المؤلفون: You, Amy, Brent, Gregory, Narasaki, Yoko, Daza, Andrea, Sim, John, Kovesdy, Csaba, Nguyen, Danh, Kalantar-Zadeh, Kamyar, Rhee, Connie

المصدر: Mayo Clinic Proceedings. 99(1)

مصطلحات موضوعية: Humans, Retrospective Studies, Thyrotropin, Hypothyroidism, Hyperthyroidism, Renal Insufficiency, Chronic, Kidney, Thyroxine

الوصف: OBJECTIVE: To examine the relationship between thyroid status and incident kidney dysfunction/chronic kidney disease (CKD) progression. PATIENTS AND METHODS: We examined incident thyroid status, ascertained by serum thyrotropin (TSH) levels measured from January 1, 2007, through December 31, 2018, among 4,152,830 patients from the Optum Labs Data Warehouse, containing deidentified retrospective administrative claims data from a large national health insurance plan and electronic health record data from a nationwide network of provider groups. Associations of thyroid status, categorized as hypothyroidism, euthyroidism, or hyperthyroidism (TSH levels >5.0, 0.5-5.0, and 5.0-10.0, >10.0-20.0, and >20.0 mIU/L, respectively) were associated with increasingly higher risk of the composite end point (reference: TSH level, 0.5 to

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الوصول الحر: https://escholarship.org/uc/item/7487v5gsTest

المؤلفون: Nguyen, Danh, Qian, Qi, You, Amy, Kurum, Esra, Rhee, Connie, Senturk, Damla

مصطلحات موضوعية: Dialysis facility staffing, Poisson regression, United States Renal Data System, end-stage kidney disease, fixed effects, generalized linear mixed model, high-dimensional parameters, multilevel varying coefficient model, propensity score, random effects

الوصف: Profiling analysis aims to evaluate health care providers, including hospitals, nursing homes, or dialysis facilities among others with respect to a patient outcome, such as 30-day unplanned hospital readmission or mortality. Fixed effects (FE) profiling models have been developed over the last decade, motivated by the overall need to (a) improve accurate identification or flagging of under-performing providers, (b) relax assumptions inherent in random effects (RE) profiling models, and (c) take into consideration the unique disease characteristics and care/treatment processes of end-stage kidney disease (ESKD) patients on dialysis. In this paper, we review the current state of FE methodologies and their rationale in the ESKD population and illustrate applications in four key areas: profiling dialysis facilities for (1) patient hospitalizations over time (longitudinally) using standardized dynamic readmission ratio (SDRR), (2) identification of dialysis facility characteristics (e.g., staffing level) that contribute to hospital readmission, and (3) adverse recurrent events using standardized event ratio (SER). Also, we examine the operating characteristics with a focus on FE profiling models. Throughout these areas of applications to the ESKD population, we identify challenges for future research in both methodology and clinical studies.

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الوصول الحر: https://escholarship.org/uc/item/2mb2c0c9Test
https://escholarship.org/content/qt2mb2c0c9/qt2mb2c0c9.pdfTest

المؤلفون: You, Amy, Page, Victoria, Hayashida, Glen, Kataoka-Yahiro, Merle, Davis, James, Wong, Linda, Narasaki, Yoko, Kalantar-Zadeh, Kamyar, Rhee, Connie

المصدر: Nephron. 147(6)

مصطلحات موضوعية: Asian, Chronic kidney disease, Hawaii, Minorities, Native Hawaiian, Pacific Islander, Humans, Hawaii, Native Hawaiian or Other Pacific Islander, Pacific Island People, Renal Insufficiency, Chronic, Risk Factors, Asian

الوصف: BACKGROUND: Several studies suggest that Asian-American and Native Hawaiian and Other Pacific Islander (NHOPI) racial/ethnic groups have a heightened risk of chronic kidney disease (CKD), but provide limited inference due to the aggregation of these groups into a single racial/ethnic category. We thus examined the association of granularly defined racial/ethnic groups with specific CKD indicators among a diverse group of participants from the National Kidney Foundation of Hawaiis Kidney Early Detection Screening (KEDS) Program. METHODS: Among 1,243 participants enrolled in 19 KEDS screening events over 2006-2009, we examined the association between Asian-American and NHOPI groups and specific CKD indicators, defined as self-reported CKD, microalbuminuria, and macroalbuminuria, using multivariable logistic regression. We then examined associations of race/ethnicity with various CKD risk factors. RESULTS: The most predominant racial/ethnic groups were White (22.0%), Multiracial (18.9%), Japanese (19.2%), Filipino (13.4%), NHOPI (8.4%), and Chinese (4.5%) participants. NHOPI and Chinese participants had a higher risk of microalbuminuria (adjusted ORs [aORs] [95% CIs] 2.48 [1.25-4.91] and 2.37 [1.07-5.27], respectively), while point estimates for all other minority groups suggested higher risk (reference: Whites). NHOPI participants also had a higher risk of macroalbuminuria and self-reported CKD. While most minorities had a higher risk of diabetes and hypertension, NHOPI and Multiracial participants had a higher risk of obesity, whereas the East Asian groups had a lower risk. CONCLUSIONS: In this community-based cohort, compared with Whites, Asian-Americans had a higher risk of early CKD indicators, whereas NHOPIs had a higher risk of more severe CKD indicators. Further studies are needed to elucidate the distinct pathways leading to CKD across diverse racial/ethnic groups in Hawaii.

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الوصول الحر: https://escholarship.org/uc/item/9f08c8ncTest

المؤلفون: Lo, Robin H, Kalantar-Zadeh, Kamyar, You, Amy S, Ayus, Juan Carlos, Streja, Elani, Park, Christina, Sohn, Peter, Nakata, Tracy, Narasaki, Yoko, Brunelli, Steven M, Kovesdy, Csaba P, Nguyen, Danh V, Rhee, Connie M

المصدر: Clinical Kidney Journal. 15(12)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Hematology, Infection, bloodstream infection, dialysis, dysnatremia, hypernatremia, hyponatremia, Clinical sciences

الوصف: BackgroundEmerging data suggest that sodium disarrays including hyponatremia are potential risk factors for infection ensuing from impairments in host immunity, which may be exacerbated by coexisting conditions (i.e. mucosal membrane and cellular edema leading to breakdown of microbial barrier function). While dysnatremia and infection-related mortality are common in dialysis patients, little is known about the association between serum sodium levels and the risk of bloodstream infection in this population.MethodsAmong 823 dialysis patients from the national Biospecimen Registry Grant Program who underwent serum sodium testing over the period January 2008-December 2014, we examined the relationship between baseline serum sodium levels and subsequent rate of bloodstream infection. Bloodstream infection events were directly ascertained using laboratory blood culture data. Associations between serum sodium level and the incidence of bloodstream infection were estimated using expanded case mix-adjusted Poisson regression models.ResultsIn the overall cohort, ∼10% of all patients experienced one or more bloodstream infection events during the follow-up period. Patients with both lower sodium levels

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الوصول الحر: https://escholarship.org/uc/item/35d5h53cTest

المؤلفون: Moore, Linda, Bross, Rachelle, Cervantes, Mackenzie, Daza, Andrea, Kovesdy, Csaba, Narasaki, Yoko, You, Amy, Nguyen, Danh, Kalantar-Zadeh, Kamyar, Malik, Shaista, Rhee, Connie

المصدر: American Journal of Clinical Nutrition. 116(4)

مصطلحات موضوعية: chronic kidney disease, dietary potassium, kidney function, mortality, plant-dominant, Animals, Antioxidants, Dietary Fiber, Kidney, Micronutrients, Nutrition Surveys, Phosphorus, Potassium, Potassium, Dietary, Renal Insufficiency

الوصف: BACKGROUND: In healthy adults, higher dietary potassium intake is recommended given that potassium-rich foods are major sources of micronutrients, antioxidants, and fiber. Yet among patients with advanced kidney dysfunction, guidelines recommend dietary potassium restriction given concerns about hyperkalemia leading to malignant arrhythmias and mortality. OBJECTIVES: Given sparse data informing these recommendations, we examined associations of dietary potassium intake with mortality in a nationally representative cohort of adults from the NHANES. METHODS: We examined associations between daily dietary potassium intake scaled to energy intake (mg/1000 kcal), ascertained by 24-h dietary recall, and all-cause mortality among 37,893 continuous NHANES (1999-2014) participants stratified according to impaired and normal kidney function (estimated glomerular filtration rates

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الوصول الحر: https://escholarship.org/uc/item/161574tqTest

المؤلفون: You, Amy S, Kalantar, Sara S, Norris, Keith C, Peralta, Rene Amel, Narasaki, Yoko, Fischman, Ronald, Fischman, Michael, Semerjian, Avedik, Nakata, Tracy, Azadbadi, Zahra, Nguyen, Danh V, Kalantar-Zadeh, Kamyar, Rhee, Connie M

المصدر: Journal of Nephrology. 35(5)

مصطلحات موضوعية: Kidney Disease, Clinical Research, Renal and urogenital, Zero Hunger, Cohort Studies, Fatigue, Humans, Patient Acuity, Prospective Studies, Quality of Life, Renal Dialysis, Renal Insufficiency, Chronic, Surveys and Questionnaires, Syndrome, Unpleasant symptoms, Symptom clusters, Uremia, Dialysis, Clinical Sciences, Urology & Nephrology

الوصف: BackgroundDialysis patients experience a high symptom burden, which may adversely impact their quality of life. Whereas other specialties emphasize routine symptom assessment, symptom burden is not well-characterized in dialysis patients. We sought to examine the prevalence and severity of unpleasant symptoms in a prospective hemodialysis cohort.MethodsAmong 122 hemodialysis patients from the prospective Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (CKD) study, CKD-associated symptoms were ascertained by the Dialysis Symptom Index, a validated survey assessing symptom burden/severity (with higher scores indicating greater symptom severity), over 6/2020-10/2020. We examined the presence of (1) individual symptoms and symptom severity scores, and (2) symptom clusters (defined as ≥ 2 related concurrent symptoms), as well as correlations with clinical characteristics.ResultsSymptom severity scores were higher among non-Hispanic White and Hispanic patients, whereas scores were lower in Black and Asian/Pacific Islander patients. In the overall cohort, the most common individual symptoms included feeling tired/lack of energy (71.3%), dry skin (61.5%), trouble falling asleep (44.3%), muscle cramps (42.6%), and itching (42.6%), with similar patterns observed across racial/ethnic groups. The most prevalent symptom clusters included feeling tired/lack of energy + trouble falling asleep (37.7%); trouble falling asleep + trouble staying asleep (34.4%); and feeling tired/lack of energy + trouble staying asleep (32.0%). Lower hemoglobin, iron stores, and dialysis adequacy correlated with higher individual and overall symptom severity scores.ConclusionWe observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse hemodialysis cohort. Further studies are needed to identify targeted therapies that ameliorate symptom burden in CKD.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0520k4gvTest

المؤلفون: Narasaki, Yoko, Rhee, Connie, You, Amy, Mukamel, Dana, Novoa, Alejandra, Otobe, Yuhei, Daza, Andrea, Kovesdy, Csaba, Crowley, Susan, Nguyen, Danh, Kalantar-Zadeh, Kamyar

المصدر: Nephrology Dialysis Transplantation. 37(Supplement_3)

مصطلحات موضوعية: Clinical Research, Aging, Kidney Disease, Renal and urogenital, Good Health and Well Being, Clinical Sciences, Urology & Nephrology

الوصف: Abstract: BACKGROUND AND AIMS: Within the Veterans Health Administration, the largest integrated healthcare system in the USA, 1.1 million Veterans (16.4%) have been identified as having chronic kidney disease (CKD). Annual spending on US Veterans with non-dialysis dependent CKD is estimated at $19 billion/year, and each year ∼10% of US Veterans with advanced CKD progress to end-stage renal disease (ESRD) requiring renal replacement therapy in the form of dialysis or kidney transplantation. While dialysis has been the dominant treatment paradigm in this population, with ∼22 000 enrolled Veterans receiving dialysis from VA-based dialysis facilities or from VA-contracted community providers, this treatment approach may not offer survival benefit nor improved quality of life in certain subgroups (elderly, multi-morbid). We sought to examine the clinical characteristics of a contemporary cohort of US Veterans with advanced CKD treated with conservative non-dialytic management versus dialysis. METHOD: In a national cohort of US Veterans receiving care from the VA healthcare system, we identified patients with advanced CKD, identified as those with ≥ 2 eGFR measurements

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الوصول الحر: https://escholarship.org/uc/item/8s65f42rTest

المؤلفون: Otobe, Yuhei, Nguyen, Danh, Guerrero, Yalitzi, Narasaki, Yoko, You, Amy, Kalantar-Zadeh, Kamyar, Rhee, Connie

المصدر: Nephrology Dialysis Transplantation. 37(Supplement_3)

مصطلحات موضوعية: Clinical Research, Cardiovascular, Aging, Metabolic and endocrine, Clinical Sciences, Urology & Nephrology

الوصف: Abstract: BACKGROUND AND AIMS: Low physical activity is common in hemodialysis (HD) patients and is associated with adverse outcomes in this population (poor health-related quality of life, cardiovascular [CV] disease, death). Prior studies show that hypothyroidism is highly prevalent in HD patients, and is associated with worse self-reported physical function. METHOD: In a substudy of the ongoing multi-center NIH THYROID-HD Trial, we examined baseline physical activity scores determined by the Human Activity Profile (HAP), a validated 94-item instrument assessing daily activities across a wide range of energy expenditures, in HD patients with TSH levels in the high-normal (TSH >3–5 mIU/L) and subclinical hypothyroid range (TSH >5–10 mIU/L). The HAP was used to derive the Maximum Activity Score (MAS) and Adjusted Activity Score (AAS), representing greatest and mean estimated energy expenditures, respectively (range 0–94, segmented to low [74] scores). RESULTS: Among 100 HD patients who underwent baseline HAP assessment, the mean ± SD MAS and AAS scores were 48 ± 22 and 23 ± 27,  respectively; median (IQR) MAS and AAS scores were 49 (31–64) and 9 (0–39), respectively (Figure 1). In the overall cohort, 83% had low, 10% moderate and 7% high AAS scores. MAS and AAS scores were significantly lower in patients who had underlying diabetes versus those without diabetes (Table 1). There was also a trend towards lower (worse) MAS and AAS scores among older versus younger patients (≥65 versus >65 years, respectively) and patients with underlying coronary artery disease (CAD) versus those without CAD. In logistic regression analyses, older age (+∆ 1-year increments) was associated with higher likelihood of low MAS scores, and diabetes trended towards a significant association (defined as

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الوصول الحر: https://escholarship.org/uc/item/1659g587Test

المؤلفون: You, Amy, Kalantar-Zadeh, Kamyar, Narasaki, Yoko, Mukamel, Dana, Crowley, Susan, Novoa, Alejandra, Otobe, Yuhei, Kovesdy, Csaba, Nguyen, Danh, Rhee, Connie

المصدر: Nephrology Dialysis Transplantation. 37(Supplement_3)

مصطلحات موضوعية: Clinical Research, Health Services, Aging, Kidney Disease, Renal and urogenital, Clinical Sciences, Urology & Nephrology

الوصف: Abstract: BACKGROUND AND AIMS: While dialysis has been the prevailing treatment paradigm in advanced CKD patients progressing to ESRD, this treatment approach may lead to a decline in physical function, loss of independence, and greater healthcare utilization among certain subgroups. We sought to compare the impact of dialysis versus conservative dialysis-free management on hospitalization lengths of stay (LOS) in advanced CKD patients. METHOD: We examined a national cohort of advanced CKD patients (≥2 eGFRs 20-years old had longer average LOS versus those treated with CM, with differences increasing with older age (∆ of + 1.25-days for hospitalizations for patients 70-years old; Fig. 1B, upper panel). In secondary analyses, differences in average LOS were even greater for those treated with early dialysis versus CM (∆ of + 1.87-days for patients 70-years old, Fig. 1B, lower panel). CONCLUSION: In a nationally representative CKD cohort, compared with dialysis, those treated with CM as an alternative patient-centered treatment strategy had shorter LOS across varying time points and age groups. Further studies are needed to examine the comparative effectiveness of CM versus dialysis transition on CKD outcomes.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/28v475drTest

المؤلفون: You, Amy S, Budoff, Matthew, Zeb, Irfan, Ahmadi, Naser, Novoa, Alejandra, Flores, Ferdinand, Hamal, Sajad, Kinninger, April, Dailing, Christopher, Nakata, Tracy, Kovesdy, Csaba P, Nguyen, Danh V, Brent, Gregory A, Kalantar‐Zadeh, Kamyar, Rhee, Connie M

المصدر: Hemodialysis International. 26(1)

مصطلحات موضوعية: Bioengineering, Cardiovascular, Assistive Technology, Cohort Studies, Humans, Hypothyroidism, Prospective Studies, Renal Dialysis, Thyrotropin, Vascular Diseases, dialysis, endothelial function, hypothyroidism, thyroid, thyrotropin, Clinical Sciences, Urology & Nephrology

الوصف: IntroductionThyroid dysfunction is a highly prevalent yet under-recognized complication in hemodialysis patients. In the general population, hypothyroidism has been associated with endothelial dysfunction due to impaired vasodilator synthesis and activity. Little is known about the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with endothelial function in hemodialysis patients.MethodsIn a secondary analysis of 99 patients from the Anti-inflammatory and anti-oxidative nutrition in hypoalbuminemic dialysis patients (AIONID) trial, we examined measurements of serum TSH and endothelial function ascertained by fingertip digital thermal monitoring (DTM), a novel method used to measure micro-vascular reactivity, collected within a 90-day period. DTM was used to measure changes in fingertip temperature during and after an ischemic stimulus (blood pressure cuff occlusion) as an indicator of changes in blood flow, and two DTM indices were assessed, namely adjusted (a) Temperature Rebound (TR), defined as the maximum temperature rebound post-cuff deflation, and adjusted (b) Area Under the Temperature Curve (TMP-AUC), defined as area under the curve between the maximum and minimum temperatures. We examined the relationship between serum TSH with impaired TR (separately) and TMP-AUC (both defined as less than the median level of observed values) using multivariable logistic regression.FindingsIn unadjusted and case-mix analyses, higher serum TSH levels (defined as the three highest quartiles) were associated with lower (worse) TR (ref: lowest TSH quartile): ORs (95% CI) 2.64 (1.01-6.88) and 2.85 (1.08-7.57), respectively. In unadjusted and case-mix analyses, higher TSH levels were associated with lower (worse) TMP-AUC: ORs (95% CI) 2.64 (1.01-6.88) and 2.79 (1.06-7.38), respectively.DiscussionIn HD patients, higher serum TSH levels were associated with worse micro-vascular reactivity measured by DTM. Further studies are needed to determine if thyroid hormone supplementation improves endothelial function in hemodialysis patients with lower levels of thyroid function.

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الوصول الحر: https://escholarship.org/uc/item/4df7w31qTest