Introduction: As part of its 2020 Impact Goals, the AHA developed the Life’s Simple 7 metric for cardiovascular health promotion. The metric consists of ideal categories for smoking, physical activity, diet, body mass index, blood pressure, blood cholesterol, and blood glucose; and its relationship with risk of chronic kidney disease (CKD) is unknown. Hypothesis: Ideal levels of health factors and the overall Life’s Simple 7 metric are associated with lower risk of developing CKD. Methods: We prospectively analyzed 15,436 Atherosclerosis Risk in Community study participants without CKD at baseline (1987-1989). Ideal levels of health factors were: non-smoker or quit >1 year ago; body mass index <25 kg/m 2 ; ≥150 minutes/week of physical activity; dietary pattern which is high in fruits and vegetables, fish, and fiber-rich whole grains, and low in sodium and sugar-sweetened beverages; total cholesterol <200 mg/dL; blood pressure <120/90 mmHg; and blood glucose <100 mg/dL. Incident CKD was defined as development of estimated glomerular filtration rate <60 mL/min/1.73 m 2 accompanied by 25% decline from baseline, hospitalization or death due to CKD, or end-stage renal disease defined by linkage with the U.S. Renal Data System. Cox regression was used to estimate associations between health factors, the overall metric, and CKD risk while adjusting for age, sex, race, and baseline kidney function. Results: At baseline, mean age was 54 years, 55% were women, and 26% were African-American. There were 2,861 incident CKD cases over a median follow-up of 22 years. Smoking, body mass index, physical activity, blood pressure, and blood glucose were associated with lower CKD risk (all p≤0.01), but diet and blood cholesterol were not. CKD risk was inversely related to the number of ideal health factors ( Figure ; p-trend<0.001; AUC: 0.7001 vs. 0.6804, p<0.001). Conclusions: The AHA Life’s Simple 7 metric, developed to measure and promote cardiovascular health, predicts reduced CKD risk.
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Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents …
Introduction: End-stage kidney disease (ESKD) is an important clinical outcome. However, there is limited work on validating algorithms to detect ESKD cases within electronic health record (EHR) data. Hypothesis: Algorithms using diagnostic and procedure codes in EHR data can accurately identify ESKD cases. Methods: Using data from Geisinger linked to the United States Renal Data System (USRDS), we developed algorithms to identify individuals with ESKD (either dialysis or kidney transplant, whichever occurred first) and validated them against ESKD cases ascertained from the USRDS data from January 1, 1996, through June 28, 2018 (gold standard). We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: To identify dialysis cases, we required 1) diagnosis codes of stage 5 chronic kidney disease or ESKD with dialysis codes within seven days or 2) three dialysis codes lasted longer than a month with any two consecutive codes occurring within 3 months. To identify kidney transplant cases, we required 1) one procedure code of kidney transplant or 2) one diagnosis code of kidney transplant in inpatients or problem list. Among 572,574 individuals (mean age, 41.6 years; female, 55.4%; White, 92.9%), the algorithms identified 4,187 ESKD cases (3,875 dialysis and 792 kidney transplant cases), while there were 4,529 ESKD cases (4,368 dialysis and 772 kidney transplant cases) by USRDS data. Our ESKD identifying algorithms’ sensitivity, specificity, PPV, and NPV were 71.1%, 99.8%, 76.9%, and 99.8%, respectively. Median (interquartile range) duration between incident dates by the algorithm and by the USRDS was -2 (-21, 86) days ( Table ). Conclusions: The algorithms developed by diagnostic and procedure codes accurately identified ESKD cases with high specificity in EHR data. Further validation is required in different health systems. Table The validity of the algorithms to identify ESKD cases IQR: interquartile range
Transplant patients have poor outcomes in coronavirus-disease 2019 (COVID-19). The pandemic's effects on rural patients' overall care experience, attitudes to telemedicine, and vaccination are poorly understood.We administered a cross-sectional survey to adult kidney transplant recipients in central Pennsylvania across four clinical sites between March 29, 2021 and June 2, 2021. We assessed the pandemic's impact on care access, telemedicine experience, attitudes toward preventive measures, vaccination, and variation by sociodemographic variables.Survey completion rate was 51% (303/594). Of these, 52.8% were rural residents. The most common impact was use of telemedicine (79.2%). Predominant barriers to telemedicine were lack of video devices (10.9%), perceived complexity (5.6%), and technical issues (5.3%). On a 0-10 Likert scale, the mean positive impression for telemedicine was 7.7; lower for patients with telephone-only versus video visits (7.0 vs. 8.2; p < .001), and age ≥60 years (7.4 vs. 8.1; p = .01) on univariate analyses. Time/travel savings were commonly identified (115/241, 47.7%) best parts of telemedicine and lack of personal connection (70/166, 42.2%) the worst. Only 68.9% had received any dose of COVID vaccination. The vaccinated group members were older (58.4 vs. 53.5 years; p = .007), and less likely rural (47.8% vs. 65.2%; p = .005). Common themes associated with vaccine hesitancy included concerns about safety (27/59, 46%), perceived lack of data (19/59, 32%), and distrust (17/59, 29%). At least one misconception about the vaccines or COVID-19 was quoted by 29% of vaccine-hesitant patients.Among respondents, the pandemic significantly impacted healthcare experience, especially in older patients in underserved communities. COVID-19 vaccination rate was relatively low, driven by misconceptions and lack of trust.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are new medications that improve cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). However, the Food and Drug Administration has issued alerts regarding increased acute kidney injury (AKI) risk with canagliflozin and dapagliflozin. We aimed to assess the real-world risk of AKI in new SGLT2 inhibitor users in two large health care utilization cohorts of patients with T2D.
Bilateral breast carcinomas may represent contralateral metastases or new primary tumors. The presence of carcinoma in situ, a lower grade, or a different histotype in the second tumor is considered a clinical criterion for a second primary tumor. In this study, 26 bilateral breast carcinomas from 13 patients were analyzed based on clinical criteria, and the results were compared with those obtained by partial allelotyping using 47 markers at 7 chromosomal arms. Of the 8 synchronous tumors, 5 were concluded to be distinct primary tumors using clinical criteria; some were confirmed by partial allelotyping. In the remaining 3 cases, partial allelotyping showed distinct primary tumors. Five patients had metachronous carcinomas with 3 distinct primary tumors, 1 metastasis, and 1 that was uncertain by clinical criteria. Three cases were confirmed by partial allelotyping, and the uncertain case was shown to be distinct primary tumors. No discrepant results were noted. Stringent application of clinical criteria is accurate for differentiating second primary tumors from metastases.
Background: Albuminuria is strongly associated with elevated risk of cardiovascular disease (CVD). While the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure (BP) lowering reduces CVD in high-risk non-diabetic adults, it is unclear whether this effect varies by albuminuria status. Methods: SPRINT randomized non-diabetic adults with elevated blood pressure and increased CVD risk to a systolic BP (SBP) goal of <120 or <140 mmHg. Albuminuria (>=30 mg/g) was measured by albumin/creatinine ratio (ACR) at baseline. Outcomes examined included the primary composite CVD outcome (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from CVD) and all-cause death. Results: A total of 8913/9361 (95.2%) participants had baseline ACR data; 51.9%, 28.7%, and 19.4% had baseline ACR < 10, 10-29.9, and >=30 mg/g, respectively. The primary composite outcome occurred in 4.0%, 6.7%, and 11.2% of individuals with baseline ACR <10, 10-29.9, and >=30 mg/g, respectively. The effect of intensive BP lowering on the primary outcome was similar in patients with albuminuria (HR 0.74, 95% CI: 0.55-0.99) and without albuminuria (HR 0.73, 95% CI: 0.59-0.91; p for interaction = 0.77). Intensive BP lowering reduced risk of stroke in patients with albuminuria (HR 0.45, 95% CI: 0.24-0.85) but not patients without albuminuria (1.13, 95% CI: 0.73-1.74; p for interaction = 0.03). Absolute risk reduction was particularly high in those with albuminuria, with a number needed to treat (NNT) of 32 to prevent 1 primary outcome and a NNT of 37 to prevent 1 death from any cause at 3 years of follow-up. By comparison, the NNT to prevent 1 primary outcome was 72 for ACR < 30 mg/g at 3 years of follow-up. Conclusions: The effect of Intensive BP lowering reduces CVD risk similarly in non-diabetic adults with and without albuminuria. Given the high CVD risk in patients with albuminuria, this high-risk population may particularly benefit from efforts to intensify BP control.
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