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  • 1
    Online-Ressource
    Online-Ressource
    Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure : A Meta-analysis
    American Medical Association (AMA) ; 2016
    In:  JAMA Vol. 315, No. 2 ( 2016-01-12), p. 164-
    Details
    In: JAMA, American Medical Association (AMA), Vol. 315, No. 2 ( 2016-01-12), p. 164-
    Materialart: Online-Ressource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2015.18202
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: American Medical Association (AMA)
    Publikationsdatum: 2016
    ZDB Id: 2958-0
    ZDB Id: 2018410-4
    SSG: 5,21
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Association of Kidney Disease Measures With Ischemic Versus Hemorrhagic Strokes : Pooled Analyses of 4 Prospective Community-Based Cohorts
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 7 ( 2014-07), p. 1925-1931
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2014-07), p. 1925-1931
    Kurzfassung: Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke. Methods— We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression. Results— Among 29 595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280 549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m 2 were 1.30 (95% confidence interval, 1.01–1.68) and 0.92 (0.47–1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27–2.07) for ischemic and 2.57 (1.37–4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke ( P =0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure. Conclusions— Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.004900
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2014
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    Abstract MP073: Combining Multiple Kidney Markers to Predict Future Risk of Clinical Outcomes: The Atherosclerosis Risk in Communities (ARIC) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Circulation Vol. 125, No. suppl_10 ( 2012-03-13)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 125, No. suppl_10 ( 2012-03-13)
    Kurzfassung: Background There is substantial interest in investigating how multiple chronic kidney disease (CKD) markers combine to predict risk, in particular using eGFR by cystatin C (eGFR cys ) as a supplement to traditional CKD markers, eGFR by creatinine (eGFR cr ) and albumin: creatinine ratio (ACR). Methods We followed 10,268 participants for a median of 11.2 years. Participants were classified into 8 categories: (1) no CKD by any marker (reference); CKD by either (2) eGFR cr or (3) eGFR cys ( 〈 60 ml/min/1.73 m 2 ) or (4) ACR (≥30 mg/g) only; CKD by both (5) eGFR cys and eGFR cr or (6) eGFR cys and ACR or (7) eGFR cr and ACR; and (8) CKD by all 3 markers. Cox proportional hazard models were used to estimate hazard ratios. Results Risk increased with the number of markers indicating CKD. eGFR cr 〈 60 alone (ACR and eGFR cys normal) was associated with increased risk of ESRD but not other outcomes [mortality: 0.95 (0.7, 1.2); coronary heart disease: 0.9 (0.6, 1.2); heart failure: 0.9 (0.6, 1.2); acute kidney injury: 1.3 (0.9, 2.0)] compared to individuals without CKD by any marker. In contrast, eGFR cys 〈 60 alone was associated with increased risk of all outcomes except coronary heart disease. When all three markers were abnormal, risk was higher compared to when combination of eGFR cr and ACR were abnormal, particularly for ESRD [ESRD: 109.2 (66.3, 179.9) vs. 12.2 (4.6, 32.2)]. More markers indicating CKD were associated with higher risk for each of the five outcomes examined after adjustment for covariates (Table). Conclusions Cystatin C is a useful confirmatory marker in those with eGFR cr 〈 60 to predict future risk of mortality, cardiovascular and kidney outcomes, particularly in the absence of albuminuria (i.e., when creatinine is the only criterion used to define CKD). Cystatin C may be used as a supplement to traditional CKD markers when more precise information about risk is needed.
    Materialart: Online-Ressource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.125.suppl_10.AMP073
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2012
    ZDB Id: 1466401-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    Online-Ressource
    Online-Ressource
    Abstract P095: Assessing Improvement Of eGFR Risk Classification In Meta-analysis: An Example of CKD-EPI and MDRD Study Equations On Cardiovascluar Mortality (for The CKD-PC Collaborators)
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Circulation Vol. 125, No. suppl_10 ( 2012-03-13)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 125, No. suppl_10 ( 2012-03-13)
    Kurzfassung: Purpose: Risk prediction models are assessed by calibration, discrimination, and reclassification. Net reclassification improvement (NRI) is a popular reclassification statistic in clinical epidemiology. However, methods to assess NRIs in a meta-analysis are not well described. Using an example of the CKD-EPI and the MDRD Study equations, we demonstrate a method to meta-analyze NRIs for eGFR category based on different equations. Methods: In a sample of 29 of 46 cohorts joining the CKD Prognosis Consortium (CKD-PC), NRI was calculated for reclassification across the following six eGFR categories (≥90, 60–89, 45–59, 30–44, 15–29, 〈 15 ml/min/1.73m 2 ) for CKD-EPI vs. MDRD Study equations. Standard errors of NRIs were calculated in analogy to McNemar’s test for paired proportions as √{(proportion of reclassification to high risk [low eGFR] category in those who developed events + proportion of reclassification to low risk [high eGFR] category in those who developed)/(# of events) + (reclassification to low risk category in those who did not develop events + reclassification to high risk category in those who did not develop)/(# of no events)}. NRIs were meta-analyzed in a random effects model applying the metan command in STATA. Results: There were a total of 830,132 participants and 22,647 deaths due to cardiovascular disease (coronary heart disease, stroke, or heart failure). NRIs for cardiovascular mortality based on eGFR category varied from −0.07 to 0.27 (p-values from 〈 0.001 to 0.921; 22 of 29 studies with p 〈 0.05) among cohorts. Standard errors also varied from 0.005 to 0.049. Meta-analyzed NRI was 0.09 (95% CI: 0.07–0.12, p 〈 0.001), suggesting that the CKD-EPI equation classifies individuals more correctly than the MDRD Study equation. The I-squared was 96.0% (p 〈 0.001), suggesting high heterogeneity across studies. Conclusion: We demonstrated how to meta-analyze NRIs, which estimate the clinical risk implication of new eGFR equations on cardiovascular disease, a leading cause of death among individuals with CKD.
    Materialart: Online-Ressource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.125.suppl_10.AP095
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2012
    ZDB Id: 1466401-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    Online-Ressource
    Online-Ressource
    Abstract MP87: Circulating sRAGE Levels And The Risk Of Heart Failure
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Kurzfassung: Introduction: Myocardial fibrosis is a key feature of heart failure, and its mechanisms are incompletely understood. It has been postulated that advanced glycation end-products (AGEs) form an etiologic link between diabetes and its vascular complications. Binding of AGEs to the cellular receptor for AGEs (RAGE) induces a state of increased oxidative stress, inflammation and fibrosis. Circulating soluble RAGEs (sRAGE) compete with cellular RAGE for the binding of AGEs which reduces the activation of the AGE-RAGE mediated pro-inflammatory and pro-fibrotic signaling pathways. We hypothesize that low levels of sRAGE will be associated with higher risk of heart failure. Methods: We conducted a prospective analysis of a random subsample of 1,157 participants from the ARIC Study who attended visit 2 (1990-1992). We included participants without a history of heart disease or heart failure, and with measured plasma sRAGE levels. Incident heart failure was defined as death from health failure or hospitalization due to heart failure. Results: In this community-based population (mean age 63 years, 60% women, 78% white), there were 132 incident cases of heart failure during approximately 20 years of follow up. Lower levels of sRAGE were significantly and independently associated with an increased risk of heart failure (Table). Analyses stratified by diabetes status at baseline showed that the risk of heart failure among those in the lowest quartile, compared to those in the upper quartile, was consistent but stronger among persons with diabetes compared to those without diabetes with HR=5.31 (95%CI 1.05-26.76) versus HR=2.50 (95%CI, 1.22-5.13), respectively. We did not observe any significant interactions by race or obesity status. Conclusions: Lower circulating levels of sRAGE are independently associated with the development of heart failure in older adults. These results highlight the pathophysiological role of the AGE-RAGE-sRAGE axis even among persons without diabetes.
    Materialart: Online-Ressource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.129.suppl_1.mp87
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2014
    ZDB Id: 1466401-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    Online-Ressource
    Online-Ressource
    Trefoil Factor 3 Predicts Incident Chronic Kidney Disease: A Case-Control Study Nested within the Atherosclerosis Risk in Communities (ARIC) Study
    S. Karger AG ; 2011
    In:  American Journal of Nephrology Vol. 34, No. 4 ( 2011), p. 291-297
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 34, No. 4 ( 2011), p. 291-297
    Kurzfassung: 〈 i 〉 Background: 〈 /i 〉 Early detection of individuals at high risk for chronic kidney disease (CKD) may aid prevention. Urinary levels of trefoil factor 3 (TFF3) are associated with acute kidney injury in animal models, but the association of TFF3 levels with incident CKD in humans is unknown. 〈 i 〉 Methods: 〈 /i 〉 We conducted a case-control study nested within the Atherosclerosis Risk in Communities (ARIC) Study and the ARIC Carotid MRI Study to determine whether urinary TFF3 levels predict incident CKD over 8.6 years of follow-up. A total of 143 participants with incident CKD (eGFR decreasing by ≧25% to 〈 60 ml/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 ) were matched on age, sex and race to 143 non-cases. 〈 i 〉 Results: 〈 /i 〉 Higher TFF3 levels at baseline were strongly associated with Black race, diabetes (both p = 0.002), and antihypertensive medication use (p = 0.02). Compared to participants with TFF3 levels in the lowest quartile, the odds ratio (OR) of incident CKD was 1.84 (95% confidence interval (CI): 0.80, 4.22) for individuals with TFF3 levels in the second quartile, 2.43 (95% CI: 1.06, 5.53) for the third quartile, and 2.77 (95% CI: 1.22, 6.28) for the fourth quartile (p trend = 0.02). Adjustment for covariates, including urinary albumin: creatinine ratio, did not markedly change the associations. Twofold higher TFF3 levels were strongly associated with incident CKD after adjustment for CKD risk factors (adjusted OR = 1.35; 95% CI: 1.11, 1.64). 〈 i 〉 Conclusions: 〈 /i 〉 Higher urinary TFF3 levels may indicate ongoing repair of damage in the kidney. Additional studies are needed to confirm whether TFF3 can be useful as a marker of increased risk for CKD.
    Materialart: Online-Ressource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000330699
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2011
    ZDB Id: 1468523-1
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 7
    Online-Ressource
    Online-Ressource
    Kidney Measures with Diabetes and Hypertension on Cardiovascular Disease: The Atherosclerosis Risk in Communities Study
    S. Karger AG ; 2015
    In:  American Journal of Nephrology Vol. 41, No. 4-5 ( 2015), p. 409-417
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 41, No. 4-5 ( 2015), p. 409-417
    Kurzfassung: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Whether the association of chronic kidney disease (CKD) with cardiovascular risk differs based on diabetes mellitus (DM) and hypertension (HTN) status remains unanswered. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We investigated 11,050 participants from the Atherosclerosis Risk in Communities Study (fourth examination (1996-1998)) with follow-up for cardiovascular outcomes (coronary disease, heart failure and stroke) through 2009. Using the Cox regression models, we quantified cardiovascular risk associated with estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) in individuals with and without DM and/or HTN and assessed their interactions. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Individuals with DM and HTN generally had higher cardiovascular risk relative to those without at all the levels of eGFR and ACR. Cardiovascular risk increased with lower eGFR and higher ACR regardless of DM and HTN status (e.g. adjusted hazards ratio (HR) for eGFR 30-44 vs. 90-104 ml/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 , 2.32 (95% CI, 1.66-3.26) in non-diabetics vs. 1.83 (1.25-2.67) in diabetics and 2.45 (2.20-5.01) in non-hypertensives vs. 1.51 (1.27-1.81) in hypertensives and corresponding adjusted HR for ACR 30-299 vs. 〈 10 mg/g, 1.70 (1.45-2.00) vs. 1.34 (1.10-1.64) and 1.42 (1.10-1.85) vs. 1.57 (1.36-1.81), respectively). Only the ACR-DM interaction reached significance, with a shallower relative risk gradient among diabetics than among non-diabetics (p = 0.02). Analysis of individual cardiovascular outcomes showed similar results. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Although individuals with DM and HTN generally had higher cardiovascular risk relative to those without these complications, both low eGFR and high ACR were associated with cardiovascular diseases regardless of the presence or absence of DM and HTN. These findings reinforce the importance of CKD in cardiovascular outcomes.
    Materialart: Online-Ressource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000433450
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2015
    ZDB Id: 1468523-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    Online-Ressource
    Online-Ressource
    Longitudinal Effects of a Decade of Aging on Carotid Artery Stiffness : The Multiethnic Study of Atherosclerosis
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 1 ( 2014-01), p. 48-53
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 1 ( 2014-01), p. 48-53
    Kurzfassung: Arterial stiffening is associated with hypertension, stroke, and cognitive decline; however, the effects of aging and cardiovascular disease risk factors on carotid artery stiffening have not been assessed prospectively in a large multiethnic longitudinal study. Methods— Distensibility coefficient and the Young’s elastic modulus (YEM) of the right common carotid artery were calculated at baseline and after a mean of 9.4 (standard deviation [SD], 0.5) years in 2650 participants. Effects of age and cardiovascular disease risk factors were evaluated by multivariable mixed regression and ANCOVA models. Results— At baseline, participants were 59.9 (SD, 9.4) years old (53% women; 25% black, 22% Hispanic, 14% Chinese). YEM increased from 1581 (SD, 927) to 1749 (SD, 1306) mm Hg ( P 〈 0.0001), and distensibility coefficient decreased from 3.1 (SD, 1.3) to 2.7 (SD, 1.1)×10 –3 mm Hg −1 ( P 〈 0.001), indicating progressive arterial stiffening. YEM increased more among participants who were aged 〉 75 years old at baseline ( P 〈 0.0001). In multivariable analyses, older age and less education independently predicted worsening YEM and distensibility coefficient. Stopping antihypertensive medication during the study period predicted more severe worsening of YEM (β=360.2 mm Hg; P =0.008). Starting antihypertensive medication after examination 1 was predictive of improvements in distensibility coefficient (β=1.1×10 –4 mm Hg –1 ; P =0.024). Conclusions— Arterial stiffening accelerates with advanced age. Older individuals experience greater increases in YEM than do younger adults, even after considering the effects of traditional risk factors. Treating hypertension may slow the progressive decline in carotid artery distensibility observed with aging and improve cerebrovascular health.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002649
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2014
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 9
    Online-Ressource
    Online-Ressource
    25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Obstetrical & Gynecological Survey Vol. 63, No. 12 ( 2008-12), p. 781-782
    Details
    In: Obstetrical & Gynecological Survey, Ovid Technologies (Wolters Kluwer Health), Vol. 63, No. 12 ( 2008-12), p. 781-782
    Materialart: Online-Ressource
    ISSN: 0029-7828
    URL: Article
    DOI: 10.1097/01.ogx.0000338098.92032.36
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2008
    ZDB Id: 2043471-6
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    Online-Ressource
    Online-Ressource
    Incidence and outcomes of fever of unknown origin after kidney transplant in the modern era
    Wiley ; 2024
    In:  Clinical Transplantation Vol. 38, No. 1 ( 2024-01)
    Details
    In: Clinical Transplantation, Wiley, Vol. 38, No. 1 ( 2024-01)
    Kurzfassung: While presumably less common with modern molecular diagnostic and imaging techniques, fever of unknown origin (FUO) remains a challenge in kidney transplant recipients (KTRs). Additionally, the impact of FUO on patient and graft survival is poorly described. Methods A cohort of adult KTRs between January 1, 1995 and December 31, 2018 was followed at the University of Wisconsin Hospital. Patients transplanted from January 1, 1995 to December 31, 2005 were included in the “early era”; patients transplanted from January 1, 2006 to December 31, 2018 were included in the “modern era”. The primary objective was to describe the epidemiology and etiology of FUO diagnoses over time. Secondary outcomes included rejection, graft and patient survival. Results There were 5590 kidney transplants at our center during the study window. FUO was identified in 323 patients with an overall incidence rate of .8/100 person‐years. Considering only the first 3 years after transplant, the incidence of FUO was significantly lower in the modern era than in the early era, with an Incidence Rate Ratio (IRR) per 100 person‐years of .48; 95% CI: .35–.63; p   〈  .001. A total of 102 (31.9%) of 323 patients had an etiology determined within 90 days after FUO diagnosis: 100 were infectious, and two were malignancies. In the modern era, FUO remained significantly associated with rejection (HR = 44.1; 95% CI: 16.6–102; p   〈  .001) but not graft failure (HR = 1.21; 95% CI: .68–2.18; p  = .52) total graft loss (HR = 1.17; 95% CI: .85–1.62; p  = .34), or death (HR = 1.17; 95% CI: .79–1.76; p  = .43. Conclusions: FUO is less common in KTRs during the modern era. Our study suggests infection remains the most common etiology. FUO remains associated with significant increases in risk of rejection, warranting further inquiry into the management of immunosuppressive medications in SOT recipients in the setting of FUO.
    Materialart: Online-Ressource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    URL: Article
    DOI: 10.1111/ctr.v38.1
    DOI: 10.1111/ctr.15217
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2024
    ZDB Id: 2739458-X
    ZDB Id: 2004801-4
    Standort Signatur Einschränkungen Verfügbarkeit
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