Chronic Kidney Research Articles

Independent and joint effects of self-reported physical activity and sedentary behaviors on mortality in community-dwelling older persons: a prospective cohort study

BackgroundThis study aims to assess the joint and independent effects of self-reported physical activity and sedentary behavior on mortality in older persons.MethodsA prospective community-based cohort study was conducted to examine physical activity (PA) level and sitting time (ST) in relation to mortality among 1,786 older persons aged 65 years and above. PA was assessed by a checklist of 26 self-reported items about PA and hours per week, and the metabolic equivalent hours/week was derived, and ST was measured by a self-reported item asking the average number of hours spent sitting per day. The participants were divided into four combination groups of PA and ST based on WHO guideline and values found in literature: high PA/short ST group, high PA/long ST group, low PA/long ST group, and low PA/short ST group. Data on death ascertainment were obtained through linkage with the national death datasets and expanded cardiovascular disease (CVD) included cardiovascular disease, diabetes, and chronic kidney disease.ResultsAfter follow-up for a median 11.1 years, 599 mortality cases were recorded, giving a crude all-cause mortality of 32.5/1,000 person-years, CVD mortality of 8.6/1,000 person-years, expanded CVD mortality of 11.9/1,000 person-years, and nonexpanded CVD mortality of 20.8/1,000 person-years. For all-cause, and expanded CVD, the hazards ratios (HRs) for the low PA/long ST group remained significant compared with that for the high PA/short ST group after all covariates were considered [HRs for all-cause mortality: 1.4 [95% confidence interval (CI) 1.1, 1.8]; and expanded CVD mortality: 1.7 (95% CI 1.1, 2.4).ConclusionsThe independent effect of PA and the joint effects of PA and ST are associated with all-cause and expanded CVD death risks. Expanded CVD mortality may be minimized by engaging in PA and reducing sedentary behaviors.

Association of stress hyperglycemia ratio with presence and severity of chronic kidney disease among US adults with diabetes mellitus.

Among diabetes mellitus (DM) patients, stress hyperglycemia ratio (SHR) is a strong predictor of short- and long-term prognosis, and adverse cardiovascular events. However, whether SHR is associated with increased risk of presence and severity of chronic kidney (CKD) disease remains undetermined. Patients with DM from the National Health and Nutrition Examination Survey (NHANES) database (1999-2020) were included and divided into 5 groups according to their SHR level (quintile 1 to 5). Study outcomes were CKD, advanced CKD (ACKD), and CKD severity. Logistic regression and restricted cubic spline (RCS) were used to assess the association between the SHR and outcomes. Totally, 6,119 patients were included. After adjustment, compared to patients with SHR in quintile 3 (as reference), the risk of CKD is 1.50 (P<0.001) for quintile 1, 1.23 (P=0.140) for quintile 2, 1.95 (P<0.001) for quintile 4, and 1.79 (P<0.001) for quintile 5. For the risk of ACKD, the OR is 1.46 (P=0.410) for quintile 1, 1.07 (P=0.890) for quintile 2, 3.28 (P=0.030) for quintile 4, and 3.89 (P=0.002) for quintile 5. For the CKD severity, the OR is 1.46 (P<0.001) for quintile 1, 1.20 (P=0.163) for quintile 2, 1.84 (P<0.001) for quintile 4, and 1.83 (P<0.001) for quintile 5. RCS analysis also showed a U-shaped association between SHR and outcomes (All P for nonlinearity<0.05). Our study demonstrated that too low or too high SHR level is significantly associated with adverse renal outcomes in patients with DM.

Peribulbar Block for Cataract Surgery in Patient with Nystagmus and Chronic Kidney Disease

Background: Management of presenile cataracts with nystagmus and chronic kidney (CKD) disease is a separate problem in anesthetic procedures. The risk of anesthesia in patients with chronic kidney disease is accumulation of nephrotoxic metabolites, unstable hemodynamic during intraoperative, and fluid overload.Case: A 43-year-old man with a diagnosis of immature presenile cataract with nystagmus and comorbid CKD was planned for phacoemulsification and intraocular lens. The anesthetic technique used was regional anesthesia with peribulbar block. Site injections in the inferotemporal and medial canthus with local anesthetic drugs levobupivacaine 0.5% 5 ml and lidocaine 2% 3 ml.Discussion: Combination of peribulbar block and mild sedation provides effective analgesic and anxiolytic effects. Peribulbar blocks in nystagmus besides sensory blocks can also block motoric function so that the position of the eyeball is in center.Conclusion: The peribulbar blockade anesthetic technique can be considered as an alternative safe anesthetic technique for cataract surgery with nystagmus and CKD.

A Comprehensive Review of Hepatitis B Vaccine Nonresponse and Associated Risk Factors.

Hepatitis B virus (HBV) infection remains a significant global health concern worldwide, contributing to high rates of mortality and morbidity, including chronic hepatitis B, cirrhosis, and hepatocellular carcinoma (HCC). Universal vaccination programs have significantly reduced the rate of HBV transmission; however, a subset of individuals fail to develop a protective immune response following vaccination and are termed nonresponders. A comprehensive search strategy using the PubMed, Google Scholar, and Web of Science databases was employed to search for relevant studies using keywords including "hepatitis B vaccine", "vaccine nonresponse", "immunogenicity", "immune response to the hepatitis B vaccine", and "associated risk factors". Factors influencing the vaccine's response include demographic factors, such as age and sex, with increased nonresponse rates being observed in older adults and males. Obesity, smoking, and alcohol consumption are lifestyle factors that decrease the vaccine response. Medical conditions, including diabetes, chronic kidney and liver diseases, HIV, celiac disease, and inflammatory bowel disease, affect the vaccine response. Major histocompatibility complex (MHC) haplotypes and genetic polymorphisms linked to immune regulation are genetic factors that further influence the vaccine's effectiveness. To reduce the global burden of hepatitis B infection, it is essential to understand these factors to improve vaccine effectiveness and develop individualized vaccination strategies.

A real-world picture of patients with a new diagnosis of acute myeloid leukemia in Italy.

6520 Background: Acute myeloid leukemia (AML) is a blood malignancy with poor prognosis. Antineoplastic strategies are still mostly restricted to fit patients. This analysis of administrative healthcare data identified and described newly AML diagnosed patients, their antineoplastic treatment and survival from the perspective of the Italian National Health Service (SSN). Methods: From the Fondazione ReS (Ricerca e Salute) database (~5 million inhabitants/year), among adults with primary/secondary in-hospital diagnosis of AML in 2018 (index date) and analysable look-back period until 2013, patients newly AML diagnosed were selected. They were characterized by age, sex and comorbidities (cardiometabolic, thyroid and cerebrovascular disorders, chronic kidney and liver disease, and inflammatory bowel diseases). During 1 year following index date, antineoplastic treatment and allogeneic stem cell transplantation (alloSCT) were assessed. Among patients undergoing antineoplastic therapy, those fit and unfit for intensive chemotherapy (ICHT) were categorized according to proxies based on the setting of chemotherapy administration (i.e., overnight hospitalization=fit, while daily hospitalization or local outpatient ambulatory=unfit). The 2-year overall survival (OS) of treated patients was assessed through a Kaplan Meyer analysis. Results: In 2018, 228 newly AML diagnosed patients (incidence: 5.7x100,000 adult inhabitants) were identified. Males were 56.6%. Mean age was 69±16 years, and 61% patients had ≥2 comorbidities. During 1 year following index date, 75% of newly AML diagnosed patients received antineoplastic treatment (males were 57%, mean age was 66±15 years, and 49% had ≥2 comorbidities). Of them, 19% underwent alloSCT (mean age was 50±14 years). On average, remaining untreated patients (57/228; 25%) were older (77±14 years) and affected by more comorbidities (79% with ≥2 comorbidities) than treated patients. At 2 years following index date, 97% of treated patients survived (vs 65% of untreated patients; p&lt;0.01). Among treated patients, 51% (mean age was 64±15 years) were considered fit for ICHT, and 24% were considered unfit for ICHT (mean age was 71±15 years). At 2 years following index date, 38% of patients fit for ICHT survived (vs 29% of patients unfit for ICHT; p&lt;0.01). Conclusions: This real-word analysis suggests that patients receiving antineoplastic treatments, regardless of a following alloSCT, were younger and affected by less comorbidities than untreated patients. Also, older patients are likely to be excluded from the ICHT option, as recommended by most of guidelines. However, these findings suggest that being treated with chemotherapy and/or alloSCT can increase survival probabilities.

#1884 Slowing kidney disease with weight loss: a randomised controlled feasibility study (SLOW-CKD Feasibility Study)

Abstract Background and Aims Obesity is a modifiable risk factor for chronic kidney (CKD) and progression to kidney failure. Low energy diets (LEDs) (800 to 1000 kcal/day) are an established weight management strategy and have demonstrated the ability to facilitate 10 to 15 kg weight loss and induce diabetes remission. However, the use of LEDs in adults with CKD is limited and there have been no randomised controlled trials (RCT) exploring their use. Before initiating a definitive trial, there is first a need to assess feasibility and safety. The primary aim of this study was to test the feasibility, acceptability and safety of a low energy diet and weight management program in individuals with obesity and CKD. Method The SLOW-CKD Feasibility Study, a 6-month multi-centre RCT in kidney outpatient clinics in Brisbane Australia, targeted adults with stages 1-3 CKD and a body mass index (BMI) ≥ 30 kg m2 with proteinuria (urinary albumin to creatinine ratio &amp;gt;3 mg/mmol). Participants wererandomised (1:1). The LED group followed a 3-month LED (800-1000 kcal/day) with meal replacements and low-calorie foods, with fortnightly dietitian support. Following this, participants entered a 3-month weight maintenance phase,emphasising healthy eating and commencing a physical activity program guided by an exercise physiologist. The usual care group was offered weight loss support through the kidney clinic, involving referral to a dietitian or weight loss program if agreeable. Primary outcomes included safety (study related serious adverse events [SAEs] and adverse events [aEs]) and feasibility (recruitment rate, retention rate, target weight loss). Secondary outcomes explored changes in anthropometry and clinical measures, patient-reported outcomes, and participant experiences through semi-structured interviews. Pre-defined safety and feasibility outcome criteria are presented in Table 1. Results Overall, 49 participants consented to participate (mean age 52.4 ± 3.8 years, 57% male). The incidence of SAEs was low and comparable between the two groups. There were two SAEs in the LED group (hypoglycaemia and acute kidney injury both requiring hospital admission) and one in the control (hypoglycaemia requiring hospital admission). The most common AE was hyperkalaemia with three episodes (&amp;gt;6.0 mmol/L) in each group. Two of the three feasibility criteria were met deeming the intervention feasible—see Table 1. Mean weight loss for the initial 3-month study period was 10.6 kg ± 5.1 kg in the LED group and 0.7 kg ± 4.3 for the usual care group (p = &amp;lt;0.00). Conclusion Our findings provide important preliminary evidence that LEDs are relatively safe, feasible, and demonstrate promising efficacy as a treatment option for obesity in adults with CKD. A definitive RCT exploring the use of LEDs to improve clinical outcomes and slow progression of CKD is warranted.

#913 Impact of retinal photography-based deep learning system on risk stratification for chronic kidney disease progression

Abstract Background and Aims We had previously developed a deep-learning-based risk evaluation system from retinal photographs, Reti-CKD, for stratifying chronic kidney (CKD) development risk in kidney function preserved people. This study aims to evaluate whether Reti-CKD can improve risk assessment of kidney disease progression in diabetic patients with prevalent CKD. Method Total of 5348 diabetic patients from two tertiary hospitals in Korea were evaluated. Patients with estimated glomerular filtration rate (eGFR) &amp;lt;90 ml/min/1.73 m2 or albuminuria were included. Those with missing data for retinal photograph, serum creatinine, or albuminuria were excluded. Patients were categorized into low-risk, moderate-risk, and high-risk groups according to the KDIGO criteria for prognosis of CKD. The KDIGO groups were additionally dichotomized based on Reti-CKD score (Reti-CKD &amp;lt;20 and ≥20). CKD progression was compared between the categories using Cox regression models. Primary outcome was CKD progression, defined as incremental progression to a higher NKF-KDOQI CKD stage. Results The mean age of the patients was 62.4 ± 11.4 years and 60.6% were male. Mean eGFR was 86.6 ± 15.3 mL/min per 1.73 m2 and albuminuria was present in 46.9%. During a median follow-up of 5.0 (interquartile range, 2.5-7.8) years, primary outcome developed in 1379 (25.8%) patients. The primary outcome incidence rate gradually increased with higher KDIGO and Reti-CKD combined risk categories. The risk for CKD progression progressively increased in KDIG moderate-risk and high-risk groups compared to low-risk. When Reti-CKD was incorporated to the KDIGO category, significant stratification of CKD progression risk was noted in the KDIGO low-risk and moderate-risk groups (Table and Figure). Additionally, the combination of KDIGO and Reti-CKD classification showed better discrimination power compared to the KDIGO only classification (delta c-statistics, 0.03; 95% CI 0.02 to 0.040). Conclusion Retinal photography-based deep learning system (Reti-CKD) further stratifies the risk of CKD progression and improves predictability in diabetic patients with reduced renal function.

Sodium-glucose cotransporter-2 inhibitors and incidence of atrial fibrillation in older adults with type 2 diabetes: a retrospective cohort analysis

ObjectivesTo investigate the risk of atrial fibrillation (AF) with sodium-glucose cotransporter-2 inhibitors (SGLT2is) compared to dipeptidyl peptidase-4 inhibitor (DPP4i) use in older US adults and across diverse subgroups.MethodsWe conducted a retrospective cohort analysis using claims data from 15% random samples of Medicare fee-for-service beneficiaries. Patients were adults with type 2 diabetes (T2D), no preexisting AF, and were newly initiated on SGLT2i or DPP4i. The outcome was the first incident AF. Inverse probability treatment weighting (IPTW) was used to balance the baseline covariates between the treatment groups including sociodemographics, comorbidities, and co-medications. Cox regression models were used to assess the effect of SGLT2i compared to DPP4i on incident AF.ResultsOf the 97,436 eligible individuals (mean age 71.2 ± 9.8 years, 54.6% women), 1.01% (n = 983) had incident AF over a median follow-up of 361 days. The adjusted incidence rate was 8.39 (95% CI: 6.67–9.99) and 11.70 (95% CI: 10.9–12.55) per 1,000 person-years in the SGLT2i and DPP4i groups, respectively. SGLT2is were associated with a significantly lower risk of incident AF (HR 0.73; 95% CI, 0.57 to 0.91; p = 0.01) than DPP4is. The risk reduction of incident AF was significant in non-Hispanic White individuals and subgroups with existing atherosclerotic cardiovascular diseases and chronic kidney disease.ConclusionCompared to the use of DPP4i, that of SGLT2i was associated with a lower risk of AF in patients with T2D. Our findings contribute to the real-world evidence regarding the effectiveness of SGLT2i in preventing AF and support a tailored therapeutic approach to optimize treatment selection based on individual characteristics.

Effects of d-alanine Intake on Amino Acid Metabolism and Kidney Function in Healthy Adults: A Multicenter, Randomized Pilot Study

Backgroundd-alanine administration prevented kidney damage in a murine acute kidney injury model. Further data are needed on the influence of d-alanine on kidney function in humans. ObjectiveThis study investigated the effects of d-alanine intake on amino acid metabolism and kidney function in healthy volunteers. MethodsThis multicenter pilot study randomly assigned individuals from the general Japanese population to receive 3 g or 6 g of d-alanine intake per day for 7 d in a 1:1 ratio. The primary endpoint was the mean change in plasma and urine d-alanine levels from baseline to 7 d after intake. The secondary endpoints were mean changes in kidney function and other clinical factors. Safety was assessed by evaluating adverse events and clinical parameters. ResultsWe randomly assigned 24 participants to the 3-g (n = 12) and 6-g d-alanine (n = 12) groups. The mean baseline estimated glomerular filtration rate (eGFR) was 73 mL/min/1.73 m2. The mean plasma d-alanine concentration increased from baseline by 77.5 ± 34.3 and 192.1 ± 80.9 nmol/mL in the 3-g and 6-g d-alanine groups (both p < 0.0001), respectively, in a dose-dependent manner (between-group difference: 114.6 nmol/mL; 95% CI: 62.1–167.2; P = 0.0002). A similar increase was observed for the urine d-alanine to creatinine ratio. The mean eGFR was elevated by 5.7 ± 8.8 mL/min/1.73 m2 in the 6-g d-alanine group (P = 0.045) but did not significantly change in the 3-g d-alanine group. Nonserious adverse events were reported in 11 participants. Conclusionsd-alanine intake increased plasma and urine d-alanine levels and was well tolerated in participants with normal kidney function. These results will be useful in future trials investigating the effects of d-alanine intake on kidney disease progression in patients with chronic kidney disease.This trial was registered at the UMIN Clinical Trials Registry as UMIN000051466.

Epidemiology, microbiological, clinical characteristics, and outcome of Burkholderia cepacia complex infections in non-cystic fibrosis adult patients from Qatar

ObjectivesBurkholderia species infections are associated with diverse and challenging clinical presentations because of distinct virulence and antimicrobial resistance factors. The study aims to evaluate the epidemiology, microbiological, and clinical outcomes of Burkholderia cepacia complex (Bcc) infections in non-cystic fibrosis (CF) patients from Qatar. MethodsA retrospective study was conducted on adult patients across all hospitals at Hamad Medical Corporation between January 2012 and December 2018 to evaluate clinically relevant Bcc in non-CF adult patients. ResultsOver 7 years, 72 episodes of Burkholderia species infections were recorded, 64 were secondary to Bcc primarily affecting males (78.12%) with a mean age of 53 years, from the Middle and Southeastern region (92.2%) affected predominantly by diabetes mellitus (34.4%), chronic kidney (23.4%), coronary heart (20.3%), and hypertensive diseases (17.2%) while recent hospitalization and admission to critical care were evident in 45.3% and 93.8% of cases, respectively. Main infection sites were urinary (43.8%) and respiratory (29.7%) with associated bacteremia recorded in 26.6% of cases. Microbiological characteristics demonstrated high-level resistance profiles leading to delayed microbiological clearance in case of bacteremia (61%) and management with multiple therapeutic agents (range 4-6) resulting in disease resolution in 90.6% of cases with observed 30-day mortality of 7.8%. ConclusionsB. cepacia infections are infrequent, recorded mainly in middle-aged males with chronic comorbidities presenting as urinary, respiratory, and bacteremia associated with hospitalization, admission to critical care, and invasive procedures. High-level antimicrobial resistance is observed necessitating multiple therapeutic agents and suboptimal bacteriological clearance.

The Correlation Between Vitamin D Deficiency and Chronic Rhinosinusitis: A Systematic Review.

Chronic rhinosinusitis (CRS) is marked by inflammation of the paranasal sinuses and mucosal lining of the nose. CRS can be classified as CRS with nasal polyps or CRS without polyps. In recent years, there has been increased attention on the immunological role of vitamin D in treating CRS, coupled with the observation of vitamin D deficiency among CRS patients. Vitamin D is acknowledged for its immunomodulatory properties, especially in allergic conditions. Recent studies suggest that individuals with CRS, especially those with CRS with nasal polyps, frequently demonstrate lower than normal levels of vitamin D. We conducted searches across various databases, including PubMed, Web of Science, ScienceDirect, and the Cochrane Library, both electronically and manually, to identify pertinent studies. Studies from 2003 to 2023 were included. Deficiency of vitamin D was considered with levels of vitamin D less than 30 ng/mL, and only original studies were included. Studies including patients taking vitamin D supplementation previously and patients with chronic kidney and liver diseases were excluded. We included nine studies that recruited 1,042 patients in total. More than half of the studies reported the presence of nasal polyps in CRS, and participants from four studies had CRS without nasal polyps. All of the included studies reported a negative correlation between levels of vitamin D and CRS. The majority of the studies depicted quite low levels of vitamin D among CRS patients. The degree of CRS severity as measured by endoscopic and radiological scores is moderately inversely correlated with vitamin D intake. Therefore, it is recommended that the relationship between various serum vitamin D concentrations and the severity of CRS be investigated in detail, along with an understanding of the cellular effects of vitamin D levels on the nasal mucosa.

Dyslipidemia in Chronic Kidney Disease

Globally chronic kidney (CKD) disease is one of the major health problems. Global prevalence of CKD is 8−16%. Prevalence of chronic kidney disease in Bangladesh is 26%. Patients with chronic kidney disease (CKD) exhibit significant alterations in lipoprotein metabolism. In this review different lipid parameters are shown from different studies and the pathogenesis of CKD induced dyslipidemia is discussed.&#x0D; Bangladesh J Med Biochem 2019; 12(2): 31-38

Cardiorenal syndrome in geriatric patients

The unfavorable mutual influence of the kidney and heart functions in acute or chronic kidney and/or heart failure has defined the cardiorenal syndrome (CRS) since aconsensus conference in 2004. The pathophysiological considerations and the subsequent treatment approaches determine the classification into five types. The syndrome has ahigh prevalence in geriatric patients. The interactions of medications on one or the other organ system require an interaction of treatment modalities in order to improve the prognosis and prevent acute deterioration. Exact knowledge of the respective indications, differential treatment approaches and specifics in dealing with CRS can improve the current undertreatment due to concerns about side effects.

Analysis of predictive factors for non-adherence to organized screening for colorectal and breast cancers in the pre-pandemic period (2018-2019) in Lombardy Region (Northern Italy)

according to the International Agency for Cancer Research on Cancer, in 2022, breast cancer is the most common cancer in the Italian population, followed by colorectal cancer. Oncological screenings represent an effective secondary prevention strategy to counteract colorectal and breast cancers, significantly reducing mortality. In Lombardy Region (Northern Italy), screening programmes have been active since 2007, but adherence, especially in specific population subgroups, remains lower than expected. to analyse potential predictors of non-adherence to colorectal and breast cancer screening in the Lombardy Region during the pre-pandemic period of 2018-2019. a retrospective cohort study aimed at investigating the role of sociodemographic variables, health status, and access to the healthcare system on non-adherence to colorectal and breast cancer screening. Statistical analyses were conducted separately by each Agency for Health Protection (ATS). The results of the models were synthesized across the Lombardy region through random-effects meta-analysis. residents within the territory of each ATS in Lombardy as of 01.01.2018 and aged between 49 and 69 years at the beginning of the follow-up. adherence to colorectal and breast cancer screenings. during the study period, across the Lombardy Region, 2,820,138 individuals were eligible to participate in colorectal cancer screening, and 1,357,344 women were eligible to participate in breast cancer screening, with an invitation coverage of 87% and 86%, respectively.For breast cancer screening, older age, cardiopathy, chronic obstructive pulmonary disease (COPD), inflammatory bowel diseases (IBD), autoimmune diseases, and presence of a rare disease are associated with a reduced risk of non-adherence. Conversely, foreign citizenship, oncological diagnosis, transplant, chronic kidney disease/dialysis, diabetes, heart failure, arterial or cerebral vasculopathy, and presence of a neurological diagnosis are associated with significant excess risks of non-participation. For colorectal cancer screening, factors favouring adherence include female gender, older age, cardiopathy, COPD, autoimmune diseases, and having access/utilization of primary care. Non-adherence is associated with foreign citizenship, transplant, chronic kidney disease/dialysis, diabetes, heart failure, arterial or cerebral vasculopathy, IBD, neurological diseases, residence in assisted living facilities, use of integrated home care, and presence of disability. this is the first study conducted in the Lombardy Region which explores the theme of equity of access to organized screenings. This analysis highlights how sociodemographic determinants, chronic conditions, and access to the healthcare and social healthcare system constitute significant risk factors for non-adherence to screening programmes. Based on the results of this analysis, communication and/or organizational change interventions will be developed to counteract inequalities in access to effective prevention procedures.

Predictors of flare-related inpatient or emergency department stay in systemic lupus erythematosus: A real-world analysis of Medicaid claims in the United States.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation. Medical management of SLE is based on reducing inflammation and tissue damage in the affected organs; however, medications used to treat SLE have been found to contribute to additional organ damage. Therefore, finding new ways to predict and prevent flares that require an inpatient (IP) stay or emergency department (ED) visit is critical for reducing the clinical and economic burden in patients with SLE. To identify risk factors of SLE flares requiring an IP/ED visit among a Medicaid-insured population with SLE. This retrospective study included patients from the Merative MarketScan Medicaid database (2013-2019). To capture patients at all stages of their SLE journey, all SLE claims for a patient were captured, and the index date was randomly selected among those claims that were at least 12 months after the first evidence of SLE. Patients were required to be continuously enrolled 1-year pre-index (year 1) and post-index (year 2). Demographics, clinical characteristics, and health care use and costs were measured in year 1, and flares requiring an IP/ED visit were identified in year 2 using the Garris algorithm. Multivariable logistic regression and classification and regression tree (CART) modeling were used to identify year 1 predictors and combination of factors, respectively, associated with flares-related IP/ED visits. Of the 8,083 patients included in the study, 37.6% of patients (n = 3,039) had a flare. Logistic regression identified ED visits in year 1 as one of the strongest predictors of flares-related IP/ED visits in year 2 (odds ratio = 2.19 [95% CI = 1.93-2.49]). SLE treatment progression to biologics (0.54 [0.42-0.70]) was the strongest predictor of decreased odds. Other strong predictors included other neurological disorders (1.63 [1.43-1.87]), Black race (1.49 [1.32-1.68]), chronic kidney disease/renal failure (1.35 [1.10-1.66]), and opioid use (1.30 [1.17-1.45]). CART modeling identified patients with an ED visit, an IP admission, and a diagnosis of Elixhauser Comorbidity Index-defined other neurological disorders in year 1 as having the highest probability of a flare-related IP/ED visit in year 2 (probability = 0.708), whereas patients without an ED visit had the lowest probability (probability = 0.185). Patients with the highest risk of a flare that required an IP/ED visit were those with a prior ED visit, IP admission, and other neurological disorders. Modeling also identified patients with prior opioid use, Black patients, and patients without SLE medications as subgroups with a high risk of a flare requiring an IP/ED visit.

Predictive Factors for Bleeding Risk in Patients Undergoing Valvular Surgery.

The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality. To develop a risk score to predict bleeding in patients after valve surgery. Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP. 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance. CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.

Systemic and ocular outcomes in patients with young-onset type 2 diabetes

PurposeTo analyze the systemic and ocular outcomes in patients with young-onset type 2 diabetes (YO-DM2) based on grade of presenting diabetic retinopathy (DR). MethodsRetrospective cohort study analysis of empaneled patients with type 2 diabetes <40 years old with retinopathy screening within the Los Angeles Department of Health Services between 01/01/2017–07/01/2021 were included. Patients were stratified based on presenting severity of DR determined on fundus photographs or clinical examination. Patient's systemic co-morbidities and ocular outcomes were then compared across each group. Procedural (e.g. intravitreal injections) and surgical interventions (e.g. pars plana vitrectomy) were documented as performed by the treating physician. Results2795 patients were screened from 12,456 patients diagnosed with diabetes younger than age 40 (22.4 %). Of these, 1496 patients were diagnosed with type 2 DM. 1084 (72.4 %) of patients presented without DR, 307 (20.5 %) presented with non-proliferative diabetic retinopathy (NPDR), and 105 (7.0 %) of patients presented with proliferative diabetic retinopathy (PDR). Increasing presenting diabetic retinopathy severity was associated with longer duration of diabetes, greater systemic comorbidities (e.g. diabetic foot disease, neuropathy, chronic kidney or end stage renal disease), worse baseline and final visual acuity, and required more procedural and surgical interventions. ConclusionsWorse presenting DR severity in patients young-onset type 2 diabetes was associated with greater comorbid systemic and ocular disease with worse visual acuity outcomes. <1 % of patients without diabetic retinopathy or with mild NPDR were likely to progress to PDR. Diabetic kidney disease was an independent risk factor for developing neovascular glaucoma and retinal detachments. Prompt evaluation and intervention in patients with YO-DM2 may help reduce the associated systemic and ocular morbidity.

Esaxerenone Protects against Diabetic Cardiomyopathy via Inhibition of the Chemokine and PI3K-Akt Signaling Pathway.

(1) Background: Diabetic cardiomyopathy (DCM) is a unique form of cardiomyopathy that develops as a consequence of diabetes and significantly contributes to heart failure in patients. Esaxerenone, a selective non-steroidal mineralocorticoid receptor antagonist, has demonstrated potential in reducing the incidence of cardiovascular and renal events in individuals with chronic kidney and diabetes disease. However, the exact protective effects of esaxerenone in the context of DCM are still unclear. (2) Methods: The DCM model was successfully induced in mice by administering streptozotocin (55 mg/kg per day) for five consecutive days. After being fed a normal diet for 16 weeks, echocardiography was performed to confirm the successful establishment of the DCM model. Subsequent sequencing and gene expression analysis revealed significant differences in gene expression in the DCM group. These differentially expressed genes were identified as potential targets for DCM. By utilizing the Swiss Target Prediction platform, we employed predictive analysis to identify the potential targets of esaxerenone. A protein-protein-interaction (PPI) network was constructed using the common targets of esaxerenone and DCM. Enrichment analysis was conducted using Metascape. (3) Results: Compared to the control, the diabetic group exhibited impaired cardiac function and myocardial fibrosis. There was a total of 36 common targets, with 5 key targets. Enrichment analysis revealed that the chemokine and PI3K-Akt signaling pathway was considered a crucial pathway. A target-pathway network was established, from which seven key targets were identified. All key targets exhibited good binding characteristics when interacting with esaxerenone. (4) Conclusion: The findings of this study suggest that esaxerenone exhibits a favorable therapeutic effect on DCM, primarily by modulating the chemokine and PI3K-Akt signaling pathway.

Hospital and long-term periods of myocardial infarction in comorbid men and women under 60 years

Aim of the study was to assess the impact of comorbidity on the hospital and 2-year stage of treatment for myocardial infarction (MI) in men and women under 60 years of age.Material and methods. The analysis included 350 patients with MI younger than 60 years of age. The majority of patients (87.4 %) were men. For all patients, the risk was calculated according to the GRACE ASC Risk Model scale and an analysis was made of the severity of comorbidity according to the own model “K9” (patent RU2734993C1 from October 27, 2020), based on the summation of 9 diseases: diabetes mellitus, atrial fibrillation, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia, anemia, chronic kidney disease.Results. Comorbidity (the presence of 2 or more diseases) was recorded insignificantly more often in men (65.9 % versus 53.6 %, p = 0.12). In men, but not in women, comorbidity was associated with a 23.5 % reduction in percutaneous coronary intervention (p = 0.006). Both in-hospital mortality and the risk of major cardiovascular events (death/MI/stroke) 2 years after discharge were minimal (up to 0.7 % and up to 8.1 %, respectively) in the absence of comorbidity in both men and women, higher in comorbid women (3.4 and 12.5 %, respectively) and maximum in comorbid men (6.1 and 18.4 %, respectively). Comorbidity more significantly aggravated the 2-year prognosis in patients undergoing percutaneous coronary intervention than in receiving primary conservative treatment, increasing the risk of developing the death/MI/stroke end point by 3 times (16.7 and 5.8 %, respectively, p = 0.013). The addition of comorbidity data to the GRACE scale in the Cox regression analysis can significantly improve the prognosis of the onset of the 2-year endpoint, increasing the χ2 value from 64.08 to 79.86, and the value of the area under the ROC-curve (AUC) to 0.79 (95 % confidence interval (95 % CI) 0.71–0.88). At the same time, ROC analysis showed that the modified GRACE scale predicts the onset of the death/ MI/stroke endpoint in men much better than in women: AUC 0.81 (95 % CI 0.72–0.90) and AUC 0.67 (95 % CI 0.51–0.83), respectively.Conclusions. Comorbidity is comparable to the GRACE scale and effectively predicts the likelihood of hospital mortality. At the same time, the GRACE scale has an unsatisfactory predictive value for the 2-year endpoint “death/MI/stroke”. Modification of the GRACE scale with data on comorbidity has important clinical implications in men, but not in women, allowing more effective stratification of the risk of adverse events in the long term after myocardial infarction.

Self-Measure Office Blood Pressure (SMOBP) and Home Blood Pressure Monitoring (HBPM) for white coat effect diagnosis among hypertension patients

Background: Hypertension is a critical factor in the deaths over the world among those who have cardiovascular diseases such as coronary artery disease, stroke, and chronic kidney disease.Purpose: This study aims to investigate the diagnosis capability of the white coat effect in hypertensive patients whose blood pressure was not on target.Methods: This study is an analytical study. Data were collected from 19 uncontrolled hypertension patients at Bang Si Thong health promoting hospital from August to December 2022. The geographic data are presented in the descriptive statistic terms of mean, difference, and standard deviation. The research outcome was analyzed by paired t-test.Results: The research results showed blood pressure measurement by SMOBP was more valuable in terms of statistical significance than Daytime HBPM (134±8.21 vs 125.5±6.74 p&lt;0.001), while it was statistically significantly lower than Office-measured (148.15±10.33 vs 134±8.21 p&lt;0.001), and there were participants whose blood pressures were going as a targeted by SMOBP 55% and HBPM 80%.Conclusion: Self-Measure Office Blood Pressure [SMOBP] can eliminate some of the white coat effect, but it could not be used instead of Home Blood Pressure Monitoring [HBPM] for the diagnosis of white coat hypertension. The SMOBP might be a choice for patients who have the white coat effect in socioeconomically disadvantaged areas.