Objective . In general population, resting heart rate (RHR) is associated with cardiovascular disease. However, its relation to chronic kidney disease (CKD) is debated. We therefore investigated the relationship between RHR and urinary albumin/creatinine ratio (UACR, an indicator of early kidney injury) in general population at different levels of blood pressure and blood glucose. Methods . We screened out 32,885 subjects from the REACTION study after excluding the subjects with primary kidney disease, heart disease, tumor history, related drug application, and important data loss. The whole group was divided into four groups (Q1: RHR≤71, Q2: 72≤RHR≤78, Q3: 79≤RHR≤86, and Q4: 87≤RHR) according to the quartile of average resting heart rate. The renal function was evaluated by UACR (divided by quartiles of all data in the center to which the subject belonged). Ordinary logistic regression was carried out to explore the association between RHR and UACR at diverse blood pressure and blood glucose levels. Results . The subjects with higher RHR quartile tend to have a higher UACR, even multifactors were adjusted. After stratifying the subjects according to blood pressure and blood glucose, the positive relationship between RHR and UACR remained in the subjects with normal blood pressure and normal glucose tolerance, while in the hypertension (SBP≥140mmHg and/or DBP≥90mmHg) group and the diabetic mellitus (FPG≥7.0mmol/L and/or PPG≥11.1mmol/L) group, the relationship disappeared. In the subjects without hypertension, compared with the Q1 group, the UACR is significant higher in the Q3 group (OR: 1.11) and the Q4 group (OR: 1.22). In the subjects with normal glucose tolerance (NGT), compared with the Q1 group, the UACR is significantly higher in the Q3 group (OR: 1.13) and the Q4 group (OR: 1.19). Conclusions . The population with higher RHR tend to have a higher UACR in the normal blood pressure group and the normal glucose tolerance group.
Objective To analyze association between different perioperative glycemic control strategies and postoperative outcomes in patients with diabetes undergoing cardiac surgery. Methods MEDLINE, Cochrane Library, Web of Science, EMBASE, Wanfang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases were searched from inception to January 31, 2019. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies, and consensus was reached by discussion with a third researcher. Results Six RCTs were included in the meta-analysis. We analyzed the effect of liberal (>180 mg/dl or 10.0 mmol/L), moderate (140–180 mg/dl or 7.8–10.0 mmol/L) and strict (<140 mg/dl or 7.8 mmol/L) glycemic control strategies in patients with diabetes undergoing cardiac surgery. The pooled results showed that strict glycemic control strategy was associated with a significant reduction in the risk of atrial fibrillation [OR = 0.48, 95%CI (0.32, 0.72), P < 0.001] and sternal wound infection [OR = 0.28, 95%CI (0.14, 0.54), P < 0.001], while there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes when compared with moderate control. In addition, there is no significant difference between moderate and liberal glycemic control strategies in postoperative mortality. However, moderate control was beneficial in reducing atrial fibrillation [OR = 0.28, 95%CI (0.13, 0.60), P = 0.001] compared with the liberal glycemic control strategy. Conclusions This meta-analysis showed when compared with moderate glycemic control strategy in patients with diabetes undergoing cardiac surgery, maintained strict glycemic control was associated with lower risk of atrial fibrillation and sternal wound infection. No benefit was found with liberal glycemic control strategy, so it could be a poor glycemic control strategy.
Abstract Background : The metabolic score for insulin resistance (METS-IR) is a novel noninsulin-based metabolic index used as a substitution marker of insulin resistance and for cardiovascular disease evaluation. However, whether METS-IR is associated with the urinary albumin–creatinine ratio (UACR) is not well known. Therefore, we explored the age- and sex-related associations between METS-IR and UACR and compared the discriminative ability of the METS-IR index and its components for elevated UACR. Methods : This study included 37,290 subjects from the REACTION study (Risk Evaluation of cAncers in Chinese diabeTic Individuals: a IONgitudinal study). METS-IR was calculated as follows:(Ln[2×fasting blood glucose{mg/dL}+fasting triglyceride level{mg/dL}]×body mass index)/(Ln [high-density lipoprotein cholesterol{mg/dL}]). Participants were divided into four groups on the basis of METS-IR: <25%, 25%–49%, 50%–74%, and ≥75%. Logistic regression analyses were conducted to determine the associations between METS-IR vs. its components{(fasting blood glucose(FBG), fasting triglyceride level, body mass index, and high-density lipoprotein cholesterol} with UACR. Results : Participants with the highest quartile METS-IR, particularly men,presented a more significant trend towards elevated UACR than towards its components (odds ratio [OR]: 1.260, 95% confidence interval [CI]:1.152–1.378, P<0.001 in all subjects; OR: 1.321, 95% CI: 1.104–1.579, P=0.002 in men; OR: 1.201, 95% CI: 1.083–1.330, P < 0.001 in women). There were significant associations between METS-IR and UACR in younger participants (<65 years for women and 55–64 years for men) and those with an estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2. Increased METS-IR was significantly associated with UACR in men with FBG ≥ 5.6 mmol/L or postprandial blood glucose ≥ 7.8 mmol/L and systolic blood pressure ≥ 120mmHg or diastolic blood pressure ≥ 80 mmHg. The relationships were significant in women with diabetes and hypertension. Conclusions : Increased METS-IR was significantly associated with elevated UACR, and its discriminative power for elevated UACR was superior to that of its components. The findings support the clinical significance of METS-IR for evaluating the cardiometabolic risk and renal function damage among Chinese adults.
Abstract Background: The burden of chronic kidney disease is increasing substantially worldwide. Neck circumference (NC), an anthropometric index for upper-body adiposity, has been recognized as an indicator of cardiometabolic diseases. However, the association between NC and renal dysfunction has not been fully disclosed. The aim of this study was to investigate the association between NC and estimated glomerular filtration rate (eGFR) in the general population in China. Methods: A total of 8805 participants (3322 men and 5483 women) were enrolled in this study. Logistic regression analysis was conducted to examine the association between NC and eGFR. The male and female subjects were divided into four groups according to the neck circumference quartiles. The primary outcome was defined as an eGFR ≤ 90 mL/min/1.73 m 2 . Results: Logistic regression analysis revealed that in both sexes, higher neck circumference was significantly associated with a higher risk of decreased eGFR even after fully adjusting for age; other anthropometric indexes, including body mass index and waist to hip ratio; traditional risk factors for chronic kidney diseases; and sociologic risk factors (Quartile1 as a reference; the odds ratios [95% confidence intervals] were as follows: Quartile 2, 1.26[0.99-1.59]; Quartile 3, 1.40[1.07-1.83]; Quartile 4, 1.71[1.22-2.38] in men; Quartile 2, 1.14[0.95-1.37]; Quartile 3, 1.31[1.03-1.66]; Quartile 4, 1.32[1.04-1.68] in women.) Stratified analyses suggested that the association was significant among subjects with prediabetes and those with normal serum uric acid levels. When the subjects were stratified according to blood pressure or BMI, the association persisted among male subjects with abnormal blood pressure and was strengthened among male subjects who were overweight/obese, while the association disappeared among female subjects. Conclusions: NC is independently associated with the risk of decreased eGFR in the general population in China, indicating that NC could contribute to renal dysfunction risk assessment.
Lipid accumulation product (LAP) as a powerful marker of visceral obesity is an independent risk factor of chronic kidney disease. The present study attempted to explore the association between LAP and albuminuria in prediabetic individuals.We conducted a cross-sectional study and enrolled 26,529 participants with prediabetes over 40 years old with prediabetes from seven provinces in China. LAP was calculated from waist circumference and fasting triglycerides. Elevated albuminuria was defined by urinary albumin-creatinine ratio (uACR) ≥30 mg/g. Propensity score matching was applied to reduce bias, comparison between LAP and other traditional visceral obesity indices was performed and multiple logistic regression models were conducted to assess the association between LAP and albuminuria in the prediabetic population.Individuals with uACR ≥30 mg/g were older and had higher BP, BMI, WC, TG, fasting insulin, glycohemoglobin and LAP, as well as lower eGFR and HDL level. Multiple logistic regression analysis showed elevated LAP was associated with increased odds of albuminuria (OR [95%CI]Q2 vs Q1 1.09 [0.94, 1.27], OR [95%CI]Q3 vs Q1 1.13 [0.97, 1.31], OR [95%CI]Q4 vs Q1 1.42 [1.21, 1.67], P for trend=0.018), and superior over waist-to-hip ratio or waist-to-height ratio. Stratification indicated that the prediabetic population with higher LAP level and characterized by female gender, middle age, being overweight, and rise in blood pressure were more likely to have increased uACR.Elevated level of LAP was associated with increased albuminuria in the prediabetic population in China.
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