المؤلفون: Daniel Scarr, Petter Bjornstad, Leif E. Lovblom, Julie A. Lovshin, Genevieve Boulet, Yuliya Lytvyn, Mohammed A. Farooqi, Vesta Lai, Andrej Orszag, Alanna Weisman, Hillary A. Keenan, Michael H. Brent, Narinder Paul, Vera Bril, David Z.I. Cherney, Bruce A. Perkins

المصدر: Kidney International Reports, Vol 4, Iss 6, Pp 786-796 (2019)

مصطلحات موضوعية: Diseases of the genitourinary system. Urology, RC870-923

الوصف: Introduction: Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods: In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matched subgroups (65 ± 8 years old and 77[55%] were women) we evaluated the performance of estimated GFR (eGFR) by creatinine (Modification of Diet and Renal Disease [MDRD], Chronic Kidney Disease–Epidemiology [CKD-EPI]cr), cystatin C (CKD-EPIcys, CKD-EPIcr-cys), and β2-microglobulin (β2M) compared with measured GFR by inulin clearance (mGFR). Performance was evaluated using metrics of bias (mean difference), precision (SD), and accuracy (proportion of eGFR that differed by >20% of mGFR). Results: Mean mGFR was 104 ± 18 ml/min per 1.73 m2 (range: 70–154 ml/min per 1.73 m2) and was not different between T1D and controls (103 ± 17 vs. 105 ± 19 ml/min per 1.73 m2, P = 0.39). All equations significantly underestimated mGFR (bias: −15 to −30 ml/min per 1.73 m2, P < 0.001 for all comparisons) except for β2M, which had bias of 1.9 ml/min per 1.73 m2 (P = 0.61). Bias was greatest in cystatin C–based equations. Precision was lowest for β2M (SD: 43.5 ml/min per 1.73 m2, P < 0.001 for each comparison). Accuracy was lowest for CKD-EPIcysC (69.1%, P < 0.001 for each comparison). Cystatin C–based equations demonstrated greater bias and lower accuracy in older age subgroups (

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2468024919300713Test; https://doaj.org/toc/2468-0249Test

الوصول الحر: https://doaj.org/article/c292c75b1ebd4628986a5c56d7f5c87fTest

المؤلفون: Daniel Scarr, Leif E Lovblom, Nancy Cardinez, Andrej Orszag, Mohammed A Farooqi, Genevieve Boulet, Alanna Weisman, Julie A Lovshin, Mylan Ngo, Narinder Paul, Hillary A Keenan, Michael H Brent, David Z Cherney, Vera Bril, Bruce A Perkins

المصدر: PLoS ONE, Vol 13, Iss 4, p e0196647 (2018)

مصطلحات موضوعية: Medicine, Science

الوصف: Point-of-care nerve conduction devices (POCD) have been studied in younger patients and may facilitate screening for polyneuropathy in non-specialized clinical settings. However, performance may be impaired with advanced age owing to age-related changes in nerve conduction. We aimed to evaluate the validity of a POCD as a proxy for standard nerve conduction studies (NCS) in older adults with type 1 diabetes (T1D).Sural nerve amplitude potential (AMP) and sural nerve conduction velocity (CV) was measured in 68 participants with ≥ 50 years T1D duration and 71 controls (from age/sex-matched subgroups) using POCD and NCS protocols. Agreement was determined by the Bland-Altman method, and validity was determined by receiver operating characteristic curves.T1D were 53% female, aged 66±8yr and had diabetes duration 54yr[52,58]. Controls were 56%(p = 0.69) female and aged 65±8yr(p = 0.36). Mean AMPPOCD and CVPOCD for the 139 participants was 7.4±5.8μV and 45.7±11.2m/s and mean AMPNCS and CVNCS was 7.2±6.1μV and 43.3±8.3m/s. Mean difference of AMPPOCD-AMPNCS was 0.3±3.8μV and was 2.3±8.5m/s for CVPOCD-CVNCS. A AMPPOCD of ≤6μV had 80% sensitivity and 80% specificity for identifying abnormal AMPNCS, while a CVPOCD of ≤44m/s had 81% sensitivity and 82% specificity to identify abnormal CVNCS. Abnormality in AMPPOCD or CVPOCD was associated with 87% sensitivity, while abnormality in both measures was associated with 97% specificity for polyneuropathy identification.The POCD has strong agreement and diagnostic accuracy for identification of polyneuropathy in a high-risk subgroup and thus may represent a sufficiently accurate and rapid test for routinely detecting those with electrophysiological dysfunction.

وصف الملف: electronic resource

العلاقة: http://europepmc.org/articles/PMC5927425?pdf=renderTest; https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/ef0fe851c2fa4db8a3c23067bdf0ac7bTest

المؤلفون: Ilia Ostrovski, Leif E Lovblom, Mohammed A Farooqi, Daniel Scarr, Genevieve Boulet, Paul Hertz, Tong Wu, Elise M Halpern, Mylan Ngo, Eduardo Ng, Andrej Orszag, Vera Bril, Bruce A Perkins

المصدر: PLoS ONE, Vol 10, Iss 11, p e0142309 (2015)

مصطلحات موضوعية: Medicine, Science

الوصف: In vivo Corneal Confocal Microscopy (IVCCM) is a validated, non-invasive test for diabetic sensorimotor polyneuropathy (DSP) detection, but its utility is limited by the image analysis time and expertise required. We aimed to determine the inter- and intra-observer reproducibility of a novel automated analysis program compared to manual analysis.In a cross-sectional diagnostic study, 20 non-diabetes controls (mean age 41.4±17.3y, HbA1c 5.5±0.4%) and 26 participants with type 1 diabetes (42.8±16.9y, 8.0±1.9%) underwent two separate IVCCM examinations by one observer and a third by an independent observer. Along with nerve density and branch density, corneal nerve fibre length (CNFL) was obtained by manual analysis (CNFLMANUAL), a protocol in which images were manually selected for automated analysis (CNFLSEMI-AUTOMATED), and one in which selection and analysis were performed electronically (CNFLFULLY-AUTOMATED). Reproducibility of each protocol was determined using intraclass correlation coefficients (ICC) and, as a secondary objective, the method of Bland and Altman was used to explore agreement between protocols.Mean CNFLManual was 16.7±4.0, 13.9±4.2 mm/mm2 for non-diabetes controls and diabetes participants, while CNFLSemi-Automated was 10.2±3.3, 8.6±3.0 mm/mm2 and CNFLFully-Automated was 12.5±2.8, 10.9 ± 2.9 mm/mm2. Inter-observer ICC and 95% confidence intervals (95%CI) were 0.73(0.56, 0.84), 0.75(0.59, 0.85), and 0.78(0.63, 0.87), respectively (p = NS for all comparisons). Intra-observer ICC and 95%CI were 0.72(0.55, 0.83), 0.74(0.57, 0.85), and 0.84(0.73, 0.91), respectively (p

وصف الملف: electronic resource

العلاقة: http://europepmc.org/articles/PMC4634969?pdf=renderTest; https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/7f53cd67ab8c459e8620e5cf2e5da01bTest

المؤلفون: Yuliya Lytvyn, Vera Bril, Hillary A. Keenan, Julie A. Lovshin, Genevieve Boulet, Mohammed A. Farooqi, Leif E. Lovblom, Andrej Orszag, Bruce A. Perkins, Alanna Weisman, Vesta Lai, Narinder Paul, Michael H. Brent, David Z.I. Cherney, Daniel Scarr, Petter Bjornstad

المصدر: Kidney International Reports, Vol 4, Iss 6, Pp 786-796 (2019)
Kidney International Reports

مصطلحات موضوعية: medicine.medical_specialty, type 1 diabetes, Population, 030232 urology & nephrology, Urology, Renal function, 030204 cardiovascular system & hematology, urologic and male genital diseases, lcsh:RC870-923, inulin clearance, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Clinical Research, cystatin C, Medicine, education, older adults, β2-microglobulin, glomerular filtration rate, Type 1 diabetes, Inulin Clearance, Creatinine, education.field_of_study, biology, business.industry, Beta-2 microglobulin, creatinine, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, female genital diseases and pregnancy complications, Cystatin C, chemistry, Nephrology, estimating equations, biology.protein, business, Kidney disease

الوصف: Introduction: Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods: In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matched subgroups (65 ± 8 years old and 77[55%] were women) we evaluated the performance of estimated GFR (eGFR) by creatinine (Modification of Diet and Renal Disease [MDRD], Chronic Kidney Disease–Epidemiology [CKD-EPI]cr), cystatin C (CKD-EPIcys, CKD-EPIcr-cys), and β2-microglobulin (β2M) compared with measured GFR by inulin clearance (mGFR). Performance was evaluated using metrics of bias (mean difference), precision (SD), and accuracy (proportion of eGFR that differed by >20% of mGFR). Results: Mean mGFR was 104 ± 18 ml/min per 1.73 m2 (range: 70–154 ml/min per 1.73 m2) and was not different between T1D and controls (103 ± 17 vs. 105 ± 19 ml/min per 1.73 m2, P = 0.39). All equations significantly underestimated mGFR (bias: −15 to −30 ml/min per 1.73 m2, P < 0.001 for all comparisons) except for β2M, which had bias of 1.9 ml/min per 1.73 m2 (P = 0.61). Bias was greatest in cystatin C–based equations. Precision was lowest for β2M (SD: 43.5 ml/min per 1.73 m2, P < 0.001 for each comparison). Accuracy was lowest for CKD-EPIcysC (69.1%, P < 0.001 for each comparison). Cystatin C–based equations demonstrated greater bias and lower accuracy in older age subgroups (

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::42b020c2fe0a943693d9d4799229ff6fTest
http://www.sciencedirect.com/science/article/pii/S2468024919300713Test

المؤلفون: Hillary A. Keenan, Yuliya Lytvyn, Julie A. Lovshin, Johnny-Wei Bai, Genevieve Boulet, David Z.I. Cherney, Mohammed A. Farooqi, Andrej Orszag, Leif E. Lovblom, Petter Bjornstad, Michael H. Brent, Alanna Weisman, Bruce A. Perkins, Vera Bril, Narinder Paul, Daniel Scarr, Sam Santiago

مصطلحات موضوعية: Male, medicine.medical_specialty, Canada, Endocrinology, Diabetes and Metabolism, Longevity, 030209 endocrinology & metabolism, Coronary Artery Disease, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Risk Factors, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Diabetic Nephropathies, Pathophysiology/Complications, Aged, Advanced and Specialized Nursing, Type 1 diabetes, business.industry, Case-control study, Middle Aged, medicine.disease, Atherosclerosis, Angiotensin II, Diabetes Mellitus, Type 1, Case-Control Studies, Cardiology, Female, business, Agatston score, Diabetic Angiopathies, Cohort study, Retinopathy

الوصف: OBJECTIVE Type 1 diabetes carries a significant risk for cardiovascular mortality, but it is unclear how atherosclerosis associates with microvascular complications. We aimed to determine the relationships between atherosclerotic burden and neuropathy, retinopathy, and diabetic kidney disease (DKD) in adults with a ≥50-year history of type 1 diabetes. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes (n = 69) underwent coronary artery calcification (CAC) volume scoring by wide-volume computerized tomography. Microvascular complications were graded as follows: neuropathy by clinical assessment, electrophysiology, vibration and cooling detection thresholds, heart rate variability, and corneal confocal microscopy; retinopathy by ultra–wide-field retinal imaging; and DKD by renal hemodynamic function measured by inulin and para-aminohippurate clearance at baseline and after intravenous infusion of angiotensin II. The cohort was dichotomized to high (≥300 Agatston units [AU]) or low ( RESULTS CAC scores were higher in participants with type 1 diabetes (median Agatston score 1,000 [interquartile range = 222, 2,373] AU vs. 1 [0.75] AU in comparators, P < 0.001). In participants with type 1 diabetes, high CAC scores associated with markers of neuropathy and retinopathy, but not with DKD, or renal hemodynamic function at baseline or in response to angiotensin II. CONCLUSIONS The presence of high CAC in adults with longstanding type 1 diabetes was associated with large nerve fiber neuropathy and retinopathy but not with renal hemodynamic function, suggesting that neuropathy, retinopathy, and macrovascular calcification share common risk factors.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a58f8e69b7773230dd953f4b8b97b9e6Test
https://europepmc.org/articles/PMC6245210Test/

المؤلفون: Vesta Lai, Bruce A. Perkins, Omar N Alhuzaim, Genevieve Boulet, Leslie Cham, Hillary A. Keenan, Daniel Scarr, Narinder Paul, Vera Bril, Michael H. Brent, Yuliya Lytvyn, Alanna Weisman, Mohammed A. Farooqi, David Z.I. Cherney, Andrej Orszag, Josephine Tse, Leif E. Lovblom, Petter Bjornstad, Julie A. Lovshin

المصدر: Diabetes Care

مصطلحات موضوعية: Male, medicine.medical_specialty, Canada, Endocrinology, Diabetes and Metabolism, Population, Longevity, Urology, Renal function, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Renal Circulation, Diabetic nephropathy, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Diabetic Nephropathies, Aminohippuric acid, Obesity, education, Pathophysiology/Complications, Adiposity, Aged, Advanced and Specialized Nursing, education.field_of_study, business.industry, Hemodynamics, Effective renal plasma flow, Middle Aged, medicine.disease, Filtration fraction, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Renal blood flow, Female, Vascular Resistance, business, medicine.drug, Glomerular Filtration Rate

الوصف: OBJECTIVE Central adiposity is considered to be an important cardiorenal risk factor in the general population and in type 1 diabetes. We sought to determine the relationship between central adiposity and intrarenal hemodynamic function in adults with long-standing type 1 diabetes with and without diabetic nephropathy (DN). RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (n = 66, duration ≥50 years) and age-/sex-matched control subjects (n = 73) were studied. The cohort was stratified into 44 DN Resistors (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73 m2 and RESULTS Whereas measures of adiposity did not associate with GFRINULIN or ERPFPAH in healthy control subjects, trunk fat mass inversely correlated with GFRINULIN (r = −0.46, P < 0.0001) and ERPFPAH (r = −0.31, P = 0.01) and positively correlated with RVR (r = 0.53, P = 0.0003) in type 1 diabetes. In analyses stratified by DN status, greater central adiposity related to lower GFRINULIN values in DN and DN Resistors, but the relationships between central adiposity and ERPFPAH and RVR were attenuated and/or reversed in patients with DN compared with DN Resistors. CONCLUSIONS The adiposity-intrarenal hemodynamic function relationship may be modified by the presence of type 1 diabetes and DN, requiring further study of the mechanisms by which adiposity influences renal hemodynamic function.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5c17bcd0002362b04ddadba07350b04aTest
https://europepmc.org/articles/PMC5860840Test/