Higher ACR Research Articles

Influence of Ventilation on Formation and Growth of 1-20 nm Particles via Ozone-Human Chemistry.

Ozone reaction with human surfaces is an important source of ultrafine particles indoors. However, 1-20 nm particles generated from ozone-human chemistry, which mark the first step of particle formation and growth, remain understudied. Ventilation and indoor air movement could have important implications for these processes. Therefore, in a controlled-climate chamber, we measured ultrafine particles initiated from ozone-human chemistry and their dependence on the air change rate (ACR, 0.5, 1.5, and 3 h-1) and operation of mixing fans (on and off). Concurrently, we measured volatile organic compounds (VOCs) and explored the correlation between particles and gas-phase products. At 25-30 ppb ozone levels, humans generated 0.2-7.7 × 1012 of 1-3 nm, 0-7.2 × 1012 of 3-10 nm, and 0-1.3 × 1012 of 10-20 nm particles per person per hour depending on the ACR and mixing fan operation. Size-dependent particle growth and formation rates increased with higher ACR. The operation of mixing fans suppressed the particle formation and growth, owing to enhanced surface deposition of the newly formed particles and their precursors. Correlation analyses revealed complex interactions between the particles and VOCs initiated by ozone-human chemistry. The results imply that ventilation and indoor air movement may have a more significant influence on particle dynamics and fate relative to indoor chemistry.

What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis

BackgroundThe rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE).AimsTo evaluate the efficacy of bowel preparation protocols regarding ACR and CR.MethodsWe conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and “booster”. The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models.ResultsTwenty-six observational studies and five RCTs included (n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8–77.5%; I2 = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7–87.7%; I2 = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0–85.6%); I2 = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8–80.1%); I2 = 85.3%], and split dose < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4–87.8%); I2 = 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9–89.2%); I2 = 89.8%], and sodium phosphate (NaP) as “booster” [86.2% (95% C.I. 82.3–90.2%); I2 = 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90); p = 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05); p = 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09), p = 0.048].ConclusionsMain quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as booster.

#6677 RELATIONSHIP BETWEEN CARDIAC TROPONIN LEVELS AND ECHOCARDIOGRAPHIC PARAMETERS IN DIABETICS WITH ADVANCED CHRONIC RENAL DISEASE (ACKD)

Abstract Background and Aims Cardiovascular disease is the leading cause of chronic kidney disease (CKD) death. On the other hand, elevated cardiac Troponin T (cTnT) levels are associated with cardiovascular events and mortality. Several studies have established an inverse association between CKD and cTnT, and knowledge of this association in diabetic patients would benefit their management. The objective of this study was to analyze the relationship between cTnT levels, renal function and echocardiographic parameters in diabetic patients with advanced chronic kidney disease (ACKD). Method A prospective study was carried out during one year of 180 patients attending for the first time for ACKD consultations, with an estimated glomerular filtration rate (eGFR) &amp;lt;30 ml/min/1.72 m2. The following data were analyzed: age, sex, diabetes, HBP, BMI, smoking, peripheral artery disease, coronary artery disease, non-age-adjusted Charlson index (non-age-CCI), eGFR by CKD EPI, ultrasensitive cTnT, Creatinine albumin ratio (ACR), C-reactive protein (CRP), ferritin, hemoglobin (Hb), ejection fraction (EF) and left ventricular hypertrophy (LVH), interventricular septum thickness (IVST) and left ventricular wall thickness (LVWT). Statistical tests were used according to the distribution of the variables. Results Baseline characteristics are summarized in Table 1. In the group of patients, when analyzing the presence or absence of diabetes, diabetic patients were significantly older, had higher troponin levels, a higher percentage of smoking, coronary artery disease, peripheral artery disease, non-age-CCI, IVST and LVH than non-diabetic patients. In diabetic patients, troponin levels correlated significantly with eGFR (0.03) and ACR (0.09), with ACR remaining as a predictive variable (0.003). It did not correlate with echocardiographic data. In non-diabetics, the correlation was significant with age and IVST and LVH (Table 2, Figure 1). In the multivariate analysis in diabetic patients, only the association remained with ACR (0.026) and in non-diabetics with eGFR (0.038) and IVST (0.004). Conclusion The cTnT levels are found to be higher in diabetic patients and with higher ACR, considering it as a therapeutic target to reduce cardiovascular risk since echocardiographic data would not discriminate this risk in this profile of patients.

#6365 ASSOCIATION OF TRADITIONAL AND NON-TRADITIONAL LIPID ABNORMALITIES WITH RENAL FUNCTION: A SURVEY IN A RURAL POPULATION OF BANGLADESH

Abstract Background and Aims The traditional and non-traditional lipid have been recognized to be involved in various atherosclerotic disease process. Several studies showed that, there is relation with renal function and dyslipidemia. Early detection of these modifiable risk factors and initiation of treatment may prevent or retard the progression of renal disease. Aim of this study was to evaluate the association of the traditional and non-traditional lipid abnormalities with renal function. Methods This cross sectional study was carried out in a rural area of Bangladesh. Renal function was evaluated by estimation of enzymatic creatinine, eGFR (CKD-EPI) and spot ACR. Total cholesterol (TC), triglyceride (TG), LDL and HDL was measured as traditional lipids and Apo-A1, APO-B, Lipo (a) as non-traditional lipids. Traditional dyslipidemia (TDLP) and non-traditional dyslipidemia (nTDLP) means abnormality in any of their components. Other tests include urine microscopy, Hb%, FBS, HbA1c, serum albumin and uric acid as additional risk marker. Results Total 201 patients were included for analysis. The mean age was 41± 13 years and male/female ratio 48:52. Around 48% were overweight. Among these 20% were hypertensive, 14% diabetic, nephropathy in13% and rest 53% had no known chronic disease. The mean value of creatinine was 0.8±0.2 mg%; eGFR was 94±23 ml/min/1.73m2, ACR was 9.70 (median), TG 182±104 mg/dl, TC 96 ±47 mg/dl; LDL 121 ± 39 mg/dl and HDL 38±6. The value of Apo-Al was 1.3 g/l (0.2-13.9), Apo-B 1.04 g/l (0.2-2.6) and Lipoprotein (a) was 17.3mg/dl (1.1-81.8). Mean value of FBS was 6.2 ±2.3 mmol/l, HbA1c 6.1 ±1.5%, Hb% 13.5 ± 1.6 g% and albumin was 4.8 ±0.5 mg%. When measured the TDLP was present in 81% and normal traditional lipids present in 19%. Similarly as a whole 50% had nTDLP and non-traditional lipids were normal in other half. Around 16% were free from both TDLP and nTDLP. The eGFR was lower in – TG &amp;gt;150 group than in &amp;lt; 150 (90 ± 24 vs. 98 ± 21 mg%, p&amp;lt;0.02); TC &amp;gt;200 than &amp;lt;200 (91 ± 23 vs. 100 ± 22 mg%, p&amp;lt;0.001); LDL &amp;gt;100 and &amp;lt; 100 (91± 23 vs. 100 ± 22 mg%, p&amp;lt;0.015) but no difference for components of nTDLP. The ACR was higher (&amp;gt; 30 mg/g) in 76% vs 24% (p&amp;lt;0.001) when TG is &amp;gt; 150 and &amp;lt; 150 mg%; 60% vs. 40% (p&amp;lt;0.05) when TC is &amp;gt; 200 and &amp;lt; 200mg%; and 81% vs. 19% (p&amp;lt;0.04) when LDL &amp;gt; 100 and &amp;lt; 100mg%. No such difference for renal functional parameters for non-traditional lipid components. In this study, eGFR had significant negative correlation with TC (r = -0.34 &amp; p&amp;lt;0.001), TG (r = -0.24 &amp; p&amp;lt;0.001), LDL (r = -0.25 &amp; p&amp;lt;0.001) and only ACR had positive correlation with TG (r = 0.17 &amp; p = 0.012). The nTDL wasn't associated with altered eGFR or ACR. Conclusion In this study it was observed that traditional lipid components were altered in 81% whereas non-traditional lipids were altered in 50% rural subjects. Only the traditional dyslipidemia was associated with lower eGFR and higher ACR.

Serum amyloid A-to-albumin ratio as a potential biomarker to predict the activity, severity, and poor prognosis of systemic lupus erythematosus.

ObjectivesTo evaluate the predictive value of serum amyloid A‐to‐albumin ratio (SAR) for active systemic lupus erythematosus (SLE), severe active SLE, and poor prognosis of SLE.MethodsOne hundred and eighty‐six patients with SLE undergoing treatment in our hospital were selected. The demographic characteristics, clinical data, and disease prognosis of all patients were collected and analyzed.ResultsThere were significant differences in SLEDAI, total glyceride (TG), serum amyloid A (SAA), SAR, urinary microalbumin‐to‐creatinine ratio (ACR), erythrocyte sedimentation rate (ESR), albumin (ALB), complement 3 (C3), anti‐dsDNA, anti‐Sm positive rate, and anti‐dsDNA positive rate between active SLE and stable SLE patients. TG, SAR, C3, ACR, and positive anti‐dsDNA were independent influencing factors of active SLE, and the odds ratio (OR) values were 2.342, 10.921, 0.832, 1.451, and 2.476, respectively. The area under curves (AUCs) of SAA, ALB, and SAR for predicting active SLE and severe active SLE were 0.743, 0.724, 0.787, 0.711, 0.686, and 0.733, respectively. The AUC of SAR for predicting the poor prognosis of active SLE was 0.719. High SAR, high ACR, low C3, and positive anti‐dsDNA were high risk factors for poor prognosis. Kaplan–Meier (K‐M) survival analysis showed that patients with high SAR, high ACR, low C3, and positive anti‐dsDNA had shorter continuous remission time than that with low SAR, low ACR, high C3, and negative anti‐dsDNA.ConclusionSAR had high predictive value for active SLE, severe active SLE, and poor prognosis of SLE. High SAR may be a potential marker for predicting the activity and prognosis of Chinese patients with SLE.

Experimental study on hysteresis behavior of precast concrete double skin shear wall with horizontal loop connection and spiral-confined vertical lap connection

Precast concrete double skin shear wall (PCDSSW) is one of the promising precast concrete structural systems for multi- and high-rise buildings, as it has the advantages of convenient construction and sound structural integrity. These walls with story size are usually connected with horizontal and vertical joints. In order to investigate the hysteresis behavior of PCDSSW with joints for broad application in the seismic zone and construction efficiency, four full-scale PCDSSWs with the spiral-confined vertical lap connection were designed with the change of lap length (100 mm and 200 mm) in the horizontal loop connection and test axial compression ratio (ACR, 0.09 and 0.23) and compared with two cast-in-place (CIP) controlling walls by the low reversed cyclic test. Test results revealed that the behavior of PCDSSW specimens was consistent with the design principle for precast shear walls with equivalent monolithic connections. The hysteresis loops of the PCDSSW specimens exhibited a similar pattern as those of the corresponding CIP specimens. Meanwhile, the stiffness degradation and energy dissipation trends in PCDSSW were comparable to that in CIP specimens. All the PCDSSWs had a similar peak strength to the corresponding CIP one, with the difference within-1.5% ∼ +7.4%. The displacement ductility of PCDSSW specimens ranged from 2.97 to 4.04 and 3.50 to 4.42 under the low and high ACR, respectively. The study showed that the PCDSSWs with the loop connection of 200 mm and 100 mm lap length could meet high and medium ductility demand, respectively, and the latter one could ease on-site construction. At last, a tri-linear restoring force model was developed based on the test results to model the hysteresis behavior of different PCDSSWs.

Role of spot urine albumin-creatinine ratio in predicting pre-eclampsia between 20-28 weeks of gestation

Preeclampsia is best characterized as a condition unique to pregnancy that can affect almost any organ system. Appropriate treatment can be given and its effects can be closely monitored. The only widely recognized procedure remains the 24hour urine collection. However, the protracted time involved in sample collection to final reporting in this method, renders it impractical. The current research was therefore aimed at determining the accuracy of the spot urine ratio of albumin-creatinine in asymptomatic pregnant women. Appropriate treatment if started at early stage of the disease helps in closely monitoring of the disease process.A hospital based prospective, observational study was conducted with 150 patients to establish whether a spot urine albumin-creatinine ratio measured between 20-28 weeks gestation could predict pre-eclampsia in asymptomatic pregnant woman in Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences and PBM Hospital, Bhubaneswar between September 2018 and April 2020.Of the study group, 28 patients had high ACR value, with 25(89.3%) developed pre-eclampsia and 3(2.4%) remained normotensive whereas among 122 (81.3%) patients that were ACR negative 3 (10.7%) patients developed pre-eclampsia. ACR had a sensitivity of 89.29%, specificity 97.54%, positive predictive value of 89.29% and the negative predictive value is 97.54%.Our analysis showed that in pre-eclampsia patients, urine albumin-creatinine ratio (UACR) values were higher and UACR &amp;#62;35.5 mg / mmol predicted pre-eclampsia well before clinical manifestations started. It is an easy, rapid and reasonably reliable method for predicting and assessing the severity of pre-eclampsia.

Sodium Intake and Proteinuria/Albuminuria in the Population-Observational, Cross-Sectional Study.

Sodium effects on proteinuria are debated. This observational, cross-sectional, population-based study investigated relationships to proteinuria and albuminuria of sodium intake assessed as urinary sodium/creatinine ratio (NaCR). In 482 men and 454 women aged 35–94 years from the Moli-sani study, data were collected for the following: urinary NaCR (independent variable); urinary total proteins/creatinine ratio (PCR, mg/g), urinary albumin/creatinine ratio (ACR, mg/g), and urinary non-albumin-proteins/creatinine ratio (calculated as PCR minus ACR) (dependent variables). High values were defined as PCR ≥ 150 mg/g, ACR ≥ 30 mg/g, and urinary non-albumin-proteins/creatinine ratio ≥ 120 mg/g. Urinary variables were measured in first-void morning urine. Skewed variables were log-transformed in analyses. The covariates list included sex, age, energy intake, body mass index, waist/hip ratio, estimated urinary creatinine excretion, smoking, systolic pressure, diastolic pressure, diabetes, history of cardiovascular disease, reported treatment with antihypertensive drug, inhibitor or blocker of the renin-angiotensin system, diuretic, and log-transformed data of total physical activity, leisure physical activity, alcohol intake, and urinary ratios of urea nitrogen, potassium, and phosphorus to creatinine. In multivariable linear regression, standardized beta coefficients of urinary NaCR were positive with PCR (women and men = 0.280 and 0.242, 95% confidence interval = 0.17/0.39 and 0.13/0.35, p < 0.001), ACR (0.310 and 0.265, 0.20/0.42 and 0.16/0.38, p < 0.001), and urinary non-albumin-proteins/creatinine ratio (0.247 and 0.209, 0.14/0.36 and 0.09/0.33, p < 0.001). In multivariable logistic regression, higher quintile of urinary NaCR associated with odds ratio of 1.81 for high PCR (1.55/2.12, p < 0.001), 0.51 of 1.62 for high ACR (1.35/1.95, p < 0.001), and of 1.84 for high urinary non-albumin proteins/creatinine ratio (1.58/2.16, p < 0.001). Findings were consistent in subgroups. Data indicate independent positive associations of an index of sodium intake with proteinuria and albuminuria in the population.

A HIGH ALDOSTERONE TO RENIN RATIO MEDIATES MICROVASCULAR AND MACROVASCULAR DAMAGE IN NEWLY-DIAGNOSED, TREATMENT-NAÏVE ESSENTIAL HYPERTENSION

Objective: The role of aldosterone in hypertension was generally considered in the context of primary hyperaldosteronism, an uncommon condition (less than 2% in the hypertensive population). However, based on an increased ambulant aldosterone-to-renin ratio (ARR), a marker of inappropriate aldosterone activity, the prevalence of primary hyperaldosteronism in the hypertensive population may be as high as 10% to 15%. There is increasing evidence to suggest a BP-independent effect of aldosterone on left ventricular structure, increased collagen deposition with fibrosis, diastolic dysfunction and arterial stiffness. We hypothesized that aldosterone and renin will be associated with microvascular and macrovascular alterations in never treated essential hypertension. Design and method: We prospectively studied newly diagnosed, untreated essential hypertensive and normotensive subjects (n = 1482, 47% females, mean age 51 ± 0.77, SEM). Pulse wave velocity (PWV), augmentation index (AIx), aortic systolic BP and pulse pressure amplification were measured with applanation tonometry(SphygmoCor). Albumin-creatinine ratio, urine sodium and potassium concentrations were determined from spot urine samples. Laboratory tests included serum creatinine and clearance, plasma renin activity, serum aldosterone, and high-sensitivity C-reactive protein(hs-CRP). Aldosterone to renin ratio(ARR) was divided into tertiles. Results were analysed using JMP Pro(Version 13, SAS for Windows). The patients gave informed consent and the study had Institutional ethics committee permission. Results: The top ARR tertile was associated with the highest levels of brachial BP, aortic systolic BP, AIx, pulse pressure amplification and PWV(P &lt; 0.001 for all). Stepwise regression analysis showed that the positive association between PWV and increasing ARR tertiles remained significant after adjustment for BP, age and other potential confounders(R2 = 0.39, p &lt; 0.05). The top ARR tertile was also associated with high potassium and low sodium urinary excretion, high ACR, low creatinine clearance and high hs-CRP (All p &lt; 0.01). Conclusions: In untreated hypertensive subjects with mild to moderate hypertension, there are significant interactions between ARR and indices of microvascular and macrovascular damage. Our findings indicate that aldosterone and renin adversely modulate microvascular and macrovascular function very early in the evolution of hypertension. While aldosterone antagonism is recommended currently for treatment-resistant hypertension, our findings suggest that it should be initiated early in hypertension.

Effect of a Gluten-Free Diet on Albuminuria in Children with Newly Diagnosed Celiac Disease

Background and Objectives: Altered gastrointestinal permeability in celiac disease (CD) is mediated by zonulin. The receptor for zonulin is expressed on podocytes. Therefore, we tested the effect of a gluten-free diet (GFD) on albuminuria in pediatric patients with newly diagnosed CD. Methods: We performed a cohort study comparing urinary albumin (μg): Cr (mg) ratio (ACR) in CD patients versus controls and in response to a GFD. Results: Children with CD (n = 46) had higher ACR than controls (n = 21), 20.2 ± 5.6 versus 8.4 ± 1.1 μg/mg, p = 0.16 and exceeded 30 μg/mg (microalbuminuria cutoff) in 7/46 cases. Seventeen patients had a follow-up assessment (interval 6.1 ± 0.7 months) on a GFD. Baseline ACR was 20.7 ± 5.2 that fell to 10.4 ± 1.5 μg/mg, p = 0.035. Conclusion: Children and adolescents with newly diagnosed CD have low-grade albuminuria that is numerically higher than controls and that declined after implementation of a GFD. CD may be associated with reversible defects in the glomerular barrier.

Disease activity improvements with optimal discriminatory ability between treatment arms: applicability in early and established rheumatoid arthritis clinical trials

BackgroundThe ACR20 has been validated as the best discriminator of efficacy in placebo-controlled trials, but not in head-to-head trials comparing effective therapies in patients with rheumatoid arthritis (RA). We assessed the most discriminatory ACR response and most discriminatory percent improvement in disease activity measures for Simplified Disease Activity index (SDAI), Clinical Disease Activity index (CDAI), and 28-joint Disease Activity Score based on C-reactive protein (DAS28(CRP)) using different patient populations and trial designs.MethodsData from two placebo-controlled studies in established RA and two head-to-head studies in early RA were analyzed. The numeric ACR response for each treatment and P value for the difference between treatments were calculated at multiple time points to determine the ACR response associated with the lowest P value. Similarly, values for percent improvement from baseline in SDAI, CDAI, and DAS28(CRP) with the most discrimination between treatments were examined.ResultsIn the head-to-head early RA trials, the minimum P value and greatest treatment difference between the active comparator arms at 6 months was achieved at higher ACR rates and greater percent improvements in other disease activity measures. In established RA, lower responses (minimum P value and maximum treatment difference) and smaller improvements in disease activity scores had better discriminatory ability at 6 months.ConclusionsThe most discriminatory ACR response rate and percent improvement in disease activity measures were higher in head-to-head active comparator trials in early RA versus placebo-controlled trials in established RA. This difference should be considered in future clinical trial designs.Trial registrationNCT00195663, NCT00420927, NCT00195702.

Correlation between Uric Acid, Albuminuria and Cardiovascular Outcome In Patients With Diabetes Mellitus

Background: Many studies have shown an association between uric acid (UA) and cardiovascular (CV) outcome in general population and diabetes, also the association between albuminuria and cardiovascular outcome is well established. The link between serum UA levels and albuminuria with subsequent CV affection is not yet clear. For this reason, we aimed to study such association. Method: One hundred and eight individuals with type 2 diabetes which were divided into two groups each constitute of 54 individuals according to presence or absence of CV disease. Routine laboratory investigations together with serum UA and urinary albumin to creatinine ratio (uACR) was analyzed in the two groups they were then correlated to each other and to different study parameters and future CV event using Framingham risk score (FRS). Results: The present study proved that there is statistical significant difference as regard risk of CVD as calculated by FRS being higher in diabetic patients with high serum UA (SUA) levels compared to those with low uric acid levels; the same apply for those with high urinary ACR. Serum UA was found to be correlated with urinary albumin execretion in patients with diabetes with and without CVD (n=108, r=0.450, p

Greater aortic stiffness is associated with renal dysfunction in participants of the ELSA-Brasil cohort with and without hypertension and diabetes.

BackgroundArterial stiffness has been associated with renal dysfunction and its progression, but the pathophysiological relation underlying this association has not been fully established, particularly among individuals without hypertension and diabetes. We investigated the cross-sectional associations between arterial stiffness and renal function in adults without cardiovascular disease, and whether this association remained among subjects without hypertension and diabetes.MethodsAll eligible participants from ELSA-Brasil (2008–2010), aged 35 to 74 years (N = 13,586) were included, of whom 7,979 were free from hypertension and diabetes. The response variables were: 1) low glomerular filtration rate (eGFR<60ml/min/1.73m2) estimated by CKD-EPI; 2) increased albumin/creatinine ratio (ACR ≥30mg/g); and 3) chronic kidney disease (CKD). Arterial stiffness was ascertained by the carotid-femoral pulse wave velocity (PWV). The covariates were sex, age, race/color, level of schooling, smoking, body mass index, total cholesterol/HDL-c glycated hemoglobin, diabetes, systolic blood pressure, heart rate and use of antihypertensive drugs. Logistic regression was used to examine the associations.ResultsAfter all adjustments, 1 m/s increase in PWV was associated with ORs equal to 1.10 (95%CI: 1.04–1.16), 1.10 (95%CI: 1.05–1.16) and 1.12 (95%CI: 1.08–1.17) of low eGFR, high ACR, and CKD, respectively. In subjects without hypertension and diabetes, these ORs were 1.19 (95%CI: 1.07–1.33), 1.20 (95%CI: 1.07–1.32) and 1.21 (95%CI: 1.11–1.30), respectively.ConclusionThe increase in PWV was associated with all renal dysfunction markers, even in individuals without hypertension and diabetes, suggesting a relation that is not completely mediated by the presence of these conditions.

Relations between dairy product intake and blood pressure: the INTERnational study on MAcro/micronutrients and blood Pressure.

Epidemiologic evidence suggests that low-fat dairy consumption may lower risk of hypertension. Dairy products may be distinctly linked to health, because of differences in nutritional composition, but little is known about specific nutrients that contribute to the dairy-blood pressure (BP) association, nor to underlying kidney function. We examined cross-sectional associations to BP of dairy product intakes, total and by type, from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) including 2694 participants aged 40-59 years from the UK and the USA. Eight BP, four 24-h dietary recalls and two 24-h urine samples were collected during four visits. Linear regression models adjusted for lifestyle/dietary factors to estimate BP differences per 2SD higher intakes of total-and-individual-types of dairy were calculated. Multivariable linear regression coefficients were estimated and pooled. In contrast to total and whole-fat dairy, each 195 g/1000 kcal (2SD) greater low-fat dairy intake was associated with a lower SBP -2.31 mmHg and DBP -2.27 mmHg. Significant associations attenuated with adjustment for dietary phosphorus, calcium, and lactose, but strengthened with urinary calcium adjustment. Stratification by median albumin-creatinine ratio (ACR; high ACR indicates impaired kidney function) showed strong associations between low-fat dairy and BP in participants with low ACR (SBP: -3.66; DBP: -2.15 mmHg), with no association in participants with high ACR. Low-fat dairy consumption was associated with lower BP, especially among participants with low ACR. Dairy-rich nutrients including phosphorus and calcium may have contributed to the beneficial associations with BP.

Postmeal triglyceridemia and variability of HbA1c and postmeal glycemia were predictors of annual decline in estimated glomerular filtration rate in type 2 diabetic patients with different stages of nephropathy

BackgroundThis study examined associations of annual glycemic variability and postprandial dysmetabolism with annual decline in estimated glomerular filtration rate (eGFR) in type 2 diabetic patients with different stages of nephropathy.MethodsIntrapersonal mean and coefficient of variation (CV) of HbA1c, fasting and postmeal concentrations of plasma glucose (FPG and PMPG, respectively) and serum triglycerides (FTG and PMTG, respectively) during the first 12 months after enrollment were calculated in a cohort of 168 type 2 diabetic patients: 53 with optimal albumin/creatinine ratio (ACR < 10 mg/g), 62 with high normal ACR (10–29 mg/g) and 53 with elevated ACR (≧30 mg/g). Annual changes in eGFR were computed using 52 (median) creatinine measurements obtained over a median follow-up of 6.0 years. Multivariate linear regressions assessed the independent correlates of changes in eGFR.ResultsKidney function declined faster in patients with high normal and elevated ACR (−1.47 and −2.01 ml/min/1.73 m2/year, respectively) compared to patients with optimal ACR (0.08 ml/min/1.73 m2/year, p < 0.05). In patients with high normal ACR, age (standardized β、-0.30、p = 0.01), CV-HbA1c (standardized β、-0.66、p < 0.001) and CV-PMPG (standardized β、-0.27、p = 0.01) was associated with annual eGFR decline independently of mean HbA1c and PMPG, sex, BMI, waist circumference, diabetes duration and therapy, means and CVs of FPG and systolic blood pressure, baseline eGFR, log ACR and uses of anti-hypertensive medications (R2 = 0.47). In patients with elevated ACR, PMTG (standardized β、-0.408, p = 0.007) was associated with annual eGFR decline (R2 = 0.15).ConclusionsConsistency of glycemic control and management of postprandial glycemia and lipidemia are important to preserve kidney function in type 2 diabetic patients.

Abstract P219: Kidney Measures and Future Risk of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Abdominal aortic aneurysm (AAA) is considered a subtype of atherosclerotic disease, but its risk factor profile is somewhat different than other atherosclerotic disease subtypes. For example, prior studies have demonstrated a null or even inverse association between diabetes and AAA. Chronic kidney disease (CKD) is a known risk factor for cardiovascular outcomes, but its association with AAA has not been explicitly investigated. Methods: We studied 10,722 participants (aged 53-75 years) without clinical history of AAA who attended the ARIC Study fourth visit (1996-98). Cox regression models were used to quantify the association of two key CKD measures—estimated glomerular filtration rate [eGFR] based on serum creatinine and cystatin C and urine albumin-to-creatinine ratio [ACR]—with incidence of AAA-related hospitalizations or deaths (ICD-9 codes: 38.44, 39.71, 441.3, 441.4, or 441.02). Results: During a median follow-up of 14 years, there were 350 cases of AAA (incidence rate 2.5 per 1000 person-years). Both low eGFR and high ACR were associated with increased risk of clinical AAA independently of each other and potential confounders, with a slightly sharper risk gradient for ACR compared to eGFR (Table). We also confirmed an inverse association between diabetes and AAA in our study, although ACR was a significant positive risk factor for AAA risk in both those with and without diabetes. By contrast, low eGFR was associated with AAA risk only in those without diabetes. Conclusion: Both eGFR and ACR were independently associated with increased risk of clinical AAA in the community, suggesting potential usefulness of CKD to identify persons at high risk of AAA beyond traditional atherosclerotic risk factors.

The Risk of Major Hemorrhage with CKD.

New staging systems for CKD account for both reduced eGFR and albuminuria; whether each measure associates with greater risk of hemorrhage is unclear. In this retrospective cohort study (2002-2010), we grouped 516,197 adults ≥40 years old by eGFR (≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, or <15 ml/min per 1.73 m(2)) and urine albumin-to-creatinine ratio (ACR; >300, 30-300, or <30 mg/g) to examine incidence of hemorrhage. The 3-year cumulative incidence of hemorrhage increased 20-fold across declining eGFR and increasing urine ACR groupings (highest eGFR/lowest ACR: 0.5%; lowest eGFR/highest ACR: 10.1%). Urine ACR altered the association of eGFR with hemorrhage (P<0.001). In adjusted models using the highest eGFR/lowest ACR grouping as the referent, patients with eGFR=15 to <30 ml/min per 1.73 m(2) had adjusted relative risks of hemorrhage of 1.9 (95% confidence interval [95% CI], 1.5 to 2.4) with the lowest ACR and 3.7 (95% CI, 3.0 to 4.5) with the highest ACR. Patients with the highest eGFR/highest ACR had an adjusted relative risk of hemorrhage of 2.3 (95% CI, 1.8 to 2.9), comparable with the risk for patients with the lowest eGFR/lowest ACR. The associations attenuated but remained significant after adjustment for anticoagulant and antiplatelet use in patients ≥66 years old. The risk of hemorrhage differed by urine ACR in high risk subgroups. Our data show that declining eGFR and increasing albuminuria each independently increase hemorrhage risk. Strategies to reduce hemorrhage events among patients with CKD are warranted.

SAT-144 - High SVR Rates with SMV + SOF in HCV GT1 and GT4 Patients with Cirrhosis or Advanced Fibrosis: A Real Practice Analysis from a Large Regional Database in Tuscany, Italy

s / Digestive and Liver Disease 48S (2016) e1–e17 e5 eGFR was ≥60mL/min/1.73m2 in 92 patients (93.8%) and between45and59mL/min/1.73m2 in6patients (6.1%).Glomerular involvement was found in 19 patients (19.4%), tubular involvement in 31 (31.6%) and they co-occurred in 10 patients (p=0.034). Subjects with glomerular or tubular involvement, or both, showed significantly lower eGFRvalues (p=0.005). AROC curvewasdrafted and a cut point of 90ml/min predicted renal involvement (RI) (sensitivity 63%, specificity 75%), although it was unable to distinguish tubular vs glomerular involvement (p=0.914). Patients with RI were older, had higher ACR and 1MCR levels and exhibited a more severe KDIGO stage. No association was found between RI and: HCV-RNA levels, liver stiffness and liver function tests. L-FABP andKIM-1 levelswere significantlyhigher inpatientswithRI. Tubular involvement was significantly associated with increased levels of L-FABPandKIM-1,while glomerular involvementwas associated only with high L-FABP level. Conclusion: Tubular and/or glomerular involvement are quite frequent in HCV cirrhotic patients. The occurrence of eGFR<90ml/min/1.73m2 allows to suspect renal involvement and should prompt to monitor renal function more closely. http://dx.doi.org/10.1016/j.dld.2015.12.024

Safety and efficacy of tocilizumab in children with systemic juvenile idiopathic arthritis

Upon therapy with tocilizumab a high ACR response was achieved by many sJIA patients, as well as a JADAS MDA. A JADAS remission was documented in up to 40% of patients. In many patients, tocilizumab was used late and as second biologic. The tolerability was good overall and comparable to those of other biologics in JIA. Only a few patients discontinued therapy because of intolerance or side effects.

A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury

Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white). Collaborative meta-analysis. 8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants). Available eGFR, ACR, and 50 or more AKI events. Age, sex, race, eGFR, urine ACR, and interactions. Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results. 16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR. Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code. Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.