (50.1%) with DKD) from a tertiary care centre in Singapore. DKD was defined as urinary albumin-creatinine ratio >3.3 mg/mmoL and/or estimated glomerular filtration rate <60 mL/min/1.73 m
2 . All exposures were analysed continuously and categorically (World Health Organization cut-points for BMI and WC; median for WHR and WHtR) with DKD using stepwise logistic regression models adjusted for traditional risk factors. Additionally, we synthesized the pooled odds ratio of 18 studies (N = 19,755) in a meta-analysis of the above relationships in T2DM. We found that overweight and obese persons (categorized using BMI) were more likely to have DKD compared to under/normal weight individuals, while no associations were found for abdominal obesity exposures. In meta-analyses however, all obesity parameters were associated with increased odds of DKD. The discordance in our abdominal obesity findings compared to the pooled analyses warrants further validation via longitudinal cohorts. [ABSTRACT FROM AUTHOR]- Published
- 2018
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45. Diabetic Microvascular Complications: Novel Risk Factors, Biomarkers, and Risk Prediction Models.
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McKay, Gareth J., Teo, Boon Wee, Zheng, Ying-Feng, Sambamoorthi, Usha, and Sabanayagam, Charumathi
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DIABETES complications ,MICROCIRCULATION disorders ,BIOMARKERS ,OBESITY ,SEDENTARY lifestyles ,LIFE expectancy - Published
- 2015
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46. Diabetic Microvascular Complications: Novel Risk Factors, Biomarkers, and Risk Prediction Models.
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McKay, Gareth J., Teo, Boon Wee, Zheng, Ying-Feng, Sambamoorthi, Usha, and Sabanayagam, Charumathi
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DIABETES complications ,BIOMARKERS ,DIABETES risk factors ,MICROCIRCULATION disorders ,PREDICTION models ,HEALTH outcome assessment - Published
- 2015
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47. Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults.
- Author
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Sabanayagam, Charumathi, Teo, Boon Wee, Tai, E Shyong, Jafar, Tazeen H, and Wong, Tien Yin
- Abstract
Background: Chronic kidney disease (CKD) is an emerging public health problem worldwide. Previous studies have shown an association between blood pressure (BP) and CKD. However, it is not clear if there are ethnic differences in this association. We examined the association between BP and CKD in a multi-ethnic Asian population in Singapore.Methods: We analysed data from three large population-based studies conducted between 2004-2011, (n=3,167 Chinese, 3,082 Malays and 3,228 Indians) aged 40-80 years. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m² from serum creatinine. Hypertension was defined as a self-reported current use of antihypertensive medication or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. We also analysed the association of CKD with individual BP components.Results: The prevalence of both hypertension and CKD was higher among Malays (68.6, 21%) compared to Chinese (57.9, 5.9%) and Indians (56.0, 7.4%), but treatment for hypertension was lower among Malays (53.4%) compared to Chinese (89.8%) and Indians (83.1%). Hypertension was associated with CKD in all three ethnic groups (OR [95% CI] = 2.71 [1.59-4.63], 2.08 [1.62-2.68], 2.43 [1.66-3.57] in Chinese, Malays and Indians). Among the BP components, both systolic and diastolic BP were associated with CKD in Malays whereas, systolic BP was not significantly associated with CKD, and diastolic BP showed an inverse association which was explained by anti-hypertensive medication use in Chinese and Indians.Conclusions: Hypertension was associated with CKD in Chinese, Malays and Indians. However, the BP components were associated with CKD only in Malays. [ABSTRACT FROM AUTHOR]- Published
- 2013
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48. 700 HYPERTENSIVE RETINOPATHY AND RISK OF CHRONIC KIDNEY DISEASE IN A MULTI-ETHNIC ASIAN POPULATION.
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Yip, Wanfen, Sabanayagam, Charumathi, Teo, Boon Wee, Tay, Wan Ting, Ikram, M. Kamran, Tai, E Shyong, Wong, Tien Yin, and Cheung, Carol Yim-lui
- Published
- 2012
- Full Text
- View/download PDF
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