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1. Reappraisal of Factors Disturbing the Relationship between Body Water Volumes and Total Body Electrical Resistance in Patients on Hemodialysis

Author

Schotman Jm, Doorenbos Cj, Wetzels Jfm, Reichert Ljm, van Borren Mmgj, de Boer H, and Kloke Hj

Subjects
Electrical resistance and conductance, business.industry, Anesthesia, medicine.medical_treatment, Body water, medicine, Total body, In patient, Hemodialysis, business
Abstract

Background: Measurements of Total Body Electrical Resistance (TBER) are used to improve fluid balance management in patients on Hemodialysis (HD). This approach is based on the inverse relation that exists between TBER and body water volumes. Interpretation errors may occur if TBER measurements are affected by factors that are not related to changes in body water. Aim of this paper was to provide an overview of the methodological artifacts commonly encountered in a clinical setting, and to strengthen current evidence of their disturbing effects by performing additional experiments. Methods: This study includes an analysis of available literature data, supplemented with additional experiments in healthy adults and patients. A cutoff of 2.7% was used to classify changes in TBER as significant within individual subjects. Results: Electrode position, electrode interference, differences of measurements performed at the right or left side of the body, presence of orthopedic prosthesis located in the limbs, fluid redistribution induced by longterm changes in body position, and electrolyte abnormalities were the main disturbing factors that can induce a significant change in TBER. Other factors either had no significant disturbing effect or could be easily avoided. Conclusion: TBER measurements require a high degree of standardization to minimize interpretation errors.

Published
2021

2. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

Author

Matsushita, K, Ballew, Sh, Coresh, J, Arima, H, Ärnlöv, J, Cirillo, Massimo, Ebert, N, Hiramoto, Js, Kimm, H, Shlipak, Mg, Visseren, Flj, Gansevoort, Rt, Kovesdy, Cp, Shalev, V, Woodward, M, Kronenberg, F, Chronic Kidney Disease Prognosis Consortium: Chalmers, J, Perkovic, V, Grams, Me, Sang, Y, Schaeffner, E, Martus, P, Levin, A, Djurdjev, O, Tang, M, Heine, G, Seiler, S, Zawada, A, Emrich, I, Sarnak, M, Katz, R, Brenner, H, Schöttker, B, Rothenbacher, D, Saum, Ku, Köttgen, A, Schneider, M, Eckardt, Ku, Green, J, Kirchner, Hl, Chang, Ar, Black, C, Marks, A, Prescott, G, Clark, L, Fluck, N, Jee, Sh, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Bots, M, Peralta, C, Hiromoto, J, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Kenealy, T, Elley, Cr, Collins, Jf, Drury, Pl, Bakker, Sj, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Jh, Ix, Barrett Connor, E, Kalantar Zadeh, K, Carrero, Jj, Gasparini, A, Qureshi, Ar, Barany, P, Algra, A, Van, Der, Graaf, Y, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Lannfelt, L, Larsson, A, Hallan, S, Levey, As, Chen, J, Kwak, L, Sang, Y., Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Matsushita, K, Ballew, Sh, Coresh, J, Arima, H, Ärnlöv, J, Cirillo, Massimo, Ebert, N, Hiramoto, J, Kimm, H, Shlipak, Mg, Visseren, Flj, Gansevoort, Rt, Kovesdy, Cp, Shalev, V, Woodward, M, Kronenberg, F, Chronic Kidney Disease Prognosis Consortium: Chalmers, J, Perkovic, V, Grams, Me, Sang, Y, Schaeffner, E, Martus, P, Levin, A, Djurdjev, O, Tang, M, Heine, G, Seiler, S, Zawada, A, Emrich, I, Sarnak, M, Katz, R, Brenner, H, Schöttker, B, Rothenbacher, D, Saum, Ku, Köttgen, A, Schneider, M, Eckardt, Ku, Green, J, Kirchner, Hl, Chang, Ar, Black, C, Marks, A, Prescott, G, Clark, L, Fluck, N, Jee, Sh, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Ad, Bots, M, Peralta, C, Hiromoto, J, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Kenealy, T, Elley, Cr, Collins, Jf, Drury, Pl, Bakker, Sj, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett Connor, E, Kalantar Zadeh, K, Carrero, Jj, Gasparini, A, Qureshi, Ar, Barany, P, Algra, A, Van, Der, Graaf, Y, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Lannfelt, L, Larsson, A, Hallan, S, Levey, A, Chen, J, Kwak, L, and Sang, Y.

Subjects
Male, Databases, Factual, Endocrinology, Diabetes and Metabolism, nefropatia, arteriopatia periferica, epidemiologia, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, arteriopatia periferica, 0302 clinical medicine, Endocrinology, Risk Factors, CRITICAL LIMB ISCHEMIA, 030212 general & internal medicine, epidemiologia, POPULATION, biology, CYSTATIN C, Incidence, Middle Aged, PREVALENCE, Diabetes and Metabolism, nefropatia, Creatinine, Female, medicine.symptom, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Renal function, ATHEROSCLEROSIS RISK, HEART-ASSOCIATION, CARDIOVASCULAR OUTCOMES, 03 medical and health sciences, Peripheral Arterial Disease, Internal medicine, Diabetes mellitus, medicine, Internal Medicine, Albuminuria, Humans, Risk factor, Renal Insufficiency, Chronic, Aged, business.industry, Critical limb ischemia, medicine.disease, Intermittent claudication, Surgery, Cystatin C, biology.protein, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Kidney disease
Abstract

BACKGROUND: Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease.METHODS: In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics.FINDINGS: We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m(2), adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m(2) and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m(2). Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR INTERPRETATION: Even mild-to-moderate chronic kidney disease conferred increased risk of incident peripheral artery disease, with a strong association between albuminuria and amputation. Clinical attention should be paid to the development of peripheral artery disease symptoms and signs in people with any stage of chronic kidney disease.FUNDING: American Heart Association, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.

Published
2017

3. Adiposity and risk of decline in glomerular filtration rate : Meta-analysis of individual participant data in a global consortium

Author

Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M, Gutierrez OM, Hosseinpanah F, Iseki K, Kenealy T, Klein B, Kronenberg F, Lee BJ, Li Y, Miura K, Navaneethan SD, Roderick PJ, Valdivielso JM, Visseren FLJ, Zhang L, Gansevoort RT, Hallan SI, Levey AS, Matsushita K, Shalev V, Woodward M, Astor B, Appel L, Greene T, Chen T, Chalmers J, Arima H, Perkovic V, Yatsuya H, Tamakoshi K, Hirakawa Y, Coresh J, Sang Y, Polkinghorne K, Chadban S, Atkins R, Levin A, Djurdjev O, Klein R, Lee K, Liu L, Zhao M, Wang F, Wang J, Tang M, Heine G, Emrich I, Zawada A, Bauer L, Nally J, Schold J, Shlipak M, Sarnak M, Katz R, Hiramoto J, Iso H, Yamagishi K, Umesawa M, Muraki I, Fukagawa M, Maruyama S, Hamano T, Hasegawa T, Fujii N, Jafar T, Hatcher J, Poulter N, Chaturvedi N, Wheeler D, Emberson J, Townend J, Landray M, Brenner H, Schöttker B, Saum KU, Rothenbacher D, Fox C, Hwang SJ, Köttgen A, Schneider MP, Eckardt KU, Green J, Kirchner HL, Ito S, Miyazaki M, Nakayama M, Yamada G, Cirillo M, Romundstad S, Øvrehus M, Langlo KA, Irie F, Sairenchi T, Rebholz CM, Young B, Boulware LE, Ishikawa S, Yano Y, Kotani K, Nakamura T, Jee SH, Kimm H, Mok Y, Chodick G, Wetzels JFM, Blankestijn PJ, van Zuilen AD, Bots M, Inker L, Peralta C, Kollerits B, Ritz E, Nitsch D, Fletcher A, Bottinger E, Nadkarni GN, Ellis SB, Nadukuru R, Fernandez E, Betriu A, Bermudez-Lopez M, Stengel B, Metzger M, Flamant M, Houillier P, Haymann JP, Froissart M, Ueshima H, Okayama A, Tanaka S, Okamura T, Elley CR, Collins JF, Drury PL, Ohkubo T, Asayama K, Metoki H, Kikuya M, Iseki C, Nelson RG, Knowler WC, Bakker SJL, Heerspink HJL, Brunskill N, Major R, Shepherd D, Medcalf J, Jassal SK, Bergstrom J, Ix JH, Barrett-Connor E, Kovesdy C, Kalantar-Zadeh K, Sumida K, Muntner P, Warnock D, Judd S, Panwar B, de Zeeuw D, Brenner B, Sedaghat S, Ikram MA, Hoorn EJ, Dehghan A, Wong TY, Sabanayagam C, Cheng CY, Banu R, Segelmark M, Stendahl M, Schön S, Tangri N, Sud M, Naimark D, Wen CP, Tsao CK, Tsai MK, Chen CH, Konta T, Hirayama A, Ichikawa K, Hadaegh F, Mirbolouk M, Azizi F, Solbu MD, Jenssen TG, Eriksen BO, Eggen AE, Lannfelt L, Larsson A, Ärnlöv J, Landman GWD, van Hateren KJJ, Kleefstra N, Chen J, Kwak L, Surapaneni A., Chang, Ar, Grams, Me, Ballew, Sh, Bilo, H, Correa, A, Evans, M, Gutierrez, Om, Hosseinpanah F, Iseki K, Kenealy, T, Klein, B, Kronenberg, F, Lee, Bj, Li, Y, Miura, K, Navaneethan, Sd, Roderick, Pj, Valdivielso, Jm, Visseren, Flj, Zhang, L, Gansevoort, Rt, Hallan, Si, Levey, A, Matsushita, K, Shalev, V, Woodward, M, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Arima, H, Perkovic, V, Yatsuya, H, Tamakoshi, K, Hirakawa, Y, Coresh, J, Sang, Y, Polkinghorne, K, Chadban, S, Atkins, R, Levin, A, Djurdjev, O, Klein, R, Lee, K, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Heine, G, Emrich, I, Zawada, A, Bauer, L, Nally, J, Schold, J, Shlipak, M, Sarnak, M, Katz, R, Hiramoto, J, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Hasegawa, T, Fujii, N, Jafar, T, Hatcher, J, Poulter, N, Chaturvedi, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Brenner, H, Schöttker, B, Saum, Ku, Rothenbacher, D, Fox, C, Hwang, Sj, Köttgen, A, Schneider, Mp, Eckardt, Ku, Green, J, Kirchner, Hl, Ito, S, Miyazaki, M, Nakayama, M, Yamada, G, Cirillo, M, Romundstad, S, Øvrehus, M, Langlo, Ka, Irie, F, Sairenchi, T, Rebholz, Cm, Young, B, Boulware, Le, Ishikawa, S, Yano, Y, Kotani, K, Nakamura, T, Jee, Sh, Kimm, H, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, van Zuilen, Ad, Bots, M, Inker, L, Peralta, C, Kollerits, B, Ritz, E, Nitsch, D, Fletcher, A, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Fernandez, E, Betriu, A, Bermudez-Lopez, M, Stengel, B, Metzger, M, Flamant, M, Houillier, P, Haymann, Jp, Froissart, M, Ueshima, H, Okayama, A, Tanaka, S, Okamura, T, Elley, Cr, Collins, Jf, Drury, Pl, Ohkubo, T, Asayama, K, Metoki, H, Kikuya, M, Iseki, C, Nelson, Rg, Knowler, Wc, Bakker, Sjl, Heerspink, Hjl, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, Sumida, K, Muntner, P, Warnock, D, Judd, S, Panwar, B, de Zeeuw, D, Brenner, B, Sedaghat, S, Ikram, Ma, Hoorn, Ej, Dehghan, A, Wong, Ty, Sabanayagam, C, Cheng, Cy, Banu, R, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, Cp, Tsao, Ck, Tsai, Mk, Chen, Ch, Konta, T, Hirayama, A, Ichikawa, K, Hadaegh, F, Mirbolouk, M, Azizi, F, Solbu, Md, Jenssen, Tg, Eriksen, Bo, Eggen, Ae, Lannfelt, L, Larsson, A, Ärnlöv, J, Landman, Gwd, van Hateren, Kjj, Kleefstra, N, Chen, J, Kwak, L, Surapaneni, A., Lifestyle Medicine (LM), Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Asayama, Kei, and Sedaghat, SeyyedMah

Subjects
CHRONIC KIDNEY-DISEASE, Male, 030232 urology & nephrology, 030204 cardiovascular system & hematology, OBESITY PARADOX, Body Mass Index, BMI, eGFR, CKD-PC, Cohort Studies, 0302 clinical medicine, Risk Factors, Urologi och njurmedicin, Medicine, ALL-CAUSE MORTALITY, Adiposity, 2. Zero hunger, Aged, 80 and over, Medicine(all), education.field_of_study, Hazard ratio, ASSOCIATION, General Medicine, Middle Aged, 3. Good health, Cohort, Female, Waist Circumference, Life Sciences & Biomedicine, WAIST CIRCUMFERENCE, Obesity paradox, Glomerular Filtration Rate, Adult, Waist, Population, Renal function, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, CKD, Urology and Nephrology, Humans, Mortality, education, Aged, Science & Technology, business.industry, Research, medicine.disease, Body Height, BODY-MASS INDEX, Kidney Failure, Chronic, WEIGHT, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Body mass index, Demography, Kidney disease
Abstract

ObjectiveTo evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR 2) and all cause mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

Published
2019

4. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis

Author

Kovesdy, CP, Matsushita, K, Sang, Y, Brunskill, NJ, Carrero, JJ, Chodick, G, Hasegawa, T, Heerspink, HL, Hirayama, A, Landman, GWD, Levin, A, Nitsch, D, Wheeler, DC, Coresh, J, Hallan, SI, Shalev, V, Grams, ME, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Woodward, M, Arima, H, Perkovic, V, Djurdjev, O, Zhang, L, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Fujii, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Green, J, Kirchner, HL, Chang, AR, Cirillo, Massimo, Jee, SH, Kimm, H, Mok, Y, Wetzels, JFM, Blankestijn, PJ, van Zuilen, Bots, M, Sarnak, M, Inker, L, Roderick, P, Fletcher, A, Bottinger, E, Nadkarni, GN, Ellis, SB, Nadukuru, R, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Gansevoort, RT, Bakker, SJL, Heerspink, HJL, Jassal, SK, Bergstrom, J, Ix, JH, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, de Zeeuw, D, Brenner, B, Gasparini, A, Elinder, CG, Barany, P, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, CP, Tsao, CK, Tsai, MK, Chen, CH, Konta, T, Ichikawa, K, Bilo, HJG, van Hateren, KJJ, Kleefstra, N, Hallan, S, Levey, AS, Ballew, SH, Chen, J, Kwak, L, Woodward, M., Kovesdy, Cp, Matsushita, K, Sang, Y, Brunskill, Nj, Carrero, Jj, Chodick, G, Hasegawa, T, Heerspink, Hl, Hirayama, A, Landman, Gwd, Levin, A, Nitsch, D, Wheeler, Dc, Coresh, J, Hallan, Si, Shalev, V, Grams, Me, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Woodward, M, Arima, H, Perkovic, V, Djurdjev, O, Zhang, L, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Fujii, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Green, J, Kirchner, Hl, Chang, Ar, Cirillo, Massimo, Jee, Sh, Kimm, H, Mok, Y, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Ad, Bots, M, Sarnak, M, Inker, L, Roderick, P, Fletcher, A, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Gansevoort, Rt, Bakker, Sjl, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, De, Zeeuw, D, Brenner, B, Gasparini, A, Elinder, Cg, Barany, P, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, Cp, Tsao, Ck, Tsai, Mk, Chen, Ch, Konta, T, Ichikawa, K, Bilo, Hjg, Van, Hateren, Kjj, Kleefstra, N, Hallan, S, Levey, A, Ballew, Sh, Chen, J, Kwak, L, Woodward, M., Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Kidney Center (GKC), and Methods in Medicines evaluation & Outcomes research (M2O)

Subjects
Hyperkalemia, 030232 urology & nephrology, HEMODIALYSIS-PATIENTS, Comorbidity, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, HYPERKALEMIA, End-stage renal disease, CHRONIC RENAL-INSUFFICIENCY, 0302 clinical medicine, SODIUM ZIRCONIUM CYCLOSILICATE, Risk Factors, Cause of Death, Estimated glomerular filtration rate, ESTIMATED GFR, education.field_of_study, Hazard ratio, Middle Aged, Prognosis, CHRONIC HEART-FAILURE, EUROPEAN-SOCIETY, Cardiovascular Diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Population, Renal function, Hypokalemia, End stage renal disease, 03 medical and health sciences, Internal medicine, medicine, Humans, Albuminuria, Renal Insufficiency, Chronic, Mortality, education, CKD Prognosis Consortium, Aged, business.industry, Proportional hazards model, POLYMERIC POTASSIUM BINDER, medicine.disease, SERUM POTASSIUM, Potassium, Kidney Failure, Chronic, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Kidney disease
Abstract

Item does not contain fulltext Aims: Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods and results: We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 +/- 16 years, average eGFR was 83 +/- 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 +/- 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts. Conclusions: Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.

Published
2018

5. Past Decline Versus Current eGFR and Subsequent Mortality Risk

Author

Naimark DMJ, Grams ME, Matsushita K, Black C, Drion I, Fox CS, Inker LA, Ishani A, Jee SA, Kitamura A, Lea JP, Nally J, Peralta CA, Rothenbacher D, Ryu S, Tonelli M, Yatsuya H, Coresh J, Gansevoort RT, Warnock DG, Woodward M, de Jong PE, the CKD Prognosis Consortium, Wright JTJr, Appel LJ, Greene T, MacMahon S, Chalmers J, Arima H, Yamashita K, Toyoshima H, Tamakoshi K, Hemmelgarn B, James M, Sang Y, Atkins RC, Polkinghorne KR, Chadban S, Shankar A, Klein R, Klein BEK, Lee KE, Levin A, Djurdjev O, Sacks FM, Curhan GC, Zawada AM, Rogacev KS, Seiler S, Heine GH, Navaneethan SD, Schold JD, Shlipak M, Sarnak MJ, Katz R, Imano H, Yamagishi K, Wheeler DC, Emberson J, Townend JN, Landray MJ, Brenner H, Müller H, Schöttker B, Hwang S-J, Meigs JB, Uphadhay A, Green J, Kirchner HL, Perkins R, Chang AR, Fluck N, Prescott GJ, Cirillo M, Hallan S, Aasarød K, Øien CM, Radtke M, Irie F, Iso H, Sairenchi T, Smith DH, Thorp ML, Johnson ES, Lee BJ, Guallar E, Chang SY, Cho J, Shin H, Chodick G, Shalev V, Birnbaum YC, Shainberg B, Wetzels JFM, Blankestijn PJ, van Zuilen AD, Levey AS, Neaton JD, Froissart M, Stengel B, Metzger M, Haymann J-P, Houillier P, Flamant M, Elley CR, Kenealy T, Moyes SA, Collins JF, Drury PL, Ohkubo T, Metoki H, Nakayama M, Imai Y, Iseki K, Nelson RG, Knowler WC, Bakker SJL, LHillege H, Jassal SK, Bergstrom J, Ix JH, Barrett-Connor E, Heerspink HJL, Brenner BE, de Zeeuw D, Kimm H, Mok Y, Tangri N, Wen C-P, Wen S-F, Tsao C-K, Tsai M-K, Ärnlöv J, Lannfelt L, Larsson A, Kovesdy CP, Kalantar-Zadeh K, Bilo HJ, Kleefstra N, Groenier KH, Joosten H, Ballew SH, Naimark, Dmj, Grams, Me, Matsushita, K, Black, C, Drion, I, Fox, C, Inker, La, Ishani, A, Jee, Sa, Kitamura, A, Lea, Jp, Nally, J, Peralta, Ca, Rothenbacher, D, Ryu, S, Tonelli, M, Yatsuya, H, Coresh, J, Gansevoort, Rt, Warnock, Dg, Woodward, M, de Jong, Pe, the CKD Prognosis, Consortium, Wright, Jtjr, Appel, Lj, Greene, T, Macmahon, S, Chalmers, J, Arima, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Hemmelgarn, B, James, M, Sang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Bek, Lee, Ke, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Zawada, Am, Rogacev, K, Seiler, S, Heine, Gh, Navaneethan, Sd, Schold, Jd, Shlipak, M, Sarnak, Mj, Katz, R, Imano, H, Yamagishi, K, Wheeler, Dc, Emberson, J, Townend, Jn, Landray, Mj, Brenner, H, Müller, H, Schöttker, B, Hwang, S-J, Meigs, Jb, Uphadhay, A, Green, J, Kirchner, Hl, Perkins, R, Chang, Ar, Fluck, N, Prescott, Gj, Cirillo, M, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Iso, H, Sairenchi, T, Smith, Dh, Thorp, Ml, Johnson, E, Lee, Bj, Guallar, E, Chang, Sy, Cho, J, Shin, H, Chodick, G, Shalev, V, Birnbaum, Yc, Shainberg, B, Wetzels, Jfm, Blankestijn, Pj, van Zuilen, Ad, Levey, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, J-P, Houillier, P, Flamant, M, Elley, Cr, Kenealy, T, Moyes, Sa, Collins, Jf, Drury, Pl, Ohkubo, T, Metoki, H, Nakayama, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Bakker, Sjl, Lhillege, H, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Heerspink, Hjl, Brenner, Be, de Zeeuw, D, Kimm, H, Mok, Y, Tangri, N, Wen, C-P, Wen, S-F, Tsao, C-K, Tsai, M-K, Ärnlöv, J, Lannfelt, L, Larsson, A, Kovesdy, Cp, Kalantar-Zadeh, K, Bilo, Hj, Kleefstra, N, Groenier, Kh, Joosten, H, Ballew, Sh, Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)

Subjects
Gerontology, Male, CHRONIC KIDNEY-DISEASE, medicine.medical_specialty, Time Factors, 030232 urology & nephrology, Renal function, 030204 cardiovascular system & hematology, ALL-CAUSE, GLOMERULAR-FILTRATION-RATE, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Cause of Death, Epidemiology, Risk of mortality, medicine, EQUATION, Humans, Clinical Epidemiology, Renal Insufficiency, Chronic, Aged, Proportional Hazards Models, business.industry, Hazard ratio, STAGE RENAL-DISEASE, DEATH, General Medicine, Middle Aged, POPULATION COHORTS, Confidence interval, Increased risk, Nephrology, CARDIOVASCULAR-DISEASE, COLLABORATIVE METAANALYSIS, Female, business, HIGHER ALBUMINURIA, All cause mortality, Glomerular Filtration Rate
Abstract

A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope-5 ml/min per 1.73 m(2) per year, whereas 7% and 4% had a slope5 ml/min per 1.73 m(2) per year, respectively. Compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m(2) per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.

Published
2016

6. Estimating Glomerular Filtration Rate

Author

Jean-Pierre Mallié, Rossini Botev, Jack F.M. Wetzels, Natale G. De Santo, Cecilé Couchoud, Nelson Lee, Jean-Pierre Fauvel, Otto Schück, Massimo Cirillo, Botev, R, Mallie, Jp, Couchoud, C, Schuck, O, Fauvel, Jp, Wetzels, Jfm, Lee, N, De Santo, Ng, and Cirillo, M

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Epidemiology, Inulin, Urology, Renal function, Kidney Function Tests, urologic and male genital diseases, Critical Care and Intensive Care Medicine, Models, Biological, Sensitivity and Specificity, Mean difference, Cohort Studies, Young Adult, chemistry.chemical_compound, Internal medicine, Chronic Kidney Disease, medicine, Humans, Registries, Renal Insufficiency, Chronic, reproductive and urinary physiology, Aged, Renal disorder [IGMD 9], Aged, 80 and over, Transplantation, Entire population, Inulin Clearance, Creatinine, urogenital system, business.industry, Limits of agreement, Reproducibility of Results, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, Diet, Endocrinology, chemistry, Nephrology, Female, business, Glomerular Filtration Rate, Kidney disease
Abstract

Item does not contain fulltext BACKGROUND AND OBJECTIVES: Evaluation of renal function by estimation of the glomerular filtration rate (GFR) is very important for the diagnosis and treatment of patients with chronic kidney disease (CKD). The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas are the most commonly used estimations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Estimated GFR values by each formula were compared with measured GFR (mGFR) by renal inulin clearance in 2208 European adults (46% women, 1.4% Caribbean blacks), with and without CKD, and mean mGFR 72.4 +/- 39.0 (range 2.2 to 177.2) ml/min/1.73 m(2). RESULTS: Overall, the CG and MDRD formulas showed bias (mean difference) -3.5 ml/min/1.73 m(2) (5.3%), P < 0.001, and -9.8 ml/min/1.73 m(2) (-6.4%), P < 0.001; precision (SD of bias) 21.5 ml/min/1.73 m(2) (43.1%) and 20.0 ml/min/1.73 m(2) (33.0%); limits of agreement (2 SD by Bland-Altman method) 39.5 to -46.5 (range 86.0) ml/min/1.73 m(2) and 30.2 to -49.8 (range 80.0) ml/min/1.73 m(2); and accuracy within +/-30% of mGFR 70.8 and 69.0%, respectively. Both formulas showed a trend for decreasing accuracy with lower mGFR levels. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification's five GFR groups, the CG and MDRD formulas properly assigned 61.6 and 57.1% of the entire population and had a range of positive predictive values 42.6 to 81.8% and 39.6 to 85.2% and of negative predictive values 81.7 to 96.6% and 76.4 to 97.5%, respectively. CONCLUSIONS: The CG and MDRD formulas had some limitations for proper GFR estimation and K/DOQI-CKD classification by GFR levels alone.

Published
2009

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