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Tan SLL, Manickam A, Abdullah N, Chai WF, Subramaniam SGE, Yuan LX, Ng MKC, Ng RQM. Improving hydration among hospitalised older adults in an acute geriatric ward with a bundled multi-component intervention. BMJ Open Qual 2025; 14:e002805. [PMID: 40280561 PMCID: PMC12035457 DOI: 10.1136/bmjoq-2024-002805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/08/2025] [Indexed: 04/29/2025] Open
Abstract
Dehydration compromises patient safety. Hospitalised frail older adults are at risk of dehydration, which can result in significant morbidity and mortality. However, current clinical practice workflows do not adequately address the issue of poor oral hydration. This study aims to analyse this problem and test solutions to increase the percentage of hospitalised older adults who consume at least 1 L of oral fluid per day from 15% to 60% in an acute geriatric ward over 3 months. A work group was formed to conduct this service improvement project. Extensive literature was searched and reviewed, brainstorming of workflow gaps along with discussions was carried out, and strategic solutions were developed. A series of implementations was carried out sequentially and cumulatively to target vital root causes. The implementations include the introduction of a bedside hydration flip chart, individualised fluid schedule chart, hydration rounds, posters to create a visual workplace and regular in-service talks for healthcare staff. The number of patients who met the minimum fluid intake was collected daily over 4 months to monitor for intervention success and sustainability. Implementing a bundled multi-component intervention increased the percentage of older adults who meet the minimum oral fluid intake of 1 L/day by 45%, making it a needful part in the management of geriatric inpatients to prevent dehydration.
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Affiliation(s)
| | | | | | | | | | - Long Xia Yuan
- Nursing Division, Singapore General Hospital, Singapore
| | | | - Rachel Qiao Ming Ng
- Department of Geriatric Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Mohanty N, Goel AK, Sahoo MR, Shah S, Mohapatra I. Determinants of Acute Kidney Injury in Children With Nephrotic Syndrome: A Prospective Observational Study. Cureus 2025; 17:e76878. [PMID: 39902002 PMCID: PMC11788226 DOI: 10.7759/cureus.76878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2025] [Indexed: 02/05/2025] Open
Abstract
Background Nephrotic syndrome (NS) is a common renal ailment among children, typically manifesting as a relapsing-remitting pattern. Most of the cases are managed on an outpatient basis, but a subset of patients experience complications, e.g., acute kidney injury (AKI). Although historically more prevalent in secondary NS, AKI is now occurring increasingly in children with idiopathic NS. However, the literature on AKI in this population consists of case reports and retrospective studies, particularly from India, so the study was planned to identify various risk factors that precipitate AKI in a child with NS. The secondary objective was to assess the hydration status of children having NS and its association with the development of AKI. Materials and methods This longitudinal study was conducted in the Department of Pediatrics at the All India Institute of Medical Sciences, Raipur, Chhattisgarh, from October 2021 to April 2023. Children of both genders and age groups between three months and 15 years, satisfying the International Society for Pediatric Neurosurgery 2021 guideline for the diagnosis of NS, were included in the study. Children having chronic kidney disease were excluded. Using the non-probability convenient sampling technique, 57 patients with NS were enrolled in the study. The patients without AKI were evaluated daily for the development of AKI using the Kidney Disease Improving Global Outcomes 2012 guideline until day 14 or discharge and followed up for six months. Records of those children who were admitted with AKI were reviewed for possible risk factors of AKI. Data was analyzed on Epi Info software enUS version 7.3.2 (Centers for Disease Control and Prevention, Atlanta, GA, USA). Categorical data were expressed as a percentage and/or 95% confidence interval (CI) of the estimate and compared using Chi-square or Fisher's exact test. A p-value ≤0.05 was considered statistically significant. The odds ratio (OR) for risk factors for AKI was determined using logistic regression. Results The mean age of the study subjects at the onset of the disease was 5.34 ± 3.66 years. The common presentations were edema (94.74%) and oliguria (80.7%). The majority (89.2%) showed a response to steroid therapy. About 56.14% of children developed AKI, and stages 2 and 3 AKI were more common, 37.5% each. About 53.12% and 46.88% of children developed pre-renal AKI and intrinsic AKI, respectively; 45.61% had hypertension at admission, with the majority having stage 1 hypertension (38.46%). Only six (10.5%) children had sickle cell trait, and all developed AKI during follow-up. Forty-two (73.68%) children had nephrotoxic drug exposure, with the most common drug being enalapril, followed by nephrotoxic antibiotics. Out of 10 children with AKI who underwent renal biopsy, focal segmental glomerulosclerosis was the most common entity (60%). The notable parameters that were found to have statistical significance for AKI were low eGFR at admission, hypertension, nephrotoxic drug exposure, inadequate water intake, fractional excretion of sodium (FeNa), and urine potassium index as markers of renal hypoperfusion, infections, steroid-resistant nephrotic syndrome, and significant glomerular lesions. Conclusion The present study demonstrates an association between traditional risk factors and the causation of AKI. However, high urine osmolality, raised urine K+ index, and FeNa suggestive of raised aldosterone levels had a significant association with AKI.
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Affiliation(s)
- Nimisha Mohanty
- Pediatrics, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Anil Kumar Goel
- Pediatrics, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Manas R Sahoo
- Pediatrics, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Seema Shah
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Ipsa Mohapatra
- Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Luo X, Tang Y, Shu Y, Xu B, Liu J, Lv Z. Association between serum osmolality and deteriorating renal function in patients with acute myocardial infarction: analysis of the MIMIC- IV database. BMC Cardiovasc Disord 2024; 24:490. [PMID: 39271971 PMCID: PMC11395587 DOI: 10.1186/s12872-024-04159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND To investigate the association between serum osmolality and deteriorating renal function in patients with acute myocardial infarction (AMI). METHODS Three thousand eight hundred eighty-five AMI patients from the Medical Information Mart for Intensive Care IV were enrolled for this study. The primary outcome was deteriorating renal function. Secondary outcomes included the new-onset of acute kidney injury (AKI) and progress of AKI. < 293.2725 mmol/L was defined as low serum osmolality, and ≥ 293.2725 mmol/L as high serum osmolality based on upper quartile. Univariate and multivariate logistic regression models were used to explore the associations between serum osmolality and the development of deteriorating renal function, the new-onset of AKI and progress of AKI among AMI patients. Subgroup analysis was also conducted. RESULTS One thousand three hundred ninety-three AMI patients developed deteriorating renal function. After adjusting all confounding factors, high serum osmolality was associated with increased risk of deteriorating renal function [odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.22-1.78], new-onset of AKI (OR = 1.31, 95% CI: 1.01-1.69), and progress of AKI risk (OR = 1.26, 95% CI: 1.01-1.59) among AMI patients. In addition, when the stratified analysis was performed for age, AMI type, cardiogenic shock, and estimated glomerular filtration rate (eGFR), high serum osmolality was risk factor for the risk of deteriorating renal function among patients aged 65 years or older, without cardiogenic shock, and with an eGFR ≥ 60 mL/min/1.73m2. CONCLUSION Higher serum osmolality increased the risk of deteriorating renal function among AMI patients.
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Affiliation(s)
- Xiaojia Luo
- Department of Cardiology, Chengdu Second People's Hospital, No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan Province, 610017, China
| | - Yong Tang
- Department of Emergency Medicine, Chengdu Second People's Hospital, Chengdu, Sichuan Province, 610017, China
| | - Yanzhang Shu
- Department of Emergency Medicine, Chengdu Second People's Hospital, Chengdu, Sichuan Province, 610017, China
| | - Baoli Xu
- Department of Emergency Medicine, Chengdu Second People's Hospital, Chengdu, Sichuan Province, 610017, China
| | - JianXiong Liu
- Department of Cardiology, Chengdu Second People's Hospital, No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan Province, 610017, China.
| | - Zhengbing Lv
- Department of Cardiology, Chengdu Second People's Hospital, No.10 Qingyunnan Street, Jinjiang District, Chengdu, Sichuan Province, 610017, China.
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Chou HH, Huang LC, Shen SP, Tsai ML, Chang YC, Lin HC. Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection. Sci Rep 2024; 14:9520. [PMID: 38664452 PMCID: PMC11045864 DOI: 10.1038/s41598-024-59943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11-1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.
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Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Lin-Chih Huang
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Shang-Po Shen
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Ming-Luen Tsai
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Road., Wufeng, Taichung, 41354, Taiwan.
- Department of Long-Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan.
| | - Hung-Chi Lin
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Asia University Hospital, Asia University, Taichung, Taiwan.
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López-Bueno JA, Díaz J, Padrón-Monedero A, Martín MAN, Linares C. Short-term impact of extreme temperatures, relative humidity and air pollution on emergency hospital admissions due to kidney disease and kidney-related conditions in the Greater Madrid area (Spain). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166646. [PMID: 37652385 DOI: 10.1016/j.scitotenv.2023.166646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
While some studies report a possible association between heat waves and kidney disease and kidney-related conditions, there still is no consistent scientific consensus on the matter or on the role played by other variables, such as air pollution and relative humidity. Ecological retrospective time series study 01-01-2013 to 31-12-2018). Dependent variables: daily emergency hospitalisations due to kidney disease (KD), acute kidney injury (AKI), lithiasis (L), dysnatraemia (DY) and hypovolaemia (HPV). Independent variables: maximum and minimum daily temperature (Tmax, Tmin, °C), and daily relative humidity (RH, %). Other variables were also calculated, such as the daily temperature for risk of kidney disease (Theat, °C) and low daily hazardous relative humidity (HRH%). As variables of air pollution, we used the daily mean concentrations of PM10, PM2.5, NO2 and O3 in μg/m3. Based on these, we then calculated their daily excesses over World Health Organisation (WHO) guideline levels (hPM10, hPM2.5, hNO2 and hO3 respectively). Poisson family generalised linear models (GLMs) (link = log) were used to calculate relative risks (RRs), and attributable risks and attributable admissions. In the models, we controlled for the covariates included: seasonalities, trend, autoregressive component, day of the week, month and year. A statistically significant association was found between Theat and all the dependent variables analysed. The greatest AKI disease burden was attributable to Theat (2.2 % (1.7, 2.6) of attributable hospital admissions), followed by hNO2 (1.7 % (0.9, 3.4)) and HRH (0.8 (0.6, 1.1)). In the case of hypovolaemia and dysnatraemia, the greatest disease burden again corresponded to Theat, with 6.9 % (6.2, 7.6) and 5.7 (4.8, 6.6) of attributable hospital admissions respectively. Episodes of extreme heat exacerbate daily emergency hospital admissions due to kidney disease and kidney-related conditions; and attributable risks are likewise seen for low relative humidity and high ozone levels.
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Affiliation(s)
- J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
| | - A Padrón-Monedero
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - M A Navas Martín
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
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Wang FL, Wang WZ, Zhang FF, Peng SY, Wang HY, Chen R, Wang JW, Li PF, Wang Y, Zhao MH, Yang C, Zhang LX. Heat exposure and hospitalizations for chronic kidney disease in China: a nationwide time series study in 261 major Chinese cities. Mil Med Res 2023; 10:41. [PMID: 37670366 PMCID: PMC10478241 DOI: 10.1186/s40779-023-00478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Climate change profoundly shapes the population health at the global scale. However, there was still insufficient and inconsistent evidence for the association between heat exposure and chronic kidney disease (CKD). METHODS In the present study, we studied the association of heat exposure with hospitalizations for cause-specific CKD using a national inpatient database in China during the study period of hot season from 2015 to 2018. Standard time-series regression models and random-effects meta-analysis were developed to estimate the city-specific and national averaged associations at a 7 lag-day span, respectively. RESULTS A total of 768,129 hospitalizations for CKD was recorded during the study period. The results showed that higher temperature was associated with elevated risk of hospitalizations for CKD, especially in sub-tropical cities. With a 1 °C increase in daily mean temperature, the cumulative relative risks (RR) over lag 0-7 d were 1.008 [95% confidence interval (CI) 1.003-1.012] for nationwide. The attributable fraction of CKD hospitalizations due to high temperatures was 5.50%. Stronger associations were observed among younger patients and those with obstructive nephropathy. Our study also found that exposure to heatwaves was associated with added risk of hospitalizations for CKD compared to non-heatwave days (RR = 1.116, 95% CI 1.069-1.166) above the effect of daily mean temperature. CONCLUSIONS Short-term heat exposure may increase the risk of hospitalization for CKD. Our findings provide insights into the health effects of climate change and suggest the necessity of guided protection strategies against the adverse effects of high temperatures.
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Affiliation(s)
- Fu-Lin Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Wan-Zhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Fei-Fei Zhang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Su-Yuan Peng
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Huai-Yu Wang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Rui Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Peng-Fei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, China
| | - Yang Wang
- National Climate Center, China Meteorological Administration, Beijing, 100081, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100034, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, China.
| | - Lu-Xia Zhang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China.
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, China.
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Peng X, Cheng J, Li H, Feijó A, Xia L, Ge D, Wen Z, Yang Q. Whole-genome sequencing reveals adaptations of hairy-footed jerboas (Dipus, Dipodidae) to diverse desert environments. BMC Biol 2023; 21:182. [PMID: 37649052 PMCID: PMC10469962 DOI: 10.1186/s12915-023-01680-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Environmental conditions vary among deserts across the world, spanning from hyper-arid to high-elevation deserts. However, prior genomic studies on desert adaptation have focused on desert and non-desert comparisons overlooking the complexity of conditions within deserts. Focusing on the adaptation mechanisms to diverse desert environments will advance our understanding of how species adapt to extreme desert environments. The hairy-footed jerboas are well adapted to diverse desert environments, inhabiting high-altitude arid regions, hyper-arid deserts, and semi-deserts, but the genetic basis of their adaptation to different deserts remains unknown. RESULTS Here, we sequenced the whole genome of 83 hairy-footed jerboas from distinct desert zones in China to assess how they responded under contrasting conditions. Population genomics analyses reveal the existence of three species in hairy-footed jerboas distributed in China: Dipus deasyi, Dipus sagitta, and Dipus sowerbyi. Analyses of selection between high-altitude desert (elevation ≥ 3000m) and low-altitude desert (< 500m) populations identified two strongly selected genes, ATR and HIF1AN, associated with intense UV radiation and hypoxia in high-altitude environments. A number of candidate genes involved in energy and water homeostasis were detected in the comparative genomic analyses of hyper-arid desert (average annual precipitation < 70mm) and arid desert (< 200mm) populations versus semi-desert (> 360mm) populations. Hyper-arid desert animals also exhibited stronger adaptive selection in energy homeostasis, suggesting water and resource scarcity may be the main drivers of desert adaptation in hairy-footed jerboas. CONCLUSIONS Our study challenges the view of deserts as homogeneous environments and shows that distinct genomic adaptations can be found among desert animals depending on their habitats.
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Affiliation(s)
- Xingwen Peng
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China
- University of Chinese Academy of Sciences, Shijingshan District, Beijing, 100049, China
| | - Jilong Cheng
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China
| | - Hong Li
- Novogene Bioinformatics Institute, Haidian District, Beijing, 100083, China
| | - Anderson Feijó
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China
- Negaunee Integrative Research Center, Field Museum of Natural History, Chicago, IL, 60605, USA
| | - Lin Xia
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China
| | - Deyan Ge
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China
| | - Zhixin Wen
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China
| | - Qisen Yang
- Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Chaoyang District, Beijing, 100101, China.
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Chapman CL, Holt SM, O'Connell CT, Brazelton SC, Howells WAB, Medved HN, Reed EL, Needham KW, Halliwill JR, Minson CT. Acute kidney injury biomarkers and hydration assessments following prolonged mild hypohydration in healthy young adults. Am J Physiol Renal Physiol 2023; 325:F199-F213. [PMID: 37318992 PMCID: PMC10396285 DOI: 10.1152/ajprenal.00086.2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
The high prevalence of inadequate hydration (e.g., hypohydration and underhydration) is concerning given that extreme heat increases excess hospitalizations for fluid/electrolyte disorders and acute kidney injury (AKI). Inadequate hydration may also be related to renal and cardiometabolic disease development. This study tested the hypothesis that prolonged mild hypohydration increases the urinary AKI biomarker product of insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase-2 ([IGFBP7·TIMP-2]) compared with euhydration. In addition, we determined the diagnostic accuracy and optimal cutoffs of hydration assessments for discriminating positive AKI risk ([IGFBP·TIMP-2] >0.3 (ng/mL)2/1,000). In a block-randomized crossover design, 22 healthy young adults (11 females and 11 males) completed 24 h of fluid deprivation (hypohydrated group) or 24 h of normal fluid consumption (euhydrated group) separated by ≥72 h. Urinary [IGFBP7·TIMP-2] and other AKI biomarkers were measured following the 24-h protocols. Diagnostic accuracy was assessed via receiver operating characteristic curve analysis. Urinary [IGFBP7·TIMP-2] [1.9 (95% confidence interval: 1.0-2.8) vs. 0.2 (95% confidence interval: 0.1-0.3) (ng/mL)2/1,000, P = 0.0011] was markedly increased in hypohydrated versus euhydrated groups. Urine osmolality (area under the curve: 0.91, P < 0.0001) and urine specific gravity (area under the curve: 0.89, P < 0.0001) had the highest overall performance for discriminating positive AKI risk. Optimal cutoffs with a positive likelihood ratio of 11.8 for both urine osmolality and specific gravity were 952 mosmol/kgH2O and 1.025 arbitrary units. In conclusion, prolonged mild hypohydration increased urinary [IGFBP7·TIMP-2] in males and females. Urinary [IGFBP7·TIMP-2] corrected to urine concentration was elevated in males only. Urine osmolality and urine specific gravity may have clinical utility for discriminating positive AKI risk following prolonged mild hypohydration.NEW & NOTEWORTHY This study found that prolonged mild hypohydration in healthy young adults increased the Food and Drug Administration approved acute kidney injury (AKI) biomarker urinary insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase-2 [IGFBP7·TIMP-2]. Urine osmolality and specific gravity demonstrated an excellent ability to discriminate positive AKI risk. These findings emphasize the importance of hydration in protecting renal health and lend early support for hydration assessment as an accessible tool to assess AKI risk.
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Affiliation(s)
- Christopher L Chapman
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Sadie M Holt
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Cameron T O'Connell
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Shaun C Brazelton
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - William A B Howells
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Hannah N Medved
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Emma L Reed
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Karen Wiedenfeld Needham
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - John R Halliwill
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Christopher T Minson
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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Tamura H. IgA nephropathy associated with Crohn's disease. World J Methodol 2023; 13:67-78. [PMID: 37456980 PMCID: PMC10348078 DOI: 10.5662/wjm.v13.i3.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/16/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
The relationship between IgA nephropathy (IgAN) and Crohn’s disease was reported. IgAN is the most common primary glomerulonephritis and one of the leading causes of chronic kidney disease and end-stage renal failure, and up to 50% of cases progressed to end-stage renal disease within 25 years after IgAN diagnosis. However, specific and effective therapeutic strategies are still lacking. In this review, we discuss the possibility of the mechanism involved in IgAN associated with Crohn’s disease based on the findings of basic and clinical studies. Although the etiology of IgAN associated with Crohn’s disease is not permanent and various factors are thought to be involved, the stabilization of the disease condition of Crohn’s disease is believed to help treat IgAN.
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Affiliation(s)
- Hiroshi Tamura
- Department of Pediatrics, Kumamoto University, Kumamoto 8608556, Japan
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Lee JM, Lim TY, Oh SB, Lee SJ, Bae YS, Jung HS. Ahnak is required to balance calcium ion homeostasis and smooth muscle development in the urinary system. Cell Biosci 2023; 13:108. [PMID: 37308968 DOI: 10.1186/s13578-023-01055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Various renal abnormalities, including hydronephrosis, polycystic kidney disease, and hydroureter, have been reported, and these abnormalities are present in DiGeorge syndrome, renal dysplasia, and acute kidney failure. Previous studies have shown that various genes are associated with renal abnormalities. However, the major target genes of nonobstructive hydronephrosis have not yet been elucidated. RESULTS We examined neuroblast differentiation-associated protein Ahnak localization and analyzed morphogenesis in developing kidney and ureter. To investigated function of Ahnak, RNA-sequencing and calcium imaging were performed in wild type and Ahnak knockout (KO) mice. Ahnak localization was confirmed in the developing mouse kidneys and ureter. An imbalance of calcium homeostasis and hydronephrosis, which involves an expanded renal pelvis and hydroureter, was observed in Ahnak KO mice. Gene Ontology enrichment analysis on RNA-seq results indicated that 'Channel Activity', 'Passive Transmembrane Transporter Activity' and 'Cellular Calcium Ion Homeostasis' were downregulated in Ahnak KO kidney. 'Muscle Tissue Development', 'Muscle Contraction', and 'Cellular Calcium Ion Homeostasis' were downregulated in Ahnak KO ureter. Moreover, peristaltic movement of smooth muscle in the ureter was reduced in Ahnak KO mice. CONCLUSIONS Abnormal calcium homeostasis causes renal disease and is regulated by calcium channels. In this study, we focused on Ahnak, which regulates calcium homeostasis in several organs. Our results indicate that Ahnak plays a pivotal role in kidney and ureter development, and in maintaining the function of the urinary system.
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Affiliation(s)
- Jong-Min Lee
- Department of Oral Biology, Taste Research Center, Oral Science Research Center, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Tae-Yang Lim
- Department of Oral Biology, Taste Research Center, Oral Science Research Center, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Sang-Bin Oh
- Department of Oral Biology, Taste Research Center, Oral Science Research Center, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Seung-Jun Lee
- Department of Oral Biology, Taste Research Center, Oral Science Research Center, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Yun Soo Bae
- Department of Life Sciences, Ewha Woman's University, Seoul, Korea
| | - Han-Sung Jung
- Department of Oral Biology, Taste Research Center, Oral Science Research Center, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Korea.
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11
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Chu L, Chen K, Crowley S, Dubrow R. Associations between short-term temperature exposure and kidney-related conditions in New York State: The influence of temperature metrics across four dimensions. ENVIRONMENT INTERNATIONAL 2023; 173:107783. [PMID: 36841184 DOI: 10.1016/j.envint.2023.107783] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Evidence describing the relationship between short-term temperature exposure and kidney-related conditions is insufficient. It remains unclear how temperature specification affects estimation of these associations. This study aimed to assess associations between short-term temperature exposure and seven kidney-related conditions and to evaluate the influence of temperature specification. METHODS We obtained data on hospital encounters in New York State (2007-2016). We assessed associations with a case-crossover design using conditional logistic regression with distributed lag non-linear models. We compared model performance (i.e., AIC) and association curves using 1) five temperature spatial resolutions; 2) temperature on an absolute versus relative scale; 3) seven temperature metrics incorporating humidity, wind speed, and/or solar radiation; and 4) five intraday temperature measures (e.g., daily minimum and daytime mean). RESULTS We included 1,209,934 unplanned adult encounters. Temperature metric and intraday measure had considerably greater influence than spatial resolution and temperature scale. For outcomes not associated with temperature exposure, almost all metrics or intraday measures showed good model performance; for outcomes associated with temperature, there were meaningful differences in performance across metrics or intraday measures. For parsimony, we modelled daytime mean outdoor wet-bulb globe temperature, which showed good performance for all outcomes. At lag 0-6 days, we observed increased risk at the 95th percentile of temperature versus the minimum morbidity temperature for acute kidney failure (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.09, 1.69), urolithiasis (OR = 1.41, 95% CI: 1.16, 1.70), dysnatremia (OR = 1.26, 95% CI: 1.01, 1.59), and volume depletion (OR = 1.88, 95% CI: 1.41, 2.51), but not for glomerular diseases, renal tubulo-interstitial diseases, and chronic kidney disease. CONCLUSIONS High-temperature exposure over one week is a risk factor for acute kidney failure, urolithiasis, dysnatremia, and volume depletion. The differential model performance across temperature metrics and intraday measures indicates the importance of careful selection of exposure metrics when estimating temperature-related health burden.
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Affiliation(s)
- Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA.
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Susan Crowley
- Department of Medicine (Nephrology), Yale University School of Medicine, New Haven, CT 06520, USA; Veterans Administration Health Care System of Connecticut, West Haven, CT 06516, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
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12
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Al-Ghamdi S, Abu-Alfa A, Alotaibi T, AlSaaidi A, AlSuwaida A, Arici M, Ecder T, El Koraie AF, Ghnaimat M, Hafez MH, Hassan M, Sqalli T. Chronic Kidney Disease Management in the Middle East and Africa: Concerns, Challenges, and Novel Approaches. Int J Nephrol Renovasc Dis 2023; 16:103-112. [PMID: 37051319 PMCID: PMC10084934 DOI: 10.2147/ijnrd.s363133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/22/2022] [Indexed: 04/14/2023] Open
Abstract
The burden of chronic kidney disease (CKD) and other comorbidities, such as hypertension and diabetes, which increase the risk of developing CKD, is on the rise in the Middle East and Africa. The Middle East and Africa CKD (MEA-CKD) steering committee, comprising eminent healthcare specialists from the Middle East and Africa, was formed to identify and propose steps to address the gaps in the management of CKD in these regions. The current article lists the MEA-CKD steering committee meeting outcomes and evaluates the available evidence supporting the role of novel therapeutic options for patients with CKD. The need of the hour is to address the gaps in awareness and screening, early diagnosis, along with referral and management of patients at risk. Measures to bring about appropriate changes in healthcare policies to ensure access to all benefit-proven protective therapies, including novel ones, at community levels are also vital for reducing the overall burden of CKD on the healthcare system as well as governing bodies, especially in developing countries of the Middle East and Africa.
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Affiliation(s)
- Saeed Al-Ghamdi
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom Saudi of Arabia
| | - Ali Abu-Alfa
- Department of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon
| | - Turki Alotaibi
- Department of Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Kuwait City, Kuwait
| | - Ali AlSaaidi
- Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq
| | | | - Mustafa Arici
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Ecder
- Department of Nephrology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Ahmed F El Koraie
- Department of Internal Medicine and Nephrology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | | | - Mohamed H Hafez
- Department of Nephrology and Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hassan
- Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Correspondence: Mohamed Hassan, Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, Tel +971 508187944, Email
| | - Tarik Sqalli
- Department of Nephrology, Moroccan Society of Nephrology, Casablanca, Morocco
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13
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Hyldbakk A, Mørch Y, Snipstad S, Åslund AKO, Klinkenberg G, Nakstad VT, Wågbø AM, Schmid R, Molesworth PP. Identification of novel cyanoacrylate monomers for use in nanoparticle drug delivery systems prepared by miniemulsion polymerisation - A multistep screening approach. Int J Pharm X 2022; 4:100124. [PMID: 35898812 PMCID: PMC9310130 DOI: 10.1016/j.ijpx.2022.100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022] Open
Abstract
Poly (alkyl cyanoacrylate) (PACA) polymeric nanoparticles (NPs) are promising drug carriers in drug delivery. However, the selection of commercially available alkyl cyanoacrylate (ACA) monomers is limited, because most monomers were designed for use in medical and industrial glues and later repurposed for drug encapsulation. This study therefore aimed to seek out novel ACA materials for use in NP systems using a toxicity led screening approach. A multistep strategy, including cytotoxicity screening of alcohols as degradation products of PACA (44 alcohols), NPs (14 polymers), and a final in vivo study (2 polymers) gave poly (2-ethylhexyl cyanoacrylate) PEHCA as a promising novel PACA candidate. For the first time, this work presents cytotoxicity data on several novel ACAs, PEHCA in vivo toxicity data, and miniemulsion polymerisation-based encapsulation of the cabazitaxel and NR688 in novel PACA candidates. Furthermore, several of the ACA candidates were compatible with a wider selection of lipophilic active pharmaceutical ingredients (APIs) versus commercially available controls. Combined, this work demonstrates the potential benefits of expanding the array of available ACA materials in drug delivery. Novel ACAs have the potential to encapsulate a wider range of APIs in miniemulsion polymerisation processes and may also broaden PACA applicability in other fields.
Screening of novel poly(alkylcyanoacrylate) (PACA) materials to broaden PACA nanomedicine potential. A comprehensive screening process evaluated the toxicity of novel poly(alkylcyanoacrylate) (PACA) materials. Novel poly(2-ethylhexyl cyanoacrylate) nanoparticles has a promising safety profile. Novel ACA materials show potential to enable encapsulation of a wider range of APIs.
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Affiliation(s)
- Astrid Hyldbakk
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway.,Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yrr Mørch
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
| | - Sofie Snipstad
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway.,Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Andreas K O Åslund
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
| | - Geir Klinkenberg
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
| | - Vu To Nakstad
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
| | - Ane-Marit Wågbø
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
| | - Ruth Schmid
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
| | - Peter P Molesworth
- Department of Biotechnology and Nanomedicine, SINTEF Industry, Trondheim, Norway
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Wang F, Wang W, Peng S, Wang HY, Chen R, Wang J, Yang C, Li P, Wang Y, Zhang L. Effects of ambient temperature on hospital admissions for obstructive nephropathy in Wuhan, China: A time-series analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 242:113876. [PMID: 35841652 DOI: 10.1016/j.ecoenv.2022.113876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
Under the background of global warming, it has been confirmed that heat exposure has a huge impact on human health. The current study aimed to evaluate the effects of daily mean ambient temperature on hospital admissions for obstructive nephropathy (ON) at the population level. A total of 19,494 hospitalization cases for ON in Wuhan, China from January 1, 2015 to December 31, 2018 were extracted from a nationwide inpatient database in tertiary hospitals according to the International Classification of Diseases (ICD)- 10 codes. Daily ambient meteorological and pollution data during the same period were also collected. A quasi-Poisson Generalized Linear Model (GLM) combined with a distributed lag non-linear model (DLNM) was applied to analyze the lag-exposure-response relationship between daily mean temperature and daily hospital admissions for ON. Results showed that there were significantly positive associations between the daily mean temperature and ON hospital admissions. Relative to the minimum-risk temperature (-3.4 ℃), the risk of hospital admissions for ON at moderate hot temperature (25 ℃, 75th percentile) occurred from lag day 4 and stayed to lag day 12 (cumulative relative risk [RR] was 1.846, 95 % confidence interval [CI]: 1.135-3.005, over lag 0-12 days). Moreover, the risk of extreme hot temperature (32 ℃, 99th percentile) appeared immediately and lasted for 8 days (RR = 2.019, 95 % CI: 1.308-3.118, over lag 0-8 days). Subgroup analyses indicated that the middle-aged and elderly (≥45 years) patients might be more susceptible to the negative effects of high temperature, especially at moderate hot conditions. Our findings suggest that temperature may have a significant impact on the acute progression and onset of ON. Higher temperature is associated with increased risks of hospital admissions for ON, which indicates that early interventions should be taken in geographical settings with relatively high temperatures, particularly for the middle-aged and elderly.
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Affiliation(s)
- Fulin Wang
- Peking University First Hospital, Beijing, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Wanzhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Suyuan Peng
- National Institute of Health Data Science at Peking University, Beijing, China
| | - Huai-Yu Wang
- National Institute of Health Data Science at Peking University, Beijing, China
| | - Rui Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China.
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou, China
| | - Yang Wang
- National Climate Center, China Meteorological Administration, Beijing, China
| | - Luxia Zhang
- National Institute of Health Data Science at Peking University, Beijing, China; Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China.
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15
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Crohn's disease may promote inflammation in IgA nephropathy: a case-control study of patients undergoing kidney biopsy. Virchows Arch 2022; 481:553-563. [PMID: 35809093 PMCID: PMC9534821 DOI: 10.1007/s00428-022-03373-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022]
Abstract
Intestinal immunity has been closely associated with the pathogenesis and progression of renal diseases, a relationship known as the "gut-kidney axis." To determine the association between immunoglobulin A nephropathy (IgAN) and Crohn's disease (CD), a clinico-pathological study was performed on patients who had IgAN with CD (CD-IgAN) and without CD (NOS-IgAN). We enrolled 29 patients diagnosed with IgAN via renal biopsy at the Tokyo Yamate Medical Center from 2009 to 2017. The patients were divided into CD-IgAN (n = 18) and NOS-IgAN (n = 11) and evaluated for clinical and pathological findings. IgA subclasses and galactose-deficient IgA1 (Gd-IgA1) were examined via immunohistochemistry using formalin-fixed paraffin-embedded sections from renal biopsy. Our results showed no significant difference in the extent of mesangial IgA subclasses or Gd-IgA1 deposition according to the presence or absence of CD. Pathologically, however, those with CD-IgAN had remarkably higher percentage of global glomerulosclerosis and extent of interstitial fibrosis and tubular atrophy (IF/TA) compared to those with NOS-IgAN. Moreover, the extent of macrophage infiltration in the glomerulus and interstitium was significantly higher in CD-IgAN than in NOS-IgAN. Clinically, the CD-IgAN group had significantly worse responsiveness to steroid treatment compared to the NOS-IgAN group. In conclusion, the similar immunological characteristics of deposited IgA molecules in the glomeruli between the CD-IgAN and NOS-IgAN groups might suggest their etiological similarity. However, a renal pathology showing advanced glomerular and tubulointerstitial sclerosis accompanying increased macrophage infiltration and highly resistant clinical features in patients with CD-IgAN suggests that some pathophysiological factors in CD, including abnormal intestinal immunity, may promote and activate the inflammatory process in IgAN via undetermined mechanisms.
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16
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Kollanus V, Tiittanen P, Lanki T. Mortality risk related to heatwaves in Finland - Factors affecting vulnerability. ENVIRONMENTAL RESEARCH 2021; 201:111503. [PMID: 34144011 DOI: 10.1016/j.envres.2021.111503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Heatwaves are known to increase mortality. However, there is a need for more quantitative information on factors affecting sensitivity to the adverse health effects, particularly in countries with cool summer temperatures. OBJECTIVES We evaluated mortality risk related to heatwave days in Finland. Risk was examined by age, sex, cause of death, and place of death, including health and social care facilities and homes. Mortality was also analysed for different patient subgroups in healthcare facilities. METHODS Heatwaves were defined as periods when the daily average temperature exceeded the 90th percentile of that from May to August in 2000-2014 for ≥4 days. In addition to all heatwave days, risk was analysed for short (4-5 days) and long (≥10 days) heatwaves. Mortality analyses were based on linking registry data on i) daily non-accidental and cause-specific mortality and ii) admissions to a health or social care facility. Statistical analyses were conducted using generalised estimating equations for longitudinal data analysis, assuming a Poisson distribution for the daily mortality count. RESULTS During all heatwave days, mortality increased among those aged 65-74 years (6.7%, 95% confidence interval 2.9-10.8%) and ≥75 years (12.8%, 95% CI 9.8-15.9%). Mortality increased in both sexes, but the risk was higher in women. Positive associations were observed for deaths due to respiratory diseases, renal diseases, mental and behavioural disorders, diseases of the nervous system, and cardiovascular diseases. Overall, effects were stronger for long than short heatwaves. During all heatwave days, mortality increased in healthcare facilities in outpatients (26.9%, 95% CI 17.3-37.2%) and inpatients. Among inpatients, the risk was higher in long-term inpatients (stay in ward > 30 days, 13.1%, 95% CI 8.6-17.7%) than others (5.8%, 95% CI 2.7-9.0%). At homes, mortality increased by 8.1% (95% CI 1.9-14.6%). Elevated risk estimates were also detected for social care facilities. CONCLUSIONS In Finland, a cold-climate Northern country, heatwaves increase mortality risk significantly among the elderly. Women are more susceptible than men, and many chronic diseases are important risk factors. To reduce heatwave-related deaths, preparedness should be improved particularly in hospital and healthcare centre wards, where the most vulnerable are long-term inpatients. However, measures are also needed to protect the elderly at home and in social care facilities, especially during prolonged hot periods.
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Affiliation(s)
- Virpi Kollanus
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland.
| | - Pekka Tiittanen
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland.
| | - Timo Lanki
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland; School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland; Department of Environmental and Biological Sciences, University of Eastern, P.O. Box 1627, FI-70211, Kuopio, Finland.
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A Portable Biodevice to Monitor Salivary Conductivity for the Rapid Assessment of Fluid Status. J Pers Med 2021; 11:jpm11060577. [PMID: 34205354 PMCID: PMC8235451 DOI: 10.3390/jpm11060577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 01/29/2023] Open
Abstract
The evaluation of fluid status can save adults from life-threatening conditions, but the current methods are invasive or time-consuming. Therefore, we developed a portable device for measuring salivary conductivity. This prospective observational study enrolled 20 volunteers with no history of systemic diseases. Participants were observed for 13 h, including water restriction for 12 h followed by rehydration with 1000 mL water within 1 h. Serum and urine biomarkers for fluid status, thirst scales, and salivary conductivity were collected during dehydration and rehydration. No significant differences in age, body mass index, glycohemoglobin, and estimated glomerular filtration rate were noted between sexes. Salivary conductivity increased after water restriction and decreased after rehydration. Similarly, urine osmolality, urine specific gravity, thirst intensity scales, and body weight followed the same trend and were statistically significant. The angiotensin-converting enzyme and aldosterone levels showed the same trend, without reaching statistical significance. The red blood cell count and hemoglobin concentration also followed the same trend. Analyzing the receiver operating characteristic curves, the area under the curve was 0.707 (95% confidence interval 0.542–0.873, p = 0.025). Using the Youden index, the optimal cutoff determined as 2678.09 μs/cm (sensitivity: 90%, specificity: 55%). This biodevice effectively screened dehydration among healthy adults.
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18
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Abstract
CONTEXT Doppler sonography is a noninvasive method to evaluate the hemodynamic status of the kidney, and its parameters are used as direct and indirect predictors of certain parenchyma and renovascular diseases. However, the effect of hydration on kidney hemodynamics has not been explored via Doppler sonography. OBJECTIVE To examine differences in arterial Doppler velocities of normal adult kidney before and after hydration. METHODS A total of 60 native kidneys in 30 normal adult participants (mean age, 26 years) were assessed using Doppler sonography. Quantitative ultrasound Doppler parameters of peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) of the main renal artery and the intrarenal (interlobar) arteries were measured immediately before and 1 hour after ingestion of 500 mL of water. We tested differences in Doppler parameters before and after hydration using a paired t test, analyzed the correlation of the increase in PSV to the increase in EDV after hydration using Pearson correlation coefficient (PCC), and examined intraobserver reliability using intraclass correlation coefficient (ICC). RESULTS Statistical analyses revealed that the differences in PSV and EDV values before and after hydration at the main renal artery and interlobar arteries of the kidney were significant (P<.001), whereas the RI at the main renal artery and interlobar arteries were not (P>.05). PCC for the correlation of the increase in PSV to the increase in EDV was greater than 0.80. ICC for intraobserver repeatability in performing kidney Doppler sonography was 0.92. CONCLUSION Our results suggest that Doppler sonography is able to demonstrate changes in kidney hemodynamics within 1 hour after hydration. The normal kidney reflects proportional increases in PSV and EDV at the main renal artery and interlobar arteries, while maintaining vascular resistance. Doppler flow velocities of renal arteries can be considered as noninvasive quantitative markers for evaluating the response of kidney hemodynamics to hydration.
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Lacey J, Corbett J, Shepherd A, Dubois A, Hughes F, White D, Tipton M, Mythen M, Montgomery H. Thirst-guided participant-controlled intravenous fluid rehydration: a single blind, randomised crossover study. Br J Anaesth 2020; 124:403-410. [PMID: 32014238 DOI: 10.1016/j.bja.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/01/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dehydration is common in hospitals and is associated with increased mortality and morbidity. Clinical assessment and diagnostic measures of dehydration are unreliable. We sought to investigate the novel concept that individuals might control their own intravenous rehydration, guided by thirst. METHODS We performed a single-blind, counterbalanced, randomised cross-over trial. Ten healthy male volunteers of mean age 26 (standard deviation [sd] 10.5) yr were dehydrated by 3-5% of their baseline body mass via exercising in the heat (35°C, 60% humidity). This was followed by a 4 h participant-controlled intravenous rehydration: individuals triggered up to six fluid boluses (4% dextrose in 0.18% sodium chloride) per hour in response to thirst. Participants undertook two blinded rehydration protocols which differed only by bolus volume: 50 ml (low volume [LV]) or 200 ml (high volume [HV]). Each hour during the rehydration phase, plasma osmolality (pOsm) was measured and thirst score recorded. Nude body mass was measured at baseline, after dehydration, and after the rehydration phase. RESULTS In both conditions, the mean dehydration-related body mass loss was 3.9%. Thirst score was strongly associated with pOsm (within-subject r=0.74) and demand for fluid decreased as pOsm corrected. In the HV condition, participants rapidly rehydrated themselves (mean fluid delivered 3060 vs 981 ml in the LV condition) to body mass and pOsm no different to their euhydrated state. CONCLUSION Healthy individuals appear able to rely on thirst to manage intravenous fluid intake. Future work must now focus on whether patient-controlled intravenous fluids could represent a paradigm shift in the management of hydration in the clinical setting. CLINICAL TRIAL REGISTRATION NCT03932890.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK; St George's Hospital NHS Trust, London, UK.
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Ant Shepherd
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Andre Dubois
- British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Danny White
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Mike Tipton
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Institute of Sport Exercise & Health, University College London, London, UK
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20
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Impending Low Intake Dehydration at Admission to A Geriatric Ward- Prevalence and Correlates in a Cross-Sectional Study. Nutrients 2020; 12:nu12020398. [PMID: 32024303 PMCID: PMC7071250 DOI: 10.3390/nu12020398] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
Dehydration risk increases with frailty and functional dependency, but a limited number of studies have evaluated this association in hospitalized geriatric patients. This cross-sectional study aimed to assess the prevalence and determinants of dehydration in patients admitted to the geriatric ward. Dehydration was diagnosed when calculated osmolarity was above 295 mMol/L. Logistic regression analyses (direct and stepwise backward) were used to assess determinants of impending dehydration. 358 of 416 hospitalized patients (86.1%) were included: 274 (76.5%) women, and 309 (86.4%) 75+ year-old. Dehydration was diagnosed in 209 (58.4%) cases. Significantly higher odds for impending dehydration were observed only for chronic kidney disease with trends for diabetes and procognitive medication when controlling for several health, biochemical, and nutritional parameters and medications. After adjusting for “dementia” the negative effect of “taking procognitive medications” became a significant one. Chronic kidney disease, diabetes, taking procognitive medications and hypertension were the main variables for the outcome prediction according to the stepwise backward regression analysis. This may indicate an additional benefit of reducing the risk of dehydration when using procognitive drugs in older patients with dementia.
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Peng H, Purkerson JM, Freeman RS, Schwaderer AL, Schwartz GJ. Acidosis induces antimicrobial peptide expression and resistance to uropathogenic E. coli infection in kidney collecting duct cells via HIF-1α. Am J Physiol Renal Physiol 2020; 318:F468-F474. [PMID: 31841391 PMCID: PMC7052658 DOI: 10.1152/ajprenal.00228.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/23/2022] Open
Abstract
Acute pyelonephritis is frequently associated with metabolic acidosis. We previously reported that metabolic acidosis stimulates expression of hypoxia-inducible factor (HIF)-1α-induced target genes such as stromal derived factor-1 and cathelicidin, an antimicrobial peptide. Since the collecting duct (CD) plays a pivotal role in regulating acid-base homeostasis and is the first nephron segment encountered by an ascending microbial infection, we examined the contribution of HIF-1α to innate immune responses elicited by acid loading of an M-1 immortalized mouse CD cell line. Acid loading of confluent M-1 cells was achieved by culture in pH 6.8 medium supplemented with 5-(N-ethyl-N-isopropyl)-amiloride to block Na+/H+ exchange activity for 24 h. Acid loading induced antimicrobial peptide [cathelicidin and β-defensin (Defb2 and Defb26)] mRNA expression and M-1 cell resistance to uropathogenic Escherichia coli infection to an extent similar to that obtained by inhibition of HIF prolyl hydroxylases, which promote HIF-1α protein degradation. The effect of acid loading on M-1 cell resistance to uropathogenic E. coli infection was reduced by inhibition of HIF-1α (PX-478), and, in combination with prolyl hydroxylase inhibitors, acidosis did not confer additional resistance. Thus, metabolic stress of acidosis triggers HIF-1α-dependent innate immune responses in CD (M-1) cells. Whether pharmacological stabilization of HIF prevents or ameliorates pyelonephritis in vivo warrants further investigation.
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Affiliation(s)
- Hu Peng
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey M Purkerson
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Robert S Freeman
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, New York
| | - Andrew L Schwaderer
- Department of Pediatrics, Riley Hospital, University of Indiana School of Medicine, Indianapolis, Indiana
| | - George J Schwartz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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Meal Frequency and Skipping Breakfast Are Associated with Chronic Kidney Disease. Nutrients 2020; 12:nu12020331. [PMID: 32012653 PMCID: PMC7071178 DOI: 10.3390/nu12020331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic underhydration and malnutrition can be associated with irreversible renal damage. This study investigated the association of meal frequency and breakfast skipping with chronic kidney disease (CKD) in South Korea. Participants (4370 participants from the Korean National Health and Nutrition Examination Survey VI 2013-2014) were divided into two groups based on meal frequency: ≥ 15 or < 15 meals/week. They were further divided into four groups based on the frequency of breakfast, lunch, and dinner consumed in the previous year. The data were analyzed with complex samples logistic regression. We found that 9.6% of the participants (n = 412) had CKD, which was associated with gender, body mass index, serum fasting glucose, daily calorie intake, hypertension, diabetes, and cerebrovascular accident. Participants consuming <15 meals/week had a higher risk of CKD than those who consumed ≥15 meals/week (adjusted odds ratio [OR] 1.531, 95% confidence interval [CI] 1.209-1.938). Participants who rarely had breakfast showed a higher risk of CKD than those who had breakfast 5-7 times/week (adjusted OR 1.572, 95% CI 1.108-2.231). Our findings suggest that <15 meals/week or skipping breakfast is associated with a higher risk of CKD in the general South Korean population, especially for men or persons aged 42-64 years.
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Daily JW, Zhang T, Wu X, Park S. Chronic water insufficiency induced kidney damage and energy dysregulation despite reduced food intake, which improved gut microbiota in female rats. J Physiol Sci 2019; 69:599-612. [PMID: 30953307 PMCID: PMC10717426 DOI: 10.1007/s12576-019-00668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/17/2019] [Indexed: 01/03/2023]
Abstract
Water intake is recommended for weight loss, but the relationship between water intake and energy metabolism is not clear. We hypothesized that long-term water insufficiency would influence energy, glucose, and lipid metabolism while modulating gut microbiota. Female rats were provided with high-fat diets with different amounts of water and food intake for 6 weeks as follows: water provided for 1 h per day with food ad libitum (WRFA), water supply ad libitum plus pair feeding of with water restricted rats(WAFR), water restriction with ad libitum food for 3 weeks and water and food intake ad libitum for 3 weeks (WR-WA) and ad libitum supply of water and food (WAFA). Water intake in WRFA was about one-third of WAFR and WAFA, whereas food intake was lowered by 30% in WRFA and WAFR than WAFA. Body fat decreased in WRFA and WAFR, but WAFR decreased fat mass more than WRFA. Energy expenditure was lower in WRFA than WAFA and carbohydrate utilization was much higher in WRFA than the other groups. The peak serum glucose concentrations were lower in WAFA than the other groups and WRFA lowered serum insulin levels more than WAFA during OGTT. WRFA shrank the glomerulus with increased apoptotic cells and damaged renal tubules compared to the WAFA and WAFR. WR-WA also exhibited greater glomerular shrinkage and apoptosis that WAFA, but not as much WRFA, indicating that the kidneys were healing after water restriction damage. WRFA exacerbated dyslipidemia compared to the WAFA and WAFR groups. The gut microbiome was similarly modulated in WRFA and WAFR, compared to WAFA, but it was mainly affected by food intake, not water restriction in the host. WRFA and WAFR increased Bacteroidetes and decreased Firmicutes compared WAFA. In conclusion, chronic insufficient water intake induced renal damage, decreased energy expenditure, and exacerbated dyslipidemia in rats with reduced food intake. However, the reduction of food intake improved gut microbiome regardless of insufficient water intake and only minor effects on the microbiome were observed due to water restriction.
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Affiliation(s)
| | - Ting Zhang
- Department of Food and Nutrition, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, Asan, 336-795, South Korea
| | - Xuangao Wu
- Department of Food and Nutrition, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, Asan, 336-795, South Korea
| | - Sunmin Park
- Department of Food and Nutrition, Obesity/Diabetes Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, Asan, 336-795, South Korea.
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Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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Differing Water Intake and Hydration Status in Three European Countries-A Day-to-Day Analysis. Nutrients 2019; 11:nu11040773. [PMID: 30987139 PMCID: PMC6520853 DOI: 10.3390/nu11040773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 01/21/2023] Open
Abstract
Adequate hydration is essential for maintaining health and functionality of the human body. Studies assessing both daily water intake and hydration status are lacking. This study explored data from the European Hydration Research Study (EHRS) and focused on total water intake (TWI), 24 h hydration status, and day-to-day variations in a sample of 573 healthy adults. TWI was assessed by food records and hydration status (urine osmolality and urine volume) was measured from 24 urine samples collected over seven consecutive days. On all weekdays, mean TWI was higher (p < 0.001 for all days) for the German subjects compared to the Greek and Spanish participants. In 37% of the male and 22% of the female subjects, the individual mean TWI was below the European Food Safety Authority (EFSA) recommendation, with 16% men (4% women) being below the EFSA recommendation on every testing day. Twenty-four hour urine osmolality was lower in women compared to men (595 ± 261 vs. 681 ± 237 mOsmol/kg; p < 0.001). More men (40%) showed a urine osmolality ≥800 mOsmol/kg at least on four days of the study period compared to women (26%) and more participants from Spain (46%) compared to Greece (29%) and Germany (11%). A large number of individuals showed an inadequate hydration status on several days per week, which may have a negative health and cognitive impact on daily life.
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Agustiyowati THR, Sitorus R, Waluyo A, Besral B. The Effectiveness of Roy’s Adaptation Model for Patients with Chronic Kidney Disease Undergoing Pre-Dialysis in Indonesia. JURNAL NERS 2019. [DOI: 10.20473/jn.v13i2.7836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patients with chronic kidney disease (CKD) undergoing pre-dialysis requires a good self-management to control low protein intake and maintain kidney function. Adaptation to the existing stimulus through coping and adjustment mechanisms is important to maintaining good kidney function. However, few studies applied nursing theory based to guide intervention in helping the adaptation of patient CKD with their condition. The purpose of this study is to evaluate the effectiveness of Roy’s adaptation model towards physiological and psychological adaptation response among patients with CKD undergoing pre-dialysis.Methods: This study was conducted using a quasi-experiment to patients with CKD pre-dialysis, age over 18 years old. We modified Roy’s adaptation model for patients with CKD undergoing pre-dialysis.Results: A total of 70 subjects agreed to join the study, 38 subjects in intervention and 32 subjects in the control group. The mean of eGFR ranged from 26.3 to 26.6 mL/min/1.73 m2. We found that Roy’s adaptation model has significantly improved drinking behavior, reduce protein intake, blood creatinine, and psychosocial adaptation response after the intervention.Conclusion: These study findings suggested that Roy’s adaptation model is effective to help patients with CKD undergoing pre-dialysis improve their behavior and maintain kidneyfunction . Model dissemination, advocacy to related units, and application in nursing care in patients with chronic kidney disease pre-dialysis are necessary.
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Hughes F, Mythen M, Montgomery H. The sensitivity of the human thirst response to changes in plasma osmolality: a systematic review. Perioper Med (Lond) 2018; 7:1. [PMID: 29344350 PMCID: PMC5763530 DOI: 10.1186/s13741-017-0081-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/21/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient's thirst can provide an accurate guide to fluid therapy. This systematic review examines the sensitivity of thirst in responding to changes in plasma osmolality in participants of any age with no condition directly effecting their sense of thirst. METHODS Medline and EMBASE were searched up to June 2017. Inclusion criteria were all studies reporting the plasma osmolality threshold for the sensation of thirst. RESULTS A total of 12 trials were included that assessed thirst intensity on a visual analogue scale, as a function of plasma osmolality (pOsm), and employed linear regression to define the thirst threshold. This included 167 participants, both healthy controls and those with a range of pathologies, with a mean age of 41 (20-78) years.The value ±95% CI for the pOsm threshold for thirst sensation was found to be 285.23 ± 1.29 mOsm/kg. Above this threshold, thirst intensity as a function of pOsm had a mean ± SEM slope of 0.54 ± 0.07 cm/mOsm/kg. The mean ± 95% CI vasopressin release threshold was very similar to that of thirst, being 284.3 ± 0.71 mOsm/kg.Heterogeneity across studies can be accounted for by subtle variation in experimental protocol and data handling. CONCLUSION The thresholds for thirst activation and vasopressin release lie in the middle of the normal range of plasma osmolality. Thirst increases linearly as pOsm rises. Thus, osmotically balanced fluid administered as per a patient's sensation of thirst should result in a plasma osmolality within the normal range. This work received no funding.
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Affiliation(s)
- Fintan Hughes
- Institute for Sport, Exercise and Health, University College London, 170 Tottenham Court Road, London, W1T 7HA UK
| | - Monty Mythen
- Institute for Sport, Exercise and Health, University College London, 170 Tottenham Court Road, London, W1T 7HA UK
| | - Hugh Montgomery
- Institute for Sport, Exercise and Health, University College London, 170 Tottenham Court Road, London, W1T 7HA UK
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28
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Wallimann T, Riek U, Möddel M. Intradialytic creatine supplementation: A scientific rationale for improving the health and quality of life of dialysis patients. Med Hypotheses 2017; 99:1-14. [DOI: 10.1016/j.mehy.2016.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/03/2016] [Indexed: 12/19/2022]
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Bunn DK, Abdelhamid A, Copley M, Cowap V, Dickinson A, Howe A, Killett A, Poland F, Potter JF, Richardson K, Smithard D, Fox C, Hooper L. Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. BMC Geriatr 2016; 16:89. [PMID: 27142469 PMCID: PMC4855348 DOI: 10.1186/s12877-016-0256-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Methods We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). The review was conducted with service user input in accordance with Cochrane Collaboration’s guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively. Results We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions. Conclusions We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try. Trial registration The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611). Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0256-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK
| | - Maddie Copley
- Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, UK
| | - Vicky Cowap
- NorseCare, Lancaster House, 16 Central Avenue, St Andrew's Business Park, Norwich, NR7 0HR, UK
| | - Angela Dickinson
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Kate Richardson
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - David Smithard
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
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30
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Abdelhamid A, Bunn D, Copley M, Cowap V, Dickinson A, Gray L, Howe A, Killett A, Lee J, Li F, Poland F, Potter J, Richardson K, Smithard D, Fox C, Hooper L. Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC Geriatr 2016; 16:26. [PMID: 26801619 PMCID: PMC4722767 DOI: 10.1186/s12877-016-0196-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/12/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Eating and drinking difficulties are recognised sources of ill health in people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions to directly improve, maintain or facilitate oral food and drink intake, nutrition and hydration status, in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Interventions included oral nutrition supplementation, food modification, dysphagia management, eating assistance and supporting the social element of eating and drinking. METHODS We comprehensively searched 13 databases for relevant intervention studies. The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data, carrying out random effects meta-analysis and narrative synthesis. RESULTS Forty-three controlled interventions were included, disappointingly none were judged at low risk of bias. Oral nutritional supplementation studies suggested small positive short term but unclear long term effects on nutritional status. Food modification or dysphagia management studies were smaller and of low quality, providing little evidence of an improved nutritional status. Eating assistance studies provided inconsistent evidence, but studies with a strong social element around eating/drinking, although small and of low quality provided consistent suggestion of improvements in aspects of quality of life. There were few data to address stakeholders' questions. CONCLUSIONS We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. People with cognitive impairment and their carers have to tackle eating problems despite this lack of evidence, so promising interventions are listed. The need remains for high quality trials tailored for people with cognitive impairment assessing robust outcomes. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero.
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Affiliation(s)
- Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
- Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK.
| | - Diane Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Maddie Copley
- Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, UK.
| | - Vicky Cowap
- NorseCare, Lancaster House 16 Central Avenue St Andrew's Business Park, Norwich, NR7 0HR, UK.
| | - Angela Dickinson
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Lucy Gray
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Jin Lee
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Francesca Li
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - John Potter
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - Kate Richardson
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - David Smithard
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
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