10,155 research outputs found
Personalising renal function monitoring and interventions in people living with heart failure: protocol for co-designing a care pathway in the RENAL-HF programme
No full textBackground Heart failure affects almost one million people in the UK and is increasing in prevalence. Many drugs used to treat heart failure impair renal function and can lead to hospitalisation. Adverse drug problems can be partially mitigated through regular renal monitoring and optimising of drug dose and choice to prevent deterioration of kidney function. This protocol describes part of a wider research programme: personalising renal function monitoring and interventions in people living with heart failure (RENAL-HF).
Aim The aim of RENAL-HF is to develop improved processes in primary care to manage kidney health in people living with heart failure.
Method The protocol covers gathering views of healthcare professionals, patients and carers, to co-develop a care pathway for use in primary care. Using a mixed methods approach, the work comprises six stages: 1) understanding current practice of optimising heart failure treatment while preserving renal function, 2) co-designing a care pathway including personalised renal function monitoring, thresholds for intervention and clinical guidelines, 3) decision-making to identify elements that will support the care pathway, 4) developing training materials for primary care to enable use of the care pathway, 5) testing the useability of the prototype care pathway, and 6) a feasibility and acceptability study to inform the pre-clinical development and usability of the care pathway ahead of a cluster randomised control trial.
Conclusion All stages will elicit evidence from primary care practices, practitioners, and patients with which to assess and refine the care pathway. The evidence will inform how algorithm-guided individualised treatment can be implemented to improve outcomes of patients with heart failure
Personalising renal function monitoring and interventions in people living with heart failure: a protocol for co-designing a care pathway in the RENAL-HF programme.
No full textBackgroundHeart failure affects almost one million people in the UK and is increasing in prevalence. Many drugs used to treat heart failure impair renal function and can lead to hospitalisation. Adverse drug problems can be partially mitigated through regular renal monitoring and optimising of drug dose and choice to prevent deterioration of kidney function. This protocol describes part of a wider research programme: personalising renal function monitoring and interventions in people living with heart failure (RENAL-HF).AimThe aim of RENAL-HF is to develop improved processes in primary care to manage kidney health in people living with heart failure.MethodThe protocol covers gathering views of healthcare professionals, patients, and carers, to co-develop a care pathway for use in primary care. Using a mixed-methods approach, the work comprises the following six stages: (1) understanding current practice of optimising heart failure treatment while preserving renal function; (2) co-designing a care pathway including personalised renal function monitoring, thresholds for intervention and clinical guidelines; (3) decision making to identify elements that will support the care pathway; (4) developing training materials for primary care to enable use of the care pathway; (5) testing the usability of the prototype care pathway; and 6) a feasibility and acceptability study to inform the pre-clinical development and usability of the care pathway ahead of a cluster randomised control trial (RCT).ConclusionAll stages will elicit evidence from primary care practices, practitioners, and patients with which to assess and refine the care pathway. The evidence will inform how algorithm-guided individualised treatment can be implemented to improve the outcomes of patients with heart failure
Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD
No full textFamily studies suggest a genetic component to the etiology of chronic kidney disease (CKD) and end stage renal disease (ESRD). Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs) for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR < 60ml/min/1.73m(2) at follow-up) and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls). SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR) were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1). SNPs in UMOD (OR = 0.92, p = 0.04) and GCKR (OR = 0.93, p = 0.03) were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression
Genome-wide association and functional follow-up reveals new loci for kidney function
No full textChronic kidney disease (CKD) is an important public health problem with a genetic component. We performed genome-wide association studies in up to 130,600 European ancestry participants overall, and stratified for key CKD risk factors. We uncovered 6 new loci in association with estimated glomerular filtration rate (eGFR), the primary clinical measure of CKD, in or near MPPED2, DDX1, SLC47A1, CDK12, CASP9, and INO80. Morpholino knockdown of mpped2 and casp9 in zebrafish embryos revealed podocyte and tubular abnormalities with altered dextran clearance, suggesting a role for these genes in renal function. By providing new insights into genes that regulate renal function, these results could further our understanding of the pathogenesis of CKD
Association of genetic variation with systolic and diastolic blood pressure among African Americans: the Candidate Gene Association Resource study.
No full textThe prevalence of hypertension in African Americans (AAs) is higher than in other US groups; yet, few have performed genome-wide association studies (GWASs) in AA. Among people of European descent, GWASs have identified genetic variants at 13 loci that are associated with blood pressure. It is unknown if these variants confer susceptibility in people of African ancestry. Here, we examined genome-wide and candidate gene associations with systolic blood pressure (SBP) and diastolic blood pressure (DBP) using the Candidate Gene Association Resource (CARe) consortium consisting of 8591 AAs. Genotypes included genome-wide single-nucleotide polymorphism (SNP) data utilizing the Affymetrix 6.0 array with imputation to 2.5 million HapMap SNPs and candidate gene SNP data utilizing a 50K cardiovascular gene-centric array (ITMAT-Broad-CARe [IBC] array). For Affymetrix data, the strongest signal for DBP was rs10474346 (P= 3.6 × 10(-8)) located near GPR98 and ARRDC3. For SBP, the strongest signal was rs2258119 in C21orf91 (P= 4.7 × 10(-8)). The top IBC association for SBP was rs2012318 (P= 6.4 × 10(-6)) near SLC25A42 and for DBP was rs2523586 (P= 1.3 × 10(-6)) near HLA-B. None of the top variants replicated in additional AA (n = 11 882) or European-American (n = 69 899) cohorts. We replicated previously reported European-American blood pressure SNPs in our AA samples (SH2B3, P= 0.009; TBX3-TBX5, P= 0.03; and CSK-ULK3, P= 0.0004). These genetic loci represent the best evidence of genetic influences on SBP and DBP in AAs to date. More broadly, this work supports that notion that blood pressure among AAs is a trait with genetic underpinnings but also with significant complexity
Sex-Specific Epidemiology of Heart Failure Risk and Mortality in Europe: Results From the BiomarCaRE Consortium
No full textOBJECTIVES: This study investigates differences between women and men in heart failure (HF) risk and mortality. BACKGROUND: Sex differences in HF epidemiology are insufficiently understood. METHODS: In 78,657 individuals (median 49.5 years of age; age range 24.1 to 98.7 years; 51.7% women) from community-based European studies (FINRISK, DanMONICA, Moli-sani, Northern Sweden) of the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium, the association between incident HF and mortality, the relationship of cardiovascular risk factors, prevalent cardiovascular diseases, biomarkers (C-reactive protein [CRP]; N-terminal pro-B-type natriuretic peptide [NT-proBNP]) with incident HF, and their attributable risks were tested in women vs. men. RESULTS: Over a median follow-up of 12.7 years, fewer HF cases were observed in women (n = 2,399 [5.9%]) than in men (n = 2,771 [7.3%]). HF incidence increased markedly after 60 years of age, initially with a more rapid increase in men, whereas incidence in women exceeded that of men after 85 years of age. HF onset substantially increased mortality risk in both sexes. Multivariable-adjusted Cox models showed the following sex differences for the association with incident HF: systolic blood pressure hazard ratio (HR) according to SD in women of 1.09 (95% confidence interval [CI]: 1.05 to 1.14) versus HR of 1.19 (95% CI: 1.14 to 1.24) in men; heart rate HR of 0.98 (95% CI: 0.93 to 1.03) in women versus HR of 1.09 (95% CI: 1.04 to 1.13) in men; CRP HR of 1.10 (95% CI: 1.00 to 1.20) in women versus HR of 1.32 (95% CI: 1.24 to 1.41) in men; and NT-proBNP HR of 1.54 (95% CI: 1.37 to 1.74) in women versus HR of 1.89 (95% CI: 1.75 to 2.05) in men. Population-attributable risk of all risk factors combined was 59.0% in women and 62.9% in men. CONCLUSIONS: Women had a lower risk for HF than men. Sex differences were seen for systolic blood pressure, heart rate, CRP, and NT-proBNP, with a lower HF risk in women
SHui open data research platform
No full textData collected and revised by individual instutions of the Shui-Consortium. Publication by the EU-China Consortium SHui.For each data-file, the author (institution) of the file is given as “operator”.-- At project end, June 30th, 2022.-- For each data-file, the author/data owner for citation is given as “operator” and “contact”.-- Plot data as .csv; catchment data ad libitum.Spatial situation data: Plot data and catchment data available; country, latitude, and longitude coordinates given.-- Temporal situation data: Long-term and single-season data available. Start and end date for each data file given.CC BY-SA. No embargo. The release on the Shui download site and CSIC repository implies expiration of any embargo delivered by the data owner.Project Co-ordinators: Dr. Jose Alfonso Gómez Calero (Instituto de Agricultura Sostenible (IAS-CISC), Dr. Weifeng Xu (Fujian Agriculture and Forest University, FAFU).This data set contains data from the SHui open-data platform for sharing long-term agricultural experiments aimed to optimizing yield and soil and water. Data and additional material are available under https://shui.boku.ac.at/shui/public/startAlphanumeric data measured at hydrologic and agronomical experiments (e.g., plant development, soil properties, hydrology, erosion, management).Further information on the data, project, partners, and publications under https://www.shui-eu.org/EU-China Consortium SHui: European Union Project 773903 and Chinese MOST.Peer reviewe
Hyperresponders vs. nonresponder patients after renal denervation: do they differ?
No full textBACKGROUND: Blood pressure (BP) response after renal denervation (RDN) is highly variable. Besides baseline BP, no reliable predictors of response have been consistently identified. The differences between patients showing a major BP decrease after RDN vs. nonresponders have not been studied so far.
AIM AND METHODS: We identified extreme BP responders (first quintile) and nonresponders (fifth quintile) to RDN defined according to office or 24-h ambulatory BP in the European Network COordinating research on Renal Denervation database (n = 109) and compared the baseline characteristics and BP changes 6 months after RDN in both subsets.
RESULTS: In extreme responders defined according to ambulatory BP, baseline BP and BP changes 6 months after RDN were similar for office and out-of-the office BP. In contrast, extreme responders defined according to office BP were characterized by a huge white-coat effect at baseline, with dramatic shrinkage at 6 months. Compared with nonresponders, extreme responders defined according to office BP were more frequently women, had higher baseline office--but not ambulatory--BP, and higher estimated glomerular filtration rate (eGFR). In contrast, when considering ambulatory BP decrease to define extreme responders and nonresponders, the single relevant difference between both subsets was baseline ambulatory BP.
CONCLUSION: This study suggests a major overestimation of BP response after RDN in extreme responders defined according to office, but not ambulatory BP. The association of lower eGFR with poor response to RDN is consistent with our previous analysis. The increased proportion of women in extreme responders may reflect sex differences in drug adherence
Renal replacement therapy in acute kidney injury from a Chinese cross-sectional study: patient, clinical, socioeconomic and health service predictors of treatment
No full textBackground: Renal replacement therapy (RRT) is important to support critically ill patients with acute kidney injury (AKI). This study, a part of a nation-wide survey for AKI conducted by the ISN AKF 0 by 25 China Consortium, aims to study the current RRT practical situation and problems in China. Methods: The current study is a part of a nation-wide survey for AKI conducted by ISN AKF 0 by 25 China Consortium. The survey included 44 sites all over the country, including 22 academic hospitals in big cities and 22 local hospitals in smaller cities or rural areas. Of the 44 sites, all have access to PD and IHD, 93.5% are capable to perform CRRT. Of total 7604 AKI cases, 896 cases (11.8%) had indications for RRT and were included in the current abstract. Results: of the 896 patients that had indications for RRT, only 59.3% received RRT. Patients who were older, male, from lower income areas, in local hospitals, or with severe comorbidities, were less likely to receive RRT. RRT treatment was associated with lower mortality (OR = 0.58, 95%CI 0.38-0.89). The RRT modalities were continuous renal replacement therapy (CRRT) in 53.9%, intermittent hemodialysis (IHD) in 38.0%, CRRT complemented by IHD in 6.2%, CRRT complemented by peritoneal dialysis (PD) in 0.8% and PD in 1.1%. Of the subgroup of patients receiving RRT who did not have an indication for modality of CRRT, 36.8% in fact received CRRT, and their medical cost and mortality rate was higher (7944[4248, 16,055] vs. 5100[2948, 9396] US dollars, p < 0.001 and 10.6% vs. 4. 4%, p = 0.047, respectively) compared with those treated with other RRT modalities). Conclusions: Extrapolated to the whole of China our results indicate that an estimated 139,000 patients with an indication of RRT are under treated without RRT over a year. Non-clinical factors influence RRT prescription for severe AKI patients. CRRT may be over-utilized in the treatment of severe AKI and the use of PD is extremely rare. These findings have implications for the effective application of medical resources in the treatment of severe AKI.National Project 985; Beijing Training Program for Talents [20110009001000002]; National Natural Science Foundation of China [81270777, 81500575]; International Society of Nephrology Research Committee; Bethune Fund Management CommitteeSCI(E)ARTICLE1
Enrichment and characterization of a bacteria consortium capable of heterotrophic nitrification and aerobic denitrification at low temperature
No full textNitrogen removal in wastewater treatment plants is usually severely inhibited under cold temperature. The present study proposes bioaugmentation using psychrotolerant heterotrophic nitrification-aerobic denitrification consortium to enhance nitrogen removal at low temperature. A functional consortium has been successfully enriched by stepped increase in DO concentration. Using this consortium, the specific removal rates of ammonia and nitrate at 10 degrees C reached as high as 3.1 mg N/(g SS h) and 9.6 mg N/ (g SS h), respectively. PCR-DGGE and clone library analysis both indicated a significant reduction in bacterial diversity during enrichment. Phylogenetic analysis based on nearly full-length 16S rRNA genes showed that Alphaproteobacteria. Deltaproteobacteria and particularly Bacteroidetes declined while Gammaproteobacteria (all clustered into Pseudomonas sp.) and Betaproteobacteria (mainly Rhodoferax ferrireducens) became dominant in the enriched consortium. It is likely that Pseudomonas spp. played a major role in nitrification and denitrification, while R. ferrireducens and its relatives utilized nitrate as both electron acceptor and nitrogen source. Crown Copyright (C) 2012 Published by Elsevier Ltd. All rights reserved.</p
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