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Biomedical subjects

W D Evans

Publications and source records attributed to W D Evans.

At least 19 recordsLinked to original sources
PubMed2005

The effect of intermittent pneumatic compression on the bone uptake of (99m)Tc-labelled methylene diphosphonate in the lower limb.

INTRODUCTION: Venous compression of the lower limbs will obstruct outflow through the deep and superficial veins, yet inflow will continue, without continual swelling of the limb. It is hypothesised that venous channels in the long bones act as collateral channels to restore outflow, and therefore general blood flow through bone will increase. Such a hemodynamic change should affect the uptake of radiopharmaceuticals by the bone, though uptake changes in themselves would not definitely indicate flow changes. The purpose of this study, therefore, was to determine whether bone uptake in the lower limb is affected by intermittent venous compression, irrespective of the mechanism involved. MATERIALS AND METHODS: The effect of intermittent pneumatic compression of the thigh and calf on the uptake of (99m)Tc-methylene diphosphonate (MDP) was studied in 24 patients. All were undergoing routine bone imaging for medical conditions that were not focused on their lower limbs, and received 1 h of the therapy at 60 mmHg on one limb only, after injection of the radiopharmaceutical. Three hours after injection the relative difference in uptake (net counts per pixel) between the two limbs was calculated. The standard imaging protocol was otherwise unchanged. RESULTS: The median differences in uptake in the intermittently compressed limb compared with the contralateral limb were +7.6% (interquartile range +3.9% to +16.0%, p<0.0005 [Wilcoxon]) for the anterior aspect of the femur; +11.7% (interquartile range +4.3% to +22.2%, p<0.0005) posterior, femur; +10.5% (interquartile range +6.5% to +13.8%, p<0.0005) anterior, tibia; +10.6% (interquartile range +5.5% to +17.6%, p<0.0005) posterior, tibia. CONCLUSION: Intermittent pneumatic compression clearly and significantly increased the uptake of (99m)Tc-MDP in long bones. These data are consistent with increases in blood flow through bone, though a direct mechanical influence on the bone cannot be excluded. This effect should be given consideration during routine therapeutic and thromboprophylactic use of intermittent compression, and if the mechanism of the uptake changes can be established, their possible clinical uses should be investigated.

Adult↗
PubMed2005

Cost effectiveness analysis of using quantitative ultrasound as a selective pre-screen for bone densitometry.

It has been suggested that quantitative ultrasound (QUS) could be used as a selective population pre-screen, to maximise the cost effectiveness of referral for dual energy X-ray absorptiometry (DXA) assessment of bone mineral density (BMD). We set out to examine how such an approach might perform in the assessment of women who were referred by general practitioners for DXA via the open access service in Cardiff. In 115 women aged 40-80 (mean 69) years we used DXA to measure BMD at lumbar spine and hip, and QUS to measure broadband ultrasound attenuation (BUA) in the heel. A bottom-up approach was used to estimate the costs of DXA and QUS. We examined the cost effectiveness of using QUS as a pre-screen, only referring subjects for the more expensive DXA assessment if BUA were less than a pre-determined threshold. The unit costs of pencil-beam DXA and QUS were approximately 44 UK pounds and 16 UK pounds respectively. We identified a BUA threshold of 60 dB/MHz as the most cost effective, and calculated a sensitivity of 81% and specificity of 89% in identifying those subjects whom DXA assessment subsequently identified as having osteoporosis. At the BUA threshold of 60 dB/MHz, pre-screening saved 969 UK pounds at the expense of missing ten women with osteoporosis as diagnosed by DXA. Therefore the cost per additional woman with osteoporosis identified using DXA alone was only 97 UK pounds. QUS assessment does not appear to have a significant cost effective benefit as a pre-screen for DXA in the studied population. A QUS pre-screen would be cost effective only if this investigation could be performed at a substantially lower cost.

Absorptiometry, Photon↗
PubMed2004

Osteopenia, excess adiposity and hyperleptinaemia during 2 years of treatment for childhood acute lymphoblastic leukaemia without cranial irradiation.

OBJECTIVE: Osteopenia and excess adiposity occur following treatment of childhood acute lymphoblastic leukaemia (ALL) and the use of cranial irradiation is thought to be a significant contributory factor. Hyperleptinaemia has also been demonstrated following cessation of treatment for childhood ALL. Therefore a prospective study was undertaken to evaluate serial changes in percentage bone mineral content (BMC), adiposity and serum leptin concentrations during 2 years of treatment of children with ALL with chemotherapy but without cranial irradiation. DESIGN AND PATIENT: Only patients treated using the MRC ALL 97/ALL 97 (modified 99) protocols for childhood ALL were eligible for entry into the study. A total of 14 patients (seven male, with a median age of 7.5 years (range 3.4-16.7 years) were recruited. Serial dual energy X-ray absorptiometry (DEXA) scanning was undertaken at diagnosis and during two years of treatment. Serum leptin concentrations were determined at the same time as the scans. RESULTS: Reductions in %BMC were observed at the hip and lumbar spine by 12 months (P < 0.01) and remained low after 24 months of treatment. Subanalysis of %BMC measurements at the hip demonstrated a greater reduction in %BMC at the trochanteric region compared to the femoral neck. The percentage corrected fat mass increased from 6 months whereas the body mass index (BMI) standard deviation score (SDS) was increased after 24 months of treatment (P < 0.05). Serum leptin concentrations increased following 24 months of therapy (P < 0.05). CONCLUSIONS: Children treated for ALL with contemporary regimens have a predisposition to osteopenia, excess adiposity and hyperleptinaemia during treatment without cranial irradiation administration. We speculate that in addition to glucocorticoid administration, leptin resistance may account in part for these observations.

Adolescent↗
PubMed2004

An analysis of an open access general practitioner bone densitometry service.

General practitioners (GPs) are increasingly involved in the selective opportunistic case finding of osteoporosis and treatment of this condition. An open access bone densitometry service has existed for GPs in the Cardiff area since 1993. The purpose of this study was to assess the effectiveness of this service, particularly with respect to the appropriateness of bone densitometry requests and the impact of the service on hospital outpatient referrals. Over a period of 12 months, 560 patients were referred to the open access service by 154 GPs. A total of 229 (41%) patients were given a clinical diagnosis of osteoporosis. Four hundred and seventy-three (84%) referrals followed the clinical referral criteria. In 85% of cases, GPs claimed that they would have referred patients to the hospital outpatient department, if there were no open access bone densitometry service. The majority of the referrals were appropriate, and the service appears to have reduced GP referrals to the specialist clinic.

Absorptiometry, Photon↗
PubMed2004

Pitfalls in the assessment of body composition in survivors of acute lymphoblastic leukaemia.

BACKGROUND: Body fat mass (FM) and fat free mass (FFM) in childhood are often estimated by conversion of a measured variable into compartmental body composition using constants or regression equations that have been previously derived in healthy individuals. Application of such constants or equations to children with disease states may lead to inappropriate conclusions since the "normal" relationships may become altered. AIMS AND METHODS: To test this hypothesis by taking measurements of body composition using dual energy x ray absorptiometry (DEXA) as a "gold standard" method and calculating hydration and body potassium constants using isotopic water dilution and whole body potassium counting. Measurements of bioelectrical impedance (BIA) by two different analysers (RJL and Holtain) were also performed to allow comparison with body water measurements. RESULTS: Measurements were performed in 35 children treated for acute lymphoblastic leukaemia (ALL) and compared to those in 21 children treated for a variety of other malignancies and 32 healthy sibling controls. The mean hydration and potassium content of FFM was significantly reduced in the ALL group compared to both other malignancies and controls. Application of equations derived from controls for the measurement of FFM derived from bioelectrical impedance led to an underestimation of 1.15 kg when compared to that derived from DEXA in children treated for ALL but not in other malignancies. For all groups combined, BIA was significantly different in the two analysers. CONCLUSION: Care needs to be taken in the application of equations derived from the normal population to body composition measurement in children treated for ALL.

Absorptiometry, Photon↗
PubMed2003

Altered tissue distribution in adults with cystic fibrosis.

BACKGROUND: Regional body composition was determined in adults with cystic fibrosis (CF). Our hypothesis was that dual energy x ray absorptiometry (DXA) scanning could assess the fat free mass, bone mineral content, and fat mass and determine the distribution of the changes. METHOD: Height squared indices were derived for fat mass (FMI), fat free mass (FFMI), and bone mineral content (BMCI) of the arm, leg, and trunk by DXA in 51 patients and 18 age/sex matched healthy subjects. RESULTS: The arm and leg FFMI in patients were less than in healthy controls (p<0.05); the deficit was leg>arm>trunk (-18.19%, -14.86%, +0.09%, p<0.02) and was related to severity of lung disease. Patients with a normal BMI and low total FFM (hidden loss) had a lower arm, leg and trunk FFMI than those with a normal BMI and total FFM (p<0.05). The BMCI for all body segments was lower in patients than in controls (p<0.001). The BMCI was lower in the leg and trunk (p<0.01) in patients with severe disease than in those with mild lung disease. In those with hidden FFM loss the BMCI was lower (p<0.05 in leg and trunk). There was no difference in the BMCI deficit between body segments. Fat mass in patients was not reduced. CONCLUSION: Preferential loss of FFM is related to severity of lung disease and occurs in patients with a normal BMI. A similar loss of BMC occurs while FM is preserved. A hierarchical pattern of FFM loss of legs>arms>trunk was shown; BMC loss was evenly distributed.

Absorptiometry, Photon↗
PubMed2001

Can media advocacy influence newspaper coverage of tobacco: measuring the effectiveness of the American stop smoking intervention study's (ASSIST) media advocacy strategies.

OBJECTIVE: To compare the rate and slant of local tobacco control print media coverage in ASSIST (American stop smoking intervention study) states as compared with non-ASSIST states. METHODS: Local tobacco control policy articles, editorials, and letters to the editors published from 1994 to 1998 clipped from all daily local newspapers in the USA were analysed (n = 95 911). The main hypothesis tested for the existence of an interaction between ASSIST intervention and time. This interaction would represent a change in the difference between ASSIST and non-ASSIST states over the course of the intervention. RESULTS: No evidence of an ASSIST-year interaction was found. However, a main effect for ASSIST was significant for the percentage of articles with the model predicting higher rates of articles for ASSIST states. Similarly the rate of letters to the editor expressing protobacco control views was higher in ASSIST states than non-ASSIST states. No main effects or interactions were found for analyses of percentage of protobacco control editorials. Models controlled for a measure of preintervention tobacco control conditions at baseline. CONCLUSIONS: The presence of an ASSIST main effect should be interpreted with caution because of the quasi-experimental design and the lack of information on article rates before the ASSIST intervention. Nonetheless, these preliminary findings suggest some possible effects of the media advocacy activities of ASSIST when controlling for differences in states' initial tobacco control conditions.

Bibliometrics↗
PubMed2000

Prediction and validation of fat-free mass in the lower limbs of young adult male Rugby Union players using dual-energy X-ray absorptiometry as the criterion measure.

The aim was to derive and cross-validate prediction equations to estimate fat-free mass (FFM) in the lower limbs of young adult male Rugby Union players. Thirty players of mean +/- SD age of 21.1 +/- 2.1 years were recruited. Bone mineral mass, fat mass and lean tissue mass were measured with a Hologic QDR 1000/W whole-body scanner. Anthropometry included circumferences, segmental leg lengths and skinfold thicknesses. Players were divided randomly into prediction (n = 15) and cross-validation (n = 15) samples. Regression equations were derived from the prediction sample and validated on the cross-validation sample. Seven equations were formulated to predict leg FFM. The two equations providing the lowest standard errors of estimate were leg length with circumferences at the knee (0.7262) and calf (0.7382); the multiple correlation was 0.83 in both instances. Cross-validation statistics found no significant differences (p > 0.05) between measured (12.4 +/-1.5 kg) and predicted leg FFM (12.1-12.4 kg). The smallest mean difference was -0.05 kg, the largest 0.26 kg; these were equivalent to -0.4 and 2.1% of the measured leg FFM respectively. Correlations between measured and predicted leg FFM were reasonably high (0.79-0.90, p < 0.001). The ratio limits of agreement confirmed that there was little bias between measured and predicted leg FFM (1.00-1.02) and a good level of agreement (1.12-1.16). Because prediction equations tend to be age, gender and population specific, unless validated for other athletic groups, the present equations should be applied to male Rugby Union players with characteristics similar to those described.

Absorptiometry, Photon↗
PubMed2000

Effect of recombinant human growth hormone on regional tissue distribution in growth hormone-deficient males.

Dual-energy X-ray absorptiometry was used to analyze the regional tissue distribution of bone mineral mass (BMM), fat mass (FM), and lean tissue mass (LTM) in the arms, trunk, and legs of 23 male growth hormone-deficient (GHD) males. Patients were assigned randomly to treatment (n = 11) and control (n = 12) groups. During the first six months, the treatment group received recombinant growth hormone (rhGH) and the control group placebo. During the second six months, both groups received rhGH. Following treatment there was a trend for BMM to be lost in the arms and legs, with gains at the trunk. Fat mass was lost mainly from the trunk. Proportionally more LTM was distributed to the arms and legs than to the trunk. Treatment was more effective in the first six months than the second. The correlation between the waist-hip ratio and trunk fat was poor, suggesting that its use in patients with GHD may be misleading.

Absorptiometry, Photon↗
PubMed2000

Bone density, body composition, and inflammatory status in cystic fibrosis.

Low body weight and loss of bone mass are major problems in adults with cystic fibrosis (CF) and chronic pulmonary infection. Although these complications probably have a multifactorial origin, we hypothesized that the continuous acute-phase inflammatory and catabolic state may contribute. We determined body composition, bone turnover, physical activity, and circulating interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and their soluble receptors in 22 adults with CF and 22 age- and sex-matched healthy subjects. Comparisons were also made within patients before and after treatment of an exacerbation of respiratory symptoms. The patients had a lower mean (95% confidence interval [CI]) fat-free mass (FFM) 39.9 (36.3, 43.6) kg than healthy subjects, 49.4 (45.1, 53.7) kg, p < 0.05. The patients were in negative nitrogen balance and 20 had bone mineral density (BMD) Z scores </= 2.5 SD (n = 13) or </= 1 SD (n = 7) at least at one site. They had increased bone collagen breakdown, greatest in those with a reduced FFM. BMD was related to FEV(1) (r = 0.44), IL-6 (r = -0.60), and TNF-alpha-soluble receptors (r = -0.42, r = -0.50). Patients with a low FFM had greater concentrations of IL-6, which suppressed less after antibiotic treatment than in those with a normal FFM. Those with a low FFM were more catabolic and less active than those with a normal FFM. The association between altered body composition, catabolic status, and circulating inflammatory mediators suggests that chronic pulmonary infection in adults with CF may be a contributory factor in the long-term complications of low weight and bone disease.

Adult↗
PubMed1999

Metabolic effects of discontinuing growth hormone treatment.

AIMS: To evaluate the effects of discontinuing growth hormone (GH) treatment on energy expenditure and body composition, which might help predict those most likely to benefit from early reintroduction of GH treatment in young adult life. METHODS: Body composition was calculated from skinfold thicknesses and dual energy x ray absorptometry (DXA). Resting metabolic rate (RMR) and whole body bone mineral content (BMC) were also measured. Measurements were made before stopping treatment, at discontinuation of GH treatment, and two weeks, six months, and one year later in 11 adolescents with growth hormone deficiency (GHD) and five adolescents without GHD who were treated with GH. Measurements were compared with 10 healthy controls, in whom measurements were repeated one year later. RESULTS: During the nine months before discontinuation of GH there were no changes in body composition, RMR, or BMC of patients with GHD, nor differences when compared with controls. RMR was reduced by 11.3 kJ/kg fat free mass two weeks after stopping GH in GHD patients and remained suppressed thereafter compared with controls. Percentage body fat increased by 4.3%/year in patients with GHD after discontinuing GH, whereas no changes were noted in control or non-GHD patients at one year. The patients experiencing the greatest reductions in RMR/kg fat free mass at six months showed the largest increases in body fat at one year. No change in BMC was noted in patients one year after stopping treatment. CONCLUSION: Important metabolic changes occur early after discontinuing GH treatment. In patients whose growth is complete, these changes might be used to predict those most likely to benefit from continuation of GH treatment into adult life.

Adolescent↗
PubMed1999

Relative osteopenia after treatment for acute lymphoblastic leukemia.

Osteoporosis in adult life is associated with a significant morbidity and may be predisposed to by osteopenia and failure to reach peak bone mass in childhood. Children treated for acute lymphoblastic leukemia (ALL) may be at risk of osteopenia as a result of previous therapy or as a consequence of the disease process itself. Dual energy x-ray absorptiometry measurements of bone mineral content (BMC) for the whole body and at the lumbar spine and hip were taken in 35 (14 male) long-term survivors of ALL and compared with results in 20 (10 male) survivors of other malignancies and 31 (17 male) healthy sibling controls. The measured BMC was expressed as a percentage of a predicted value derived from the control group and based on the variables that had influence upon it. BMC (%) was reduced at the spine in the ALL group compared with controls [92.4 (8.0)% versus 100.4 (9.7)%, respectively; p < 0.005] and at the hip compared with both other malignancies and controls [89.0 (11.5)% versus 96.1 (11.7)% and 100.4 (9.2)%, respectively; p < 0.0005]. Increasing length of time off therapy was associated with a significant increase in %BMC at both the spine and the hip. For the spine, this association was significantly different between the ALL group and other malignancies, suggesting that any gain in %BMC after therapy was slower in children treated for ALL. Both exercise capacity and levels of physical activity were correlated with %BMC at the hip (r = 0.44, p < 0.001 and r = 0.29, p < 0.01, respectively). Previous exposure to methotrexate, ifosfamide, and bleomycin was associated with a reduction in %BMC at the spine. Exposure to 6-mercaptopurine and cisplatin was associated with a reduction at the hip. In conclusion, children treated for ALL are osteopenic. The mechanism is probably multifactorial but is partially related to previous chemotherapy, limited exercise capacity, and relative physical inactivity.

Adult↗
PubMed1998

Bone mineral density, collagen type 1 alpha 1 genotypes and bone turnover in premenopausal women with diabetes mellitus.

Osteopenia is a recognised complication of diabetes mellitus which could be due to abnormal bone turnover or disturbances in the calcium/parathyroid hormone/vitamin D axis or both. Genetic factors also play an important part in determining bone mass although this has not been studied in diabetes. Recently a polymorphism of the collagen type 1 alpha 1 (COL1A1) gene has been shown to be associated with low bone mass in British women. To identify subjects with diabetes who may be at risk of developing osteoporosis and fractures, we analysed bone mineral density in relation to the biochemical markers of bone turnover, calcium homeostasis and the COL1A1 genotype in a group of premenopausal women with Type I (insulin-dependent) diabetes mellitus (n = 31), Type II (non-insulin dependent) diabetes mellitus (n = 21) and control subjects (n = 20). Bone mineral density was lower at the femoral neck in the subjects with Type I diabetes (p = 0.08) as were serum 25-hydroxyvitamin D compared with control subjects (p = 0.023) and this was negatively correlated with serum collagen type 1 C-terminal propeptide (r = -0.56, p < 0.001). Bone mineral density in Type II diabetes was not different from control subjects, after correction for body mass index. Bone resorption was, however, raised in the Type II diabetic subjects as reflected by the higher urinary deoxypyridinoline values (p = 0.016) and lower collagen type 1 C-terminal propeptide:deoxypyridinoline ratio (p = 0.04). In the whole group studied, subjects with the COL1A1 's' genotype had lower bone mineral density at the femoral neck (p = 0.01) which was partly attributable to a lower body mass index. Following multiple regression analysis body mass index and collagen type 1 C-terminal propeptide concentrations remained determinants of bone mass at all three sites, whereas genotype appeared to be a predictor of bone mass at the femoral neck only. We conclude that measurement of these variables could prove useful in firstly identifying those diabetic women at risk of osteoporosis and secondly guiding therapeutic intervention.

Adult↗
PubMed1998

Radioiodine treatment in unsuspected pregnancy.

OBJECTIVE: Radioiodine is being used increasingly as first line therapy for hyperthyroidism. Our aim is to highlight some of the difficulties which can occur following the use of 131I to treat hyperthyroidism in fertile women. PATIENTS: We present 3 cases of young women to whom radioiodine was given, only to find some weeks later that they had been pregnant at the time of treatment. CONCLUSIONS: These cases serve as a reminder of the importance of obtaining an accurate and full menstrual and contraceptive history. Guidelines advocate the application of the ten day rule with the further recommendation that pregnancy testing may be undertaken as an alternative.

Adult↗
PubMed1998

Effect of replacement doses of thyroxine on bone mineral density.

INTRODUCTION: Hyperthyroidism is associated with a reduction in bone mineral density (BMD). Suppressive doses of thyroxine (T4), inducing subclinical hyperthyroidism, have been reported by some investigators to reduce BMD. Little work has been done on replacement doses of T4. AIM: The aim was to investigate the effect of replacement doses of T4 on BMD. STUDY DESIGN: Cross-sectional study of hypothyroid patients on long-term T4 replacement doses, comparing those who had primary hypothyroidism with those who were previously hyperthyroid. PATIENTS: Fifty women on replacement doses of T4 for more than 5 years were recruited. Twenty-five were treated for primary (group 1) and 25 for radioiodine-induced hypothyroidism (group 2). They were well matched for age, menstrual status, smoking history, body mass index (BMI), dose and duration of T4 replacement as well as thyroid status. MEASUREMENTS: BMD was assessed by dual energy X-ray absorptiometry. Free T4 (FT4), FT3 as well as ultrasensitive TSH assays were used to assess thyroid status. RESULTS: The two groups showed no difference in BMD (g/cm2) of the lumbar spine (1.008 vs. 0.957, P = 0.25), femoral neck (0.745 vs. 0.735, P = 0.79) and total hip (0.878 vs. 0.837, P = 0.24). When the two groups were pooled, there was no significant difference between the patients and a reference population with femoral neck and total hip BMD expressed as a standard deviation (Z) score. However, the lumbar spine mean Z score was significantly greater than zero. For each site, there was a negative correlation of BMD with age in at least one group but, in general, BMI, FT4, FT3 and duration of T4 replacement did not correlate with BMD. T4 dose, however, had a consistent positive correlation with BMD in the spine, femoral neck and the hip (P = 0.01, 0.04 and 0.02, respectively) in group 2 but not group 1. CONCLUSION: In this study, there is no evidence for a difference in bone mineral density in patients receiving replacement doses of thyroxine irrespective of the aetiology of their hypothyroidism. The reduced bone mineral density associated with hyperthyroidism appears to be restored, maintained and in some cases possibly improved while on long-term thyroxine replacement post-radioiodine.

Absorptiometry, Photon↗
PubMed1998

Measured and predicted bone mineral content in healthy boys and girls aged 6-18 years: adjustment for body size and puberty.

Dual-energy X-ray absorptiometry (DEXA) is a rapid and precise technique for the assessment of bone mineralization in children. Interpretation of the results in growing children is complex as results are influenced by age, body size (height and weight) and puberty. Conventionally, bone mineral data derived from DEXA have been presented as an areal density [BMD; bone mineral content (BMC, g)/projected bone area (BA, cm2)], yet this fails to account for changes in BMC that result from changes in age, body size or pubertal development. Measurement of BMC and BA of the whole body, lumbar spine and left hip were made in 58 healthy boys and girls using DEXA. The relationship between BMC and BA was curvilinear, with the best fit being that of a power model (BMD = BMC/BAlambda, where lambda is the exponent to which BA is raised in order to remove its influence on BMC). The value of lambda changed when measures of body size and puberty were taken into account (e.g. for lumbar spine from 1.66 to 1.49). Predictive formulae for BMC were produced using regression analysis and based on the variables of age, body size and pubertal development. This provides a method for interpreting the measured BMC which is independent of such variables and a constant reference range for children aged 6-18 y.

Absorptiometry, Photon↗
PubMed1998

Determining true glomerular filtration status in newly presenting type 2 diabetic subjects using age and sex adjustment.

OBJECTIVE: To determine age- and sex-adjusted reference ranges (ASARRs) for glomerular filtration status using data from nondiabetic subjects and to apply these to newly presenting type 2 diabetic subjects. RESEARCH DESIGN AND METHODS: Glomerular filtration rate corrected for body surface area (cGFR) was determined using a radionuclide (51Cr-EDTA) method in 75 non-diabetic subjects (37 men, 38 women) and 219 type 2 diabetic subjects (157 men, 62 women). The 95% constant reference ranges (CRRs) were calculated as mean nondiabetic cGFR+/-1.96 SD. The 95% ASARRs were calculated by Altman's method from the nondiabetic cGFR versus age regression residuals for both male and female subjects. RESULTS: Using Altman's method, the intercepts, but not the gradients, of the cGFR versus age regressions were significantly different between male and female subjects (intercept difference [95% CI] 8.2 [1.3-15.1], gradient difference -0.4 [-1.1 to 0.3]). Fitting a common gradient, 95% ASARRs for normofiltration were found to be from 123.9 - (0.89 X age) to 181.7 - (0.89 x age) for male subjects, and from 116.0 - (0.89 X age) to 173.2 - (0.89 X age) for female subjects. The 95% CRR for normofiltration was 70.2-138.1 ml x min(-1) x (1.73 m)(-2). When applied to the diabetic cGFRs, the CRRs and ASARRs gave, respectively, 17% (37/219) versus 21% (46/219) hyperfiltrators and 83% (181/219) versus 79% (172/219) normofiltrators. Using the ASARRs, 14 normofiltrators (6 men, 8 women) were reclassified as hyperfiltrators (change [n/total n] [95% CI] 8% [14/181] [4-12]), and 5 hyperfiltrators (5 men, 0 women) were reclassified as normofiltrators (change 14% [5/37] [5-30]). CONCLUSIONS: We conclude that age and sex adjustment are essential to assess glomerular filtration status.

Adult↗