Spot Urine Samples Research Articles

O81 EFFECT OF ANTIHYPERTENSIVE MEDICATIONS ON URINARY SODIUM TO POTASSIUM (Na/K) RATIO

Background: The urinary sodium to potassium ratio (Na/K) greater than 2 indicating either excess sodium or insufficient potassium intake. However, the effect of antihypertensive medications on the urinary Na/K ratio has not been evaluated. We hypothesized that antihypertensive medication would acutely affect the urinary Na/K ratio. Methods: Male and female C57BL/6J mice, 14 weeks old, and a separate cohort of 24-month-old mice were subjected to a regular chow diet (NaCl 0.4%) and a high salt diet (4%). Urinary Na/K ratios in spot urine samples were measured three times a week. After baseline measurements, all animals were treated with one antihypertensive medication for 2 weeks, followed by a one-week washout period. The effects of enalapril (25 mg/kg/day), hydrochlorothiazide (25 mg/kg/day), and amlodipine (10 mg/kg/day)—were compared under a high salt diet mimicking human salt consumption. Urinary Na/K ratios collected on day 1 (acute) and day 8 (subacute) after initiating medication were compared to the vehicle period using a two-way ANOVA. Medication was administered with food using gel food pellets. Results: Under regular chow, the urinary Na/K ratio was 0.65±0.58 (n=15) with no interaction between sex or age (all p>0.05). Under a high salt diet, the urinary Na/K ratio increased to 4.5±2.2 (p<0.01 vs. regular chow) with no differences between sex and age. After the washout period, enalapril, both acutely and subacutely, did not affect the Na/K ratio. Similarly, hydrochlorothiazide did not affect the Na/K ratio in either period. However, amlodipine reduced the Na/K ratio in both acute and subacute periods (p<0.001). No interaction was observed with sex or age. The effect of amlodipine was related to higher potassium excretion (43.9±23 vs. 81.6±33 meq/L; p<0.001) with no changes in sodium excretion (152.2±75 vs. 173.3±43.5 meq/L; p=0.8). Conclusion: The Na/K ratio reflects salt and potassium consumption. The Na/K ratio is not affected by enalapril or hydrochlorothiazide. Amlodipine decreases the Na/K ratio acutely and subacutely due to increased potassium excretion.

Development and validation of a prediction model for estimating 24-Hour Urinary Sodium Excretion using spot urine samples in adult patients

To assess whether 24-h urinary sodium excretion (24uNa) can be estimated from spot samples in adult patients who attend hospital clinics. Methods: A cross-sectional study with a development (284 patients) and a validation cohort (229 patients) was conducted at our hospital. A multivariate linear regression model was built which was compared with former models. Concordance analyses and comparison of the ability to correctly classify each patient against a prespecified uNa cut-off value of 130 mmol/24h were performed, assessed by the C-statistic. The model was well calibrated (slope [95%CI] in internal validation: 0.965 [0.947-0.987], showing good discrimination, and performed robustly in an external validation cohort (slope: 0.811 [0.675-0.946]). The mean bias between the measured and the estimated 24uNa by NaRYC was 24.85 mmol/24h [17.06-32.63]. The NaRYC had the highest values of Pearson coefficient (0.613 p<0.0001), accuracy (P30): 56.8%, and AUC-ROC: 0.822 [0.766-0.869] as compared to other seven equations. Although the mean bias of the results is quite acceptable, the variability observed in the 95%CI makes not recommend the general use of a spot as a substitute of the 24-hour urine in order to estimate the total urine excretion of Na in a single subject basis.

Impact of Skin Care Products on Phthalates and Phthalate Replacements in Children: the ECHO-FGS.

Phthalates and their replacements have been implicated as developmental toxicants. Young children may be exposed to phthalates/replacements when using skin care products (SCPs). Our objective is to assess the associations between use of SCPs and children's urinary phthalate/replacement metabolite concentrations. Children (4-8 years old) from the Environmental Influences on Child Health Outcomes-Fetal Growth Study (ECHO-FGS) cohort provided spot urine samples from 2017 to 2019, and mothers were queried about children's SCP use in the past 24 h (). Concentrations of 16 urinary phthalate/replacement metabolites were determined by liquid chromatography-tandem mass spectrometry (). We used linear regression to estimate the child's use of different SCPs as individual predictors of urinary phthalate/replacement metabolites, adjusted for urinary specific gravity, age, sex assigned at birth, body mass index, and self-reported race/ethnic identity, as well as maternal education, and season of specimen collection. We created self-organizing maps (SOM) to group children into "exposure profiles" that reflect discovered patterns of use for multiple SCPs. Children had lotions applied (43.0%) frequently, but "2-in-1" hair-care products (7.5%), sunscreens (5.9%), and oils (4.3%) infrequently. Use of lotions was associated with 1.17-fold [95% confidence interval (CI): 1.00, 1.34] greater mono-benzyl phthalate and oils with 2.86-fold (95% CI: 1.89, 4.31) greater monoethyl phthalate (MEP), 1.43-fold (95% CI: 1.09, 1.90) greater monobutyl phthalate (MBP), and 1.40-fold (95% CI: 1.22, 1.61) greater low-molecular-weight phthalates (LMW). Use of 2-in-1 haircare products was associated with 0.84-fold (95% CI: 0.72, 0.97) and 0.78-fold (95% CI: 0.62, 0.98) lesser mono(3-carboxypropyl) phthalate (MCPP) and MBP, respectively. Child's race/ethnic identity modified the associations of lotions with LMW, oils with MEP and LMW, sunscreen with MCPP, ointments with MEP, and hair conditioner with MCPP. SOM identified four distinct SCP-use exposure scenarios (i.e., profiles) within our population that predicted 1.09-fold (95% CI: 1.03, 1.15) greater mono-carboxy isononyl phthalate, 1.31-fold (95% CI: 0.98, 1.77) greater mono-2-ethyl-5-hydroxyhexyl terephthalate, 1.13-fold (95% CI: 0.99, 1.29) greater monoethylhexyl phthalate, and 1.04-fold (95% CI: 1.00, 1.09) greater diethylhexyl phthalate. We found that reported SCP use was associated with urinary phthalate/replacement metabolites in young children. These results may inform policymakers, clinicians, and parents to help limit children's exposure to developmental toxicants. https://doi.org/10.1289/EHP13937.

Urine Protein to Creatinine Ratio for the Assessment of Bevacizumab-Associated Proteinuria in Patients with Gynecologic Cancers: A Diagnostic and Quality Improvement Study.

Proteinuria is a common adverse event arising from treatment with bevacizumab, requiring diagnostic testing via 24-h urine collection. However, this method is cumbersome. We assessed urine screenings in gynecologic cancer patients from February 2021 to May 2022. Along with a simple urine dipstick (UD), the urine microalbumin, total protein, and creatinine were measured and calculated as the urine albumin to creatinine ratio (UACR) and the urine protein to creatinine ratio (UPCR), which were further adjusted through the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations to be estimated and correlated with 24-h urine total protein content. The incremental cost-effectiveness ratio was used for cost analysis. There were 129 urine samples from 36 patients. The sensitivity and specificity for the UACR were 0.56 and 0.97, and for the UPCR, 0.71 and 0.88, respectively. The 24-h TP correlated strongly with the UACR (r = 0.75; p < 0.001) and UPCR (r = 0.79; p < 0.001) and fair for the simple UD (r = 0.35; p < 0.001). The UPCR saves one unnecessary 24-h urine test for less than a dollar compared to a simple UD. The results indicate that using the UPCR could enhance diagnostic accuracy, lower costs, and reduce unnecessary 24-h urine sampling.

Co-exposure to parabens, bisphenol A, and triclosan and the associations with dyslipidemia in Chinese older adults: The mediation effect of oxidative stress

Dyslipidemia is a prevalent metabolic disorder in older adults and has negative effects on cardiovascular health. However, the combined effect of paraben, bisphenol A (BPA), and triclosan (TCS) exposure on dyslipidemia and the underlying mechanisms remain unclear. This cross-sectional study recruited 486 individuals ≥60 years in Shenzhen, China. Morning spot urine samples were collected and analyzed for four parabens, BPA, TCS, and 8-hydroxy-2′-deoxyguanosine (8-OHdG), a typical biomarker for oxidative stress, using mass spectrometry. Blood samples were tested for lipid levels using an automated biochemical analyzer. Quantile-based g-computation (QGC) was used to assess the combined effects of exposures on dyslipidemia. Mediation analysis was applied to investigate the mediating role of 8-OHdG between exposure and dyslipidemia. QGC showed that co-exposure to parabens, BPA, and TCS was positively linked with hypercholesterolemia (OR: 1.17, 95%CI: 1.10–1.24, P < 0.001) and hyper-LDL-cholesterolemia (OR: 1.35, 95%CI: 1.05–1.75, P = 0.019). Methylparaben (MeP), n-propyl paraben (PrP), and butylparaben (BtP) were the major contributors. 8-OHdG mediated 6.5% and 13.0% of the overall effect of the examined chemicals on hypercholesterolemia and hyper-LDL-cholesterolemia, respectively (all P < 0.05). Our study indicated that co-exposure to parabens, BPA, and TCS is associated with dyslipidemia and oxidative stress partially mediate the association. Future research is needed to explore additional mechanisms underlying these relationships.

Arsenic speciation analysis in human urine for long term epidemiological studies: The Multi-Ethnic Study of Atherosclerosis (MESA)

Arsenic is a ubiquitous toxic metalloid causing serious health problems. Speciation analysis of arsenic in human urine provides valuable insights for large-scale epidemiological studies and informs on sources of exposure as well as human metabolism. The Multi-Ethnic Study of Atherosclerosis (MESA) is a valuable cohort for assessing chronic low-moderate arsenic exposure and health effects in an ethnically diverse US population. We present a state-of-the-art arsenic speciation analysis methodology and its application to 7677 MESA spot urine samples based on high-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry. This method is fast, robust and detects a total of 11 individual As species at method detection limits of 0.02–0.03 μg arsenic/L urine for each individual species. Our analytical approach features excellent mean method accuracy (98%) and precision (5%) for the main arsenic species in urine (arsenobetaine, methylarsonic acid, dimethylarsinic acid, and total inorganic As); intra- (3–6%) and inter-day coefficients of variability (5–6%); column recovery (96 ± 7%); and spike recovery (97 ± 6%). The main arsenic species were detectable in ≥95% of urine samples due to the implementation of an oxidation step. Each individual minor arsenic species was detectable in ≤25% of all urines, although at least one of them was detected in almost half the participants. We identified two minor urinary arsenic species as dimethylarsinoylacetic acid and dimethylarsinoylpropionic acid, potential metabolites of seafood-related arsenicals. We observed differences in individual As species excretion by race/ethnicity, with Asian-American participants featuring 3–4 times higher concentrations compared to other participants. We also found differences by site, body mass index, smoking status, rice intake, and water arsenic levels, potentially indicating different exposures or related to individual bio-metabolism. The proposed approach is suitable for epidemiological studies and the collected data will constitute the base for future research on potential health effects of chronic low-level arsenic exposure.

Salt reduction attempts in workers after specific food service facility guidance provided by a public health center: A case study at a worksite in Kawagoe City, Saitama Prefecture

Objective The Kawagoe City Public Health Center implemented a project to reduce salt intake through specific food service facility guidance in workplace cafeterias. Here, we report the study results.Methods The target worksite was company A, with approximately 270 employees, located in Kawagoe City, Saitama Prefecture. There were 214 participants (approximately 80%). The project was conducted from November 2019 to November 2021. The long-term goal was to decrease the number of hypertensive cases in the city. Project outcomes included decreased salt intake, urinary sodium/potassium ratio, and average blood pressure. The project aimed to improve the cafeteria menu, focusing on salt reduction by offering Smart Meals® and reducing the salt equivalents in all menus. The project output indicators included reduced amount of salt in cafeteria menu items, increased frequency of cafeteria use, increased positive evaluations of the cafeteria, and increased daily awareness of the need for salt reduction. Spot urine samples, blood pressure measurements, and self-administered questionnaire data were collected during annual physical examinations. The amount of salt in the cafeteria menu was evaluated by receiving monthly data from the food service company to which company A outsourced its cafeteria operations.Results The analysis included 102 individuals with complete data from to 2019-2021. Estimated salt intake (g/day) from spot urine decreased from 10.3±2.1 in 2019 to 9.8±2.4 in 2020 and 9.5±2.0 in 2021 (P=0.003). Systolic blood pressure (mmHg) decreased from 114.7±12.5 in 2019 to 111.7±12.1 in 2020 and 110.6±12.0 in 2021 (P=0.010). Compared to 2019, changes in dietary salt equivalents in cafeteria menus in 2020 and 2021decreased for set meals A and B, curries, and noodles (P<0.001).Conclusion We offered Smart Meals® and reduced salt equivalents in all workplace cafeteria menus. After 1-2 years, employees' salt intake and blood pressure levels were lower. These results provide implications for the implementation of food environment improvements in public health centers and other local government agencies to promote the Health Japan 21 (third term) strategy.

Diagnostic performance of an albuminuria point-of-care test in screening for chronic kidney disease among young people living with HIV in Uganda: a cross-sectional study

ObjectivesThe main aim was to determine the diagnostic performance of an albuminuria point-of-care test (POC) for diagnosis of chronic kidney disease among young people living with HIV (YPLHIV) in Uganda.DesignWe...

Impact of a nudge-based food environment intervention in a hospital convenience store on staff’s food intake and Na/K

BackgroundA food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees’ eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior.MethodsUsing a pre–post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis.ResultsA total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing “balanced meals” to lower Na/K and salads to increase potassium excretion were second.ConclusionsFood environment intervention using nudge tactics can improve staff’s food intake and lower Na/K.Trial registrationRegistration number: UMIN000049444 (UMIN-CTR).Date of registration: November. 7. 2022.

Rapid UHPLC-MS/MS measurement of pregnanediol 3-glucuronide in spot urine samples for detecting ovulation.

Biochemical confirmation of ovulation typically involves measuring serum progesterone levels during the mid-luteal phase. Alternatively, this information could be obtained by monitoring urinary excretion of conjugated metabolites of ovarian steroids such as pregnanediol 3-glucuronide (PDG) using immunoassay techniques that have methodological limitations. The aim of the present study was to develop a mass spectrometry (MS)-based method for the rapid and accurate measurement of urinary PDG levels in spot urine samples. A "dilute and shoot" ultra-high-performance liquid cromatography tandem mass spectrometry (UHPLC-MS/MS) method was developed for measuring PDG urinary concentration with a 6-min analysis time. The method underwent validation in accordance with ISO 17025 documentation for quantitative methods, proving an efficient separation of PDG from other structurally similar glucuro-conjugated steroid metabolites and ensuring a sufficient sensitivity for detecting the target analyte at concentrations as low as 0.01 μg/mL. The validation protocol yielded satisfactory results in terms of accuracy, repeatability, intermediate precision, and combined uncertainty. Additionally, the stability of both the samples and calibration curves was also conducted. The application to real urine samples confirmed the method's capability to measure PDG levels throughout an entire menstrual cycle and detecting ovulation. The rapidity of the analytical platform would therefore enable high throughput analysis, which is advantageous for large cohort clinical studies.

External validation of the natriuretic response prediction equation to discriminate diuretic response in heart failure.

Incomplete decongestion due to lack of titration of diuretics to effective doses is a common reason for readmission in patients with acute decompensated heart failure (ADHF). The natriuretic response prediction equation (NRPE) is a novel tool that proved to be rapid and accurate to predict natriuretic response and does not need urine collection. However, the NRPE has not been externally validated. The goal of this study was to externally validate the discrimination capacity of the NRPE in patients with ADHF and fluid overload. Patients admitted with ADHF who required intravenous loop diuretics were included. A spot urine sample was obtained ~2h following diuretic administration, and a timed 6-h urine collection by study staff was carried out. Urine sodium and urine creatinine from the spot urine sample were used to predict the 6-h natriuretic response using the NRPE. The primary goal was to validate the NRPE to discriminate poor loop diuretic natriuretic response (sodium output <50 mmol in the 6h following diuretic administration). The NRPE was compared with urine sodium and measured urine output which are the methods currently recommended by international guidelines to assess diuretic response. Eighty-seven diuretic administrations from 49 patients were analysed. Mean age of patients was 57±17 years and 67% were male. Mean estimated glomerular filtration rate was 65±28mL/min/1.73m2, and ejection fraction was 35±15%. Median dose of intravenous furosemide equivalents administered the day of the study was 80 mg (IQR 40 - 160). Poor natriuretic response occurred in 39% of the visits. The AUC of the NRPE to predict poor natriuretic response during the 6-h urine collection was 0.91 (95% CI 0.85-0.98). Compared with the NRPE, spot urine sodium concentration (AUC 0.75) and urine output during the corresponding nursing shift (AUC 0.74) showed lower discrimination capacity. In this cohort of patients with ADHF, the NRPE outperformed spot urine sodium concentration and all other metrics related to diuretic response to predict poor natriuretic response. Our findings support the use of this equation at other settings to allow rapid and accurate prediction of natriuretic response.

Feeding or pen surface application of clinoptilolite with different particle sizes: impact on nitrogen utilization and manure ammonia emissions in feedlot cattle.

This study investigated the effects of feeding clinoptilolite (CLN; 2.5% of diet dry matter) with a particle size of either 30- or 400-µm on ruminal fermentation characteristics, measures of nitrogen (N) utilization, and manure ammonia-N (NH3) emissions in feedlot cattle. The impact of directly applying 30- or 400-µm CLN to the pen surface (2,250kg/ha) on manure NH3-N emissions was also evaluated. Six beef heifers were used in a replicated 3 × 3 Latin square design with 21-d periods. Dietary treatments were 1) finishing ration with no supplement (CON), 2) CON + 30-µm CLN (CLN-30), and 3) CON + 400-µm CL (CLN-400). Intake was measured daily. To evaluate fermentation characteristics, ruminal fluid was collected on day 19. Indwelling pH loggers were used to measure ruminal pH from days 15 to 21. Blood was collected 3-h post-feeding on day 21 for metabolite analysis. Fecal grab and urine spot samples were also collected from days 19 to 21 to measure nutrient digestibility, route of N excretion, and in vitro NH3 emissions. There was no diet effect (P ≥ 0.12) on nutrient intake and apparent total tract digestibility, and ruminal short-chain fatty acid profile and pH. Ruminal NH3 concentration, which was lower (P = 0.04) for CLN-30 than CON heifers, did not differ between CON and CLN-400 heifers. Although there was no diet effect (P = 0.50) on plasma urea-N (PUN) concentration, proportion of urea-N excreted in urine was lower (P = 0.01) for CLN-30 than CON and CLN-400 heifers. Urinary NH3-N excretion, which was greater (P ≤ 0.04) for CLN-400 than CON heifers, did not differ between CLN-30 and CLN-400 heifers. Feeding CLN also increased (P ≤ 0.02) fecal excretion of potassium (K) and iron (Fe) and reduced (P = 0.01) urinary excretion of calcium (Ca). There was a treatment × time interaction (P = 0.01) for NH3 emission rate, which was greatest within the first 36h of incubation and was lower for manure from CLN-400 compared to CON and CLN-30 heifers and pen surface application treatments. Cumulative NH3 emissions were lower (P < 0.01) for manure from CLN-400 compared to CON and CLN-30 heifers and the pen surface application treatments. Although surface application was ineffective, feeding 400-µm CLN to finishing cattle could result in a beneficial decrease in manure NH3 emissions. However, changes in fecal and urine excretion of minerals like K and Ca, which suggest a decrease in bioavailability, need to be considered when feeding CLN in finishing cattle diets.

2324 Feasibility of screening for frailty, sarcopenia and nutritional status in elective surgery for colorectal cancer

Abstract Introduction Preoperative frailty is a key determinant of post-surgical outcomes and often co-exists with sarcopenia and malnutrition. Older patients account for a significant proportion of patients undergoing surgery for colorectal cancer and are therefore more likely to be affected by these risk factors. Methods Patients aged 65 and over undergoing planned surgery for colorectal cancer were recruited across five sites. Participants were screened preoperatively using the Clinical Frailty Scale (CFS) and Groningen Frailty Indicator (GFI). Nutritional status was assessed using the short form mini nutritional assessment (MNA-SF) and participant collection of spot urine samples to objectively measure habitual dietary intake. Sarcopenia was assessed through grip strength, gait speed and psoas muscle measurement using preoperative CT imaging. The non-radiological screening measures were repeated eight-weeks postoperatively, with additional urine samples collected in the first and fourth weeks. Results Forty-three participants (mean age 76 years, 60% male) were recruited, of which 32% were frail. Using the mini-nutritional assessment 42% of participants were identified as at risk of malnutrition and 9% as malnourished. Urine assessment of habitual dietary intake is ongoing. There was a high prevalence of sarcopenia - 67% determined by hand grip strength and 42% by CT analysis. Mean length of stay following surgery was 6.9 days. 28% of participants were unable to complete the in-person post-operative follow up due to ill health, poor appetite and exhaustion. Conclusions This ongoing study has demonstrated the feasibility of incorporating frailty, nutritional status and sarcopenia screening alongside routine clinical care, in older adults undergoing surgery. However, retaining participants in observational studies during postoperative periods of convalescence, or whilst undergoing adjuvant treatment, is challenging. This study has also highlighted the potential of home urine sampling as a viable method of dietary assessment within community settings to aid malnutrition screening.

Formula-led methods using first morning fasting spot urine to assess usual salt intake: a secondary analysis of PURE study data.

Observational studies that assess the relationship between salt intake and long-term outcomes require a valid estimate of usual salt intake. The gold-standard measure in individuals is sodium excretion in multiple nonconsecutive 24-h urines. Multiple studies have demonstrated that random spot urine samples are not valid for estimating usual salt intake; however, some researchers believe that fasting morning spot urine samples produce a better measure of usual salt intake than random spot samples. We have used publicly available data from a PURE China validation study to compare estimates of usual salt intake from morning spot urine samples and three published formulae with mean of two 24-h urine samples (reference). We estimated the means and 95% confidence intervals of absolute and relative errors for each formula-led method and the degree to which estimates were able to be classified into the correct quartile of intake. Bland-Altman plots were used to test the level of agreement. The results show that compared with the reference method, all formulae-led estimates from spot urine collections have high error rates: both random and systematic. This is demonstrated for individual estimates, as well as by quartiles of reference salt intake. This study conclusively demonstrates the unsuitability of morning spot urine formula-led estimates of usual salt intake. Our findings support international recommendations to not conduct, fund, or publish research studies that use spot urine samples with estimating equations to assess individuals' salt intake in association with health outcomes.

MyACR: A Point-of-Care Medical Device for Determination of Albumin-Creatinine Ratio (uACR) in Random Urine Samples as a Marker of Nephropathy.

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the world's population. Monitoring urine albumin-to-creatinine ratio (uACR) has become the gold standard for nephropathy diagnosis and control. The objective of the present study was to develop a simple, accurate, sensitive, and rapid point-of-care test (PoCT) device, MyACR, for uACR measurement, intended for use in community healthcare to screen for the risk and monitor the progress of CKD. Albumin and creatinine concentrations in urine samples were determined using spectrophotometric dye (tetrabromophenol blue)-binding and colorimetric Jaffe assay, respectively. Urine samples were diluted with distilled water (1:80) and mixed separately with albumin and creatinine reaction mixture. The creatinine reaction was incubated at room temperature (25 °C) for 30 min before analysis. Optical density (OD) was measured at the wavelengths of 625 nm (albumin) and 515 nm (creatinine). All calibration curves (0-60 mg/L and 0-2 mg/dL for albumin and creatinine) yielded linear relationships with correlation coefficients (R2) of >0.997. Good accuracy (% deviation of mean value (DMV) ≤ 5.42%) and precision (% coefficients of variation (CV) ≤ 12.69%) were observed from both the intra- and inter-day assays for the determination of albumin and creatinine using MyACR. The limit of quantification (LOQ) of albumin and creatinine in urine samples determined using MyACR and a laboratory spectrophotometer were 5 mg/L and 0.25 mg/dL, respectively, using 37.5 μL urine spiked samples (n = 5). The device was well-applied with clinical samples from 20 CKD patients. The median (range) of %DMV of the central (hospital) laboratory method (immune-based assay) was 3.48 (-17.05 to 21.64)%, with a high correlation coefficient (R2 > 0.98). In conclusion, MyACR showed satisfactory test performance in terms of accuracy, reproducibility, and sensitivity. Cost-effectiveness and improvement in clinical decision making need to be proven in future multisite community and home studies.

Longevity of Schistosoma mansoni circulating cathodic antigens in filter paper dried urine spots

ObjectivesThis study aims to determine the temporal stability of Schistosoma mansoni circulating cathodic antigens (CCA) in filter paper-based dried urine spot (FP-DUS) samples under varying temperatures condition. MethodsUrine from 20 children confirmed to have S. mansoni infection using Kato-Katz (at least 1 egg per gram of stool) and Schisto POC-CCA (2+ and 3+) methods were stored in form of FP-DUS and urine at room temperature (RT), 4 °C and −20 °C. Standard urine and FP-DUS Schisto POC-CCA methods were employed to detect CCA in urine and FP-DUS samples respectively, at weeks 4, 8 and 12. The results were reported as negative or positive (trace, 1+. 2+, and 3+). ResultsIn FP-DUS samples, POC-CCA scores initially increase after 4–8 weeks, but then showed a decrease in intensity while still remaining positive, independent of temperature condition. From week 4 to week 12, at least 80 % of urine samples had POC-CCA score of 3+, independent of temperature condition. However, 2 urine samples at RT tested negative at weeks 8 and 12. ConclusionsDespite the decrease in the intensity of test line in many samples, S. mansoni CCA remains stable and detectable in urine samples stored in FP-DUS.

Urinary polycyclic aromatic hydrocarbon metabolites in Chinese pregnant women: Concentrations, variability, predictors, and association with oxidative stress biomarkers

Polycyclic aromatic hydrocarbons (PAHs) are a class of pervasive contaminants having adverse health effects. Urinary monohydroxylated PAHs (OH-PAHs) are commonly employed as biomarkers to estimate PAH exposure levels in humans. However, little is understood about the variability in OH-PAHs among pregnant women across trimesters and their relationship with oxidative stress biomarkers (OSBs). Based on a prospective birth cohort study conducted in Wuhan, China, we selected 644 women who donated (spot) urine samples across different trimesters and measured the urinary concentrations of eight OH-PAHs and three selected OSBs (8-OHG, 8-OHdG, and HNEMA) to explore the relationship between the OH-PAHs and OSBs. Pregnant women were found to be ubiquitously exposed to the PAHs, with detection rates of the OH-PAHs ranging from 86.3% to 100%. 2-Hydroxynaphthalene (2-OH-Nap) had the highest urinary concentrations among the OH-PAHs during the three trimesters (specific gravity-adjusted median values for the first, second, and third trimesters: 1.86, 2.39, and 2.20 ng/mL, respectively). However, low reproducibility of the OH-PAHs was observed across the three trimesters with intraclass correlation coefficients ranged between 0.02 and 0.22. Most urinary OH-PAHs had the highest concentrations at the first trimester and the lowest at the third trimester. Some OH-PAH concentrations were higher in pregnant women with lower educational level [2-hydroxyphenanthrene (2-OH-Phen) and 3-hydroxyphenanthrene (3-OH-Phen)], those who were overweight [2-OH-Nap, 2/3-hydroxyfluorene (2/3-OH-Fluo), 2-OH-Phen, and 4-hydroxyphenanthrene (4-OH-Phen)], those who were unemployed during pregnancy [1-hydroxynaphthalene, 1/9-hydroxyphenanthrene, and 4-OH-Phen], and the samples donated in summer (most OH-PAHs, except for 2-OH-Nap). In multivariable linear mixed-effects model analyses, every OH-PAH was found to be significantly associated with increased levels of the three OSBs. For example, each interquartile range-fold increase in 2/3-OH-Fluo concentration was associated with the largest increase in 8-OHdG (65.4%) and 8-OHG (49.1%), while each interquartile range-fold increase in 3-OH-Phen concentration was associated with the largest increase in HNEMA (76.3%). Weighted quantile sum regression models, which were used to examine the joint effect of OH-PAH mixture on the OSBs, revealed positive associations between the OH-PAH mixture exposure and the OSBs. Specifically, 2/3-OH-Fluo and 2-OH-Nap were the major contributors in the association with oxidative damage of nucleic acids (8-OHdG and 8-OHG), while hydroxyphenanthrenes and 1-hydroxypyrene were the major contributors in the association with oxidative damage of lipid (HNEMA). Further work is required to examine the potential mediating role of oxidative stress in the relationship of adverse health outcomes with elevated PAH exposure among pregnant women.

Dietary intake of luteolin is negatively associated with all-cause and cardiovascular mortality in chronic kidney disease patients

BackgroundLuteolin (Lut), a flavonoid present in the daily diet, exhibits potent anti-inflammatory and renoprotective effects. However, the association between Lut and chronic kidney disease (CKD) remains uncertain. The objective of this study is to explore the potential correlation.MethodsA total of 2,393 CKD patients were enrolled in a prospective cohort in the National Health and Nutrition Examination Survey (NHANES). A 24-h dietary recall was utilized to estimate the intake of dietary Lut based on the type and amount of food consumed. The National Death Index mortality data was utilized to ascertain all-cause and cardiac mortality (as of December 27, 2023). Cox proportional hazards model was used to estimate the relationship between Lut intake and mortality risk.ResultsThe median Lut intake was 0.305 mg/day, with interquartile range was 0.105–0.775 mg/day. During the follow-up period (median, 93 months), 682 all-cause deaths (217 cardiovascular disease [CVD] deaths) were recorded. Per unit increase in Lut intake reduced all-cause mortality by 27% (P < 0.001) and cardiac mortality by 34% (P = 0.01) in CKD patients. There was an inverse dose–response association between Lut intake (range: 0–8.945 mg/day) and mortality risk. Consistent results were also shown when stratified by age, sex, race, marital status, body mass index, CKD stage, urine protein creatinine ratio strata, CKD progression risk, hypertension, and CVD.ConclusionDietary Lut intake is associated with a reduction in all-cause and cardiac mortality among CKD patients, potentially attributable to the anti-inflammatory characteristics of Lut.

Associations between urine specific gravity and race/ethnicity at the population level: Implications for hydration status categorization.

We aimed to evaluate how urine specific gravity (USG) and rates of supposed hypohydration vary by race/ethnicity, and to examine how adjustment for several important factors impacts estimated USG. Using the National Health and Nutrition Examination Survey, this cross-sectional study evaluated a total of 4195 (2098 female, 2097 male) Americans and categorized them as supposedly hypohydrated (USG≥1.020) or not using spot urine samples. USG and prevalence of supposed hypohydration were compared across racial/ethnic groups, separately by gender. The analyses considered the impact of urine creatinine, body composition, age, dietary nutrients, and physical activity. Differences in supposed hypohydration prevalence were observed by race/ethnicity in men (p = .030) and women (p < .001). In unadjusted models, Black women's USG (1.0189) was higher (p < .05) than all the other race/ethnicity groups' USG (1.0142-1.0171). In men, Blacks' USG (1.0197) was higher (p < .05) than the USG of Whites (1.0177) and other/multi-racial (1.0176) but not Mexican Americans (1.0196) or other Hispanics (1.0192). Adjustments for age, arm circumference, nutrients (protein, sodium, potassium, and moisture), and physical activity minimally influenced USG estimates. Further adjustment for urine creatinine lowered USG for Black women and men by 0.003 and 0.0023, respectively, with no notable lowering of USG in the other races/ethnicities. Supplemental analyses matching Whites and Blacks on age, moisture intake, and poverty-to-income ratio confirmed racial differences in urine creatinine and USG, though the effects were most pronounced in women. Using a USG≥1.020 to identify hypohydration in all races/ethnicities may be inappropriate due to, among other factors, differences in urinary creatinine.

Exploring associations between the Phthalate Environmental Reproductive Health Literacy (PERHL) scale & biomarkers of phthalate exposure: A pilot study.

Perinatal exposure to phthalates is associated with adverse health impacts for parents and children. The field of environmental health literacy seeks to measure how environmental health information is conceptualized and used to inform behaviors. We assessed whether scores on the validated Phthalate Environmental Reproductive Health Literacy (PERHL) scale were associated with biomarkers of phthalate exposure. 42 members of the Environmental Reproductive and Glucose Outcomes (ERGO) cohort completed the PERHL scale and provided spot urine samples. Phthalate summary measures for model outcomes were created by calculating molar sums of specific gravity-corrected metabolite concentrations representing exposure to parent phthalate, Di(2-ethylhexyl)phthalate (DEHP), personal care product (PCP)-associated phthalates, and parent butyl-phthalates. Linear regression models were used to estimate the associations of the PERHL scale scores with phthalate summary measures, controlling for educational attainment (college degree or higher vs. no college degree), age (years), and race and ethnicity (non-Hispanic White vs. non-White). Higher scores on the PERHL Scale and subscales were generally associated with lower ΣDEHP, Σbutyl, and ΣPCP metabolite concentrations. A one-point increase in the 'Protective Behavior/Risk Control' subscale score was significantly associated with a -30.3% (95% CI: -50.1, -2.6) decrease in ΣDEHP, and a -30.6% (95% CI: -51.5, -0.63) decrease in Σbutyl metabolite concentrations.