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Biomedical subjects

Gary C Curhan

Publications and source records attributed to Gary C Curhan.

At least 55 records · Page 3Linked to original sources
PubMed2004

Postmenopausal hormone therapy and risk of developing urinary incontinence.

OBJECTIVE: To better understand associations between post-menopausal hormone therapy and the development of urinary incontinence. METHODS: Postmenopausal hormone use was assessed via biennial mailed questionnaires beginning in 1976 among Nurses' Health Study participants. In 1996, 39,436 post-menopausal women aged 50-75 years reported no leaking of urine and were followed-up for 4 years to identify incident cases of incontinence. We used logistic regression to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relation of postmenopausal hormone use from 1976 to 1996 to the development of incontinence from 1996 to 2000. RESULTS: We identified 5,060 incident cases of occasional (leaking urine 1-3 times/month) and 2,495 cases of frequent incontinence (leaking at least weekly) for average yearly incidence rates of 3.2% and 1.6%, respectively. The risk of incontinence was elevated among women taking postmenopausal hormones compared with women who had never taken hormones (oral estrogen: RR 1.54, 95% CI 1.44, 1.65; transdermal estrogen: RR 1.68, 95% CI 1.41, 2.00; oral estrogen with progestin: RR 1.34, 95% CI 1.24, 1.44; transdermal estrogen with progestin: RR 1.46, 95% CI 1.16, 1.84). There was little risk after the cessation of hormones (RR 1.14, 95% CI 1.06, 1.23) and a decreasing risk of incontinence with increasing time since last hormone use; 10 years after stopping hormones, the risk was identical in women who had and had never taken hormone therapy (RR 1.02, 95% CI 0.91, 1.14). CONCLUSION: Postmenopausal hormone therapy appears to increase risk of developing urinary incontinence. This risk does not vary by route of administration, type of hormones, or dose taken, but is diminished upon cessation of use. LEVEL OF EVIDENCE: II-2

Age Distribution↗
PubMed2004

Kidney dysfunction, inflammation, and coronary events: a prospective study.

Kidney dysfunction and high C-reactive protein (CRP) levels are independently associated with coronary events. However, it is unclear whether the risk of coronary events associated with decreased kidney function is at least partially mediated by inflammation and whether the association between inflammatory biomarkers and coronary events is influenced by level of kidney function. With the use of a prospective, nested, case-control study design, the association among kidney function, inflammatory biomarker levels, and coronary events was studied. A total of 244 women who were participants in the Nurses' Health Study and had no history of cardiovascular disease received a diagnosis of an incident coronary event (defined as nonfatal myocardial infarction or death as a result of coronary disease) during the follow-up period from 1990 to 1998 and were matched to 486 control subjects. Serum creatinine and inflammatory biomarker levels were measured in blood samples collected in 1989. Creatinine clearance (CrCl) was estimated using creatinine, age, weight, and height. In multivariate analyses, the odds ratio (OR) for a coronary event in women with an estimated CrCl <60 ml/min was 2.33 (95% confidence interval [CI], 1.01 to 5.38) compared with those with a CrCl > or =90 ml/min. When soluble tumor necrosis factor receptor (sTNFR) I and II levels were added into this model individually, the observed OR for women with CrCl <60 ml/min was attenuated. In analyses stratified by estimated CrCl, higher high-sensitivity CRP (hs-CRP), IL-6, and sTNFR I and II levels each were significantly associated with an increased odds of coronary events in women with an estimated CrCl < or =74 ml/min but not in women with an estimated CrCl > or =75 ml/min. The OR per 5-mg/L unit increase in hs-CRP was 1.68 (95% CI, 1.13 to 2.52) for women with an estimated CrCl < or =74 ml/min, compared with 1.23 (95% CI, 0.86 to 1.76) and 0.99 (95% CI, 0.76 to 1.29) for women with an estimated CrCl 75 to 89 and > or =90 ml/min, respectively (P = 0.004 for interaction). In conclusion, kidney dysfunction is associated with an increased odds of coronary events, and inflammation, as assessed by higher sTNFR I and II levels, may mediate some of this risk. Higher inflammatory biomarkers levels, specifically, hs-CRP, IL-6, and sTNFR I and II, were significantly associated with coronary events only in women with reduced kidney function. These findings warrant further investigation in other populations.

Adult↗
PubMed2004

Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up.

Diet plays an important role in the pathogenesis of kidney stones. Because the metabolism of many dietary factors, such as calcium, may change with age, the relation between diet and kidney stones may be different in older adults. Uncertainty also remains about the association between many dietary factors, such as vitamin C, magnesium, and animal protein, and the risk of kidney stone formation. To examine the association between dietary factors and the risk of incident, symptomatic kidney stones in men and to determine whether these associations vary with age, a prospective cohort study was conducted of 45,619 men without a history of nephrolithiasis. Self-administered food frequency questionnaires were used to assess diet every 4 yr. A total of 1473 incident symptomatic kidney stones were documented during 477,700 person-years of follow-up. For men aged <60 yr, the multivariate relative risk (RR) for stone formation in the highest quintile of dietary calcium as compared with the lowest quintile was 0.69 (95% confidence interval [CI], 0.56 to 0.87; P = 0.01 for trend). By contrast, there was no association between dietary calcium and stone formation in men aged 60 yr or older. The multivariate RR for men who consumed 1000 mg or greater of vitamin C per day compared with those who consumed less than the recommended dietary allowance of 90 mg/d was 1.41 (95% CI, 1.11 to 1.80; P = 0.01 for trend). Other dietary factors showed the following multivariate RR among men in the highest quintile of intake compared with those in the lowest: magnesium, 0.71 (95% CI, 0.56 to 0.89; P = 0.01 for trend); potassium, 0.54 (95% CI, 0.42 to 0.68; P < 0.001 for trend); and fluid, 0.71 (95% CI, 0.59 to 0.85; P < 0.001 for trend). Animal protein was associated with risk only in men with a body mass index <25 kg/m(2) (RR, 1.38; 95% CI, 1.05 to 1.81; P = 0.03 for trend). Sodium, phosphorus, sucrose, phytate, vitamin B(6), vitamin D, and supplemental calcium were not independently associated with risk. In conclusion, the association between calcium intake and kidney stone formation varies with age. Magnesium intake decreases and total vitamin C intake seems to increase the risk of symptomatic nephrolithiasis. Because age and body size affect the relation between diet and kidney stones, dietary recommendations for stone prevention should be tailored to the individual patient.

Adult↗
PubMed2004

Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement.

BACKGROUND: It is well known that serum creatinine may be used as a marker of renal function only if taking into account factors that influence creatinine production, such as age, gender, and weight. Serum cystatin C has been proposed as a potentially superior marker than serum creatinine, because serum cystatin C level is believed to be produced at a constant rate and not to be affected by such factors. However, there are limited data on factors that may influence serum cystatin C levels, and there are limited data comparing cystatin C-based estimates of renal function with creatinine-based estimates that adjust for such factors, especially in individuals with normal, or mildly reduced, renal function. METHODS: This was a cross-sectional study of 8058 inhabitants of the city of Groningen, The Netherlands, 28 to 75 years of age. Serum cystatin C and serum creatinine levels were measured, and creatinine clearance was determined from the average of two separate 24-hour urine collections. We performed multivariate analyses to identify factors independently associated with serum cystatin C levels after adjusting for creatinine clearance. Then, partial Spearman correlations were obtained after adjusting for factors that may influence serum cystatin C and creatinine levels. We also compared the goodness-of-fit (R(2)) of different multivariate linear regression models including serum cystatin C level and serum creatinine level for the outcome of creatinine clearance. RESULTS: Older age, male gender, greater weight, greater height, current cigarette smoking, and higher serum C-reactive protein (CRP) levels were independently associated with higher serum cystatin C levels after adjusting for creatinine clearance. After adjusting for age, weight, and gender, the partial Spearman correlations between creatinine and, respectively, serum cystatin C level and serum creatinine level were -0.29 (P < 0.001) and -0.42 (P < 0.001), respectively. The R(2) values for serum cystatin C level and serum creatinine level adjusted for age, weight, and gender were 0.38 and 0.42, respectively. The addition of cigarette smoking and serum CRP levels did not improve the R(2) value for the multivariate serum cystatin C-based model. CONCLUSION: Serum cystatin C appears to be influenced by factors other than renal function alone. In addition, we found no evidence that multivariate serum cystatin C-based estimates of renal function are superior to multivariate serum creatinine-based estimates.

Adult↗
PubMed2004

Gemfibrozil for secondary prevention of cardiovascular events in mild to moderate chronic renal insufficiency.

BACKGROUND: Although cardiovascular disease and low high-density lipoprotein (HDL) cholesterol are common in people with renal insufficiency, data addressing the cardiovascular benefits of fibric acid derivatives in this population are sparse. We conducted a post hoc subgroup analysis of a randomized double-blind, placebo-controlled trial to determine whether gemfibrozil is effective and safe for secondary prevention of cardiovascular events in individuals with chronic renal insufficiency (CRI). METHODS: Using an analysis plan that was developed a priori, we analyzed data from the Veterans' Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) study; a randomized trial of gemfibrozil versus placebo in 2531 men with established coronary disease, an HDL cholesterol level of 40 mg/dL (1.0 mmol/L) or less, and a low-density lipoprotein (LDL) cholesterol level of 140 mg/dL (3.6 mmol/L) or less. Of these, 1046 men had CRI as defined by creatinine clearance </=75 mL/min using the Cockcroft-Gault equation, 99.8% of whom had either mild or moderate renal impairment (creatinine clearance 60-75 or 30-59.9 mL/min, respectively). RESULTS: The incidence of the primary outcome (coronary death or nonfatal myocardial infarction) was lower in participants with CRI who received gemfibrozil compared to placebo [hazard ratio (HR) 0.73; 95% CI 0.56-0.96, P= 0.02). The cumulative incidence of the primary end point was reduced from 24.3% to 18.2%. In subjects with CRI, gemfibrozil also significantly reduced the risk of the combined outcome of coronary death, nonfatal myocardial infarction, or stroke (HR 0.74, 95% CI 0.58-0.95, P= 0.02), but not the need for coronary revascularization (HR 0.85, 95% CI 0.66-1.10, P= 0.21) or total mortality (HR 1.03, 95% CI 0.78-1.35, P= 0.85). The overall incidence of adverse effects was similar in individuals receiving gemfibrozil and placebo. However, the risk of sustained increases in serum creatinine was increased in gemfibrozil recipients compared with placebo (5.9 vs. 2.8%, P= 0.02). CONCLUSION: Gemfibrozil appears effective for secondary prevention of cardiovascular events in individuals with mild to moderate chronic renal insufficiency and HDL cholesterol of 40 mg/dL or less. However, the benefit and safety of gemfibrozil in people with more severe impairment of kidney function requires further study.

Aged↗
PubMed2004

Role of nutrition in the formation of calcium-containing kidney stones.

Diet plays an important role in the pathogenesis of calcium-containing kidney stones. Although much work has demonstrated that specific dietary components alter urinary composition and supersaturation, relatively few studies link the ingestion of these components with actual nephrolithiasis. This article reviews the dietary factors thought to promote or inhibit the formation of calcium stones and discusses the current controversies in the field of nutrition and nephrolithiasis. Special attention is paid to the roles of dietary calcium, supplemental calcium, oxalate, phytate, and n-3 fatty acids. We offer dietary recommendations to individuals who have suffered from a calcium-containing kidney stone, and emphasize that a patient's 24-hour urine chemistries should be used to help guide dietary intervention.

Animals↗
PubMed2004

Drawbacks of the use of indirect estimates of renal function to evaluate the effect of risk factors on renal function.

Many epidemiologic studies presently aim to evaluate the effect of risk factors on renal function. As direct measurement of renal function is cumbersome to perform, epidemiologic studies generally use an indirect estimate of renal function. The consequences of using different methods of renal function measurement in studies that evaluate the effect of cardiovascular risk factors on renal function were questioned. Data of the 8592 Prevention of Renal and Vascular End-stage Disease study participants, in whom the association was plotted between various cardiovascular risk factors and renal function measured either by creatinine clearance based on two 24-h urine collections or by the Cockcroft-Gault or Modification of Diet in Renal Disease formula were used. A repeated measurement analysis was used to compare the slopes of the linear regression lines of the risk factors and the different methods of renal function measurements. The relation between cardiovascular risk factors and renal function seems to be different when different methods for renal function are used. This was most pronounced for age, weight, and body mass index and less pronounced (but still statistical significant) for BP, cholesterol, and glucose. The relation between weight or body mass index and renal function showed completely different directions, depending on the renal function method used. In conclusion, the interpretation of the relation of cardiovascular risk factors and renal function is affected by the method selected to estimate renal function. For studying the relation of risk factors and renal function in large population studies, indirect estimates of renal function should be used with caution.

Body Mass Index↗
PubMed2004

Effect of gemfibrozil on change in renal function in men with moderate chronic renal insufficiency and coronary disease.

BACKGROUND: Limited data suggest that low levels of serum high-density lipoprotein cholesterol (HDL-C) and high levels of triglyceride-rich lipoproteins may be associated with more rapid rates of kidney function loss in individuals with chronic renal insufficiency (CRI). Although fibric acid derivatives increase serum HDL-C levels and decrease triglyceride levels, their effects on renal function are largely unknown. We conducted this study to determine whether gemfibrozil reduced rates of renal function loss in people with moderate CRI. METHODS: This was a post hoc subgroup analysis in the Veterans Affairs High-Density Lipoprotein Intervention Trial, a randomized double-blind trial of gemfibrozil versus placebo in 2,531 men with coronary disease, HDL-C levels of 40 mg/dL or less (< or =1.0 mmol/L), low-density lipoprotein cholesterol levels of 140 mg/dL or less (< or =3.6 mmol/L), and a range of triglyceride values. Moderate CRI is defined as estimated glomerular filtration rate (GFR) of 30 to 59.9 mL/min/1.73 m2 at baseline. Multivariate regression was used to calculate rates of decline in estimated GFR for individuals administered gemfibrozil or placebo, controlling for prospectively determined potential confounders. RESULTS: Change in renal function could be calculated in 1,981 individuals, of whom 399 individuals (20.2%) were eligible for inclusion. Among 399 study subjects, the rate of change in renal function in the gemfibrozil group during a median of 61 months was not significantly different from that in the placebo group (0.49 mL/min/1.73 m2/y faster; 95% confidence interval, 0.09 slower to 1.09 faster; P = 0.10). No clinically relevant effect of gemfibrozil on renal function was observed in groups defined by baseline lipid levels, kidney function, diabetic status, or other components of the metabolic syndrome. The incidence of transient (10% versus 4%; P = 0.01), but not sustained (9% versus 4%; P = 0.07), increases in serum creatinine levels of 0.5 mg/dL or greater (> or =44 micromol/L) was significantly greater in the gemfibrozil group. However, in 5 subjects with acute increases in serum creatinine levels, serum creatine kinase levels were significantly elevated as well, suggesting that myocyte toxicity may have been responsible. Even when these individuals were excluded, no clinically significant effect of gemfibrozil on kidney function was observed. CONCLUSION: Gemfibrozil does not appear to exert a clinically relevant effect on rates of kidney function loss in individuals with moderate CRI, low HDL-C levels, and concomitant coronary disease.

Aged↗
PubMed2003

Mild renal insufficiency and risk of congestive heart failure in men and women > or =70 years of age.

Mild renal insufficiency is increasingly recognized as an independent risk factor for cardiovascular disease. However, few data exist regarding its relation to risk of congestive heart failure (CHF), a major public health problem in the elderly. To determine if mild renal insufficiency is associated with risk of incident CHF in the elderly, we analyzed data from 3,618 participants in the prospective, community-based Established Populations for Epidemiologic Studies of the Elderly (EPESE), who had no known CHF and had serum creatinine levels measured from 1987 to 1989. Mean age of the study population was 78.3 +/- 5.4 years; 84% had creatinine values <1.5 mg/dl and 98% had creatinine values < or =2.0 mg/dl. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation. During 3.9 years of follow-up, 488 subjects developed incident CHF as defined by hospital discharge and death certificate data. In a multivariate proportional hazards model, CrCl was inversely associated with CHF risk (p value for trend <0.001). Those in the lowest quartile of CrCl (< or =36.9 ml/min) had a nearly twofold (hazards ratio [HR] 1.99, 95% confidence intervals [CI] 1.43 to 2.79) greater risk of incident CHF compared with those in the highest quartile (>57.4 ml/min). Renal insufficiency, defined as creatinine > or =1.5 mg/dl in men and > or =1.3 mg/dl in women, was also associated with increased CHF risk (multivariate HR 1.43, 95% CI 1.17 to 1.74). Thus, mild renal insufficiency was a strong independent predictor of CHF in this cohort, suggesting that serum creatinine may offer a readily accessible tool to identify elderly patients at risk for CHF.

Age Factors↗
PubMed2003

The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency.

BACKGROUND: In individuals with moderate to severe renal insufficiency, low protein intake may slow renal function decline. However, the long-term impact of protein intake on renal function in persons with normal renal function or mild renal insufficiency is unknown. OBJECTIVE: To determine whether protein intake influences the rate of renal function change in women over an 11-year period. DESIGN: Prospective cohort study. SETTING: Nurses' Health Study. PARTICIPANTS: 1624 women enrolled in the Nurses' Health Study who were 42 to 68 years of age in 1989 and gave blood samples in 1989 and 2000. Ninety-eight percent of women were white, and 1% were African American. MEASUREMENTS: Protein intake was measured in 1990 and 1994 by using a semi-quantitative food-frequency questionnaire. Creatinine concentration was used to estimate glomerular filtration rate (GFR) and creatinine clearance. RESULTS: In multivariate linear regression analyses, high protein intake was not significantly associated with change in estimated GFR in women with normal renal function (defined as an estimated GFR > or = 80 mL/min per 1.73 m2). Change in estimated GFR in this subgroup over the 11-year period was 0.25 mL/min per 1.73 m2 (95% CI, -0.78 to 1.28 mL/min per 1.73 m2) per 10-g increase in protein intake; the change in estimated GFR was 1.14 mL/min per 1.73 m2 (CI, -3.63 to 5.92 mL/min per 1.73 m2) after measurement-error adjustment for protein intake. In women with mild renal insufficiency (defined as an estimated GFR > 55 mL/min per 1.73 m2 but <80 mL/min per 1.73 m2), protein intake was significantly associated with a change in estimated GFR of -1.69 mL/min per 1.73 m2 (CI, -2.93 to -0.45 mL/min per 1.73 m2) per 10-g increase in protein intake. After measurement-error adjustment, the change in estimated GFR was -7.72 mL/min per 1.73 m2 (CI, -15.52 to 0.08 mL/min per 1.73 m2) per 10-g increase in protein intake, an association of borderline statistical significance. High intake of nondairy animal protein in women with mild renal insufficiency was associated with a significantly greater change in estimated GFR (-1.21 mL/min per 1.73 m2 [CI, -2.34 to -0.33 mL/min per 1.73 m2] per 10-g increase in nondairy animal protein intake). CONCLUSIONS: High protein intake was not associated with renal function decline in women with normal renal function. However, high total protein intake, particularly high intake of nondairy animal protein, may accelerate renal function decline in women with mild renal insufficiency.

Adult↗
PubMed2003

Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease. We compared the incidence rates of myocardial infarction and stroke in subjects with and without rheumatoid arthritis. METHODS AND RESULTS: A prospective cohort study was conducted among the 114 342 women participating in the Nurses' Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976. All self-reported cases of rheumatoid arthritis were confirmed by medical record review. Fatal and nonfatal myocardial infarctions and strokes were similarly confirmed. Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors. Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infarctions and strokes were confirmed during 2.4 million person-years of follow-up. The adjusted relative risk of myocardial infarction in women with rheumatoid arthritis compared with those without was 2.0 (95% confidence interval [CI], 1.23 to 3.29). For stroke, the adjusted relative risk was 1.48 (95% CI, 0.70 to 3.12). Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infarction of 3.10 (95% CI, 1.64 to 5.87). CONCLUSION: In this large prospective cohort of women, participants with rheumatoid arthritis had a significantly increased risk of myocardial infarction but not stroke compared with those without rheumatoid arthritis. If these data are confirmed, aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis.

Adult↗
PubMed2003

Time trends in reported prevalence of kidney stones in the United States: 1976-1994.

BACKGROUND: A body of evidence establishes that the occurrence of kidney stone disease has increased in some communities of industrialized countries. Information on recent temporal trends in the United States is lacking and population-based data on epidemiologic patterns are limited. Study objective was to determine whether kidney stone disease prevalence increased in the United States over a 20-year period and the influence of region, race/ethnicity, and gender on stone disease risk. METHODS: We measured the prevalence of kidney stone disease history from the United States National Health and Nutrition Examination Survey (II and III), population-based, cross-sectional studies, involving 15,364 adult United States residents in 1976 to 1980 and 16,115 adult United States residents in 1988 to 1994. RESULTS: Disease prevalence among 20- to 74-year-old United States residents was greater in 1988 to 1994 than in 1976 to 1980 (5.2% vs. 3.8%, P < 0.05), greater in males than females, and increased with age in each time period. Among 1988 to 1994 adults, non-Hispanic African Americans had reduced risk of disease compared to non-Hispanic Caucasians (1.7% vs. 5.9%, P < 0.05), and Mexican Americans (1.7% vs. 2.6%, P < 0.05). Also, age-adjusted prevalence was highest in the South (6.6%) and lowest in the West (3.3%). Findings were consistent across gender and multivariate adjusted odds ratios for stone disease history, including all demographic variables, as well as diuretic use, tea or coffee consumption, and dietary intake of calcium, protein, and fat did not materially change the results. CONCLUSION: Prevalence of kidney stone disease history in the United States population increased between 1980 and 1994. A history of stone disease was strongly associated with race/ethnicity and region of residence.

Adult↗
PubMed2003

The association between mental health, physical function, and hemodialysis mortality.

BACKGROUND: Mortality rates for individuals on chronic hemodialysis remain very high; therefore, strategies are needed to identify individuals at greatest risk for mortality so preventive strategies can be implemented. One such approach is to stratify individuals by self-reported mental health and physical function. Examining these parameters at baseline, and over time, may help identify individuals at greater risk for mortality. METHODS: We enrolled 14,815 individuals with end-stage renal disease (ESRD) and followed these individuals for up to 2 years. The mean age was 61.0 +/- 15.4 years (range, 20 to 96 years) and 31% were African Americans. The SF-36 Health Survey was administered 1 to 3 months after hemodialysis initiation and 6 months later. We examined the associations between the initial SF-36 Health Survey mental component summary (MCS) and physical component summary (PCS) scores and mortality during the follow-up period, and examined the associations between 6-month decline in PCS and MCS scores and subsequent mortality. We also examined the interactions between age and MCS and PCS scores. The general population-based mean of each of these scores was 50 with a standard deviation of 10. The main outcome measurement was death. RESULTS: Self-reported baseline mental health (MCS score) and physical function (PCS score) were both independently associated with increased mortality, and 6-month decline in these parameters was also associated with increased mortality. The multivariate hazard ratios for 1-year mortality for MCS scores of less than 30, 30 to 39, and 40 to 49 were 1.48 (95% CI, 1.32 to 1.64), 1.23 (95% CI, 1.14 to 1.32) and 1.18 (95% CI, 1.10 to 1.26) compared with a MCS score of 50 or more. The hazard ratios for PCS scores of less than 20, 20 to 29, and 30 to 39 were 1.97 (95% CI, 1.64 to 2.36), 1.62 (95% CI, 1.36 to 1.92), and 1.32 (95% CI, 1.11 to 1.57) compared with a PCS score of 50 or more. Six-month decline in self-reported mental health (hazard ratio, 1.07; 95% CI, 1.02 to 1.12, per 10-point decline in MCS score) and physical function (hazard ratio, 1.25; 95% CI, 1.18 to 1.33, per 10-point decline in PCS score) were also both significantly associated with an additional increase in mortality beyond baseline risk. We also found a significant interaction between age and physical function (P = 0.02). Specifically, there was a graded response between the PCS score category and mortality in most age strata, but this relationship was not observed in the oldest age (85 years old or older). CONCLUSION: In individuals newly initiated on chronic hemodialysis, self-reported baseline mental health and physical function are important, independent predictors of mortality, and there is a graded relationship between these parameters and mortality risk. Following these parameters over time provides additional information on mortality risk. One must also consider age when interpreting the relationship between physical function and mortality.

Adult↗
PubMed2003

The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study.

Approximately 10 million adults in the United States have experienced the passage of a kidney stone, and up to 5 million have been diagnosed with gout by a physician. Previous reports have suggested that gout increases the risk for the development of kidney stones, but there are no prospective data. We used data from a cohort of 51,529 male health care professionals to examine the independent association between gout and kidney stone disease. In a cross-sectional analysis of gout and kidney stone disease reported on the 1986 baseline questionnaire, the prevalence of kidney stone disease was almost twofold higher in men with history of gout compared to those without (15% vs. 8%). After adjusting for age and body mass index (BMI), a history of gout remained significantly associated with kidney stone disease (OR 1.88; 95% CI 1.68 to 2.11). We then prospectively examined the risk of incident kidney stones in men with and without a confirmed diagnosis of gout after excluding men who reported a history of kidney stone disease or gout on the baseline questionnaire. A confirmed diagnosis of gout increased the multivariate relative risk of incident kidney stones (RR 2.12; 95% CI 1.22 to 3.68). In contrast, a history of kidney stone disease was not associated with increased risk of gout (RR 1.05; 95% CI 0.54 to 2.07). In conclusion, a history of gout independently increases the risk for incident kidney stones in men. Physicians should provide dietary counseling, such as increasing fluid intake and decreasing salt consumption, to subjects with gout in addition to other risk factors, such as family history of kidney stones, in order to decrease the likelihood of stone formation.

Adult↗
PubMed2003

High-normal blood pressure and microalbuminuria.

BACKGROUND: High-normal blood pressure (BP) is associated with increased cardiovascular risk compared with optimal BP, but no study has specifically examined the association between high-normal BP and microalbuminuria, an established predictor of future cardiovascular events. METHODS: This was a cross-sectional study of normotensive (systolic BP [SBP] < 140 mm Hg, diastolic BP [DBP] < 90 mm Hg) individuals without diabetes with no hypertension history enrolled in the Third National Health and Nutrition Examination Survey. BP was categorized as high normal (SBP, 130 to 139 mm Hg or DBP, 85 to 89 mm Hg), normal (SBP, 120 to 129 mm Hg or DBP, 80 to 84 mm Hg), and optimal (SBP < 120 mm Hg and DBP < 80 mm Hg). We also separately examined SBP, DBP, mean arterial pressure (MAP), and pulse pressure. Microalbuminuria was defined using sex-specific cutoff values (urine albumin-creatinine ratio > or = 17 and < or = 250 microg/mg [> or =1.0 and < or =28 mg/mmol] for men and > or = 25 and < or = 355 microg/mg for women [> or =3 and < or =40 mg/mmol]). We used multivariate logistic regression to analyze the association between different BP measurements and microalbuminuria. RESULTS: Compared with optimal BP, high-normal BP was significantly associated with increased odds of microalbuminuria (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.51 to 3.01). Similarly, MAP (OR, 1.41; 95% CI, 1.15 to 1.74 per 10-mm Hg increment), SBP (OR, 1.27; 95% CI, 1.09 to 1.48 per 10-mm Hg increment), and DBP (OR, 1.29; 95% CI, 1.06 to 1.57 per 10-mm Hg increment) were significantly associated with microalbuminuria. CONCLUSION: High-normal BP is significantly associated with microalbuminuria compared with optimal BP and may be a biomarker of the increased cardiovascular risk observed in this population.

Adult↗
PubMed2003

Permanent cessation of menses and postmenopausal hormone use in dialysis-dependent women: the HELP study.

BACKGROUND: Earlier onset of menopause is associated with an increased risk for cardiovascular disease, especially among women with surgical menopause. Information on age at or reasons for the permanent cessation of menses among women with end-stage renal disease (ESRD) remains limited, although cardiovascular disease accounts for more than half of all cardiovascular deaths in this population. METHODS: We used data from the Hemodialysis and Estrogen Levels in Postmenopausal Patients Study to examine the reported age when menses permanently ceased, reasons for the permanent cessation of menses, and prevalence of surgical menopause. We also investigated the frequency of current and past postmenopausal hormone (PMH) use among dialysis-dependent women and their views toward PMH therapy. RESULTS: Among 238 postmenopausal hemodialysis-dependent women, median age when menses permanently ceased was 48 years. Permanent cessation of menses was attributed to natural causes in 65%, surgical reasons in 30% (16%, hysterectomy without bilateral oophorectomy; 14%, hysterectomy with bilateral oophorectomy), kidney failure in 2%, radiation or chemotherapy in 1%, and other causes in 2%. Among women with a history of bilateral oophorectomy, 71% became menopausal before the age of 35 years. Current and past PMH use was reported by 6% and 17% of the women, respectively, whereas 77% were never administered hormones. Only 2% stated a kidney doctor ever recommended PMH therapy, and 54% said they would not take PMHs if prescribed by their kidney doctor. CONCLUSION: Many women with ESRD experience surgical menopause before the age of 35 years, which may contribute to the excess cardiovascular mortality among women with ESRD. PMH use remains low among dialysis-dependent women. However, two randomized controlled trials have noted a significantly increased risk for cardiovascular events in women administered estrogen in combination with progestin. Thus, risks associated with PMH use may outweigh the benefits in a population with a very high rate of cardiovascular disease, such as postmenopausal hemodialysis-dependent women.

Adult↗