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Accepting kidneys from older living donors: impact on transplant recipient outcomes.

https://arctichealth.org/en/permalink/ahliterature136196
Source
Am J Transplant. 2011 Apr;11(4):743-50
Publication Type
Article
Date
Apr-2011
Author
A. Young
S J Kim
M R Speechley
A. Huang
G A Knoll
G V Ramesh Prasad
D. Treleaven
M. Diamant
A X Garg
Author Affiliation
Division of Nephrology, University of Western Ontario, Canada. ann.young@lhsc.on.ca
Source
Am J Transplant. 2011 Apr;11(4):743-50
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Cadaver
Canada
Cohort Studies
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection
Humans
Kidney - physiopathology - surgery
Kidney Function Tests
Kidney Transplantation - mortality
Living Donors
Male
Medical Records
Middle Aged
Registries
Retrospective Studies
Tissue and Organ Procurement
Young Adult
Abstract
Older living kidney donors are regularly accepted. Better knowledge of recipient outcomes is needed to inform this practice. This retrospective cohort study observed kidney allograft recipients from Ontario, Canada between January 2000 and March 2008. Donors to these recipients were older living (= 60 years), younger living, or standard criteria deceased (SCD). Review of medical records and electronic healthcare data were used to perform survival analysis. Recipients received 73 older living, 1187 younger living and 1400 SCD kidneys. Recipients of older living kidneys were older than recipients of younger living kidneys. Baseline glomerular filtration rate (eGFR) of older kidneys was 13 mL/min per 1.73 m² lower than younger kidneys. Median follow-up time was 4 years. The primary outcome of total graft loss was not significantly different between older and younger living kidney recipients [adjusted hazard ratio, HR (95%CI): 1.56 (0.98-2.49)]. This hazard ratio was not proportional and increased with time. Associations were not modified by recipient age or donor eGFR. There was no significant difference in total graft loss comparing older living to SCD kidney recipients [HR: 1.29 (0.80-2.08)]. In light of an observed trend towards potential differences beyond 4 years, uncertainty remains, and extended follow-up of this and other cohorts is warranted.
PubMed ID
21401866 View in PubMed
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The accuracy of quantitative parameters in (99m) Tc-MAG3 dynamic renography: a national audit based on virtual image data.

https://arctichealth.org/en/permalink/ahliterature277742
Source
Clin Physiol Funct Imaging. 2016 Mar;36(2):146-54
Publication Type
Article
Date
Mar-2016
Author
Gustav Brolin
Lars Edenbrandt
Göran Granerus
Anna Olsson
David Afzelius
Agneta Gustafsson
Cathrine Jonsson
Jessica Hagerman
Lena Johansson
Katrine Riklund
Michael Ljungberg
Source
Clin Physiol Funct Imaging. 2016 Mar;36(2):146-54
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Computer simulation
Feasibility Studies
Female
Gamma Cameras
Humans
Image Interpretation, Computer-Assisted
Kidney - physiopathology - radionuclide imaging
Kidney Diseases - physiopathology - radionuclide imaging
Male
Monte Carlo Method
Observer Variation
Phantoms, Imaging
Predictive value of tests
Radioisotope Renography - instrumentation - methods - standards
Radiopharmaceuticals - administration & dosage
Reproducibility of Results
Software
Sweden
Technetium Tc 99m Mertiatide - administration & dosage
Abstract
Assessment of image analysis methods and computer software used in (99m) Tc-MAG3 dynamic renography is important to ensure reliable study results and ultimately the best possible care for patients. In this work, we present a national multicentre study of the quantification accuracy in (99m) Tc-MAG3 renography, utilizing virtual dynamic scintigraphic data obtained by Monte Carlo-simulated scintillation camera imaging of digital phantoms with time-varying activity distributions. Three digital phantom studies were distributed to the participating departments, and quantitative evaluation was performed with standard clinical software according to local routines. The differential renal function (DRF) and time to maximum renal activity (Tmax ) were reported by 21 of the 28 Swedish departments performing (99m) Tc-MAG3 studies as of 2012. The reported DRF estimates showed a significantly lower precision for the phantom with impaired renal uptake than for the phantom with normal uptake. The Tmax estimates showed a similar trend, but the difference was only significant for the right kidney. There was a significant bias in the measured DRF for all phantoms caused by different positions of the left and right kidney in the anterior-posterior direction. In conclusion, this study shows that virtual scintigraphic studies are applicable for quality assurance and that there is a considerable uncertainty associated with standard quantitative parameters in dynamic (99m) Tc-MAG3 renography, especially for patients with impaired renal function.
PubMed ID
25348641 View in PubMed
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Acute kidney injury assessed by cystatin C after transcatheter aortic valve implantation and late renal dysfunction.

https://arctichealth.org/en/permalink/ahliterature267312
Source
J Cardiothorac Vasc Anesth. 2014 Aug;28(4):960-5
Publication Type
Article
Date
Aug-2014
Author
Malin Johansson
Shahab Nozohoor
Henrik Bjursten
Per Ola Kimblad
Johan Sjögren
Source
J Cardiothorac Vasc Anesth. 2014 Aug;28(4):960-5
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - diagnosis - epidemiology - etiology
Aged
Aged, 80 and over
Aortic Valve Stenosis - surgery
Biological Markers - blood
Creatinine - blood
Cystatin C - blood
Female
Follow-Up Studies
Glomerular Filtration Rate - physiology
Humans
Incidence
Kidney - physiopathology
Male
Prognosis
Prospective Studies
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Transcatheter Aortic Valve Replacement - adverse effects
Abstract
The aim of the present study was to evaluate acute kidney injury (AKI) with cystatin C following transcatheter aortic valve implantation (TAVI) and to assess the impact of postoperative AKI on outcome and late renal function.
A prospective study.
Single, tertiary referral center.
Sixty-eight consecutive patients with severe aortic stenosis and advanced comorbidity.
Blood samples were collected on 4 occasions pre- and postoperatively to determine levels of s-creatinine and cystatin C. Additionally, a sample was collected at followup 12 months postoperatively for the determination of s-creatinine.
The mean preoperative eGFR (s-creatinine) was 67±24 mL/min/1.73 m² compared to 45±21 mL/min/1.73 m² with eGFR (cystatin C) (p
PubMed ID
24315756 View in PubMed
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The AGES-Reykjavik Study suggests that change in kidney measures is associated with subclinical brain pathology in older community-dwelling persons.

https://arctichealth.org/en/permalink/ahliterature300494
Source
Kidney Int. 2018 09; 94(3):608-615
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Date
09-2018
Author
Sanaz Sedaghat
Jie Ding
Gudny Eiriksdottir
Mark A van Buchem
Sigurdur Sigurdsson
M Arfan Ikram
Osorio Meirelles
Vilmundur Gudnason
Andrew S Levey
Lenore J Launer
Author Affiliation
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Source
Kidney Int. 2018 09; 94(3):608-615
Date
09-2018
Language
English
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Keywords
Aged
Albuminuria - physiopathology - urine
Cerebral Small Vessel Diseases - diagnosis - epidemiology
Creatinine - urine
Disease Progression
Female
Follow-Up Studies
Glomerular Filtration Rate - physiology
Humans
Incidence
Independent living
Kidney - physiopathology
Magnetic Resonance Imaging
Male
Prospective Studies
Renal Insufficiency, Chronic - physiopathology - urine
Risk factors
Serum Albumin
White Matter - diagnostic imaging - pathology
Abstract
Decreased glomerular filtration rate (GFR) and albuminuria may be accompanied by brain pathology. Here we investigated whether changes in these kidney measures are linked to development of new MRI-detected infarcts and microbleeds, and progression of white matter hyperintensity volume. The study included 2671 participants from the population-based AGES-Reykjavik Study (mean age 75, 58.7% women). GFR was estimated from serum creatinine, and albuminuria was assessed by urinary albumin-to-creatinine ratio. Brain MRI was acquired at baseline (2002-2006) and 5 years later (2007-2011). New MRI-detected infarcts and microbleeds were counted on the follow-up scans. White matter hyperintensity progression was estimated as percent change in white matter hyperintensity volumes between the two exams. Participants with a large eGFR decline (over 3 ml/min/1.73m2 per year) had more incident subcortical infarcts (odds ratio 1.53; 95% confidence interval 1.05, 2.22), and more marked progression of white matter hyperintensity volume (difference: 8%; 95% confidence interval: 4%, 12%), compared to participants without a large decline. Participants with incident albuminuria (over 30 mg/g) had 21% more white matter hyperintensity volume progression (95% confidence interval: 14%, 29%) and 1.86 higher odds of developing new deep microbleeds (95% confidence interval 1.16, 2.98), compared to participants without incident albuminuria. The findings were independent of cardiovascular risk factors. Changes in kidney measures were not associated with occurrence of cortical infarcts. Thus, larger changes in eGFR and albuminuria are associated with increased risk for developing manifestations of cerebral small vessel disease. Individuals with larger changes in these kidney measures should be considered as a high risk population for accelerated brain pathology.
PubMed ID
29960746 View in PubMed
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Albuminuria and Microalbuminuria as Predictors of Cognitive Performance in a General Population: An 11-Year Follow-Up Study.

https://arctichealth.org/en/permalink/ahliterature298098
Source
J Alzheimers Dis. 2018; 62(2):635-648
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2018
Author
Laura L Ekblad
Sini Toppala
Jouni K Johansson
Seppo Koskinen
Jouko Sundvall
Juha O Rinne
Pauli Puukka
Matti Viitanen
Antti Jula
Author Affiliation
Turku PET Centre, University of Turku, c/o Turku University Hospital, Turku, Finland.
Source
J Alzheimers Dis. 2018; 62(2):635-648
Date
2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Albuminuria - epidemiology
Cognition
Cognitive Dysfunction - epidemiology
Creatinine - urine
Cross-Sectional Studies
Female
Finland - epidemiology
Follow-Up Studies
Humans
Kidney - physiopathology
Linear Models
Male
Middle Aged
Multivariate Analysis
Neuropsychological Tests
Risk factors
Abstract
Microalbuminuria, defined as urine albumin-to-creatinine ratio (UACR)>3.0?mg/mmol and = 30?mg/mmol, is an early marker of endothelial damage of the renal glomeruli. Recent research suggests an association among microalbuminuria, albuminuria (UACR?>?3.0?mg/mmol), and cognitive impairment. Previous studies on microalbuminuria, albuminuria, and cognition in the middle-aged have not provided repeated cognitive testing at different time-points. We hypothesized that albuminuria (micro- plus macroalbuminuria) and microalbuminuria would predict cognitive decline independently of previously reported risk factors for cognitive decline, including cardiovascular risk factors. In addition, we hypothesized that UACR levels even below the cut-off for microalbuminuria might be associated with cognitive functioning. These hypotheses were tested in the Finnish nationwide, population-based Health 2000 Survey (n?=?5,921, mean age 52.6, 55.0% women), and its follow-up, Health 2011 (n?=?3,687, mean age at baseline 49.3, 55.6% women). Linear regression analysis was used to determine the associations between measures of albuminuria and cognitive performance. Cognitive functions were assessed with verbal fluency, word-list learning, word-list delayed recall (at baseline and at follow-up), and with simple and visual choice reaction time tests (at baseline only). Here, we show that micro- plus macroalbuminuria associated with poorer word-list learning and a slower reaction time at baseline, with poorer word-list learning at follow-up, and with a steeper decline in word-list learning during 11 years after multivariate adjustments. Also, higher continuous UACR consistently associated with poorer verbal fluency at levels below microalbuminuria. These results suggest that UACR might have value in evaluating the risk for cognitive decline.
PubMed ID
29480195 View in PubMed
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Albuminuria and renal function as predictors of cardiovascular events and mortality in a general population of patients with type 2 diabetes: a nationwide observational study from the Swedish National Diabetes Register.

https://arctichealth.org/en/permalink/ahliterature107516
Source
Diab Vasc Dis Res. 2013 Nov;10(6):520-9
Publication Type
Article
Date
Nov-2013
Author
Maria K Svensson
Jan Cederholm
Björn Eliasson
Björn Zethelius
Soffia Gudbjörnsdottir
Author Affiliation
Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Source
Diab Vasc Dis Res. 2013 Nov;10(6):520-9
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Aged
Albuminuria - diagnosis - epidemiology - mortality - physiopathology
Cardiovascular Diseases - diagnosis - epidemiology - mortality - physiopathology
Comorbidity
Diabetes Mellitus, Type 2 - diagnosis - epidemiology - mortality - physiopathology
Diabetic Nephropathies - diagnosis - epidemiology - mortality - physiopathology
Female
Heart Failure - epidemiology
Humans
Hyperlipidemias - epidemiology
Hypertension - epidemiology
Kidney - physiopathology
Male
Middle Aged
Prognosis
Registries
Risk factors
Smoking - adverse effects - epidemiology
Sweden - epidemiology
Time Factors
Abstract
Reduced renal function and albuminuria predict cardiovascular (CV) events and mortality in type 2 diabetes (T2D). In addition, we evaluated the role of co-existing congestive heart failure (CHF) and other CV risk factors on CV events in a large observational population-based cohort of T2D patients.
We included 66,065 patients with T2D who were reported to the National Diabetes Register (NDR) in Sweden between 2003-2006 with a follow-up of 5.7 years. Data on outcomes were collected from the cause of death and hospital discharge registers.
A total of 10% of patients experienced a CV event and 3.7% of these were fatal. Increasing levels of albuminuria and renal impairment were independently associated with increasing risk of CV events and all-cause mortality also when adjusting for CHF. In normoalbuminuric patients, a reduction in renal function is an important predictor of CV events and all-cause mortality. Glycaemic control (high HbA1c), smoking and hyperlipidaemia had important effects on risk for CV events in patients with albuminuria, while high blood pressure, but not glycaemic control, had an effect in patients with normoalbuminuric renal impairment.
Albuminuria and renal impairment are independent risk factors for CV outcomes and mortality in T2D, albuminuria being the strongest risk factor and relevant at all levels of renal function. In normoalbuminuric patients, a reduction in renal function is an important predictor of CV events and all-cause mortality.
PubMed ID
24002670 View in PubMed
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An evidence-based approach to earlier initiation of dialysis.

https://arctichealth.org/en/permalink/ahliterature207191
Source
Am J Kidney Dis. 1997 Dec;30(6):899-906
Publication Type
Article
Date
Dec-1997
Author
D N Churchill
Author Affiliation
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. churchil@fhs.csu.mcmaster.ca
Source
Am J Kidney Dis. 1997 Dec;30(6):899-906
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Bias (epidemiology)
Canada
Case-Control Studies
Cause of Death
Cohort Studies
Comorbidity
Confounding Factors (Epidemiology)
Databases as Topic
Diet, Protein-Restricted
Dietary Proteins - administration & dosage
Dietary Supplements
Evidence-Based Medicine
Follow-Up Studies
Glomerular Filtration Rate
Hospitalization
Humans
Kidney - physiopathology
Kidney Diseases - genetics
Kidney Failure, Chronic - physiopathology - therapy
Nutritional Status
Probability
Randomized Controlled Trials as Topic
Referral and Consultation
Renal Dialysis
Survival Rate
Time Factors
Treatment Outcome
Treatment Refusal
United States
Abstract
The objective was to review evidence addressing the optimal time to initiate dialysis treatment. The database was derived from an evidence-based review of the medical literature and from the Canada-United States peritoneal dialysis study. The publications were divided into (1) those addressing the clinical impact of early versus late referral to a dialysis program; (2) those evaluating the association between residual renal function at initiation of dialysis and the concurrent nutritional status; (3) those evaluating the association between residual renal function at initiation of dialysis and subsequent clinical outcomes, including patient survival. There were five studies evaluating early versus late referral, three cohort design and two case-control design. Late referrals had worse outcomes than early referrals. The former had more serious comorbidity and many had been noncompliant with follow-up. The latter were more likely to have hereditary renal disease. Renal function was slightly worse at initiation among those referred late. Three studies addressed the association between renal function at initiation of dialysis and concurrent nutritional status. Two showed decreased protein intake with diminished glomerular filtration rate (GFR). Poor nutritional status is associated with decreased patient survival among both incident and prevalent dialysis patients. The third study reported excellent patient survival among patients with late initiation of dialysis. These patients had received a supplemented low-protein diet and were not malnourished at initiation of dialysis. Three groups have studied the association between GFR at initiation of dialysis and clinical outcomes. Decreased GFR at initiation of dialysis is associated with a increased probability of hospitalization and death. None of these studies has used the rigorous randomized clinical trial design, and they are therefore subject to bias. Referral time bias, comorbidity, patient compliance, and starting time bias are potential confounders. A randomized clinical trial is required to resolve this important issue. However, there is sufficient evidence to justify initiation of dialysis at a Ccr of 9 to 14 mL/min if there is any clinical or laboratory evidence of malnutrition.
PubMed ID
9398139 View in PubMed
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Association between copeptin and declining glomerular filtration rate in people with newly diagnosed diabetes. The Skaraborg Diabetes Register.

https://arctichealth.org/en/permalink/ahliterature276186
Source
J Diabetes Complications. 2015 Nov-Dec;29(8):1062-5
Publication Type
Article
Author
M. Pikkemaat
O. Melander
K. Bengtsson Boström
Source
J Diabetes Complications. 2015 Nov-Dec;29(8):1062-5
Language
English
Publication Type
Article
Keywords
Biomarkers - blood
Cohort Studies
Diabetes Mellitus, Type 2 - blood - complications
Diabetic Nephropathies - epidemiology - physiopathology
Disease Progression
Female
Follow-Up Studies
Glomerular Filtration Rate
Glycopeptides - blood
Humans
Kidney - physiopathology
Male
Middle Aged
Reagent kits, diagnostic
Renal Insufficiency - complications - epidemiology - physiopathology
Renal Insufficiency, Chronic - complications - epidemiology - physiopathology
Retrospective Studies
Risk
Sweden - epidemiology
Up-Regulation
Abstract
Copeptin has shown association with development of chronic kidney disease (CKD) in people with diabetes. Early detection of individuals having the highest risk could help avoid this complication. Therefore we decided to study copeptin concentrations and estimated glomerular filtration rate (eGFR) retrospectively in people with newly diagnosed diabetes.
People with newly diagnosed type 2 diabetes in 1996-1998 from Skaraborg Diabetes Register (SDR) were reinvestigated in 2008-2010. Copeptin concentration at the time of diagnosis was determined. Creatinine and cystatin C were used for determination of eGFR at baseline and at reinvestigation (n=161). Data on cardiovascular complications were extracted from national registers. Analyzes were done with logistic regression.
From baseline to follow up eGFR decreased with 33ml. Twenty-nine individuals (18.1%) developed CKD stage 3. There was a significant association between elevated copeptin concentrations and development of CKD stage 3 (OR=1.78, 95% CI=1.01-3.16). When adjusting for GFR at baseline the association between copeptin and GFR decline was borderline significant (OR=1.79, 95% CI=0.99-3.25, p=0.055).
Determination of copeptin may early identify people with diabetes and high risk for CKD. To prevent complications for these individuals aggressive treatment should be discussed.
PubMed ID
26321369 View in PubMed
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Association of level of kidney function and platelet aggregation in acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature88557
Source
Am J Kidney Dis. 2009 Aug;54(2):262-9
Publication Type
Article
Date
Aug-2009
Author
Karlsson Fredrik
Modica Angelo
Mooe Thomas
Author Affiliation
Department of Internal Medicine, Section of Cardiology, Ostersund Hospital, Ostersund, Sweden. fredrik.karlsson@jll.se
Source
Am J Kidney Dis. 2009 Aug;54(2):262-9
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Chronic Disease
Humans
Kidney - physiopathology
Kidney Diseases - blood - complications - physiopathology
Myocardial Infarction - blood - complications - physiopathology
Platelet Aggregation
Prospective Studies
Abstract
BACKGROUND: Decreased kidney function has been established as an important risk factor in patients presenting with acute coronary syndrome. In acute coronary syndrome, increased platelet aggregation is associated with vascular complications. The aim of this study is to examine whether decreased kidney function is associated with altered platelet function in patients presenting with acute myocardial infarction. STUDY DESIGN: Prospective cohort. SETTING & PARTICIPANTS: 413 patients presenting with acute myocardial infarction admitted to the cardiac intensive care unit at Ostersund Hospital, Ostersund, Sweden. PREDICTORS: Glomerular filtration rate less than 60 mL/min/1.73 m(2) estimated from serum cystatin C level, comorbidity, medications, and markers of inflammation and hemostasis. OUTCOMES & MEASUREMENTS: Platelet aggregation was assessed by measuring the formation of small platelet aggregates (SPAs) by using a laser light scattering method. A greater SPA level indicates greater platelet aggregation. Platelet aggregation analysis was performed on days 1, 2, 3, and 5 in-hospital. RESULTS: We observed a significant increase in platelet aggregation during the first 3 days in the hospital regardless of kidney function (P
PubMed ID
19560852 View in PubMed
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119 records – page 1 of 12.