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1. Farnesoid X receptor activation protects against renal fibrosis via modulation of β-catenin signaling

Author

Dan-Qin Sun, Fuqiang Yuan, Meng-Zhu Fu, Meng-Yang Zhong, Shi-Liang Zhang, Yan Lu, Giovanni Targher, Christopher D. Byrne, Ming-Hua Zheng, and Wei-Jie Yuan

Subjects
Bile acid, FXR, β-Catenin, Tubular epithelial cells, Renal fibrosis, Internal medicine, RC31-1245
Abstract

Objective: Activation of farnesoid X receptor (FXR), a bile acid nuclear receptor, may be implicated in the pathophysiology of diabetic nephropathy. We explored a possible role for FXR activation in preventing renal fibrosis in high fat diet (HFD)-fed mice. Methods: We investigated the effects of HFD on mouse kidney and renal tubular epithelial cells both in vivo and in vitro, and observed the changes of FXR and β-catenin pathway. FXR agonist was also used to alleviate this HFD-induced effect, and the interaction between FXR and β-catenin was further verified. Results: Mice were fed by a 60% kcal fat diet for 20 weeks developed the typical traits of metabolic syndrome with subsequent renal lipid accumulation and renal injury. Treatment with the FXR agonist CDCA or GW4064 decreased body weight, renal lipid accumulation, as well as renal injury. Moreover, renal β-catenin signaling was activated and improved with FXR-agonist treatment in HFD-fed mice. To examine whether FXR affected β-catenin signaling, and was involved in tubulo-interstitial fibrosis, we explored the FXR expression and function in ox-LDL induced-renal tubular injury. In rat proximal tubular epithelial cells (NRK-52E) stimulated by ox-LDL, FXR protein was decreased compared to control group, and phosphorylated (Ser675) β-catenin was activated by ox-LDL in a dose- and time-dependent manner. Ox-LDL enhanced α-SMA and fibronectin expressions and reduced E-cadherin levels, whereas FXR agonism or FXR overexpression inhibited fibronectin and α-SMA expressions and restored E-cadherin. Moreover, FXR agonist treatment also decreased phosphorylated (Ser675) β-catenin, nuclear translocation and β-catenin-mediated transcription induced by ox-LDL in NRK-52E cells. We showed that FXR could bind with β-catenin via the AF1 domain, and disrupt the assembly of the core β-catenin/TCF4 complex. Conclusion: These experimental data suggest that FXR activation, via modulating β-catenin signaling, may contribute to attenuating the development of lipid-mediated tubulo-interstitial fibrosis.

Published
2024
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2. Metabolic dysfunction-associated fatty liver disease increases risk of chronic kidney disease: a systematic review and meta-analysis

Author

Gian Paolo Fadini, Giovanni Targher, Masahide Hamaguchi, Herbert Tilg, Seung Up Kim, Dan-Qin Sun, Xuhong Hou, Jianghua Zhou, Christopher D Byrne, Byung-wan Lee, Masato Furuhashi, and Ning-Jian Wang

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and aim Metabolic dysfunction-associated fatty liver disease (MAFLD) is an alternative description and classification of non-alcoholic fatty liver disease (NAFLD) that may have better utility than NAFLD in clinical practice. We performed a meta-analysis to quantify the magnitude of the association between MAFLD and risk of both prevalent and incident chronic kidney disease (CKD).Methods We systematically searched PubMed, Medline (OVID), Embase (OVID), Web of Science and Cochrane Library from database inception until 29 May 2022. We included observational studies examining the association between MAFLD and risk of CKD, defined by estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or presence of abnormal albuminuria. Meta-analysis was performed using random-effects models to obtain summary HRs or ORs with 95% CIs.Results Seventeen observational studies with aggregate data on 845 753 participants were included in meta-analysis. In the 7 cohort studies, the pooled random-effects HR for incident CKD in patients with MAFLD was 1.29 (95% CI 1.17 to 1.41, I2=87.0%). In the 10 cross-sectional studies, the pooled random-effects OR for prevalent CKD in patients with MAFLD was 1.35 (95% CI 1.11 to 1.64, I2=92.6%).Conclusion MAFLD is significantly associated with an increased prevalence and incidence of CKD.PROSPERO registration number CRD42022352366.

Published
2023
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3. Remodeling the model for end‐stage liver disease for predicting mortality risk in critically ill patients with cirrhosis and acute kidney injury

Author

Xiao‐Dong Zhou, Qin‐Fen Chen, Dan‐Qin Sun, Chen‐Fei Zheng, Dong‐Jie Liang, Jian Zhou, Song‐Jie Wang, Wen‐Yue Liu, Sven VanPoucke, Xiao‐Dong Wang, Ke‐Qing Shi, Wei‐Jian Huang, and Ming‐Hua Zheng

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Serum creatinine measurement demonstrates a poor specificity and sensitivity for the early diagnosis of acute kidney injury (AKI) in patients with cirrhosis. The existing model for end‐stage liver disease (MELD) score reveals multiple pitfalls in critically ill patients with cirrhosis and acute kidney injury (CAKI). The aim of this study was to re‐evaluate the role of creatinine values in the existing MELD score and to develop a novel score for CAKI, named the “acute kidney injury–model for end‐stage liver disease score” (AKI‐MELD score). We extracted 651 CAKI from the Multiparameter Intelligent Monitoring in Intensive Care database. A time‐dependent Cox regression analysis was performed for developing remodeled MELD scores (Reweight‐MELD score, Del‐Cr‐MELD score, and AKI‐MELD score). The area under the receiver operating characteristic curve provided the discriminative power of scoring models related to outcome. The hazard ratio of creatinine was 1.104 (95% confidence interval [CI], 0.945‐1.290; P = 0.211). Reweight‐MELD score and Del‐Cr‐MELD score (decreasing the weight of creatinine) were superior to the original MELD score (all P < 0.001). The new AKI‐MELD score consists of bilirubin, the international normalized ratio, and the ratio of creatinine in 48 hours to creatinine at admission. It had competitive discriminative ability for predicting mortality (area under the receiver operating characteristic curve, 0.720 [95% CI, 0.653‐0.762] at 30 days, 0.688 [95% CI, 0.630‐0.742] at 90 days, and 0.671 [95% CI, 0.612‐0.725] at 1 year). Further, AKI‐MELD score had significantly higher predictive ability in comparison with MELD score, MELD‐Na score, and Updated MELD score (all P < 0.001). Conclusion: The predictive value of creatinine for CAKI should be re‐evaluated. AKI‐MELD score is a potentially reliable tool to determine the prognosis for mortality of CAKI. (Hepatology Communications 2017;1:748–756)

Published
2017
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4. Prognostic value of hematocrit levels among critically ill patients with acute kidney injury

Author

Ying Zhou, Ming-Hua Zheng, Chao-Sheng Chen, Dan-Qin Sun, Xin-Xin Chen, Mei Sun, Yan-Hui Wang, Yi Liu, Jing-Ye Pan, and Chen-Fei Zheng

Subjects
Medicine
Abstract

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

Published
2019
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5. Norcholic acid: a novel biomarker of early kidney injury in patients with metabolic dysfunction-associated fatty liver disease

Author

Dan-Qin Sun, Cuifang Xu, Wen-Ying Chen, Fuqiang Yuan, Giovanni Targher, Amedeo D. Lonardo, Jing Zhao, Ana Liu, Mingming Su, Jun-Ping Shi, Yan Ni, and Zheng Ming-Hua

Abstract

Background Bile acids (BAs) are signaling molecules that regulate numerous metabolic processes in metabolic dysfunction-associated (MAFLD) and chronic kidney disease (CKD). Whether BAs are also associated with early abnormalities in renal function in MAFLD is uncertain.Methods We quantitatively measured plasma BA concentrations in biopsy-proven MAFLD patients with or without abnormal albuminuria (defined as albumin-to-creatinine ratio ≥ 30 mg/g) and in healthy controls, by using ultraperformance liquid chromatography coupled to tandem mass spectrometry.Results Plasma BA profiles (conjugated BAs, glycine-conjugated BAs, glycine-conjugated primary BAs, total conjugated primary BAs, and glycine-conjugated primary BAs) were up-regulated in MAFLD patients with abnormal albuminuria compared to their counterparts with normal albuminuria and healthy controls. In particular, we identified a distinct individual BA, i.e., norcholic acid (NorCA) that was markedly upregulated in MAFLD patients with abnormal albuminuria, and that was also positively correlated with albuminuria. Moreover, the combination of NorCA, tauro-deoxycholic acid, tauro-lithocholic acid and cholic acid, improved identification of abnormal albuminuria in MAFLD patients in a predictive model, that also included diabetes, hypertension, body mass index, and serum alanine aminotransferase levels (AUC = 0.80, 95%CI 0.740–0.863).Conclusion BA biomarkers are increased in patients with MAFLD and abnormal albuminuria and further investigation of their role in renal function is warranted.

Published
2023
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6. An international Delphi consensus statement on metabolic dysfunction-associated fatty liver disease and risk of chronic kidney disease

Author

Dan-Qin Sun, Giovanni Targher, Christopher D. Byrne, David C. Wheeler, Vincent Wai-Sun Wong, Jian-Gao Fan, Herbert Tilg, Wei-Jie Yuan, Christoph Wanner, Xin Gao, Michelle T. Long, Mehmet Kanbay, Mindie H. Nguyen, Sankar D. Navaneethan, Yusuf Yilmaz, Yuli Huang, Rino A. Gani, Pierluigi Marzuillo, Jérôme Boursier, Huijie Zhang, Chan-Young Jung, Jin Chai, Luca Valenti, George Papatheodoridis, Giovanni Musso, Yu-Jun Wong, Mohamed El-Kassas, Nahum Méndez-Sánchez, Silvia Sookoian, Michael Pavlides, Ajay Duseja, Adriaan G. Holleboom, Junping Shi, Wah-Kheong Chan, Yasser Fouad, Junwei Yang, Sombat Treeprasertsuk, Helena Cortez-Pinto, Masahide Hamaguchi, Manuel Romero-Gomez, Mamun Al Mahtab, Ponsiano Ocama, Atsushi Nakajima, Chunsun Dai, Mohammed Eslam, Lai Wei, Jacob George, Ming-Hua Zheng, Sun D., Targher G., Byrne C. D., Wheeler D. C., Wong V. W., Fan J., Tilg H., Yuan W., Wanner C., Gao X., et al., Sun, Dan-Qin, Targher, Giovanni, Byrne, Christopher D., Wheeler, David C., Wong, Vincent Wai-Sun, Fan, Jian-Gao, Tilg, Herbert, Yuan, Wei-Jie, Wanner, Christoph, Gao, Xin, Long, Michelle T., Kanbay, Mehmet, Nguyen, Mindie H., Navaneethan, Sankar D., Yilmaz, Yusuf, Huang, Yuli, Gani, Rino A., Marzuillo, Pierluigi, Boursier, Jérôme, Zhang, Huijie, Jung, Chan-Young, Chai, Jin, Valenti, Luca, Papatheodoridis, George, Musso, Giovanni, Wong, Yu-Jun, El-Kassas, Mohamed, Méndez-Sánchez, Nahum, Sookoian, Silvia, Pavlides, Michael, Duseja, Ajay, Holleboom, Adriaan G., Shi, Junping, Chan, Wah-Kheong, Fouad, Yasser, Yang, Junwei, Treeprasertsuk, Sombat, Cortez-Pinto, Helena, Hamaguchi, Masahide, Romero-Gomez, Manuel, Al Mahtab, Mamun, Ocama, Ponsiano, Nakajima, Atsushi, Dai, Chunsun, Eslam, Mohammed, Wei, Lai, George, Jacob, and Zheng, Ming-Hua

Subjects
Internal Diseases, Tarımsal Bilimler, SURGERY, NUTRITION & DIETETICS, Beslenme ve Diyetetik, Gastroenterology and Hepatology, chronic kidney disease (CKD), Sağlık Bilimleri, İç Hastalıkları, Clinical Medicine (MED), BESLENME VE DİYETETİK, Ziraat, Gastroenteroloji-(Hepatoloji), Surgery Medicine Sciences, Health Sciences, Tarım Bilimleri, Beslenme ve Dietetik, Klinik Tıp (MED), Tarım ve Çevre Bilimleri (AGE), General Environmental Science, Cerrahi, Internal Medicine Sciences, Nutrition and Dietetics, Klinik Tıp, Hepatology, Agricultural Sciences, CERRAHİ, GASTROENTEROLOGY & HEPATOLOGY, Gastroenterology, Agriculture, Dahili Tıp Bilimleri, Agriculture & Environment Sciences (AGE), CLINICAL MEDICINE, GASTROENTEROLOJİ VE HEPATOLOJİ, Tıp, Hepatoloji, Gastroenteroloji, Delphi consensus, consensus, Cerrahi Tıp Bilimleri, General Earth and Planetary Sciences, Medicine, Metabolic dysfunction-associated fatty liver disease (MAFLD), non-alcoholic fatty liver disease (NAFLD)
Abstract

Background: With the rising global prevalence of fatty liver disease related to metabolic dysfunction, the association of this common liver condition with chronic kidney disease (CKD) has become increasingly evident. In 2020, the more inclusive term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace the term non-alcoholic fatty liver disease (NAFLD). The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD. However, to date, there is no appropriate guidance on CKD in individuals with MAFLD. Furthermore, there has been little attention paid to the link between MAFLD and CKD in the Nephrology community. Methods and Results: Using a Delphi-based approach, a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD. Conclusions: This Delphi-based consensus statement provided guidance on the epidemiology, mechanisms, management and treatment of MAFLD and CKD, as well as the relationship between the severity of MAFLD and risk of CKD, which establish a framework for the early prevention and management of these two common and interconnected diseases.

Published
2023

7. Secondary bile acids improve risk prediction for non-invasive identification of mild liver fibrosis in nonalcoholic fatty liver disease

Author

A‐Na Liu, Cui‐Fang Xu, Ya‐Ru Liu, Dan‐Qin Sun, Ling Jiang, Liang‐Jie Tang, Pei‐Wu Zhu, Sui‐Dan Chen, Wen‐Yue Liu, Xiao‐Dong Wang, Giovanni Targher, Christopher D. Byrne, Vincent Wai‐Sun Wong, Junfen Fu, Ming‐Ming Su, Rohit Loomba, Ming‐Hua Zheng, and Yan Ni

Subjects
nonalcoholic fatty liver disease, risk prediction, Hepatology, secondary bile acids, Gastroenterology, NASH, Pharmacology (medical), liver fibrosis
Published
2023

8. Association of metabolic dysfunction-associated fatty liver disease with kidney disease

Author

Ting-Yao Wang, Rui-Fang Wang, Zhi-Ying Bu, Giovanni Targher, Christopher D. Byrne, Dan-Qin Sun, and Ming-Hua Zheng

Subjects
Male, MAFLD, Review, MAFLD, NAFLD, CKD, chronic kidney disease, Review, Diabetes Mellitus, Type 2, Nephrology, Non-alcoholic Fatty Liver Disease, NAFLD, CKD, Humans, Female, Obesity, Renal Insufficiency, Chronic, Biomarkers, chronic kidney disease
Abstract

Non-alcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in more than 5% of hepatocytes in the absence of excessive alcohol consumption and other secondary causes of hepatic steatosis. In 2020, the more inclusive term metabolic (dysfunction)-associated fatty liver disease (MAFLD) — defined by broader diagnostic criteria — was proposed to replace the term NAFLD. The new terminology and revised definition better emphasize the pathogenic role of metabolic dysfunction and uses a set of definitive, inclusive criteria for diagnosis. Diagnosis of MAFLD is based on evidence of hepatic steatosis (as assessed by liver biopsy, imaging techniques or blood biomarkers and scores) in persons who are overweight or obese and have type 2 diabetes mellitus or metabolic dysregulation, regardless of the coexistence of other liver diseases or excessive alcohol consumption. The known association between NAFLD and chronic kidney disease (CKD) and our understanding that CKD can occur as a consequence of metabolic dysfunction suggests that individuals with MAFLD — who by definition have fatty liver and metabolic comorbidities — are at increased risk of CKD. In this Perspective article, we discuss the clinical associations between MAFLD and CKD, the pathophysiological mechanisms by which MAFLD may increase the risk of CKD and the potential drug treatments that may benefit both conditions.

Published
2022

9. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. Amir, Javier Ampuero, Noha Anas, Pietro Andreone, Soa Fy Andriamandimby, Mahmoud Anees, Peltec Angela, Manal Antonios, Wael Arafat, Jose Moreno Araya, Juan Armendariz-Borunda, Matthew J. Armstrong, Hassan Ashktorab, Patricia Aspichueta, Fathia Assal, Mira Atef, Dina Attia, Hoda Atwa, Reham Awad, Mohyeldeen Abd Elaziz Awad, Sally Awny, Obafemi Awolowo, Yaw Asante Awuku, Ibrahim Ayada, Than Than Aye, Sherif Ayman, Hedy Ayman, Hesham Ayoub, Hosny M. Azmy, Romiro P. Babaran, Omneya Badreldin, Ahmed Badry, İbrahim Halil Bahçecioğlu, Amira Bahour, Jiajia Bai, Yasemin Balaban, Muthuswamy Balasubramanyam, Khaled Bamakhrama, Jesus M Banales, Babu Bangaru, Jianfeng Bao, Jorge Suazo Barahona, Salma Barakat, Sandra Maria Barbalho, Bikwa Barbra, Beatriz Barranco, Francisco Barrera, Ulrich Baumann, Shamardan Bazeed, Eva Bech, Aourarh Benayad, Andreas Benesic, David Bernstein, Fernando Bessone, Susie Birney, Cyrille Bisseye, Martin Blake, Bilal Bobat, Leonilde Bonfrate, Dmitry S Bordin, Francisco Bosques-Padilla, Jerome Boursier, Boushab Mohamed Boushab, David Bowen, Patricia Medina Bravo, Paul N Brennan, Bisi Bright, Ilse Broekaert, Xabier Buque, Diego Burgos-Santamaría, Julio Burman, Luca Busetto, Chris D. Byrne, Patricia Anne I. Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. Dabbous, George N Dalekos, Patricia D'Alia, Li Dan, Viet Hang Dao, Mostafa Darwish, Christian Datz, Milagros B Davalos-Moscol, Heba Dawoud, Blanca Olaechea de Careaga, Robert de Knegt, Victor de Ledinghen, Janaka de Silva, Nabil Debzi, Marie Decraecker, Elvira Del Pozo, Teresa C Delgado, Manuel Delgado-Blanco, Łukasz Dembiński, Adilson Depina, Moutaz Derbala, Hailemichael Desalegn, Christèle Desbois-Mouthon, Mahmoud Desoky, Anouk Dev, Agostino Di Ciaula, Moisés Diago, Ibrahima Diallo, Luis Antonio Díaz, Melisa Dirchwolf, Paola Dongiovanni, Andrriy Dorofeyev, Xiaoguang Dou, Mark W. Douglas, Michael Doulberis, Cecil K. Dovia, Adam Doyle, Ivana Dragojević, Joost PH Drenth, Xuefei Duan, Audrius Dulskas, Dan L Dumitrascu, Oliver Duncan, Vincent Dusabejambo, Rev. Shem N.A. Dwawhi, Sho Eiketsu, Doaa El Amrousy, Ahmed El Deeb, Ghada El Deriny, Hesham Salah El Din, Salwa El Kamshishy, Mohamed El Kassas, Maissa El Raziky, Osama A Elagamy, Wafaa Elakel, Dina Elalfy, Hanaa Elaraby, Heba ElAwady, Reda Elbadawy, Hanaa Hassan Eldash, Manal S. Eldefrawy, Carol Lezama Elecharri, Amel Elfaramawy, Mohammed Elfatih, Mahmoud Elfiky, Mohamed Elgamsy, Mohamed Elgendy, Mohamed A. El-Guindi, Nagi Elhussieny, Ahmed Maher Eliwa, Zeineb Elkabbany, Hesham El-Khayat, Nehal M. El-Koofy, Alaa Elmetwalli, Amr Elrabat, Fathiya El-Raey, Fatma Elrashdy, Medhat Elsahhar, Esraa M. Elsaid, Shimaa Elsayed, Hany Elsayed, Aly Elsayed, Amr M. Elsayed, Hamdy Elsayed, Magdy El-Serafy, Ahmed M. Elsharkawy, Reem Yehia Elsheemy, Eman Elsayed Elshemy, Sara Elsherbini, Naglaa Eltoukhy, Reda Elwakil, Ola Emad, Shaimaa Emad, Mohamed Embabi, Ilkay Ergenç, Tatiana Ermolova, Gamal Esmat, Doaa M. Esmat, Enrique Carrera Estupiñan, Said Ettair, Tcaciuc Eugen, Mohammed Ezz-Eldin, Lidia Patricia Valdivieso Falcón, Yu-Chen Fan, Samah Fandari, Mahmoud Farag, Taghreed Mohamed Farahat, Eman M. Fares, Michael Fares, Eduardo Fassio, Hayam Fathy, Dina Fathy, Wael Fathy, Soheir Fayed, Dan Feng, Gong Feng, Miguel Fernández-Bermejo, Cristina Targa Ferreira, Javier Díaz Ferrer, Alastair Forbes, Rabab Fouad, Hanan M. Fouad, Tove Frisch, Hideki Fujii, Shuhei Fukunaga, Shinya Fukunishi, Hacer Fulya, Masato Furuhashi, Yasmine Gaber, Augusto Jose G. Galang, Jacqueline Cordova Gallardo, Rocío Galloso, Mahmoud Gamal, Reham Gamal, Hadeel Gamal, Jian Gan, Anar Ganbold, Xin Gao, George Garas, Tony Garba, Miren García-Cortes, Carmelo García-Monzón, Javier García-Samaniego, Amalia Gastaldelli, Manuel Gatica, Elizabeth Gatley, Tamar Gegeshidze, Bin Geng, Hasmik Ghazinyan, Salma Ghoneem, Luca Giacomelli, Gianluigi Giannelli, Edoardo G. Giannini, Matthew Giefer, Pere Ginès, Marcos Girala, Pablo J Giraudi, George Boon-Bee Goh, Ahmed Ali Gomaa, Benbingdi Gong, Dina Hilda C. Gonzales, Humberto C. Gonzalez, Maria Saraí Gonzalez-Huezo, Isabel Graupera, Ivica Grgurevic, Henning Grønbæk, Xuelian Gu, Lin Guan, Ibrahima Gueye, Alice Nanelin Guingané, Ozen Oz Gul, Cuma Bulent Gul, Qing Guo, Pramendra Prasad Gupta, Ahmet Gurakar, Juan Carlos Restrepo Gutierrez, Ghada Habib, Azaa Hafez, Emilia Hagman, Eman Halawa, Osama Hamdy, Abd Elkhalek Hamed, Dina H. Hamed, Saeed Hamid, Waseem Hamoudi, Yu Han, James Haridy, Hanan Haridy, David C H Harris Harris, Michael Hart, Fuad Hasan, Almoutaz Hashim, Israa Hassan, Ayman Hassan, Essam Ali Hassan, Adel Ahmed Hassan, Magda Shehata Hassan, Fetouh Hassanin, Alshymaa Hassnine, John Willy Haukeland, Amr Ismael M. Hawal, Jinfan He, Qiong He, Yong He, Fang-Ping He, Mona Hegazy, Adham Hegazy, Osama Henegil, Nelia Hernández, Manuel Hernández-Guerra, Fatima Higuera-de-la-Tijera, Ibrahim Hindy, Keisuke Hirota, Lee Chi Ho, Alexander Hodge, Mohamed Hosny, Xin Hou, Jiao-Feng Huang, Yan Huang, Zhifeng Huang, Yuan Huang, Ang Huang, Xiao-Ping Huang, Sheng Hui-ping, Bela Hunyady, Mennatallah A. Hussein, Osama Hussein, Shahinaz Mahmoud Hussien, Luis Ibáñez-Samaniego, Jamal Ibdah, Luqman Ibrahim, Miada Ibrahim, Ibrahim Ibrahim, Maria E. Icaza-Chávez, Sahar Idelbi, Ramazan Idilman Idilman, Mayumi Ikeda, Giuseppe Indolfi, Federica Invernizzi, Iram Irshad, Hasan Mohamed Ali Isa, Natacha Jreige Iskandar, Abdulrahman Ismaiel, Mariam Ismail, Zulkifli Ismail, Faisal Ismail, Hideki Iwamoto, Kathryn Jack, Rachael Jacob, Fuad Jafarov, Wasim Jafri, Helen Jahshan, Prasun K Jalal, Ligita Jancoriene, Martin Janicko, Hiruni Jayasena, Meryem Jefferies, Vivekanand Jha, Fanpu Ji, Yaqiu Ji, Jidong Jia, Changtao Jiang, Ni Jiang, Zong-zhe Jiang, Xing Jin, Yi Jin, Xu Jing, Qian Jingyu, Maia Jinjolava, FX Himawan Haryanto Jong, Alina Jucov, Ibecheole Julius, Mona Kaddah, Yoshihiro Kamada, Abobakr kamal, Enas Mohamed Kamal, Ashraf Sayed Kamel, Jia-Horng Kao, Maja Karin, Thomas Karlas, Mohammad Kashwaa, Leolin Katsidzira, Eda Kaya, M.Azzam Kayasseh, Bernadette Keenan, Caglayan Keklikkiran, William Keml, Deia K. 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Soares Martins, Rana Marwan, Karen Frances Mason, Ghadeer Masoud, Mohamed Naguib Massoud, Maria Amalia Matamoros, Rosa Martín Mateos, Asmaa Mawed, Jean Claude Mbanya, Charles Mbendi, Lone McColaugh, Duncan McLeod, Juan Francisco Rivera Medina, Ahmed Megahed, Mai Mehrez, Iqbal Memon, Shahin Merat, Randy Mercado, Ahmed Mesbah, Taoufik Meskini, Mayada Metwally, Rasha Metwaly, Lei Miao, Eileen Micah, Luca Miele, Vladimir Milivojevic, Tamara Milovanovic, Yvonne L. Mina, Milan Mishkovik, Amal Mishriki, Tim Mitchell, Alshaimaa Mohamed, Mona Mohamed, Sofain Mohamed, Shady Mohammed, Ahmed Mohammed, Viswanathan Mohan, Sara Mohie, Aalaa Mokhtar, Reham Moniem, Mabel Segura Montilla, Jose Antonio Orozco Morales, María María Sánchez Morata, Jose Maria Moreno-Planas, Silvia Morise, Sherif Mosaad, Mohamed Moselhy, Alaa Mohamed Mostafa, Ebraheem Mostafa, Nezha Mouane, Nasser Mousa, Hamdy Mahfouz Moustafa, Abeer Msherif, Kate Muller, Christopher Munoz, Ana Beatriz Muñoz-Urribarri, Omar Alfaro Murillo, Feisul Idzwan Mustapha, Emir Muzurović, Yehia Nabil, Shaymaa Nafady, Ayu Nagamatsu, Atsushi Nakajima, Dan Nakano, Yuemin Nan, Fabio Nascimbeni, Mirella S. Naseef, Nagwa Nashat, Taran Natalia, Francesco Negro, Alexander V. Nersesov, Manuela Neuman, Masolwa Ng'wanasayi, Yan Ni, Amanda Nicoll, Takashi Niizeki, Dafina Nikolova, Wang Ningning, Madunil Niriella, K.A Nogoibaeva, Rozeena Nordien, Catherine O Sullivan, James O'Beirne, Solomon Obekpa, Ponsiano Ocama, Missiani Ochwoto, Michael Promise Ogolodom, Olusegun Ojo, Nana Okrostsvaridze, Claudia P. Oliveira, Raul Contreras Omaña, Omneya M. Omar, Hanaa Omar, Mabroka Omar, Salma Omran, Reham Omran, Marian Muse Osman, Nevin Owise, Theobald Owusu-Ansah, P. Martín Padilla- Machaca, Sirish Palle, Ziyan Pan, Xiao-Yan Pan, Qiuwei Pan, Apostolis Papaefthymiou, Feliciano Chanana Paquissi, Gabriella Par, Arit Parkash, Diana Payawal, Kevork M. 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L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022
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10. Clinical utility of the MAFLD definition

Author

Dan-Qin Sun, Pei-Wu Zhu, Kenneth I. Zheng, Ming-Hua Zheng, and Yi Jin

Subjects
medicine.medical_specialty, Hepatology, business.industry, medicine, MEDLINE, Intensive care medicine, business
Published
2021
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11. MAFLD and risk of CKD

Author

Kenneth I. Zheng, Rafael S Rios, Dan-Qin Sun, Haoyang Zhang, Wei-Jie Yuan, Ting-Yao Wang, Christopher D. Byrne, Ming-Hua Zheng, Giovanni Targher, and Yan Jin

Subjects
Adult, Male, Risk, 0301 basic medicine, medicine.medical_specialty, Metabolic dysfunction-associated fatty liver disease, National Health and Nutrition Examination Survey, Endocrinology, Diabetes and Metabolism, Urinary system, 030209 endocrinology & metabolism, Comorbidity, Disease, Kidney Function Tests, urologic and male genital diseases, Logistic regression, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, Chronic kidney disease, Nonalcoholic fatty liver disease, Prevalence, medicine, Humans, Renal Insufficiency, Chronic, Ultrasonography, business.industry, Fatty liver, Middle Aged, Nutrition Surveys, medicine.disease, female genital diseases and pregnancy complications, Cross-Sectional Studies, 030104 developmental biology, Albuminuria, Female, medicine.symptom, business, Kidney disease, Non-alcoholic fatty liver disease
Abstract

Background/aims: Whereas nonalcoholic fatty liver disease (NAFLD) is a multisystem disease, the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and extra-hepatic diseases is not known. The aim of this cross-sectional study was to compare the prevalence of chronic kidney disease (CKD) in patients with either MAFLD or NAFLD, and then to examine the association between the presence and severity of MAFLD and CKD and abnormal albuminuria. Methods: A total of 12,571 individuals with complete biochemical and liver ultrasonography data from the Third National Health and Nutrition Examination Survey (1988–1994) were included in the analysis. Multivariable logistic regression analyses were performed to test the independence of associations between MAFLD or MAFLD severity as the key exposures and CKD (defined as either CKD stage ≥1 or stage ≥3) or abnormal albuminuria (urinary albumin-to-creatinine ratio ≥ 3 mg/mmol) as the outcomes. Results: The prevalence of MAFLD and NAFLD was 30.2% (n = 3794) and 36.2% (n = 4552), respectively. MAFLD individuals had a lower eGFR (74.96 ± 18.21 vs. 76.46 ± 18.24 ml/min/1.73 m 2, P < 0.001) and a greater prevalence of CKD (29.60% vs. 26.56%, P < 0.05) than NAFLD individuals. Similarly, there was a higher prevalence CKD in MAFLD than in non-metabolic dysfunction-associated NAFLD (P < 0.05). Notably, after adjustment for sex, age, ethnicity, alcohol intake and diabetes, the severity of MAFLD (i.e. NAFLD fibrosis score ≥ 0.676) was associated with 1.34-fold higher risk of prevalent CKD (P < 0.05). Conclusions: MAFLD identifies patients with CKD better than NAFLD. MAFLD and MAFLD with increased liver fibrosis score are strongly and independently associated with CKD and abnormal albuminuria.

Published
2021

12. The HSD17B13 rs72613567 variant is associated with lower levels of albuminuria in patients with biopsy-proven nonalcoholic fatty liver disease

Author

Kenneth I. Zheng, Yong-Ping Chen, Ming-Hua Zheng, Xiao-Dong Wang, Christopher D. Byrne, Haoyang Zhang, Wei-Jie Yuan, Yan Jin, Ting-Yao Wang, Dan-Qin Sun, and Giovanni Targher

Subjects
Male, 17-Hydroxysteroid Dehydrogenases, Endocrinology, Diabetes and Metabolism, Biopsy, Medicine (miscellaneous), 030204 cardiovascular system & hematology, Kidney, Gastroenterology, 17-Beta hydroxysteroid dehydrogenase 13, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Risk Factors, Chronic kidney disease, Nonalcoholic fatty liver disease, Prevalence, Nutrition and Dietetics, medicine.diagnostic_test, Liver biopsy, Middle Aged, Phenotype, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Glomerular Filtration Rate, Adult, medicine.medical_specialty, China, Urinary system, Renal function, 030209 endocrinology & metabolism, Lower risk, Polymorphism, Single Nucleotide, Risk Assessment, 03 medical and health sciences, Young Adult, Lipocalin-2, Diabetes mellitus, Internal medicine, medicine, Albuminuria, Humans, Genetic Predisposition to Disease, Genetic Association Studies, business.industry, medicine.disease, Cross-Sectional Studies, business, Kidney disease
Abstract

Background and Aims: several susceptibility gene variants predisposing to nonalcoholic fatty liver disease (NAFLD) have been identified in chronic kidney disease (CKD). Evidence supports that 17-beta hydroxysteroid dehydrogenase 13 (HSD17B13) rs72613567 plays a role in NAFLD development by affecting lipid homeostasis. Since lipid droplets may accumulate in the kidneys and contribute to renal injury, we investigated the association between the HSD17B13 rs72613567 variant and markers of renal function/injury in NAFLD.Methods and Results: we measured estimated glomerular filtration rate (eGFR), urinary/serum neutrophil gelatinase-associated lipocalin (NGAL), and urinary albumin-to-creatinine ratio (u-ACR) in individuals with biopsy-proven NAFLD. Multivariable regression analyses were undertaken to examine the associations between the HSD17B13 rs72613567 variant and markers of renal function/injury. Individuals were stratified by HSD17B13 rs72613567 genotypes into -/-, A/- and A/A groups. HSD17B13 rs72613567 genotypes were not significantly associated with eGFR and urinary/serum NGAL levels. Conversely, the prevalence of abnormal albuminuria in the A/- + A/A group was lower than in the -/- group (4.92% vs. 19.35%, p=0.001). Additionally, the mean u-ACR levels were lower among carriers of the A/- or A/A genotypes with coexisting hypertension or diabetes, than among those with the -/- genotype. The risk of abnormal albuminuria (adjusted-odds ratio 0.16, p=0.001) remained significantly lower in the A/- + A/A group after adjustment for established renal risk factors and histologic severity of NAFLD.Conclusion: HSD17B13 rs72613567: A allele is associated with a lower risk of having abnormal albuminuria, but not with lower eGFR or urinary/serum NGAL levels, in patients with biopsy-proven NAFLD.

Published
2020

13. Higher liver stiffness scores are associated with early kidney dysfunction in patients with histologically-proven non-cirrhotic NAFLD

Author

Yong-Ping Chen, Kenneth I. Zheng, Haluk Tarik Kani, Fang-Zhou Ye, J.-R. Yang, Hanyue Zhang, Christopher D. Byrne, Wei-Jie Yuan, Ming-Hua Zheng, Dan-Qin Sun, Giovanni Targher, Yusuf Yilmaz, Sun, D-Q, Ye, F-Z, Kani, H. T., Yang, J-R, Zheng, K., I, Zhang, H-Y, Targher, G., Byrne, C. D., Chen, Y-P, Yuan, W-J, Yilmaz, Y., and Zheng, M-H

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, STRESS, Endocrinology, Diabetes and Metabolism, Liver fibrosis, Renal function, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Logistic regression, Severity of Illness Index, Gastroenterology, DISEASE, STEATOHEPATITIS, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Non-alcoholic Fatty Liver Disease, Internal medicine, Internal Medicine, medicine, Albuminuria, Humans, Liver stiffness measurement, Renal Insufficiency, Stage (cooking), RISK, INSULIN-RESISTANCE, business.industry, Early kidney dysfunction, Fatty liver, Ultrasound, MICROALBUMINURIA, Histology, General Medicine, Middle Aged, medicine.disease, Diabetes Mellitus, Type 2, Elasticity Imaging Techniques, Female, Microalbuminuria, Transient elastography, business, Glomerular Filtration Rate
Abstract

Aim: The association between liver fibrosis (LF), as assessed by either histology or liver stiffness measurement (LSM), and the presence of early kidney dysfunction (EKD) was investigated in this study, as was also the diagnostic performance of LSM for identifying the presence of EKD in patients with non-alcoholic fatty liver disease (NAFLD).Materials and Methods: A total of 214 adults with non-cirrhotic biopsy-proven NAFLD were recruited from two independent medical centres. Their histological stage of LF was quantified using Brunt’s criteria. Vibration-controlled transient elastography (TE), using M-probe (FibroScan®) ultrasound, was performed in 154 patients and defined as significant when LSM was ≥ 8.0 kPa. EKD was defined as the presence of microalbuminuria with an estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2. Logistic regression modelling was used to estimate the likelihood of having EKD with NAFLD (LSM–EKD model).Results: The prevalence of EKD was higher in patients with vs without LF on histology (22.14% vs 4.82%, respectively; P < 0.001) and, similarly, EKD prevalence was higher in patients with LSM ≥ 8.0 kPa vs LSM < 8.0 kPa (23.81% vs 6.59%, respectively; P < 0.05). The area under the ROC curve of the LSM–EKD model for identifying EKD was 0.80 (95% CI: 0.72–0.89). LF detected by either method was associated with EKD independently of established renal risk factors and potential confounders.Conclusion: LF was independently associated with EKD in patients with biopsy-proven NAFLD. Thus, TE-measured LSM, a widely used technique for quantifying LF, can accurately identify those patients with NAFLD who are at risk of having EKD.

Published
2020

14. PNPLA3 rs738409 is associated with renal glomerular and tubular injury in NAFLD patients with persistently normal ALT levels

Author

Giovanni Targher, Xiao-Yan Pan, Haoyang Zhang, Hong-Lei Ma, Xiao-Dong Wang, Wei-Jie Yuan, Christopher D. Byrne, Pei-Wu Zhu, Ming-Hua Zheng, Dan-Qin Sun, Gang Xu, Yong-Ping Chen, and Kenneth I. Zheng

Subjects
Adult, Male, medicine.medical_specialty, Urinary system, Renal function, Lipocalin, Kidney, Polymorphism, Single Nucleotide, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Genotype, Humans, Medicine, Genetic Predisposition to Disease, Renal Insufficiency, Chronic, Alleles, Hepatology, business.industry, renal tubular injury, Membrane Proteins, non-alcoholic fatty liver disease, Alanine Transaminase, patatin-like phospholipase domain-containing protein 3, Lipase, Middle Aged, medicine.disease, chronic kidney disease, Logistic Models, medicine.anatomical_structure, Case-Control Studies, 030220 oncology & carcinogenesis, Albuminuria, Biomarker (medicine), Female, 030211 gastroenterology & hepatology, medicine.symptom, business, Glomerular Filtration Rate, Kidney disease
Abstract

Background & Aims: Patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409 polymorphism is associated with NAFLD severity and the PNPLA3 gene is expressed in the kidneys, but whether PNPLA3 rs738409 polymorphism is also associated with renal tubular injury (RTI) is uncertain. We assessed the effect of PNPLA3 genotypes on biomarkers of RTI and glomerular function in subjects with NAFLD who had either normal (nALT) or abnormal (abnALT) alanine aminotransaminase levels. Methods: Two hundred and seventeen patients with histologically proven NAFLD of which 75 had persistently nALT (below upper limit of normal for 3 months) were included. Multivariable regression analyses were undertaken to test associations between PNPLA3 genotype and biomarkers of kidney dysfunction. Results: The nALT patient group had higher urinary neutrophil gelatinase-associated lipocalin levels (u-NGAL, a biomarker of RTI) (P

Published
2020

15. Subclinical acute kidney injury in COVID-19 patients: a retrospective cohort study

Author

Christopher D. Byrne, Ming-Hua Zheng, Ting Yao Wang, Giovanni Targher, Kenneth I. Zheng, Yong-Ping Chen, and Dan Qin Sun

Subjects
Continuous renal replacement therapy, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, MEDLINE, Kidney Failure, Betacoronavirus, Clinical Practice: Letter to the Editor, Internal medicine, Pandemic, medicine, Humans, Viral, Clinical Practice: Case Report, Chronic, Pandemics, Retrospective Studies, Subclinical infection, Coronavirus disease 2019, biology, SARS-CoV-2, business.industry, End-stage kidney disease, Acute kidney injury, COVID-19, Retrospective cohort study, Pneumonia, Acute Kidney Injury, medicine.disease, biology.organism_classification, Kidney Failure, Chronic, Coronavirus Infections, business, Dialysis
Abstract

Since December 2019, the epidemic of coronavirus disease 2019 (COVID-19) has spread very rapidly in China and worldwide. In this article, we report on a 75-year-old man infected with 2019 novel coronavirus who has end-stage kidney disease (ESKD). COVID-19 patients with ESKD need isolation dialysis, but most of them cannot be handled in time due to limited continuous renal replacement therapy (CRRT) machines. CRRT provided benefits for this patient by removing potentially damaging toxins and stabilizing his metabolic and hemodynamic status. With the control of uremia and fluid status, this patient ended up with an uneventful post-CRRT course, absence of clinical symptoms, and negative PCR tests. Greater efforts are needed to decrease the mortality of COVID-19-infected ESKD patients.

Published
2020

16. WISP1 silencing confers protection against epithelial–mesenchymal transition of renal tubular epithelial cells in rats via inactivation of the wnt/β‐catenin signaling pathway in uremia

Author

Yuan‐Zhen Chen, Ben‐Qing Wu, Guang‐Kuai Zheng, Lian‐Fang Huang, Mei Lin, Yi Zheng, Cong Huang, Dan‐Qin Sun, Dan Song, and Rong‐Quan Chen

Subjects
Male, 0301 basic medicine, Epithelial-Mesenchymal Transition, Physiology, Clinical Biochemistry, Models, Biological, CCN Intercellular Signaling Proteins, Rats, Sprague-Dawley, 03 medical and health sciences, 0302 clinical medicine, Cyclin D1, Proto-Oncogene Proteins, medicine, Animals, Gene silencing, Gene Silencing, Epithelial–mesenchymal transition, RNA, Small Interfering, Wnt Signaling Pathway, beta Catenin, Uremia, Chemistry, Activator (genetics), Wnt signaling pathway, Epithelial Cells, Cell Biology, Transfection, medicine.disease, Fibrosis, Cell biology, Kidney Tubules, 030104 developmental biology, 030220 oncology & carcinogenesis, Signal transduction
Abstract

Uremia can affect hepatic metabolism of drugs by regulating the clearance of drugs, but it has not been clarified whether gene silencing could modulate the epithelial-mesenchymal transition (EMT) process in uremia. Hence, we investigated the effect of WISP1 gene silencing on the renal tubular EMT in uremia through the wnt/β-catenin signaling pathway. Initially, microarray-based gene expression profiling of uremia was used to identify differentially expressed genes. Following the establishment of uremia rat model, serum creatinine, and urea nitrogen of rats were detected. Renal tubular epithelial cells (TECs) were transfected with shRNA-WISP1 lentivirus interference vectors and LiCI (the wnt/β-catenin signaling pathway activator) to explore the regulatory mechanism of WISP1 in uremia in relation to the wnt/β-catenin signaling pathway. Then, expression of WISP1, wnt2b, E-cadherin, α-SMA, c-myc, Cyclin D1, MMP-2, and MMP-9 was determined. Furthermore, TEC migration and invasion were evaluated. Results suggested that WISP1 and the wnt/β-catenin signaling pathway were associated with uremia. Uremic rats exhibited increased serum creatinine and urea nitrogen levels, upregulated WISPl, and activated wnt/β-catenin signaling pathway. Subsequently, WISP1 silencing decreased wnt2b, c-myc, Cyclin D1, α-SMA, MMP-2, and MMP-9 expression but increased E-cadherin expression, whereas LiCI treatment exhibited the opposite trends. In addition, WISP1 silencing suppressed TEC migration and invasion, whereas LiCI treatment promoted TEC migration and invasion. The findings indicate that WISP1 gene silencing suppresses the activation of the wnt/β-catenin signaling pathway, thus reducing EMT of renal TECs in uremic rats.

Published
2018
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17. Serum lactate level accurately predicts mortality in critically ill patients with cirrhosis with acute kidney injury

Author

Ming-Hua Zheng, Xiao-Ming Chen, Feng-Bin Lu, Lai Zhang, Sven Van Poucke, Dan-Qin Sun, Yong-Ping Chen, and Chenfei Zheng

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Time Factors, Cirrhosis, Databases, Factual, Critical Illness, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, Hospital Mortality, Lactic Acid, 030212 general & internal medicine, Aged, Hepatology, business.industry, Mortality rate, Hazard ratio, Acute kidney injury, 030208 emergency & critical care medicine, Acute Kidney Injury, Middle Aged, Prognosis, medicine.disease, Confidence interval, Up-Regulation, Intensive Care Units, Quartile, Predictive value of tests, Female, Hyperlactatemia, business, Biomarkers
Abstract

Background and aim Serum lactate levels are routinely measured in critically ill patients with cirrhosis, and hyperlactatemia is a common finding, but its prognostic value remains controversial. Our aim was to examine whether serum lactate level could be used as a predictor of outcome in critically ill patients with cirrhosis (CICP) with acute kidney injury (AKI). Patients and methods In this study, we included 480 consecutive patients with cirrhosis admitted to ICU, complicated with AKI, and were followed up for 365 days. Patients were divided into four groups (Q1-Q4) by serum lactate quartiles: Q1≤1.8 mg/dl, Q2=1.9-2.4 mg/dl, Q3=2.5-4.0 mg/dl, and Q4≥4.1 mg/dl. The hazard ratio (HR) and 95% confidence intervals (CIs) for hospital mortality were calculated across each quartile of serum lactate, using the Q1 as reference, and four models were built to adjust for the HR of mortality. Results Compared with patients in the survival group, nonsurvivors had higher serum lactate levels. Mortality rate increased progressively as the serum lactate level increased (Q1: 56.06%, Q2: 62.16%, Q3: 72.73% and Q4: 75.86%), and this relationship remained statistically significant after rigorous control of confounding factors in Q2, Q3, and Q4 with HRs of 1.03 (95% CI: 0.73-1.46), 1.40 (95% CI: 1.01-1.95), and 1.84 (95% CI: 1.28-2.64), respectively. Conclusion Our study brings a new perspective to the role of lactate monitoring in CICP with AKI. Elevated serum lactate levels are associated with a higher mortality rate in CICP with AKI. Elevated serum lactate levels should be part of rapid diagnosis and initiation of therapy to improve clinical outcome.

Published
2018
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18. Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury

Author

Xiao-Ming Chen, Kenneth I. Zheng, Dan-Qin Sun, Chenfei Zheng, Ming-Hua Zheng, Wei-Jie Yuan, Wen-Yue Liu, and Lai Zhang

Subjects
medicine.medical_specialty, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, medicine, Acidosis, Hepatology, business.industry, Metabolic acidosis, Mortality rate, Hazard ratio, Acute kidney injury, medicine.disease, Intensive care unit, Hospital morality, 030220 oncology & carcinogenesis, Lactic acidosis, Cardiology, 030211 gastroenterology & hepatology, Original Article, medicine.symptom, business, Cohort study, Critically ill cirrhotic patients
Abstract

Background and Aims: The metabolic acid-base disorders have a high incidence of acute kidney injury (AKI) in critically ill cirrhotic patients (CICPs). The aims of our study were to ascertain the composition of metabolic acidosis of CICPs with AKI and explore its relationship with hospital mortality. Methods: Three-hundred and eighty consecutive CICPs with AKI were eligible for the cohort study. Demographic, clinical and laboratory parameters were recorded and arterial acid-base state was analyzed by the Stewart and Gilfix methodology. Results: Net metabolic acidosis, lactic acidosis, acidosis owing to unmeasured anions, acidemia, and dilutional acidosis were less frequent in the non-survival group compared to the survival group of CICPs. The presence of acidemia, acidosis owing to unmeasured anions, and lactic acidosis were independently associated with increased risk of intensive care unit 30-day mortality, with hazard ratios of 2.11 (95% confidence interval (CI): 1.43–3.12), 3.38 (95% CI: 2.36–4.84), and 2.16 (95% CI: 1.47–3.35), respectively. After full adjustment for confounders, the relationship between acidosis owing to unmeasured anions with hospital mortality was still significant, with hazard ratio of 2.29 (95% CI: 1.22–4.30). Furthermore, arterial lactate concentration in combination with chronic liver failure-sequential organ failure assessment and BEUMA had the strongest ability to differentiate 30-day mortality (area under the receiver operating characteristic curve: 0.79, 95% CI: 0.74–0.83). Conclusions: CICPs with AKI exhibit a complex metabolic acidosis during intensive care unit admission. Lactic acidosis and BEUMA, novel markers of acid-base disorders, show promise in predicting mortality rate of CICPs with AKI.

Published
2019

19. Increased levels of low-density lipoprotein cholesterol within the normal range as a risk factor for nonalcoholic fatty liver disease

Author

Shengjie Wu, Ming-Hua Zheng, Ke-Qing Shi, Gui-Qi Zhu, Dan-Qin Sun, Martin Braddock, Dong-Chu Zhang, Dan Song, and Wen-Yue Liu

Subjects
Adult, Male, China, medicine.medical_specialty, Cross-sectional study, Population, 03 medical and health sciences, 0302 clinical medicine, Reference Values, Risk Factors, Internal medicine, Nonalcoholic fatty liver disease, Prevalence, medicine, Humans, Cumulative incidence, Longitudinal Studies, Prospective Studies, Risk factor, education, low-density lipoprotein cholesterol, education.field_of_study, Traditional medicine, business.industry, Incidence (epidemiology), Fatty liver, nutritional and metabolic diseases, non-alcoholic fatty liver disease, Cholesterol, LDL, Odds ratio, Middle Aged, Prognosis, medicine.disease, Cross-Sectional Studies, risk factor, Oncology, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Research Paper, Follow-Up Studies
Abstract

// Dan-Qin Sun 1 * , Wen-Yue Liu 2 * , Sheng-Jie Wu 3 * , Gui-Qi Zhu 4, 5 , Martin Braddock 6 , Dong-Chu Zhang 7 , Ke-Qing Shi 4, 8 , Dan Song 1 , Ming-Hua Zheng 4, 8 1 Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi 214002, China 2 Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China 3 Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China 4 Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China 5 School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China 6 Global Medicines Development, AstraZeneca R&D, Alderley Park, United Kingdom 7 Wenzhou Medical Center, Wenzhou People’s Hospital, Wenzhou 325000, China 8 Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China * These authors have contributed equally to this work Correspondence to: Ming-Hua Zheng, e-mail: zhengmh@wmu.edu.cn Dan Song, e-mail: sdwx66@163.com Keywords: low-density lipoprotein cholesterol, non-alcoholic fatty liver disease, risk factor. Received: October 09, 2015 Accepted: December 04, 2015 Published: December 30, 2015 ABSTRACT Objectives: Dyslipidemia exists within the setting of NAFLD and the relationship of a normal level of low-density lipoprotein cholesterol (LDL-c) with NAFLD is largely unknown. This large population-based study aimed to investigate the association between LDL-c levels within the normal range and the incidence of NAFLD. Methods: A total of 60527 subjects from 2 medical centers who had undergone liver ultrasonography were initially enrolled into this study. NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. Subjects were divided into 4 groups (Q1 to Q4) by normal LDL-c quartiles : Q1: ≤ 2.00, Q2: 2.10-2.35, Q3: 2.36-2.68 and Q4: 2.69-3.12 mmol/L. The odds ratios (OR), hazard ratio (HR) and 95% confidence intervals (CIs) for NAFLD were calculated across each quartile of LDL-c, using the Q1 as reference. Results: The prevalence rates of NAFLD in a cross-sectional population from Q1 to Q4 were 19.34%, 25.86%, 35.65% and 42.08%, respectively. The OR for NAFLD in the cross-sectional population were 1.31 (95% CI 1.14-1.54), 1.73 (95% CI 1.46-2.04), and 1.82 (95% CI 1.49-2.23), respectively, after adjusting for known confounding variables. The HR for NAFLD in the longitudinal population were 1.23 (95% CI 1.12-1.35), 1.57 (95% CI 1.44-1.72) and 2.02 (95% CI 1.86-2.21), compared with Q1. Subjects with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD. Conclusions: Increased levels of LDL-c within the normal range may play a significant role in the prevalence and incidence of NAFLD, independent of other confounding factors.

Published
2015
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20. Comparative efficacy of vasoconstrictor therapies for type 1 hepatorenal syndrome: a network meta-analysis

Author

Yi-Jing Han, Ming-Hua Zheng, Dan-Qin Sun, Tian-Tian Zou, Jian-Hong Zhong, Martin Braddock, Yu-Jie Zhou, and Ji-Na Zheng

Subjects
Drug, Male, medicine.medical_specialty, Comparative Effectiveness Research, Hepatorenal Syndrome, media_common.quotation_subject, Population, Plasma Substitutes, Lypressin, law.invention, Norepinephrine (medication), 03 medical and health sciences, Norepinephrine, 0302 clinical medicine, Hepatorenal syndrome, Randomized controlled trial, law, Risk Factors, Internal medicine, Albumins, medicine, Odds Ratio, Humans, Vasoconstrictor Agents, 030212 general & internal medicine, education, media_common, Randomized Controlled Trials as Topic, education.field_of_study, Hepatology, business.industry, Gastroenterology, Middle Aged, medicine.disease, Surgery, Indirect comparison, Treatment Outcome, Vasoconstriction, Meta-analysis, 030211 gastroenterology & hepatology, Female, Terlipressin, business, medicine.drug
Abstract

The outcome of a comparative efficacy and safety of vasoconstrictor therapies for treatment of patients with type 1 hepatorenal syndrome (HRS-1) remain inconclusive. Areas covered: We searched literature databases for randomized controlled trials (RCTs) until 31 January 2016, and included ten eligible RCTs. In conclusion, terlipressin was the most efficacious vasoconstrictor drug for HRS-1, but had a higher probability of causing AEs. Norepinephrine was an attractive alternative to terlipressin and associated with less AEs. Expert commentary: To date, most previous traditional meta-analyses included trials with a limited population and compared terlipressin alone or with albumin against no intervention or albumin. Since different HRS types have different diagnoses and show different responses to vasoconstrictors, it may be questionable to combine data from patients with type 1 and type 2 HRS, which has been reported for most previous meta-analyses. Thus, performing a high-quality network meta-analysis of the existing literature is a valuable way to interrogate published data and to draw conclusions which may inform on the best interventional strategy.

Published
2017

21. SAT-336-lLver stiffness measurement: An alternative practical predictor for early kidney dysfunction in patients with non-alcoholic fatty liver disease

Author

Pei-Wu Zhu, Hong-Lei Ma, Yong-Ping Chen, Chenfei Zheng, Fang-Zhou Ye, Haoyang Zhang, Dan-Qin Sun, Haluk Tarik Kani, Ming-Hua Zheng, Yusuf Yilmaz, Wei-Jie Yuan, Xiaodong Wang, and Wen-Yue Liu

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, Fatty liver, Kidney dysfunction, Medicine, Non alcoholic, In patient, Disease, business, medicine.disease, Gastroenterology
Published
2019
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22. Prognostic value of hematocrit levels among critically ill patients with acute kidney injury

Author

Xinxin Chen, Dan-Qin Sun, Yan-Hui Wang, Jingye Pan, Mei Sun, Yi Liu, Ming-Hua Zheng, Chaosheng Chen, Chenfei Zheng, and Ying Zhou

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Critically ill, lcsh:R, Immunology, Acute kidney injury, lcsh:Medicine, Retrospective cohort study, 030204 cardiovascular system & hematology, Hematocrit, medicine.disease, Intensive care unit, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Immunology and Allergy, Medicine, 030212 general & internal medicine, Hematocrit levels, business
Abstract

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

Published
2019
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23. AKI-CLIF-SOFA: a novel prognostic score for critically ill cirrhotic patients with acute kidney injury

Author

Ke-Qing Shi, Sven Van Poucke, Xiao-Dong Wang, Chenfei Zheng, Ming-Hua Zheng, Ji-Dong Wang, Zhi Mao, Wen-Yue Liu, and Dan-Qin Sun

Subjects
Liver Cirrhosis, Male, Aging, medicine.medical_specialty, Critical Care, Organ Dysfunction Scores, Critical Illness, 030232 urology & nephrology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Model for End-Stage Liver Disease, law, Internal medicine, medicine, Humans, Simplified Acute Physiology Score, Intensive care medicine, critically ill cirrhosis, Aged, Receiver operating characteristic, Proportional hazards model, business.industry, sequential organ failure assessment score, Acute kidney injury, Cell Biology, Acute Kidney Injury, Middle Aged, Models, Theoretical, medicine.disease, Prognosis, Intensive care unit, SAPS II, 030211 gastroenterology & hepatology, Female, business, Kidney disease, Research Paper
Abstract

Critically ill cirrhotic patients with acute kidney injury (AKI) are associated with high mortality rates. The aims of this study were to develop a specific prognostic score for critically ill cirrhotic patients with AKI, the acute kidney injury - Chronic Liver Failure - Sequential Organ Failure- Assessment score (AKI-CLIF-SOFA) score. This study focused on 527 cirrhotic patients with AKI admitted to intensive care unit and constructed a new scoring system, the AKI-CLIF-SOFA, which can be used to prognostically assess mortality in these patient population. Parameters included in this model were analysed by cox regression. The area under the receiver operating characteristic curve (auROC) of AKI-CLIF-SOFA scoring system was 0.74 in 30 days, 0.74 in 90 days, 0.72 in 270 days and 0.72 in 365 days. Additionally, this study demonstrated that the new model had more discriminatory power than chronic liver failure- sequential organ failure assessment score (CLIF-SOFA), SOFA, model for end stage liver disease (MELD), kidney disease improving global outcomes (KDIGO) and simplified acute physiology score II (SAPS II) (auROC: 0.72, 0.66, 0.64, 0.62, 0.63 and 0.65 respectively, all P < 0.05) for the prediction of the 365-days mortality. Therefore, AKI-CLIF-SOFA demonstrated a valuable discriminative ability compared with KDIGO, CLIF-SOFA, MELD, SAPS II and SOFA in critically ill cirrhotic patients with AKI.

Published
2016

24. Association of low-density lipoprotein cholesterol within the normal range and NAFLD in the non-obese Chinese population: a cross-sectional and longitudinal study

Author

Martin Braddock, Li-Ren Wang, Shengjie Wu, Ming-Hua Zheng, Ke-Qing Shi, Yi-Ran Chen, Wen-Yue Liu, Dong-Chu Zhang, Dan Song, and Dan-Qin Sun

Subjects
Adult, Male, Longitudinal study, medicine.medical_specialty, China, Cross-sectional study, Population, Gastroenterology and Hepatology, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Asian People, Non-alcoholic Fatty Liver Disease, Reference Values, Risk Factors, Internal medicine, Prevalence, Medicine, Humans, Cumulative incidence, Longitudinal Studies, Prospective Studies, Risk factor, Prospective cohort study, education, Dyslipidemias, Ultrasonography, education.field_of_study, low-density lipoprotein cholesterol, business.industry, non-obese, Incidence (epidemiology), Research, nutritional and metabolic diseases, General Medicine, Cholesterol, LDL, digestive system diseases, Cross-Sectional Studies, risk factor, 030220 oncology & carcinogenesis, Physical therapy, 030211 gastroenterology & hepatology, Female, business, Body mass index
Abstract

Objectives The relationship between normal low-density lipoprotein cholesterol (LDL-c) levels and non-alcoholic fatty liver disease (NAFLD) in non-obese individuals remains unclear. We aimed to investigate the precise prevalence and incidence of NAFLD within the normal LDL-c range in non-obese individuals. Design Cross-sectional and longitudinal study. Setting Wenzhou Medical Center of Wenzhou People9s Hospital from 2010 to 2014. Participants 183 903 non-obese individuals were enrolled from a cross-sectional population, and a total of 16 173 initially NAFLD-free non-obese individuals were included who completed a 5-year follow-up examination in the longitudinal population. Results In our study, NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. The cross-sectional study showed that at baseline, the prevalence of NAFLD was 13.9% in non-obese individuals with normal LDL-c levels. The prospective study demonstrated that NAFLD-free participants developed NAFLD during the 5-year follow-up period, with a cumulative incidence of 14.4%. In addition, the ORs for NAFLD in the cross-sectional population were 1.11 (95% CI 1.04 to 1.18), 1.37 (95% CI 1.27 to 1.47) and 1.56 (95% CI 1.43 to 1.69), respectively, after adjusting for known confounding variables. The HRs for NAFLD in the longitudinal population were 1.15 (95% CI 0.98 to 1.36), 1.32 (95% CI 1.10 to 1.58) and 1.82 (95% CI 1.47 to 2.52), compared with Q1. Individuals with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD in non-obese individuals. Conclusions NAFLD is prevalent in the non-obese Chinese population. Furthermore, this is the first study to demonstrate that increased normal LDL-c levels are independently associated with an elevated risk of NAFLD in non-obese individuals.

Published
2016

25. Serum uric acid: a new therapeutic target for nonalcoholic fatty liver disease

Author

Shengjie Wu, Ming-Hua Zheng, Wen-Yue Liu, Martin Braddock, Dan-Qin Sun, Ke-Qing Shi, Gui-Qi Zhu, Qian-Di Lu, and Dan Song

Subjects
0301 basic medicine, medicine.medical_specialty, Inflammasomes, Clinical Biochemistry, Hyperuricemia, Biology, Bioinformatics, digestive system, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Insulin resistance, Non-alcoholic Fatty Liver Disease, Internal medicine, Drug Discovery, Nonalcoholic fatty liver disease, medicine, Animals, Humans, Molecular Targeted Therapy, Pharmacology, Metabolic Syndrome, Serum uric acid, nutritional and metabolic diseases, Treatment options, medicine.disease, digestive system diseases, Independent factor, Uric Acid, 030104 developmental biology, Endocrinology, chemistry, Drug Design, Molecular Medicine, Uric acid, 030211 gastroenterology & hepatology, Metabolic syndrome, Insulin Resistance
Abstract

Nonalcoholic fatty liver disease (NAFLD) is a major, worldwide public health problem. NAFLD is recognized as a major cause of liver-related morbidity and mortality. However, physicians are currently limited by available treatment options. Recently, numerous studies have reported a correlation between serum uric acid (SUA) and NAFLD with numerous clinical and experimental studies demonstrating a significant correlation. This review will focus on the role of SUA in the development of NAFLD and its potential role as a new target for therapeutic intervention.This review discusses SUA as a significant independent factor in the development of NAFLD. Moreover, we introduce the causal relationship between SUA, metabolic syndrome, and NAFLD. We discuss two major theories of insulin resistance and inflammasomes as potential explanations of the mechanistic link between SUA and NAFLD. In addition, we review current and emerging therapeutic medications to control appropriate SUA levels.There is an urgent need to develop novel, safe and effective therapies for the growing NAFLD epidemic. Reduction of SUA may be a promising potential treatment for patients with NAFLD. Clinical studies are required to determine the therapeutic effect of attenuation of hyperuricemia in humans with NAFLD.

Published
2015

27. Pharmacotherapy for Hepatic encephalopathy: view of Evidence-Based Medicine

Author

Qian Jiang, Ai-Min Wu, Yong-Ping Chen, Dan-Qin Sun, Minghua Zheng, and Keqing Shi

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Neonatal encephalopathy, Population, Evidence-based medicine, Bioinformatics, medicine.disease, Jadad scale, Rifaximin, law.invention, chemistry.chemical_compound, Pharmacotherapy, chemistry, Randomized controlled trial, law, medicine, business, Intensive care medicine, education, Hepatic encephalopathy
Abstract

Hepatic encephalopathy (HE) refers to a complex and reversible neuro-psychiatric syndrome that results from complications of acute or chronic hepatic failure, particularly alcoholic cirrhosis. It will lead to frequent life disruptions, poor quality of life and extensive use of health care resources. We conducted the review of several agents based on randomized controlled trials (RCTs) of high-quality Jadad scores (≥3) to provide effective information for clinical practice. Rifaximin appears at least to be as effective as conventional treatments, but not superior to them. L-Ornithine-L-aspartate appears to be a safe and effective treatment of chronic HE when compared with a placebo regime. Other treatments include non-absorbable disaccharides (NAD) and benzodiazepine receptor antagonists. In spite of the variability in the improvement of HE, NAD and non-absorbed antibiotics such as rifaximin offer a favorable benefit–risk ratio in the improvement of HE. Further RCTs with power calculation and a multi-centre approach with adequate population number are needed to resolve the heterogeneous results

Published
2012
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28. Association of low-density lipoprotein cholesterol within the normal range and NAFLD in the non-obese Chinese population: a cross-sectional and longitudinal study.

Author

Dan-Qin Sun, Sheng-Jie Wu, Wen-Yue Liu, Li-Ren Wang, Yi-Ran Chen, Dong-Chu Zhang, Braddock, Martin, Ke-Qing Shi, Dan Song, and Ming-Hua Zheng

Abstract

Objectives: The relationship between normal low-density lipoprotein cholesterol (LDL-c) levels and non-alcoholic fatty liver disease (NAFLD) in non-obese individuals remains unclear. We aimed to investigate the precise prevalence and incidence of NAFLD within the normal LDL-c range in non-obese individuals. Design: Cross-sectional and longitudinal study. Setting: Wenzhou Medical Center of Wenzhou People's Hospital from 2010 to 2014. Participants: 183 903 non-obese individuals were enrolled from a cross-sectional population, and a total of 16 173 initially NAFLD-free non-obese individuals were included who completed a 5-year follow-up examination in the longitudinal population. Results: In our study, NAFLD was defined by ultrasonographic detection of steatosis in the absence of other liver disease. The cross-sectional study showed that at baseline, the prevalence of NAFLD was 13.9% in non-obese individuals with normal LDL-c levels. The prospective study demonstrated that NAFLD-free participants developed NAFLD during the 5-year follow-up period, with a cumulative incidence of 14.4%. In addition, the ORs for NAFLD in the cross-sectional population were 1.11 (95% CI 1.04 to 1.18), 1.37 (95% CI 1.27 to 1.47) and 1.56 (95% CI 1.43 to 1.69), respectively, after adjusting for known confounding variables. The HRs for NAFLD in the longitudinal population were 1.15 (95% CI 0.98 to 1.36), 1.32 (95% CI 1.10 to 1.58) and 1.82 (95% CI 1.47 to 2.52), compared with Q1. Individuals with higher LDL-c level within the normal range had an increased cumulative incidence rate of NAFLD in non-obese individuals. Conclusions: NAFLD is prevalent in the non-obese Chinese population. Furthermore, this is the first study to demonstrate that increased normal LDL-c levels are independently associated with an elevated risk of NAFLD in non-obese individuals. [ABSTRACT FROM AUTHOR]

Published
2016
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