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Both genetic predisposition and low educational attainment (EA) are associated with higher risk of chronic kidney disease. We examined the interaction of EA and genetic risk in kidney function outcomes. We included 3,597 participants from the Prevention of Renal and Vascular End-Stage Disease Cohort Study, a longitudinal study in a community-based sample from Groningen, the Netherlands (median follow-up, 11 years; 1997-2012). Kidney function was approximated by obtaining estimated glomerular filtration rate (eGFR) from serum creatinine and cystatin C. Individual longitudinal linear eGFR trajectories were derived from linear mixed models. Genotype data on 63 single-nucleotide polymorphisms, with known associations with eGFR, were used to calculate an allele-weighted genetic score (WGS). EA was categorized into high, medium, and low. In ordinary least squares analysis, higher WGS and lower EA showed additive effects on reduced baseline eGFR; the interaction term was nonsignificant. In analysis of eGFR decline, the significant interaction term suggested amplification of genetic risk by low EA. Adjustment for known renal risk factors did not affect our results. This study presents the first evidence of gene-environment interaction between EA and a WGS for eGFR decline and provides population-level insights into the mechanisms underlying socioeconomic disparities in chronic kidney disease., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

The link between exposure to endocrine disrupting chemicals (EDCs) and the rapid increase in prevalence of obesity has recently been suggested. However, the magnitude and health impact of EDC exposure in at-risk populations remain largely unclear. In this study, we investigated the effect of a dietary intervention driven reduction in adipose tissue on the magnitude of urinary EDC exposure and mobilization, and whether higher EDC exposure leads to impaired weight loss in obese individuals. In this post-hoc analysis of the Lifestyle, OverWeight, Energy Restriction (LOWER) study from the Netherlands, 218 subjects were included. Five parabens, three bisphenols and thirteen metabolites of eight phthalates were measured in 24-h urine using LC-MS/MS, before and after three-months of a calory-restricted weight reduction intervention program. Associations between adiposity-related traits and EDCs were tested using multivariable linear regression and linear mixed effects models. A multiple testing correction based on the false discovery rate (FDR) was applied. After the 3-month intervention, urinary paraben and bisphenol excretions remained similar. Excretions of mono-butyl phthalates and most high-molecular-weight phthalates decreased, whereas mono-ethyl phthalate increased (all FDR<0.05). A reduction in adipose tissue was not associated with higher urinary EDC excretions. Higher baseline EDC excretions were associated with higher post-intervention body-mass index (methyl-, propylparaben), waist circumference (propylparaben, mono-n-butyl phthalate, mono-benzyl phthalate), and body fat percentage (mono-ethyl phthalate, mono-benzyl phthalate). Associations between parabens and body-mass index, and mono-benzyl phthalate and waist circumference and body fat percentage remained after multiple testing correction (all FDR<0.05). In a study of obese participants, we observed a reduction in most phthalates after a weight reduction intervention. A reduction in adipose tissue may not lead to mobilization and successively to higher urinary EDC excretions. Higher baseline paraben and phthalate exposures were associated with reduced weight loss, suggesting obesogenic properties., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The longitudinal association between low education and chronic kidney disease (CKD) and its underlying mechanisms is poorly characterized. We therefore examined the association of low education with incident CKD and change in kidney function, and explored potential mediators of this association., Methods: We analysed data on 6078 participants from the community-based Prevention of Renal and Vascular End-stage Disease study. Educational level was categorized into low, medium and high (< secondary, secondary/equivalent, > secondary schooling, respectively). Kidney function was assessed by estimating glomerular filtration rate (eGFR) by serum creatinine and cystatin C at five examinations during ∼11 years of follow-up. Incident CKD was defined as new-onset eGFR <60 mL/min/1.73 m2 and/or urinary albumin ≥30 mg/24 h in those free of CKD at baseline. We estimated main effects with Cox regression and linear mixed models. In exploratory causal mediation analyses, we examined mediation by several potential risk factors., Results: Incident CKD was observed in 861 (17%) participants. Lower education was associated with higher rates of incident CKD [low versus high education; hazard ratio (HR) (95% CI) 1.25 (1.05-1.48), Ptrend = 0.009] and accelerated eGFR decline [B (95% CI) -0.15 (-0.21 to -0.09) mL/min/1.73 m2/year, Ptrend < 0.001]. The association between education and incident CKD was mediated by smoking, potassium excretion, body mass index (BMI), waist-to-hip ratio (WHR) and hypertension. Analysis on annual eGFR change in addition suggested mediation by magnesium excretion, protein intake and diabetes., Conclusions: In the general population, we observed an inverse association of educational level with CKD. Diabetes and the modifiable risk factors smoking, poor diet, BMI, WHR and hypertension are suggested to underlie this association. These findings provide support for targeted preventive policies to reduce socioeconomic disparities in kidney disease., (© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Marfan syndrome (MFS) is diagnosed according to the Ghent nosology, which has recently been revised. In the Netherlands, evaluation for possible MFS is performed in specialized Marfan outpatient clinics. We investigated the diagnostic yield in our clinic and the impact of the 2010 nosology. All adult patients (n = 343) who visited our clinic between 1998 and 2008 were included. We analyzed their reasons for referral, characteristics, and established diagnoses. In addition, we applied the 2010 nosology to all patients and compared the outcomes to those obtained with the 1996 nosology. Diagnoses that were made using the 1996 and the 2010 Ghent nosology included MFS (44/343 vs. 47/343), familial thoracic aortic aneurysm and/or dissection (22/343 vs. 22/343 patients), Loeys-Dietz syndrome (4/343 vs. 4/343 patients), and (familial) mitral valve prolapse (MVPS; 5/343 vs. 28/343 patients). In both nosologies, 77% of MFS patients had an FBN1 mutation. The 2010 nosology led to an increase in the number of diagnoses made: 4 additional cases of MFS were identified (one patient was "lost" who no longer fulfilled the criteria) and 23 additional cases of MVPS were diagnosed. The diagnostic yield of patients with aortic root dilatation was 65% using the 1996 nosology and 70% using the 2010 nosology. The change in diagnoses did not lead to a difference in clinical follow-up. We conclude that the diagnostic yield of our specialized clinic was high, in particular in patients with aortic root dilatation. Further more the 2010 Ghent nosology led to a significant increase in the number of diagnoses made, mainly due to lowering of the diagnostic threshold for MVPS., (Copyright © 2012 Wiley Periodicals, Inc.)