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1. Prediction of Cardiovascular Events by Pulse Waveform Parameters: Analysis of CARTaGENE

Author

Louis‐Charles Desbiens, Catherine Fortier, Annie‐Claire Nadeau‐Fredette, François Madore, Bernhard Hametner, Siegfried Wassertheurer, Mohsen Agharazii, and Rémi Goupil

Subjects
cardiovascular prediction, central pressure, pulse wave analysis, wave separation analysis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Waveform parameters provide approximate data about aortic wave reflection. However, their association with cardiovascular events remains controversial and their role in cardiovascular prediction is unknown. Methods and Results We analyzed participants aged between 40 and 69 from the population‐based CARTaGENE cohort. Baseline pulse wave analysis (central pulse pressure, augmentation index) and wave separation analysis (forward pressure, backward pressure, reflection magnitude) parameters were derived from radial artery tonometry. Associations between each parameter and major adverse atherosclerotic events (MACE; cardiovascular death, stroke, myocardial infarction) were obtained using adjusted Cox models. The incremental predictive value of each parameter compared with the 10‐year atherosclerotic cardiovascular disease score alone was assessed using hazard ratios, c‐index differences, continuous net reclassification indexes, and integrated discrimination indexes. From 17 561 eligible patients, 2315 patients had a MACE during a median follow‐up of 10.1 years. Central pulse pressure, forward pressure, and backward pressure, but not augmentation index and reflection magnitude, were significantly associated with MACE after full adjustment. All parameters except forward pressure statistically improved MACE prediction compared with the atherosclerotic cardiovascular disease score alone. The greatest prediction improvement was seen with augmentation index and reflection magnitude but remained small in magnitude. These 2 parameters enhanced predictive performance more strongly in patients with low baseline atherosclerotic cardiovascular disease scores. Up to 5.7% of individuals were reclassified into a different risk stratum by adding waveform parameters to atherosclerotic cardiovascular disease scores. Conclusions Some waveform parameters are independently associated with MACEs in a population‐based cohort. Augmentation index and reflection magnitude slightly improve risk prediction, especially in patients at low cardiovascular risk.

Published
2022
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2. Can Peer Review Be Kinder? Supportive Peer Review: A Re-Commitment to Kindness and a Call to Action

Author

Catherine M. Clase, Elizabeth Dicks, Rachel Holden, Manish M. Sood, Adeera Levin, Kamyar Kalantar-Zadeh, Linda W Moore, Susan J. Bartlett, Aminu K. Bello, Clara Bohm, Darren Bridgewater, Josee Bouchard, Dylan Burger, Juan Jesús Carrero, Maoliosa Donald, Meghan Elliott, Maya J. Goldenberg, Meg Jardine, Ngan N. Lam, W. Joy Maddigan, François Madore, Thomas A. Mavrakanas, Amber O. Molnar, G. V. Ramesh Prasad, Claudio Rigatto, Karthik K. Tennankore, Elena Torban, Laurel Trainor, Christine A. White, and Sunny Hartwig

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Peer review aims to select articles for publication and to improve articles before publication. We believe that this process can be infused by kindness without losing rigor. In 2014, the founding editorial team of the Canadian Journal of Kidney Health and Disease (CJKHD) made an explicit commitment to treat authors as we would wish to be treated ourselves. This broader group of authors reaffirms this principle, for which we suggest the terminology “supportive review.”

Published
2022
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3. Clinical Value of Complement Activation Biomarkers in Overt Diabetic Nephropathy

Author

Karyne Pelletier, Arnaud Bonnefoy, Hugo Chapdelaine, Vincent Pichette, Matthieu Lejars, François Madore, Soumeya Brachemi, and Stéphan Troyanov

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Background: Experimental studies support a role of complement activation in diabetic nephropathy (DN), yet few clinical correlates exist. We evaluated urinary levels of sC5b-9 membrane attack complex (MAC) in patients with overt DN, and examined its association with the glomerular filtration rate (GFR) decline, proteinuria, and inflammatory biomarkers. We explored different complement pathways and compared our findings to autoimmune glomerulonephritis. Methods: We prospectively followed 83 patients with DN and obtained repeated measurements of proteinuria, complement fragments (sC5b-9, C4a, C1q, mannose-binding lectin–associated serine protease [MASP]-1, and factor Bb), monocyte chemoattractant protein-1 (MCP-1), and transforming growth factor (TGF)-β1. We assessed independence and interactions using general linear models and repeated measures analyses and compared levels with subjects with active focal and segmental glomerulosclerosis, ANCA-associated vasculitis, and membranous and IgA nephropathies (n = 63). Results: The diabetic cohort had an initial GFR of 25 ± 9 ml/min per 1.73 m2 and a renal function decline of 2.9 ± 3.0 ml/min per 1.73 m2 per year. All complement biomarkers were strongly intercorrelated and associated with biomarker inflammation and fibrosis, proteinuria, and the rate of renal function decline. There was a significant interaction (P = 0.03) between the level of proteinuria and urinary sC5b-9: in individuals with higher levels of urinary MAC, the relationship between proteinuria and the rate of renal function decline was more pronounced than in those with low urinary MAC. Finally, patients with DN had levels of urinary sC5b-9 comparable to autoimmune glomerulonephritis, when stratified by the level of proteinuria. Conclusion: Urinary MAC is present in patients with overt DN at levels comparable to autoimmune glomerulonephritis and correlates with the GFR decline, supporting that complement activation and its measurement are clinically relevant in DN. Keywords: complement activation, diabetic nephropathy, fibrosis, inflammation, proteinuria, glomerulonephritis

Published
2019
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4. 4.1 Hypertension is Associated with Adverse Cardiovascular Outcomes only when Both Brachial and Central Blood Pressures are Elevated

Author

Remi Goupil, Florence Lamarche, Mohsen Agharazii, and François Madore

Subjects
Specialties of internal medicine, RC581-951, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The range of central blood pressure (BP) found in individuals with high-normal brachial BP overlaps the one found in hypertension (HTN) and normotension. As central BP is possibly a better predictor of cardiovascular (CV) disease, the aim of this study was to determine the risk associated with different central/brachial BP patterns. Methods: 13,759 participants from a populational cohort with central BP and prospective data from governmental databases who were not treated for HTN were selected. Major adverse CV events (MACE) comprised myocardial infarction, stroke, heart failure and CV death. Thresholds for brachial and central HTN were identified as 135 and 125 mmHg respectively. Individuals were separated into 4 BP patterns: normal BP; isolated brachial HTN; isolated central HTN; concordant brachial and central HTN. CV risk for each pattern was compared to normal BP with a Cox proportional hazard model adjusted for multiple covariables. Results: 688 MACE occurred over a median follow-up of 70.0 months. Characteristics of individuals in each BP phenotype are presented in Table 1. Only the concordant brachial and central HTN pattern had higher risk of MACE [HR 1.37 95% CI (1.15–1.64), p = 0.001] compared to normal BP. Sensitivity analyses with different definitions of central HTN and after stratification for sex yielded similar results. Demographic characteristics Normal BP (n = 10,611) Isolated brachial HTN (n = 394) Isolated central HTN (n = 496) Concordant HTN (n = 2,258) n 10,611 394 496 2,258 Age 51 (46–57) 53 (47–60) 54 (49–62) 56 (51–63) Male sex 43% 88% 38% 58% Caucasian race 89% 88% 91% 89% Cardiovascular disease 2% 2% 4% 2% Diabetes 4% 8% 3% 6% Active smoking 19% 22% 16% 21% BMI (kg/m2) 26 ± 5 28 ± 3 28 ± 5 28 ± 5 eGFR (ml/min/1.73 m2) 90 ± 14 87 ± 15 89 ± 14 88 ± 14 10-year Framingham risk score (%) 8 ± 7 17 ± 10 11 ± 7 18 ± 12 LDL-c (mmol/L) 3.1 ± 0.8 3.1 ± 0.9 3.3 ± 0.9 3.3 ± 0.9 Heart rate (bpm) 70 ± 10 77 ± 11 65 ± 9 71 ± 11 Aspirin 6% 8% 11% 9% Statin 10% 16% 16% 13% Conclusions: In untreated individuals, both central and brachial BP need to be elevated to increase CV risk. These findings provide support for the utility of routine central BP measurements in clinical practice.

Published
2020
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5. Diagnosis and outcomes of acute kidney injury using surrogate and imputation methods for missing preadmission creatinine values

Author

Amélie Bernier-Jean, William Beaubien-Souligny, Rémi Goupil, François Madore, François Paquette, Stéphan Troyanov, and Josée Bouchard

Subjects
Acute kidney injury, Baseline creatinine, Diagnosis, Epidemiology, Surrogate, Outcomes, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Abstract Background Missing preadmission serum creatinine (SCr) values are a common obstacle to assess acute kidney injury (AKI) diagnosis and outcomes. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest using a SCr computed from the Modification of Diet in Renal Disease (MDRD) with an estimated glomerular filtration rate of 75 ml/min/1.73 m2. We aimed to identify the best surrogate method for baseline SCr to assess AKI diagnosis and outcomes. Methods We compared the use of 1) first SCr at hospital admission 2) minimal SCr over 2 weeks after intensive care unit admission 3) MDRD computed SCr and 4) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) computed SCr to assess AKI diagnosis and outcomes. We then performed multilinear regression models to predict preadmission SCr and imputation strategies to assess AKI diagnosis. Results Our one-year retrospective cohort study included 1001 critically ill adults; 498 of them had preadmission SCr values. In these patients, AKI incidence was 25.1% using preadmission SCr. First SCr had the best agreement for AKI diagnosis (22.5%; kappa = 0.90) and staging (kappa = 0.81). MDRD, CKD-EPI and minimal SCr overestimated AKI diagnosis (26.7%, 27.1% and 43.2%;kappa = 0.86, 0.86 and 0.60, respectively). However, MDRD and CKD-EPI computed SCr had a better sensitivity than first SCr for AKI (93% and 94% vs. 87%). Eighty-eight percent of patients experienced renal recovery at least 3 months after hospital discharge. All methods except the first SCr significantly underestimated the percentage of renal recovery. In a multivariate model, age, male gender, hypertension, heart failure, undergoing surgery and log first SCr best predicted preadmission SCr (adjusted R2 = 0.56). Imputation methods with first SCr increased AKI incidence to 23.9% (kappa = 0.92) but not with MDRD computed SCr (26.7%;kappa = 0.89). Conclusion In our cohort, first SCr performed better for AKI diagnosis and staging, as well as for renal recovery after hospital discharge than MDRD, CKD-EPI or minimal SCr. However, MDRD SCr and CKD-EPI SCr improved AKI diagnosis sensitivity. Imputation methods minimally increased agreement for AKI diagnosis.

Published
2017
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6. An Adjustable Dalteparin Sodium Dose Regimen for the Prevention of Clotting in the Extracorporeal Circuit in Hemodialysis: A Clinical Trial of Safety and Efficacy (the PARROT Study)

Author

Steven Soroka, Mohsen Agharazii, Sandra Donnelly, Louise Roy, Norman Muirhead, Serge Cournoyer, Martin MacKinnon, Neesh Pannu, Brendan Barrett, François Madore, Karthik Tennankore, Jo-Anne Wilson, Fiona Hilton, Nancy Sherman, Kevin Wolter, John Orazem, and Guillaume Feugère

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Background: Dalteparin sodium, a low-molecular-weight heparin, is indicated for prevention of clotting in the extracorporeal circuit during hemodialysis (HD). Product labeling recommends a fixed single-bolus dose of 5000 international units (IU) for HD sessions lasting up to 4 hours, but adjustable dosing may be beneficial in clinical practice. Objective: The aim of the PARROT study was to investigate the safety and efficacy of an adjustable dose of dalteparin in patients with end-stage renal disease requiring 3 to 4 HD sessions per week. Design: A 7-week, open-label, multicenter study with a single treatment arm, conducted between October 2013 and March 2016. Setting: Ten sites in Canada. Patients: A total of 152 patients with end-stage renal disease requiring 3 to 4 HD sessions per week. Measurements: The primary outcome was the proportion of HD sessions completed without premature termination due to inadequate anticoagulation. Methods: All participants initially received a dose of 5000 IU dalteparin, which could be adjusted at subsequent HD sessions when clinically indicated, by increment or decrement of 500 or 1000 IU, with no specified dose limits. Results: Patients were followed for 256 patient-months. Nearly all (99.9%; 95% confidence interval [CI]: 99.7-100) evaluable HD sessions were completed without premature clotting. Dose was adjusted for more than half (52.3%) of participants, mostly owing to clotting or access compression time >10 minutes. Median dalteparin dose was 5000 IU (range: 500-13 000 IU). There were no major bleeds, and minor bleeding was reported in 2.3% of all HD sessions. There was no evidence of bioaccumulation. Limitations: This short-term study, with a single treatment arm, was designed to optimize dalteparin dose using a flexible dosing schedule; it was not designed to specifically evaluate dalteparin dose minimization, provide a direct comparison of dalteparin versus unfractionated heparin, or provide information on long-term safety for flexible dalteparin dosing. Patients were excluded if they were at high risk of bleeding, including those on anticoagulants and those on antiplatelet agents other than aspirin

Published
2018
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7. Perceptions of Prognostic Risks in Chronic Kidney Disease: A National Survey

Author

Helen H. L. Chiu, Navdeep Tangri, Ognjenka Djurdjev, Brendan J. Barrett, Brenda R. Hemmelgarn, François Madore, Claudio Rigatto, Norman Muirhead, Manish M. Sood, Catherine M. Clase, and Adeera Levin

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Background: Predicting the clinical trajectories of chronic kidney disease (CKD) to discern personalized care remains a complex challenge in nephrology. Understanding the appropriate risk thresholds and time frame associated with predicting risks of key outcomes (kidney failure, cardiovascular (CV) events, and death) is critical in facilitating decision-making. As part of an exploratory research and practice support needs assessment, we aimed to determine the importance of the time frames for predicting key outcomes, and to assess the perceived demand for risk prediction tools among Canadian nephrologists. Methods: A web-based survey was developed by a pan-Canadian expert panel of practitioners. Upon pre-test for clarity and ease of completion, the final survey was nationally deployed to Canadian nephrologists. Anonymous responses were gathered over a 4-month period. The results were analyzed using descriptive statistics. Results: One hundred eleven nephrologists responded to our survey. The majority of the respondents described prediction of events over time frames of 1–5 years as being “extremely important” or “very important” to decision-making on a 5-point Likert scale. To plan for arteriovenous fistula referral, the respondents deemed thresholds which would predict probability of kidney failure between >30 and >50 % at 1 year, as useful, while many commented that the rate of progression should be included for decision-making. Over 80 % of the respondents were not satisfied with their current ability to predict the progression to kidney failure, CV events, and death. Most of them indicated that they would value and use validated risk scores for decision-making. Conclusions: Our national survey of nephrologists shows that the risk prediction for major adverse clinical outcomes is valuable in CKD at multiple time frames and risk thresholds. Further research is required in developing relevant and meaningful risk prediction models for clinical decision-making in patient-centered CKD care.

Published
2015
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8. Establishing a Canadian National Clinical Trials Network for Kidney Disease: Proceedings of a Planning Workshop

Author

Claudio Rigatto, Michael Walsh, Nadia Zalunardo, Catherine M Clase, Braden J Manns, François Madore, Susan M Samuel, Catherine J Morgan, Wim Wolfs, and Rita S. Suri

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Knowledge generation through randomized controlled trials (RCTs) is critical to advance the medical evidence base, inform decision-making, and improve care and outcomes. Unfortunately, nephrology has typically lagged behind other medical specialties in this regard. The establishment of formal clinical trial networks can facilitate the successful conduct of RCTs and has significantly increased the number of RCTs performed worldwide in other medical specialties. No such formal network of nephrology trialists exists in Canada. On April 24, 2014, the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) Clinical Trials Committee held a stakeholder engagement meeting to address this gap and improve the nephrology clinical trial landscape in Canada. The meeting was held in Vancouver in association with the 2014 Canadian Society of Nephrology Annual General Meeting and was co-sponsored by the Kidney Foundation of Canada and CANN-NET. Attendees included nephrologists from university- and non-university-affiliated nephrology practices, administrators, and representatives from the Kidney Foundation of Canada. Through structured presentations and facilitated group discussions, the group explored the extent to which nephrology trials are currently happening in Canada, barriers to leading or participating in larger investigator-initiated trials, and strategies to improve clinical trial output in nephrology in Canada. The themes and action items arising from this meeting are discussed.

Published
2015
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9. Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex

Author

Tae Won Yi, Brendan Smyth, Gian Luca Di Tanna, Clare Arnott, Kathryn Cardoza, Amy Kang, Carol Pollock, Rajiv Agarwal, George Bakris, David M. Charytan, Dick de Zeeuw, Hiddo J.L. Heerspink, Bruce Neal, David C. Wheeler, Christopher P. Cannon, Hong Zhang, Bernard Zinman, Vlado Perkovic, Adeera Levin, Kenneth W. Mahaffey, Meg Jardine, Barry M. Brenner, Tom Greene, Meg J. Jardine, Gary Meininger, Nicole Li, Inna Kolesnyk, Diego Aizenberg, Roberto Pecoits-Filho, David Cherney, Gregorio Obrador, Glenn Chertow, Tara Chang, Carmel Hawley, Linong Ji, Takashi Wada, Vivekanand Jha, Soo Kun Lim, Mary Anne Lim-Abrahan, Florence Santos, Dong-Wan Chae, Shang-Jyh Hwang, Evgueniy Vazelov, Ivan Rychlík, Samy Hadjadj, Vera Krane, László Rosivall, Luca De Nicola, Alexander Dreval, Michał Nowicki, Adalbert Schiller, Larry Distiller, Jose L. Górriz, Mykola Kolesnyk, null David, C. Wheeler, Rodolfo Andres Ahuad Guerrero, Juan Pablo Albisu, Andres Alvarisqueta, Ines Bartolacci, Mario Alberto Berli, Anselmo Bordonava, Pedro Calella, Maria Cecilia Cantero, Luis Rodolfo Cartasegna, Esteban Cercos, Gabriela Cecilia Coloma, Hugo Colombo, Victor Commendatore, Jesus Cuadrado, Carlos Alberto Cuneo, Ana Maria Cusumano, Walter Guillermo Douthat, Ricardo Dario Dran, Eduardo Farias, Maria Florencia Fernandez, Hernan Finkelstein, Guillermo Fragale, Jose Osvaldo Fretes, Nestor Horacio Garcia, Anibal Gastaldi, Elizabeth Gelersztein, Jorge Archibaldo Glenny, Joaquin Pablo Gonzalez, Patricia del Carmen Gonzalez Colaso, Claudia Goycoa, Gustavo Cristian Greloni, Adrian Guinsburg, Sonia Hermida, Luis Isaias Juncos, Maria Isabel Klyver, Florencia Kraft, Fernando Krynski, Paulina Virginia Lanchiotti, Ricardo Alfonso Leon de la Fuente, Nora Marchetta, Pablo Mele, Silvia Nicolai, Pablo Antonio Novoa, Silvia Ines Orio, Fabian Otreras, Alejandra Oviedo, Pablo Raffaele, Jorge Hector Resk, Lucas Rista, Nelson Rodriguez Papini, Jorgelina Sala, Juan Carlos Santos, Lilia Beatriz Schiavi, Horacio Sessa, Tomas Smith Casabella, Maria Rosa Ulla, Maria Valdez, Augusto Vallejos, Adriana Villarino, Virginia Esther Visco, Alfredo Wassermann, Cesar Javier Zaidman, Ngai Wah Cheung, Carolyn Droste, Ian Fraser, David Johnson, Peak Mann Mah, Kathy Nicholls, David Packham, Joseph Proietto, Anthony Roberts, Simon Roger, Venessa Tsang, Roberto Abrão Raduan, Fernando Augusto Alves da Costa, Celso Amodeo, Luiz Alberto Andreotti Turatti, Rachel Bregman, Fernanda Cristina Camelo Sanches, Luis Henrique Canani, Antônio Roberto Chacra, João Lindolfo Cunha Borges, Sérgio Alberto Cunha Vêncio, Roberto Jorge da Silva Franco, Domingos d’Avila, Evandro de Souza Portes, Pedro de Souza, Luciane Mônica Deboni, Fadlo Fraige Filho, Bruno Geloneze Neto, Marcus Gomes, Suely Keiko Kohara, Elizete Keitel, Jose Francisco Kerr Saraiva, Hugo Roberto Kurtz Lisboa, Fabiana Loss de Carvalho Contieri, Rosângela Milagres, Renan Montenegro Junior, Claudia Moreira de Brito, Miguel Nasser Hissa, Ângela Regina Nazario Sabbag, Irene Noronha, Daniel Panarotto, Roberto Pecoits Filho, Márcio Antônio Pereira, Wladmir Saporito, Antonio Scafuto Scotton, Tiago Schuch, Roberto Simões de Almeida, Cássio Slompo Ramos, João Soares Felício, Fernando Thomé, Jean Carlo Tibes Hachmann, Sérgio Yamada, Cesar Yoiti Hayashida, Tarissa Beatrice Zanata Petry, Maria Teresa Zanella, Viktoria Andreeva, Angelina Angelova, Stefan Dimitrov, Veselka Genadieva, Gabriela Genova-Hristova, Kiril Hristozov, Zdravko Kamenov, Atanas Koundurdjiev, Lachezar Lozanov, Viktor Margaritov, Boyan Nonchev, Rangel Rangelov, Alexander Shinkov, Margarita Temelkova, Ekaterina Velichkova, Andrian Yakov, Naresh Aggarwal, Ronnie Aronson, Harpreet Bajaj, Guy Chouinard, James Conway, Serge Cournoyer, Gerald DaRoza, Sacha De Serres, François Dubé, Ronald Goldenberg, Anil Gupta, Milan Gupta, Sam Henein, Hasnain Khandwala, Lawrence Leiter, François Madore, Alan McMahon, Norman Muirhead, Vincent Pichette, Remi Rabasa-Lhoret, Andrew Steele, Navdeep Tangri, Ali Torshizi, Vincent Woo, Nadia Zalunardo, María Alicia Fernández Montenegro, Juan Gonzalo Godoy Jorquera, Marcelo Medina Fariña, Victor Saavedra Gajardo, Margarita Vejar, Nan Chen, Qinkai Chen, Shenglian Gan, Yaozhong Kong, Detian Li, Wenge Li, Xuemei Li, Hongli Lin, Jian Liu, Weiping Lu, Hong Mao, Yan Ren, Weihong Song, Jiao Sun, Lin Sun, Ping Tu, Guixia Wang, Jinkui Yang, Aiping Yin, Xueqing Yu, Minghui Zhao, Hongguang Zheng, Jose Luis Accini Mendoza, Edgar Arcos, Jorge Avendano, Jorge Ernesto Andres Diaz Ruiz, Luis Hernando Garcia Ortiz, Alexander Gonzalez, Eric Hernandez Triana, Juan Diego Higuera, Natalia Malaver, Dora Inés Molina de Salazar, Ricardo Rosero, Monica Alexandra Terront Lozano, Luis Valderrama Cometa, Alex Valenzuela, Ruben Dario Vargas Alonso, Ivan Villegas, Hernan Yupanqui, Dagmar Bartaskova, Petr Barton, Jana Belobradkova, Lenka Dohnalova, Tomas Drasnar, Richard Ferkl, Katarina Halciakova, Vera Klokocnikova, Richard Kovar, Jiri Lastuvka, Martin Lukac, Satu Pesickova, Karel Peterka, Jiri Pumprla, Ivan Rychlik, Frantisek Saudek, Vladimir Tesar, Martin Valis, Pavel Weiner, Stanislav Zemek, Eric Alamartine, Sophie Borot, Bertrand Cariou, Bertrand Dussol, Jean-Pierre Fauvel, Pierre Gourdy, Alexandre Klein, Yannick Le Meur, Alfred Penfornis, Ronan Roussel, Pierre-Jean Saulnier, Eric Thervet, Philippe Zaoui, Volker Burst, Markus Faghih, Grit Faulmann, Hermann Haller, Reinhold Jerwan-Keim, Stephan Maxeiner, Björn Paschen, Georg Plassmann, Ludger Rose, Ronaldo Arturo Gonzalez Orellana, Franklin Paul Haase, Juan Pablo Moreira Diaz, Luis Alberto Ramirez Roca, Jose Antonio Sánchez Arenales, José Vicente Sanchez Polo, Erick Turcios Juarez, Gyongyi Csecsei, Botond Csiky, Peter Danos, Laszlo Deak, Mihaly Dudas, Eleonora Harcsa, Katalin Keltai, Sandor Keresztesi, Krisztian Kiss, Laszlo Konyves, Lajos Major, Margit Mileder, Marta Molnar, Janos Mucsi, Tamas Oroszlan, Ivan Ory, Gyorgy Paragh, Eva Peterfai, Gizella Petro, Katalin Revesz, Robert Takacs, Sandor Vangel, Szilard Vasas, Marianna Zsom, Oomman Abraham, Raju Sree Bhushan, Dewan Deepak, Fernando M. Edwin, Natarajan Gopalakrishnan, Noble Gracious, Alva Hansraj, Dinesh Jain, C.B. Keshavamurthy, Dinesh Khullar, Sahay Manisha, Jayameena Peringat, Narayan Prasad, Rao K. Satyanarayana, Reddy Sreedhar, Melemadathil Sreelatha, Bhimavarapu Sudhakar, Ramesh Chandra Vyasam, Riccardo Bonadonna, Pietro Castellino, Antonio Ceriello, Luca Chiovato, Salvatore De Cosmo, Giuseppe Derosa, Alberto Di Carlo, Graziano Di Cianni, Giovanni Frascà, Giorgio Fuiano, Giovanni Gambaro, Giacomo Garibotto, Carlo Giorda, Fabio Malberti, Marcora Mandreoli, Edoardo Mannucci, Emanuela Orsi, Piermarco Piatti, Domenico Santoro, Ferdinando Carlo Sasso, Gaetano Serviddio, Andrea Stella, Roberto Trevisan, Anna Maria Veronelli, Luca Zanoli, Hitoshi Akiyama, Hiromi Aoki, Akimichi Asano, Tadashi Iitsuka, Shizuo Kajiyama, Susumu Kashine, Toshio Kawada, Takamoto Kodera, Hiroshi Kono, Kazunori Koyama, Yasuro Kumeda, Shozo Miyauchi, Kazuyuki Mizuyama, Tetsuji Niiya, Hiroko Oishi, Satoshi Ota, Terue Sakakibara, Masahiko Takai, Osamu Tomonaga, Mitsuru Tsujimoto, Masakiyo Wakasugi, Yasushi Wakida, Takayuki Watanabe, Masayo Yamada, Kazuhiro Yanagida, Toshihiko Yanase, Wataru Yumita, Egle Gaupsiene, Dalia Kozloviene, Antanas Navickas, Egle Urbanaviciene, Rohana Abdul Ghani, Khalid Abdul Kadir, Norsiah Ali, Mohd Daud Che Yusof, Chye Lee Gan, Mastura Ismail, Wei Yen Kong, Swee Win Lam, Li Yuan Lee, Chek Loong Loh, Anita Bhajan Manocha, Kee Sing Ng, Nik Nur Fatnoon Nik Ahmad, Vanassa Ratnasingam, Saiful Shahrizal Bin Shudim, Paranthaman Vengadasalam, Luis David Abraira Munoz, Melchor Alpizar Salazar, Juan Baas Cruz, Mario Burgos Soto, Jose Chevaile Ramos, Alfredo Chew Wong, Jose Ricardo Correa Rotter, Tonatiu Diaz Escalante, Favio Edmundo Enriquez Sosa, Fernando Flores Lozano, Luis Fernando Flota Cervera, Paul Frenk Baron, Cecilia Garcia Ballesteros, Jose David Gomez Rangel, Luis Enrique Herrera Jimenez, Sergio Saul Irizar Santana, Fernando Jimenez Flores, Hugo Laviada Molina, Rosa Isela Luna Ceballos, Belia Martin del Campo Blanco, Guadalupe Morales Franco, Oscar Tarsicio Moreno Loza, Cynthia Mustieles Rocha, Gregorio Obrador Vera, Ricardo Orozco Castellanos, Juan Peralta Calcaneo, Miguel Angel Reyes Rosano, Hiromi Rodriguez Pattzi, Juan Rosas Guzman, Isabel Erika Rucker Joerg, Sandra Berenice Saavedra Sanchez, Jose Hector Sanchez Mijangos, Pablo Serrano Sanson, Juan Alfredo Tamayo y Orozco, Eloisa Tellez Chavez, Alejandro Valdes Cepeda, Luis Venegas Carrillo, Juan Villagordoa Mesa, Rolando Zamarripa Escobedo, John Baker, Paul Noonan, Russell Scott, Robert Walker, Edward Watson, Michael Williams, Simon Young, Zaynab Abejuela, Jeimeen Agra, Grace Aquitania, Clodoaido Caringal, Rhea Severina Comia, Lalaine Delos Santos, Olivert Gomez, Cecilia Jimeno, Gerry Tan, Marsha Tolentino, Christy Yao, Yvette Ethel Yap, Ma. Dovie Lallaine Ygpuara, Renata Bijata-Bronisz, Lucyna Hotlos, Andrzej Januszewicz, Barbara Kaczmarek, Anna Kaminska, Lech Lazuka, Andrzej Madej, Stanislaw Mazur, Dorota Mlodawska-Choluj, Michal Nowicki, Grazyna Orlowska-Kowalik, Grazyna Popenda, Barbara Rewerska, Dariusz Sowinski, Liliana Monica Angelescu, Veronica Anghel, Rodica-Ioana Avram, Mihaela-Magdalena Busegeanu, Adriana Cif, Dana Cosma, Carmen Crisan, Luiza Despina Demian, Ioana Emilia Ferariu, Ildiko Halmagyi, Nicolae Hancu, Mircea Munteanu, Doru Negru, Adriana Gabriela Onaca, Ligia Petrica, Amorin Remus Popa, Aurelian-Emil Ranetti, Cristian Serafinceanu, Cristina Toarba, Alina Agafyina, Olga Barbarash, Olga Barysheva, Daniil Chizhov, Vladimir Dobronravov, Irina Glinkina, Elena Grineva, Vladimir Khirmanov, Elena Kolmakova, Tatiana Koroleva, Liudmila Kvitkova, Viacheslav Marasaev, Ashot Mkrtumyan, Tatiana Morugova, Galina Nagibovich, Oleg Nagibovich, Sergei Nedogoda, Irina Osipova, Tatiana Raskina, Yulia Samoylova, Olga Sazonova, Minara Shamkhalova, Elena Shutemova, Yuriy Shwartz, Oleg Uriasyev, Sergey Vorobyev, Anna Zateyshchikova, Dmitry Zateyshshikov, Tatyana Zykova, Slobodan Antic, Miodrag Djordjevic, Aleksandra Kendereski, Katarina Lalic, Nebojsa Lalic, Vesna Popovic-Radinovic, Jana Babikova, Olga Benusova, Ingrid Buganova, Jan Culak, Andrej Dzupina, Jana Dzuponova, Peter Fulop, Adriana Ilavska, Emil Martinka, Zuzana Ochodnicka, Daniel Pella, Iveta Smatanova, Fayzal Ahmed, Aysha Badat, Johannes Breedt, Lawrence Distiller, Vimladhevi Govender, Ravendran Govender, Mukesh Joshi, Jaco Jurgens, Gulam Latiff, Landman Lombard, Mohamed Mookadam, Nomangesi Ngcakani, Hendrik Nortje, Helena Oosthuizen, Larisha Pillay-Ramaya, Hans Prozesky, Jeevren Reddy, Paul Rheeder, Mary Seeber, Young Min Cho, In-Kyung Jeong, Sin Gon Kim, Yeong Hoon Kim, Hyuk-Sang Kwon, Min Jeong Kwon, Byung-Wan Lee, JungEun Lee, Moon-Kyu Lee, Moon-Suk Nam, Kook-Hwan Oh, Cheol- Young Park, Sun-Hee Park, Kun Ho Yoon, Pere Alvarez Garcia, Luis Asmarats Mercadal, Clara Barrios, Fernando Cereto Castro, Secundino Cigarran Guldris, Marta Dominguez Lopez, Jesus Egido de los Rios, Gema Fernandez Fresnedo, Antonio Galan Serrano, Isabel Garcia, Francisco Javier Gonzalez Martinez, Jose Esteban Jodar Gimeno, Manuel Lopez Mendoza, Tamara Malek Marin, Cristobal Morales Portillo, Maria Antonia Munar Vila, Manuel Muñoz Torres, Javier Nieto Iglesias, Jonay Pantoja Perez, Merce Perez Vera, Jose M. Portoles Perez, María Angustias Quesada Simón, Rafael Simo Canonge, Alfonso Soto Gonzalez, Manel Terns Riera, Francisco Jose Tinahones Madueno, Mercedes Velo Plaza, Chwen-Tzuei Chang, Lee-Ming Chuang, Te-Lin Hsia, Chang-Hsun Hsieh, Chih-Ching Lin, Yung- Chuan Lu, Wayne H-H Sheu, Olga Barna, Svitlana D. Bilyk, Volodymyr Botsyurko, Iryna Dudar, Ivan Fushtey, Olga Godlevska, Oleksandr Golovchenko, Olga Gyrina, Anatoliy Kazmirchuk, Iuliia Komisarenko, Oleksii Korzh, Nonna Kravchun, Oleg Legun, Borys Mankovskyy, Liliya Martynyuk, Yuriy Mostovoy, Nataliia Pashkovska, Larysa Pererva, Tetyana Pertseva, Oleksandr Samoylov, Ivan Smirnov, Yevgeniya Svyshchenko, Halyna Tomashkevych, Ivan Topchii, Nadiya Tryshchuk, Vira Tseluyko, Vadym Vizir, Maryna Vlasenko, Tetiana Zlova, Liliia Zub, Salah Abusnana, Mohamed Railey, Kamal Abouglila, Paul Ainsworth, Zishan Ali, Vijayaraman Arutchelvam, Maria Barnard, Srikanth Bellary, Emyr Davies, Mark Davies, Simon Davies, Alison Dawson, Mohsen El Kossi, Patrick English, Donald Fraser, Luigi Gnudi, Anthony Gunstone, Timothy Hall, Wasim Hanif, Alan Jackson, Andrew Johnson, Franklin Joseph, Singhan Krishnan, Mick Kumwenda, Iain MacDougall, Paul Nixon, Joseph O'Hare, Sam Philip, Shenaz Ramtoola, Manish Saxena, Davesh Sennik, Godwin Simon, Baldev Singh, Jeffrey Stephens, Anna Strzelecka, Rehan Symonds, Wayne Turner, Mona Wahba, John Wakeling, David Wheeler, Peter Winocour, Joseph Abdallah, Raied Abdullah, Matthew Abramowitz, Idalia Acosta, Joseph Aiello, Laura Akright, Ayim Akyea-Djamson, Rajendran Alappan, Radica Alicic, Amer Al-Karadsheh, Dale Crawford Allison, Carlos Arauz-Pacheco, Shahabul Arfeen, Ahmed Arif, Moogali Arvind, Naveen Atray, Ahmed Awad, Peggy Barnhill, Elizabeth Barranco, Carlos Barrera, Matthew Beacom, Venkata Behara, Diogo Belo, Rhonda Bentley-Lewis, Ramon Berenguer, Lidia Bermudez, Marializa Bernardo, Mihaela Biscoveanu, Cynthia Bowman-Stroud, Donald Brandon, Osvaldo Brusco, Robert Busch, Yamil Canaan, Alicia Chilito, Tom Christensen, Cynthia Christiano, Elena Christofides, Caroucel Chuateco, Kenneth Cohen, Robert Cohen, Debbie Cohen-Stein, Charles Cook, Daniel Coyne, Nizar Daboul, Riad Darwish, Adarsh Daswani, Kenneth Deck, Cyrus Desouza, Devasmita Dev, Monika Dhillon, Sohan Dua, Frank Eder, Ana Maria Elosegui, Mohamed El-Shahawy, John Ervin, Alberto Esquenazi, John Evans, Steven Fishbane, Juan Frias, Eugenia Galindo-Ramos, Claude Galphin, Adline Ghazi, Enrique Gonzalez, David Gorson, Anupama Gowda, Barbara Greco, Stephen Grubb, Rakesh Gulati, Jamal Hammoud, Stuart Handelsman, Israel Hartman, Kenneth Hershon, Daniel Hiser, George Hon, Radu Jacob, Maria Jaime, Aamir Jamal, Charles Kaupke, Gerald Keightley, Elizabeth Kern, Rakhi Khanna, Zeid Khitan, Sun Kim, Nelson Kopyt, Csaba Kovesdy, Gopal Krishna, Jeffrey (Jay) Kropp, Amrendra Kumar, Jayant Kumar, Neil Kumar, Jorge Kusnir, Wendy Lane, Mary Lawrence, Lawrence Lehrner, John Lentz, Dennis Levinson, Derek Lewis, Kenneth Liss, Andreas Maddux, Hiralal Maheshwari, Sreedhar Mandayam, Isam Marar, Bhasker Mehta, John Middleton, Jorge Mordujovich, Ramon Moreda, Moustafa Moustafa, Samuel Mujica Trenche, Mohanram Narayanan, Javier Narvarte, Tareq Nassar, George Newman, Brian Nichol, Philip Nicol, Josier Nisnisan, A. Kaldun Nossuli, Chamberlain Obialo, Sarah Olelewe, Michael Oliver, Andrew O'Shaughnessy, John Padron, Rohit Pankhaniya, Reginald Parker, Devesh Patel, Gnyandev Patel, Nina Patel, Humberto Pavon, Armando Perez, Carlos Perez, Alan Perlman, Karlton Pettis, Walter Pharr, Andrea Phillips, Raman Purighalla, Luis Quesada-Suarez, Rajiv Ranjan, Sanjeev Rastogi, Jakkidi Reddy, Marc Rendell, Lisa Rich, Michael Robinson, Hector Rodriguez, Sylvia Rosas, Fadi Saba, Rallabhandi Sankaram, Ravi Sarin, Robert Schreiman, David Scott, Mohamed Sekkarie, John Sensenbrenner, Muhammad Shakeel, Michael Shanik, Sylvia Shaw, Stephen Smith, Richard Solomon, Amy Sprague, Leslie Spry, Pusadee Suchinda, Senan Sultan, Prasanth Surampudi, Sherry Sussman, Anjanette Tan, Antonio Terrelonge, Michael Thompson, Fernando Trespalacios, Bruce Trippe, Pilar Trueba, Marcel Twahirwa, John Updegrove, Peter Van Buren, Mark Vannorsdall, Freemu Varghese, Pedro Velasquez-Mieyer, Sailaja Ventrapragada, Goga Vukotic, Khurram Wadud, Mark Warren, Henry Watson, Ronald Watts, Daniel Weiner, James Welker, Jean Welsh, Shelley Williams, and Michelle Zaniewski-Singh

Subjects
age, diabetes, Nephrology, kidney outcomes, sex, Diabetic kidney disease, canagliflozin, cardiovascular outcomes, chronic kidney disease, sodium/glucose cotransporter 2 inhibitors
Abstract

Rationale & Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kidney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a randomized controlled trial.Setting & Participants: Participants in the CREDENCE trial.Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kidney failure, doubling of serum creatinine concentration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Outcomes were evaluated by age at baseline (Results: The mean age of the cohort was 63.0 ± 9.2 years, and 34% were female. Older age and female sex were independently associated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (a composite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.48-0.82], and 0.89 [0.61-1.29] for ages Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791.

Published
2023

10. Screening for Primary Aldosteronism Among Hypertensive Adults with Obstructive Sleep Apnea: A Retrospective Population-Based Study

Author

Gregory L Hundemer, Haris Imsirovic, Tetyana Kendzerska, Anand Vaidya, Alexander A Leung, Gregory A Kline, Rémi Goupil, François Madore, Mohsen Agharazii, Greg Knoll, and Manish M Sood

Subjects
Internal Medicine
Abstract

BACKGROUNDHypertension plus obstructive sleep apnea (OSA) is recommended in some guidelines as an indication to screen for primary aldosteronism (PA), yet prior data has brought the validity of this recommendation into question. Given this context, it remains unknown whether this screening recommendation is being implemented into clinical practice.METHODSWe conducted a population-based retrospective cohort study of all adult Ontario (Canada) residents with hypertension plus OSA from 2009 to 2020 with follow-up through 2021 utilizing provincial health administrative data. We measured the proportion of individuals who underwent PA screening via the aldosterone-to-renin ratio by year. We further examined screening rates among patients with hypertension plus OSA by the presence of concurrent hypokalemia and resistant hypertension. Clinical predictors associated with screening were assessed via Cox regression modeling.RESULTSThe study cohort included 53,130 adults with both hypertension and OSA, of which only 634 (1.2%) underwent PA screening. Among patients with hypertension, OSA, and hypokalemia, the proportion of eligible patients screened increased to 2.8%. Among patients ≥65 years with hypertension, OSA, and prescription of ≥4 antihypertensive medications, the proportion of eligible patients screened was 1.8%. Older age was associated with a decreased likelihood of screening while hypokalemia and subspecialty care with internal medicine, cardiology, endocrinology, or nephrology were associated with an increased likelihood of screening. No associations with screening were identified with sex, rural residence, cardiovascular disease, diabetes, or respirology subspecialty care.CONCLUSIONSThe population-level uptake of the guideline recommendation to screen all patients with hypertension plus OSA for PA is exceedingly low.

Published
2023

11. Increased Excess Pressure After Creation of an Arteriovenous Fistula in End-Stage Renal Disease

Author

Siegfried Wassertheurer, Catherine Fortier, James E. Sharman, Rémi Goupil, Mathilde Paré, Bernhard Hametner, François Madore, Mohsen Agharazii, Martin G. Schultz, and Fabrice Mac-Way

Subjects
Adult, Male, medicine.medical_specialty, hypertension, Brachial Artery, Population, Diastole, Hemodynamics, Arteriovenous fistula, nephrology and kidney, Pulse Wave Analysis, End stage renal disease, Vascular Stiffness, cardiovascular disease, Internal medicine, Internal Medicine, medicine, Humans, AcademicSubjects/MED00200, cardiovascular diseases, education, Pulse wave velocity, Aged, education.field_of_study, business.industry, blood pressure, Original Articles, Middle Aged, medicine.disease, Blood pressure, Arteriovenous Fistula, Cardiology, AcademicSubjects/SCI00960, Kidney Failure, Chronic, Aortic stiffness, Female, business
Abstract

BACKGROUND Reservoir-wave analysis (RWA) separates the arterial waveform into reservoir and excess pressure (XSP) components, where XSP is analogous to flow and related to left ventricular workload. RWA provides more detailed information about the arterial tree than traditional blood pressure (BP) parameters. In end-stage renal disease (ESRD), we have previously shown that XSP is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). In this study, we examined whether XSP increases after creation of an AVF in ESRD. METHODS Before and after a mean of 3.9 ± 1.2 months following creation of AVF, carotid pressure waves were recorded using arterial tonometry. XSP and its integral (XSPI) were derived using RWA through pressure wave analysis alone. Aortic stiffness was assessed by carotid–femoral pulse wave velocity (CF-PWV). RESURLTS In 38 patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs. 72 ± 12 mm Hg, P = 0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs. 127 ± 26 mm Hg, P = 0.137). However, carotid XSP (14 [12–19] to 17 [12–22] mm Hg, P = 0.031) and XSPI increased significantly (275 [212–335] to 334 [241–439] kPa∙s, P = 0.015), despite a reduction in CF-PWV (13 ± 3.6 vs. 12 ± 3.5 m/s, P = 0.025). CONCLUSIONS Creation of an AVF resulted in increased XSP in this population, despite improvement in diastolic BP and aortic stiffness. These findings underline the complex hemodynamic impact of AVF on the cardiovascular system., Graphical Abstract Graphical Abstract

Published
2021

12. University of Montreal's Clinician-Investigator Program: A 10-Year Descriptive Evaluation

Author

Samuel Mailhot-Larouche, Vincent Chauvette, David Bergeron, Catherine Larochelle, Geneviève Du Pont-Thibodeau, Han Wang, Héloïse Cardinal, Isabelle Bourdeau, Nathalie Auger, Nathalie Bureau, MD, MSc Bureau, Alexandre Prat, Didier Jutras-Aswad, François Madore, Guillaume Emeriaud, Houda Bahig, Marie-Hélène Mayrand, Rafik Tadros, Stefan Parent, Philippe Richebe, MD, PhD Richebe, Yahye Merhi, and Dang Nguyen

Subjects
General Medicine
Abstract

Purpose: Clinician-investigators have an important role in the development and implantation of new therapies and treatment modalities; however, there have been several reports highlighting a pending shortage in the clinician-investigators’ workforce. In Canada, the Royal College has promoted the development of clinician-investigators programs (CIP) to facilitate the training of these individuals. There is currently a paucity of data regarding the outcomes of such programs. This study aims to identify the strengths and areas of improvement of the Montreal University CIP. Methods: An internet-based 51-question survey was distributed to all the alumni from the University of Montreal CIP. Participation was voluntary and no incentives were provided. The response rate was 64%. Results: Among respondents, 50% (n=16) had completed their clinical residency and all CIP requirements. The majority of these individuals (63%) had become independent investigators and had secured provincial and national funding. Satisfaction of the respondents was high regarding the overall program (85%), the research skills developed during the CIP (84%) and the financial support obtained during the program (72%). The satisfaction rate regarding career planning was lower (63%). Conclusion: This survey demonstrates that, while indicators are favorable, some areas still require improvement. Several steps to improve the CIP have been identified; notably, the transition from the CIP to early independent career has been identified as critical in the development of clinician-investigators and steps have been taken to improve this progression

Published
2022

13. Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Author

Yasmine Abbaoui, Catherine Fortier, Louis-Charles Desbiens, Cédric Kowalski, Florence Lamarche, Annie-Claire Nadeau-Fredette, François Madore, Mohsen Agharazii, and Rémi Goupil

Subjects
Male, Cross-Sectional Studies, Brachial Artery, Humans, Arterial Pressure, Blood Pressure, Blood Pressure Determination, Female, General Medicine, Article, Aged
Abstract

Women are at higher risk of cardiovascular events than men with similar blood pressure (BP). Whether this discrepancy in risk is associated with the accuracy of brachial cuff BP measurements is unknown.To examine the difference in brachial cuff BP accuracy in men and women compared with invasively measured aortic BP and to evaluate whether noninvasive central BP estimation varies with sex.This cross-sectional study enrolled 500 participants without severe aortic stenosis or atrial fibrillation from January 1 to December 31, 2019, who were undergoing nonurgent coronary angiography at a tertiary care academic hospital.Simultaneous measurements of invasive aortic BP and noninvasive BP.Sex differences in accuracy were determined by calculating the mean difference between the noninvasive measurements (brachial and noninvasive central BP) and the invasive aortic BP (reference). Linear regression and mediation analyses were performed to identify mediators between sex and brachial cuff accuracy.This study included 500 participants (145 female [29%] and 355 male [71%]; 471 [94%] White; mean [SD] age, 66 [10] years). Baseline characteristics were similar for both sexes apart from body habitus. Despite similar brachial cuff systolic BP (SBP) (mean [SD], 124.5 [17.7] mm Hg in women vs 124.4 [16.4] in men; P = .97), invasive aortic SBP was higher in women (mean [SD], 130.9 [21.7] in women vs 124.7 [20.1] mm Hg in men; P .001). The brachial cuff was relatively accurate compared with invasive aortic SBP estimation in men (mean [SD] difference, -0.3 [11.7] mm Hg) but not in women (mean [SD] difference, -6.5 [12.1] mm Hg). Noninvasive central SBP (calibrated for mean and diastolic BP) was more accurate in women (mean [SD] difference, 0.6 [15.3] mm Hg) than in men (mean [SD] difference, 8.3 [14.2] mm Hg). This association of sex with accuracy was mostly mediated by height (3.4 mm Hg; 95% CI, 1.1-5.6 mm Hg; 55% mediation).In this cross-sectional study, women had higher true aortic SBP than men with similar brachial cuff SBP, an association that was mostly mediated by a shorter stature. This difference in BP measurement may lead to unrecognized undertreatment of women and could partly explain why women are at greater risk for cardiovascular diseases for a given brachial cuff BP than men. These findings may justify the need to study sex-specific BP targets or integration of sex-specific parameters in BP estimation algorithms.

Published
2022

14. Prediction of Cardiovascular Events by Type I Central Systolic Blood Pressure

Author

François Madore, Rémi Goupil, Mohsen Agharazii, and Florence Lamarche

Subjects
medicine.medical_specialty, business.industry, Hemodynamics, Strain (injury), medicine.disease, Blood pressure, Internal medicine, Primary prevention, Internal Medicine, Cardiology, Medicine, business, Prospective cohort study, Target organ
Abstract

Compared with brachial blood pressure (BP), central systolic BP (SBP) can provide a better indication of the hemodynamic strain inflicted on target organs, but it is unclear whether this translates into improved cardiovascular risk stratification. We aimed to assess which of central or brachial BP best predicts cardiovascular risk and to identify the central SBP threshold associated with increased risk of future cardiovascular events. This study included 13 461 participants of CARTaGENE with available central BP and follow-up data from administrative databases but without cardiovascular disease or antihypertensive medication. Central BP was estimated by radial artery tonometry, calibrated for brachial SBP and diastolic BP (type I), and a generalized transfer function (SphygmoCor). The outcome was major adverse cardiovascular events. Cox proportional-hazards models, differences in areas under the curves, net reclassification indices, and integrated discrimination indices were calculated. Youden index was used to identify SBP thresholds. Over a median follow-up of 8.75 years, 1327 major adverse cardiovascular events occurred. The differences in areas under the curves, net reclassification indices, and integrated discrimination indices were of 0.2% ([95% CI, 0.1–0.3] P P =0.01), and 0.0004 ([95% CI, −0.0001 to 0.0014] P =0.3), all likely not clinically significant. Central and brachial SBPs of 112 mm Hg (95% CI, 111.2–114.1) and 121 mm Hg (95% CI, 120.2–121.9) were identified as optimal BP thresholds. In conclusion, central BP measured with a type I device is statistically but likely not clinically superior to brachial BP in a general population without prior cardiovascular disease. Based on the risk of major adverse cardiovascular events, the optimal type I central SBP appears to be 112 mm Hg.

Published
2021

15. Impact of updated recommendations on acetylsalicylic acid use for primary prevention of cardiovascular disease in Canada: a population-based survey

Author

Jason R. Guertin, Fanny Lepeytre, Josée Bouchard, Rémi Goupil, Stéphan Troyanov, François Madore, and Myriam Khalili

Subjects
Adult, Male, Canada, medicine.medical_specialty, Population, Comorbidity, Disease, Chemoprevention, Diabetes mellitus, Primary prevention, Preventive Health Services, Odds Ratio, medicine, Humans, Myocardial infarction, education, Stroke, Aged, education.field_of_study, Aspirin, business.industry, Research, General Medicine, Middle Aged, medicine.disease, Obesity, Primary Prevention, Cross-Sectional Studies, Cardiovascular Diseases, Population Surveillance, Family medicine, Female, Health Impact Assessment, business, Dyslipidemia
Abstract

Background The debate over acetylsalicylic acid (ASA) therapy for primary prevention of cardiovascular disease (CVD) has recently resurfaced, but scarce data are available on prophylactic ASA use in Canada for this purpose. This study aimed to evaluate the prevalence and factors associated with ASA use, and the potential impact of implementing the most recent (2016) US Preventive Services Task Force recommendations for primary CVD prevention in a Canadian setting. Methods We performed a cross-sectional analysis using data from the CARTaGENE study, which included a representative sample (n = 20 004) of the 2018 general population of the province of Quebec. We assessed eligibility for ASA treatment using US Preventive Services Task Force criteria (age 50-69 yr, no past history of myocardial infarction or stroke, and 10-year risk of CVD of at least 10%). We extrapolated to the entire 2018 Quebec population the number of people who would need to start ASA treatment. Results A total of 6231 respondents in the CARTaGENE study (54.2% of those aged 50-69 yr with no prior history of CVD) were found to be potentially eligible for ASA use for primary CVD prevention. Of the 6231, 1379 (22.1%) were receiving prophylactic ASA treatment. Factors found to be related to ASA use included age, male sex, regular medical visits, lower education level, obesity, hypertension, diabetes and dyslipidemia. Income and smoking status were not found to be significantly associated with ASA use. Our results indicate that 885 261 people would potentially have started ASA treatment if the US Preventive Services Task Force recommendations had been implemented in Quebec in 2018. Interpretation Prevalent ASA use for primary CVD prevention was low. Implementation of the 2016 US Preventive Services Task Force recommendations would require initiating ASA treatment in a substantial proportion of people, with undetermined potential benefits.

Published
2020

16. Screening Rates for Primary Aldosteronism Among Individuals With Hypertension Plus Hypokalemia: A Population-Based Retrospective Cohort Study

Author

Rémi Goupil, Greg Knoll, Gregory L. Hundemer, Nicholas Yozamp, Haris Imsirovic, Manish M. Sood, Mohsen Agharazii, François Madore, and Anand Vaidya

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Hypokalemia, Population based, Disease, Article, chemistry.chemical_compound, Primary aldosteronism, Hyperaldosteronism, Renin, Internal Medicine, medicine, Humans, Aldosterone, Antihypertensive Agents, Aged, Retrospective Studies, High rate, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, chemistry, Hypertension, Female, medicine.symptom, business
Abstract

Primary aldosteronism is a common, yet highly underdiagnosed, cause of hypertension that leads to disproportionately high rates of cardiovascular disease. Hypertension plus hypokalemia is a guideline-recommended indication to screen for primary aldosteronism, yet the uptake of this recommendation at the population level remains unknown. We performed a population-based retrospective cohort study of adults ≥18 years old in Ontario, Canada, with hypertension plus hypokalemia (potassium

Published
2021

17. Health status after invasive or conservative care in coronary and advanced kidney disease

Author

Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic, Spertus J.A., Jones P.G., Maron D.J., Mark D.B., O'Brien S.M., Fleg J.L., Reynolds H.R., Stone G.W., Sidhu M.S., Chaitman B.R., Chertow G.M., Hochman J.S., Bangalore S, and ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic

Subjects
Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of

Published
2020

20. POS-491 A NEW VISION FOR NEPHROLOGY TRIALS IN CANADA

Author

François Madore, Rita S. Suri, Karthik K. Tennankore, H. Vorster, D. Sparkes, and A. Murdoch

Subjects
Nephrology, medicine.medical_specialty, business.industry, Family medicine, Internal medicine, medicine, RC870-923, business, Diseases of the genitourinary system. Urology
Published
2021

21. Association of Glomerular Hyperfiltration and Cardiovascular Risk in Middle-Aged Healthy Individuals

Author

François Madore, Annie-Claire Nadeau-Fredette, Rémi Goupil, Mohsen Agharazii, and Marie-Eve Dupuis

Subjects
Adult, Male, medicine.medical_specialty, Population, Renal function, Blood Pressure, urologic and male genital diseases, Interquartile range, Risk Factors, Internal medicine, medicine, Humans, Prospective Studies, education, Original Investigation, Aged, education.field_of_study, business.industry, urogenital system, Research, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Online Only, Nephrology, Cardiovascular Diseases, Cohort, Cardiology, Female, Kidney Diseases, business, Glomerular hyperfiltration, Cohort study, Kidney disease, Glomerular Filtration Rate
Abstract

Key Points Question Is glomerular hyperfiltration associated with future cardiovascular events in healthy individuals? Findings In this cohort study of 9515 patients with health information accessed through the CARTaGENE research platform, glomerular hyperfiltration was shown to be associated with increased risk of cardiovascular events in middle-aged healthy individuals. Meaning This study found an increased cardiovascular disease risk associated with glomerular hyperfiltration in middle-aged healthy individuals, suggesting that glomerular hyperfiltration could be a useful cardiovascular biomarker in this population., This population-based cohort study examines whether glomerular hyperfiltration is associated with a higher risk of cardiovascular events in healthy middle-aged individuals., Importance Glomerular hyperfiltration is associated with increased risk of cardiovascular disease in high-risk conditions, but its significance in low-risk individuals is uncertain. Objective To determine whether glomerular hyperfiltration is associated with increased cardiovascular risk in healthy individuals. Design, Setting, and Participants This was a prospective population-based cohort study, for which enrollment took place from August 2009 to October 2010, with follow-up available through March 31, 2016. Analysis of the data took place in October 2019. The cohort was composed of 9515 healthy individuals, defined as individuals without hypertension, diabetes, cardiovascular disease, estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2, or statin and/or aspirin use, identified among 20 004 patients aged 40 to 69 years with health information accessed through the CARTaGENE research platform. Exposures Individuals with glomerular hyperfiltration (eGFR >95th percentile after stratification for sex and age) were compared with individuals with normal filtration rate (eGFR 25th-75th percentiles). Main Outcomes and Measures Adverse cardiovascular events were defined as a composite of cardiovascular mortality, myocardial infarction, unstable angina, heart failure, stroke, and transient ischemic attack. Risk of adverse cardiovascular events was assessed using Cox and fractional polynomial regressions and propensity score matching. Results From the 20 004 CARTaGENE participants, 9515 healthy participants (4050 [42.6%] male; median [interquartile range] age, 50.4 [45.9-55.6] years) were identified. Among these, 473 had glomerular hyperfiltration (median [interquartile range] eGFR, 112 [107-115] mL/min/1.73 m2) and 4761 had a normal filtration rate (median [interquartile range] eGFR, 92 [87-97] mL/min/1.73 m2). Compared with the normal filtration rate, glomerular hyperfiltration was associated with an increased cardiovascular risk (hazard ratio, 1.88; 95% CI, 1.30-2.74; P = .001). Findings were similar with propensity score matching. The fractional polynomial regression showed that only the highest eGFR percentiles were associated with increased cardiovascular risk. The cardiovascular risk of individuals with glomerular hyperfiltration was similar to that of the 597 participants with an eGFR between 45 and 60 mL/min/1.73 m2 (hazard ratio, 0.90; 95% CI, 0.56-1.42; P = .64). Conclusions and Relevance These findings suggest that glomerular hyperfiltration is independently associated with increased cardiovascular risk in middle-aged healthy individuals. This risk profile appears to be similar to stage 3a chronic kidney disease.

Published
2020

22. Diagnosis and outcomes of acute kidney injury using surrogate and imputation methods for missing preadmission creatinine values

Author

François Paquette, William Beaubien-Souligny, Amélie Bernier-Jean, Stéphan Troyanov, Josée Bouchard, François Madore, and Rémi Goupil

Subjects
Nephrology, Male, Epidemiology, 030232 urology & nephrology, Kidney Function Tests, urologic and male genital diseases, lcsh:RC870-923, law.invention, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Patient Admission, law, Outcome Assessment, Health Care, Diagnosis, Prevalence, Medicine, 030212 general & internal medicine, Longitudinal Studies, Acute kidney injury, Quebec, Surrogate, Middle Aged, Prognosis, Intensive care unit, female genital diseases and pregnancy complications, Treatment Outcome, Creatinine, Baseline creatinine, Cohort, Female, Research Article, medicine.medical_specialty, Renal function, Outcomes, Sensitivity and Specificity, behavioral disciplines and activities, 03 medical and health sciences, Internal medicine, Humans, Aged, Retrospective Studies, business.industry, Reproducibility of Results, Retrospective cohort study, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, chemistry, business, Biomarkers, Kidney disease
Abstract

Background Missing preadmission serum creatinine (SCr) values are a common obstacle to assess acute kidney injury (AKI) diagnosis and outcomes. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest using a SCr computed from the Modification of Diet in Renal Disease (MDRD) with an estimated glomerular filtration rate of 75 ml/min/1.73 m2. We aimed to identify the best surrogate method for baseline SCr to assess AKI diagnosis and outcomes. Methods We compared the use of 1) first SCr at hospital admission 2) minimal SCr over 2 weeks after intensive care unit admission 3) MDRD computed SCr and 4) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) computed SCr to assess AKI diagnosis and outcomes. We then performed multilinear regression models to predict preadmission SCr and imputation strategies to assess AKI diagnosis. Results Our one-year retrospective cohort study included 1001 critically ill adults; 498 of them had preadmission SCr values. In these patients, AKI incidence was 25.1% using preadmission SCr. First SCr had the best agreement for AKI diagnosis (22.5%; kappa = 0.90) and staging (kappa = 0.81). MDRD, CKD-EPI and minimal SCr overestimated AKI diagnosis (26.7%, 27.1% and 43.2%;kappa = 0.86, 0.86 and 0.60, respectively). However, MDRD and CKD-EPI computed SCr had a better sensitivity than first SCr for AKI (93% and 94% vs. 87%). Eighty-eight percent of patients experienced renal recovery at least 3 months after hospital discharge. All methods except the first SCr significantly underestimated the percentage of renal recovery. In a multivariate model, age, male gender, hypertension, heart failure, undergoing surgery and log first SCr best predicted preadmission SCr (adjusted R2 = 0.56). Imputation methods with first SCr increased AKI incidence to 23.9% (kappa = 0.92) but not with MDRD computed SCr (26.7%;kappa = 0.89). Conclusion In our cohort, first SCr performed better for AKI diagnosis and staging, as well as for renal recovery after hospital discharge than MDRD, CKD-EPI or minimal SCr. However, MDRD SCr and CKD-EPI SCr improved AKI diagnosis sensitivity. Imputation methods minimally increased agreement for AKI diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0552-3) contains supplementary material, which is available to authorized users.

Published
2017

26. Contributors

Author

Robert C. Albright, Richard Amerling, Paolo Angeli, Maria Lucia Angelotti, Massimo Antonelli, Riccardo Antoniotti, Nishkantha Arulkumaran, Pierre Asfar, Stephen R. Ash, Filippo Aucella, Francesco Aucella, Samuele Ave, Sean M. Bagshaw, Vasanthi Balaraman, Ian Baldwin, Joanne M. Bargman, Gina-Marie Barletta, Jeffrey F. Barletta, Shriganesh R. Barnela, Hülya Bayır, Monica Beaulieu, Antonio Bellasi, Rinaldo Bellomo, François Beloncle, Arjun Bhansali, Azra Bihorac, Frederic T. Billings, Horst-Walter Birk, Luis Ignacio Bonilla-Reséndiz, Josée Bouchard, Edmund Bourke, George Braitberg, Alessandra Brendolan, Alessandra Brocca, Patrick D. Brophy, Richard Bucala, Timothy E. Bunchman, Emmanuel A. Burdmann, Laurence W. Busse, Renato Antunes Caires, Pietro Caironi, Roberta Camilla, Israel Campos, Bernard Canaud, Vincenzo Cantaluppi, Maria P. Martinez, Giovambattista Capasso, Joseph A. Carcillo, Eleonora Carlesso, Francesco G. Casino, Giuseppe Castellano, Matteo Catania, Kelly A. Cawcutt, Jorge Cerda, Elliot Charen, Lakhmir S. Chawla, Stefano Chiaramonte, Horng-Ruey Chua, Bruno Cianciaruso, Paola Ciceri, Jacek Cieslak, William R. Clark, Rolando Claure-Del Granado, Anna Clementi, Ivan N. Co, Fernanda Oliveira Coelho, Ferruccio Conte, Howard E. Corey, Laura Cosmai, Elerson Carlos Costalonga, Andrea Costamagna, Maria Rosa Costanzo, Mario Cozzolino, Carl H. Cramer, Paolo Cravedi, Carlo Crepaldi, Jacques Creteur, R. John Crew, Verônica Torres da Costa e Silva, Andrew Davenport, Andrew R. Davies, Rohit D'Costa, Dawson F. Dean, Charlotte Debiais, Massimo de Cal, Paras Dedhia, Harm-Jan de Grooth, Roberto Dell'Aquila, Sergio Dellepiane, Richard Phillip Dellinger, Lucia Del Vecchio, Thomas A. Depner, Silvia De Rosa, Clifford S. Deutschman, Prasad Devarajan, A. Dewitte, Biagio R. Di Iorio, Luca Di Lullo, Lucia Di Micco, Matteo Di Nardo, Xiaoqiang Ding, Fiorella D'Ippoliti, Salvatore Di Somma, Kent Doi, David J. Dries, Wilfred Druml, Graeme Duke, Francois Durand, Michael T. Eadon, Devin Eckstein, Moritoki Egi, Somchai Eiam-Ong, Paul W.G. Elbers, Francesca Elli, Steve Elliott, David R. Emlet, Zoltan Endre, Roger G. Evans, Vito Fanelli, Fatemeh Fattahi, Christine Kinggaard Federspiel, Marcela A. Ferrada, Fiorenza Ferrari, Enrico Fiaccadori, Marco Fiorentino, Caleb Fisher, Michael F. Flessner, Marco Formica, Lui G. Forni, Claire Francoz, Craig French, Dana Y. Fuhrman, Giordano Fumagalli, Miriam Galbusera, Maurizio Gallieni, Hilary S. Gammill, Dayong Gao, Francesco Garzotto, Giuseppe Gatta, Kelly R. Genga, Simonetta Genovesi, Yuri S. Genyk, Christel Geradin, Loreto Gesualdo, Davide Giavarina, Anna Giuliani, Ilya G. Glezerman, Stuart L. Goldstein, Thomas A. Golper, Hernando Gómez, Antonio Granata, Giuseppe Grandaliano, Giacomo Grasselli, A.B. Johan Groeneveld, Philippe Guerci, Kyle J. Gunnerson, Nikolas Harbord, Lyndsay A. Harshman, Anthony J. Hennessy, Graham L. Hill, Charles Hobson, Bernd Hohenstein, Patrick M. Honoré, Edward Horwitz, Leila Hosseinian, Eric A.J. Hoste, Andrew A. House, H. David Humes, Faeq Husain-Syed, Can Ince, Todd S. Ing, Rita Jacobs, Dharmvir Jaswal, Arun Jeyabalan, Olivier Joannes-Boyau, Michael Joannidis, Emily Joyce, Sandra L. Kane-Gill, Lewis J. Kaplan, Kianoush Kashani, Nevin Katz, John A. Kellum, Ramesh Khanna, Nahmah Kim-Campbell, Joshua D. King, Christopher J. Kirwan, Joseph E. Kiss, David Klein, Peter Kotanko, Raymond T. Krediet, Martin K. Kuhlmann, Jan Willem Kuiper, Philippe Lachance, Norbert Lameire, Thomas Langer, Yugeesh R. Lankadeva, Louis-Philippe Laurin, Elena Lazzeri, Martine Leblanc, Joannie Lefebvre, Paolo Lentini, Hélène Leray-Moragués, Adeera Levin, Susie Q. Lew, Helen Liapis, Kathleen D. Liu, Sergio Livigni, Francesco Locatelli, Anna Lorenzin, Jian-Da Lu, Renhua Lu, Nicholas Lysak, Etienne Macedo, Niti Madan, François Madore, Linda L. Maerz, Matthew J. Maiden, Rakesh Malhotra, Marita Marengo, Filippo Mariano, Paul E. Marik, John J. Marini, Rossella Marino, Mark R. Marshall, Johan Mårtensson, Ryo Matsuura, Clive N. May, Patrizio Mazzone, Jerry McCauley, Peter A. McCullough, Blaithin A. McMahon, Ravindra L. Mehta, Caterina Mele, Madhav Menon, Mario Meola, Aicha Mérouani, Jean-Yves Meuwly, Paola Milla, Madhukar Misra, Paraish S. Misra, Barry A. Mizock, Jwalant R. Modi, Gilbert Moeckel, Bruce A. Molitoris, Santo Morabito, Roberto Pozzi Mucelli, Patrick T. Murray, Raghavan Murugan, Mitra K. Nadim, Devika Nair, Federico Nalesso, Mauro Neri, Trung C. Nguyen, Zhaohui Ni, Marina Noris, Tessa Novick, John C. O'Horo, Mark Douglas Okusa, Steven M. Opal, Helen Ingrid Opdam, Marlies Ostermann, Emerenziana Ottaviano, Heleen M. Oudemans-van Straaten, Christian Overgaard-Steensen, Massimo A. Padalino, Vincenzo Panichi, Priyanka Parameswaran, Samir S. Patel, Didier Payen, Federico Pea, W. Frank Peacock, Sandrica Young Peart, Sadudee Peerapornratana, Paolo Pelosi, Zhi-Yong Peng, Norberto Perico, Licia Peruzzi, Francesco Pesce, Antonio Pesenti, Ilaria Petrucci, Phuong-Chi Pham, Phuong-Thu Pham, Richard K.S. Phoon, Salvatore Piano, Michael R. Pinsky, Lise Piquilloud, Valentina Pistolesi, Lindsay D. Plank, Frans B. Plötz, Manuel Alfredo Podestá, Camillo Porta, Marco Pozzato, Michele Prencipe, John R. Prowle, Zudin A. Puthucheary, Lirong Qu, Jean-Sebastien Rachoin, Jai Radhakrishnan, V. Marco Ranieri, Ranistha Ratanarat, Giuseppe Remuzzi, Shelby Resnick, Oleksa G. Rewa, Zaccaria Ricci, Christophe Ridel, Kinan Rifai, Troels Ring, Lilia M. Rizo-Topete, Eric Roessler, Paola Romagnani, Stefano Romagnoli, Claudio Ronco, Federico Ronco, Mitchell H. Rosner, Emanuele Rossetti, James A. Russell, Georges Saab, Alice Sabatino, Sonali S. Saboo, Sara Samoni, Penny Lynn Sappington, Marco Sartori, Judy Savige, Francesco Paolo Schena, Antoine Guillaume Schneider, Pieter Schraverus, Wibke Schulte, Giuseppe Segoloni, Matthew W. Semler, Aashish Sharma, Andrew Shaw, Naitik Sheth, Ashutosh Shukla, Eric C. Siddall, Theodore M. Sievers, Edward D. Siew, Kai Singbartl, Mervyn Singer, Pooja Singh, Loren E. Smith, Sachin S. Soni, Mara Serrano Soto, Herbert D. Spapen, Nattachai Srisawat, Ajay Srivastava, Giovanni Stellin, Jordan M. Symons, Balazs Szamosfalvi, Kian Bun Tai, Unmesh V. Takalkar, Isaac Teitelbaum, Ciro Tetta, Charuhas V. Thakar, Marta Tonon, Francesco Trepiccione, Darrell Triulzi, Chopra Tushar, Shigehiko Uchino, Ali Valika, Wim Van Biesen, Wim Vandenberghe, Raymond Vanholder, Jill Vanmassenhove, Anton Verbine, Marco Vergano, Gianluca Villa, Pierre-Marc Villeneuve, Jean-Louis Vincent, Christophe Vinsonneau, Grazia Maria Virzì, Federico Visconti, Ravindran Visvanathan, Li Van Vong, Hans-Dieter Walmrath, Peter A. Ward, Matthew A. Weir, Xiaoyan Wen, Julia Wendon, James Frank Winchester, Adrian Wong, Elke L. Woodhouse, Jun Xue, Anju Yadav, Preethi Yerram, Lenar Yessayan, Jane Y. Yeun, Alex W. Yu, Marta Zaccaria, Miriam Zacchia, Teena P. Zachariah, Nereo Zamperetti, Fernando G. Zampieri, Pierluigi Zanco, Alberto Zanella, Luca Zanoli, Michael Zappitelli, Jose J. Zaragoza, Alexander Zarbock, Marta Zaroccolo, Han Zhang, and Andrea Zimmer

Published
2019

27. Fracture status in middle-aged individuals with early CKD: cross-sectional analysis of the CARTaGENE survey

Author

Aboubacar Sidibé, Fabrice Mac-Way, Rémi Goupil, François Madore, and Louis-Charles Desbiens

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Population, Renal function, 030209 endocrinology & metabolism, urologic and male genital diseases, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Age Distribution, Diabetes mellitus, Internal medicine, medicine, Prevalence, Humans, Renal Insufficiency, Chronic, education, Aged, Ultrasonography, education.field_of_study, business.industry, Quebec, Odds ratio, Middle Aged, medicine.disease, Health Surveys, female genital diseases and pregnancy complications, Rheumatology, Calcaneus, Blood pressure, Cross-Sectional Studies, Female, 030101 anatomy & morphology, business, Osteoporotic Fractures, Kidney disease, Glomerular Filtration Rate
Abstract

Whether early chronic kidney disease (CKD) is associated with fracture in middle-aged adults is unclear. In a cross-sectional analysis of the CARTaGENE survey, we observed that early CKD was not associated with increased fracture, did not modify the association between calcaneal QUS and fracture, but modified the association between clinical, pharmacological parameters and fracture. The association between advanced CKD and increased fracture risk is well described. However, whether early CKD is associated with increased fractures, especially in middle-aged adults, is unclear. We aimed to assess if early CKD is associated with increased fracture status and whether early CKD status modifies the association between calcaneal quantitative ultrasound parameters, clinical, pharmacological parameters, and fractures. Cross-sectional analysis of CARTaGENE, a population-based survey of 40- to 69-year-old individuals. Individuals with CKD (stage 2, estimated glomerular filtration rate [eGFR] 60–89 ml/min/1.73 m2; stage 3, eGFR 30–59) were compared to non-CKD individuals (eGFR > 90). Fracture status (excluding face, toe, hand, and patella) was identified through a questionnaire at baseline. Calcaneal quantitative ultrasound (QUS) was measured in each participant. A total of 17,608 individuals (656 CKD stage 3; 8227 stage 2; 8725 non-CKD) were included. CKD stage 2 and 3 individuals (mean eGFR 78 and 53 ml/min/1.73 m2) were older and had more diabetes, cardiovascular disease, and hypertension. Fracture status prevalence was 14.9% in CKD stage 3, 10.8% in CKD stage 2, and 9.0% in non-CKD individuals. Fracture status prevalence was similar between CKD and non-CKD individuals when stratified by age or after adjustment for demographic and clinical parameters. QUS stiffness index was associated with fracture status in both CKD stage 3 (standardized odds ratio [sOR] = 1.525 [1.200 to 1.939] per 1 SD decrease), stage 2 (sOR = 1.415 [1.310 to 1.530]), and non-CKD individuals (sOR = 1.477 [1.361 to 1.602]). The associations between blood pressure, antihypertensive, and fracture status followed a U-shape throughout the progression of CKD. CKD stage 3 was not associated with an increase in fracture status. QUS parameters were similarly associated with fracture status in patients with and without CKD.

Published
2018

28. Advanced chronic kidney disease populations have elevated trimethylamine N-oxide levels associated with increased cardiovascular events

Author

Richard B. Kim, Bridget L. Morse, Ognjenka Djurdjev, Mila Tang, Norman Muirhead, Brendan Barrett, Daniel T. Holmes, Francois Madore, Catherine M. Clase, Claudio Rigatto, Adeera Levin, Mohsen Agharazii, Joanne Blouin, France Samson, Ayub Akbarii, Judy Cheesman, Jennilea Courtney, Sabrina Hamer, Edita Delic, Valerie Cronin, Paul Barré, Jeffrey Golden, Elizabeth Langille, Sandra Adams, Janet Morgan, Catherine Clase, Cathy Moreau, Susan Cooper, Brian Forzley, Susan Caron, Shauna Granger, Susan Valley, Helen Sather, Serge Cournoyer, Lorraine Menard, Michèle Roy, Hélène Skidmore, Dolores Beaudry, Janis Dionne, Josephine Chow, Valla Sahraei, Sandra Donnelly, Niki Dacouris, Rosa Marticorena, Brenda Hemmelgarn, Sharon Gulewich, Troy Hamilton, Paul Keown, Nadia Zalunardo, Daniel Rogers, Reena Tut, Matthew Paquette, Rossitta Yung, Nancy Ferguson, Helen Chiu, Kathleen Carlson, Lina Sioson, Taylor Perry, Zainab Sheriff, Naama Rozen, Charmaine Lok, Michelle Cross, Cathy Forrester, Alexandra Cotoi, François Madore, Manon Maltais, Louise Moist, Kerri Gallo, Sarah Langford, Leah Slamen, Danielle Cram, Mary Jeanne Edgar, Taylor Gray, Cameron Edgar, Karen Groeneweg, Eileen McKinnon, Erin McRae, Kyla Blackie, Bharat Nathoo, Kimmy Lau, Malvinder Parmar, Sylvie Gelinas, Martine Leblanc, Lucie Lépine, Dolores Friesen, Steven Soroka, Susan Fleet, Jeanette Squires, Siva Thanamayooran, Michael Binder, Christine Hines, Brenda McNeil, Patrice McDougall, Joy Howard, Deborah Gillis, Kathleen Hines, Sheldon Tobe, Mary Chessman, Nancy Perkins, Martha Agelopoulos, Stacey Knox, Tiffany Richards, Marcello Tonelli, Susan Szigety, Dawn Opgenorth, Karen Yeates, and Karen Mahoney

Subjects
cardiovascular risk, Male, 0301 basic medicine, Canada, medicine.medical_specialty, Time Factors, Renal function, Trimethylamine N-oxide, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Kidney, Risk Assessment, Severity of Illness Index, Gastroenterology, Disease-Free Survival, Methylamines, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Tandem Mass Spectrometry, Interquartile range, Internal medicine, medicine, Humans, Prospective Studies, Renal Insufficiency, Chronic, Risk factor, Aged, Aged, 80 and over, trimethylamine N-oxide, business.industry, Hazard ratio, Middle Aged, medicine.disease, Confidence interval, Up-Regulation, 030104 developmental biology, Endocrinology, chemistry, Cardiovascular Diseases, Nephrology, Cohort, Female, business, chronic kidney disease, Biomarkers, Glomerular Filtration Rate, Kidney disease
Abstract

Cardiovascular disease is more common in patients with chronic kidney disease (CKD), and traditional risk factors do not adequately predict those at risk for cardiovascular (CV) events. Recent evidence suggests elevated trimethylamine N-oxide (TMAO), created by gut microflora from dietary L-carnitine and choline, is associated with CV events. We investigated the relationship of TMAO levels in patients with stages 3b and 4 CKD to ischemic CV events using the CanPREDDICT cohort, a Canada-wide observational study with prospective 3-year follow-up of adjudicated CV events. Baseline samples were obtained for 2529 CKD patients. TMAO, choline, and L-carnitine levels were measured using tandem mass spectrometry. Baseline median TMAO level was high for the whole cohort (20.41 μM; interquartile range [IQR]: 12.82–32.70 μM). TMAO was independently associated with CV events (hazard ratio 1.23; 95% confidence interval: 1.06–1.42 / 1 SD lnTMAO) after adjusting for all potential CV risk factors. Those in the highest TMAO quartile had significantly higher risk of CV events (adjusted hazard ratio 1.59; 95% confidence interval: 1.04–2.43; P = 0.0351) in the analysis of recurring ischemic events. Among those with stage 3b CKD (hazard ratio 1.45; 95% confidence interval: 1.12–1.87 / 1 SD lnTMAO), independent of kidney function, TMAO levels identified those at highest risk for events. Our results suggest that TMAO may represent a new potentially modifiable CV risk factor for CKD patients. Further studies are needed to determine sources of variability and if lowering of TMAO reduces CV risk in CKD.

Published
2016

29. Uromodulin in a Pathway Between Decreased Renal Urate Excretion and Albuminuria

Author

Francois-Christophe Marois-Blanchet, Stéphan Troyanov, Renata Cifkova, Philip Awadalla, Pierre Dumas, Francois Harvey, Johanne Tremblay, François Madore, Alena Krajčoviechová, and Pavel Hamet

Subjects
Adult, Male, medicine.medical_specialty, Fractional excretion of sodium, Tamm–Horsfall protein, Genotype, Population, Glucose Transport Proteins, Facilitative, Renal function, 030204 cardiovascular system & hematology, Kidney Function Tests, Excretion, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Uromodulin, Internal Medicine, medicine, Albuminuria, Humans, 030212 general & internal medicine, education, Aged, Retrospective Studies, Creatinine, education.field_of_study, biology, business.industry, Middle Aged, Uric Acid, Renal Elimination, Endocrinology, Cross-Sectional Studies, chemistry, biology.protein, SLC22A12, Female, medicine.symptom, business, Biomarkers, Glomerular Filtration Rate
Abstract

BACKGROUND The mechanism explaining the inverse association between renal urate and albumin excretion remains unclear. First, we evaluated the impact of candidate variants in the main urate transporter genes (i.e., SLC2A9, SLC22A12, ABCG2) on the association between fractional excretion of uric acid (FEUA) and urinary albumin/creatinine ratio (uACR). Second, we examined uromodulin and sodium excretion as mediators of the association between FEUA and uACR. METHODS We performed cross-sectional analysis of 737 French Canadians from the CARTaGENE cohort, a random sample of the Quebec population aged 40–69 years (a total of 20,004 individuals). Individuals with available genotyping and urinary data were obtained from a sub-study including gender-matched pairs with high and low Framingham Risk Score and vascular rigidity index. We further excluded individuals with an estimated glomerular filtration rate RESULTS Final analyses included 593 individuals (45.5% of men; mean age 54.3 ± 8.6). We observed an antagonistic interaction between rs13129697 variant of the SLC2A9 gene and FEUA tertiles on uACR (P = 0.002). Using the mediation analysis, uromodulin explained 32%, fractional excretion of sodium (FENa) 44%, and uromodulin together with FENa explained 70% of the inverse relationship between FEUA and uACR. Bootstrapping process confirmed the role of both mediators. CONCLUSIONS Our data suggest that the association of albuminuria with decreased renal urate excretion may be modified by the transporter SLC2A9, and mediated by uromodulin and sodium handling.

Published
2018

30. PERIPHERAL AND CENTRAL ARTERIAL PARAMETERS, BONE DENSITY AND FRACTURES

Author

François Madore, Rémi Goupil, Mohsen Agharazii, Fabrice Mac-Way, and Louis-Charles Desbiens

Subjects
medicine.medical_specialty, Bone density, Physiology, business.industry, Internal medicine, Incidence (epidemiology), Internal Medicine, Fracture (geology), Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, Peripheral
Abstract

Objective:Several studies have reported an association between hypertension and fracture incidence. Nevertheless, whether peripheral and central arterial parameters are associated with bone density and fracture incidence has not been studied. Furthermore, whether these associations are influenced by

Published
2019

31. Plasmapheresis

Author

François Madore

Abstract

Plasmapheresis has been applied over the last several decades as primary or adjunctive treatment for a number of primary renal diseases and systemic conditions with renal involvement. The present review discusses renal conditions for which plasmapheresis may be attempted with recommendations based on evidence from the literature. Other indications of special interest for renal physicians (e.g., sepsis and multiple organ failure, drug overdose, and poisoning) are also discussed. In addition, the present text reviews general apheresis principles, technical considerations for optimal plasmapheresis prescription, and possible complications of plasmapheresis. Knowledge of disease mechanisms and plasmapheresis principles is invaluable in applying a plasmapheresis treatment regimen appropriately.

Published
2017

32. 1.1 CENTRAL BLOOD PRESSURE, STATINS AND LDL-CHOLESTEROL: A MEDIATION ANALYSIS

Author

François Madore, Rémi Goupil, Mohsen Agharazii, and Florence Lamarche

Subjects
Ldl cholesterol, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, lcsh:Specialties of internal medicine, business.industry, General Medicine, Endocrinology, Central blood pressure, lcsh:RC581-951, lcsh:RC666-701, Internal medicine, medicine, lipids (amino acids, peptides, and proteins), business
Abstract

Background: Central blood pressure (CBP) is a better predictor of cardiovascular burden than peripheral blood pressure (BP). While studies have suggested a reduction in peripheral BP with statins, it remains uncertain to what extent statins reduce CBP and whether this reduction is mediated through a decrease in LDL-cholesterol (LDL). Methods: Of the 20,004 CARTaGENE participants, 17,011 had CBP and LDL measurements (n = 13,439 without, n = 3,133 with statins). Linear and logistic regression analyses were used to evaluate the association between CBP, LDL and statin use (after stratification for treatment indication for the latter). The impact of LDL on the association between statin use and CBP was determined by mediation analyses. All analyses were adjusted for age, sex, diabetes, cardiovascular disease, smoking, eGFR, BMI, uric acid, heart rate, anti-hypertensive agents and aspirin. Results: Lower levels of LDL were associated with lower systolic and diastolic CBP in participants treated with (b = 0.098 and 0.125; p < 0.001) and without statins (b = 0.089 and 0.105; p < 0.001). Statin use as primary prevention (per ACC/AHA guidelines; n = 8,865) was also associated with lower systolic CBP, diastolic CBP and central pulse pressure (b = −0.091, −0.073 and −0.055; p < 0,001). Mediation analyses demonstrated that 15%, 46% and -22% of these effects were achieved through the concomitant changes in LDL (Table 1). In secondary prevention (n = 995), statins use was not associated with lower CBP, although the small sample size may lack power. Conclusion: In this populational cohort, statin use as primary prevention is associated with lower CBP. These changes are mediated directly by statins but also indirectly through effects on LDL.

Published
2017

33. Central and Brachial Blood Pressures, Statins, and Low-Density Lipoprotein Cholesterol: A Mediation Analysis

Author

Rémi Goupil, Annie-Claire Nadeau-Fredette, François Madore, Mohsen Agharazii, and Florence Lamarche

Subjects
Adult, Male, medicine.medical_specialty, Statin, medicine.drug_class, Diastole, Pulsatile flow, 030204 cardiovascular system & hematology, Risk Assessment, Severity of Illness Index, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Severity of illness, Internal Medicine, medicine, Secondary Prevention, Humans, Ankle Brachial Index, 030212 general & internal medicine, Aged, Analysis of Variance, Framingham Risk Score, business.industry, Quebec, Blood Pressure Determination, Cholesterol, LDL, Middle Aged, Prognosis, Pulse pressure, Primary Prevention, Blood pressure, Cross-Sectional Studies, Treatment Outcome, chemistry, Cardiovascular Diseases, Low-density lipoprotein, Hypertension, Cardiology, lipids (amino acids, peptides, and proteins), Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

Central blood pressure may be a better predictor of cardiovascular disease than brachial pressure. Although statins reduce brachial pressure, their impact on central pressure remains unknown. Furthermore, whether this effect is mediated through a decrease in low-density lipoprotein cholesterol (LDL-c) is unknown. This study aims to characterize the association of statins and LDL-c with central and brachial blood pressures and to quantify their respective effects. Of the 20 004 CARTaGENE participants, 16 507 had available central blood pressure, LDL-c, and Framingham risk score. Multivariate analyses were used to evaluate the association between central pressure and LDL-c in subjects with or without statins. The impact of LDL-c on the association between statin and pressure parameters was determined through mediation analyses. LDL-c was positively associated with systolic and diastolic central pressure in nonusers (β=0.077 and 0.106; P P P P

Published
2017

34. Carbamazepine poisoning treated by multiple extracorporeal treatments

Author

Martin Albert, Alexis Payette, Stéphan Troyanov, Marc Ghannoum, Josée Bouchard, and François Madore

Subjects
Male, Mechanical ventilation, business.industry, medicine.medical_treatment, Context (language use), General Medicine, Carbamazepine, Middle Aged, Hemoperfusion, Extracorporeal, Renal Dialysis, Nephrology, Anesthesia, Toxicity, Hemofiltration, medicine, Humans, cardiovascular diseases, business, Dialysis, medicine.drug
Abstract

Context Hemoperfusion (HP) or dialysis is occasionally used following carbamazepine (CBZ) toxicity but it remains unclear which is the most efficient modality. We describe a case of severe CBZ intoxication treated with different extracorporeal modalities during which CBZ toxicokinetics were compared. Case details A 58-year-old man was transferred to our facility 24 hours after ingesting over 14 g of sustained-release CBZ. Because of worsening neurological condition requiring mechanical ventilation and CBZ levels reaching 47.6 μg/mL, he underwent three intermittent hemodialysis (IHD), two continuous veno-venous hemofiltration (CVVH), and one IHD with HP (IHD-HP). IHD and CVVH removed 1.73 g of carbamazepine over 43 hours. Mean apparent half-life was 8.8 hours during IHD 49.1 hours during CVVH, and 5.1 hours during IHD-HP, while measured endogenous half-life after extracorporeal therapies was 81.4 hours. Mean CBZ clearances were 106.2 mL/min during IHD and 21.2 mL/ min during CVVH. His neurological status improved during extracorporeal elimination, and he was discharged without sequela after 16 days. Treatments were well tolerated aside from thrombocytopenia during IHDHP. Discussion All extracorporeal treatments facilitated CBZ elimination, although CVVH was significantly less efficient than IHD and IHD-HP. IHD-HP may be better than IHD alone but must be weighed against its risks. IHD appears sufficient to eliminate CBZ and may need to be repeated or prolonged according to the clinical context if CBZ absorption is delayed.

Published
2015

35. Continuous venovenous hemofiltration using customized replacement fluid for acute kidney injury with severe hypernatremia

Author

François Madore, Stéphan Troyanov, François Paquette, Rémi Goupil, and Josée Bouchard

Subjects
medicine.medical_specialty, Salt content, medicine.medical_treatment, Sodium, continuous renal replacement therapy, 030232 urology & nephrology, chemistry.chemical_element, 030204 cardiovascular system & hematology, urologic and male genital diseases, acute renal failure, Electrolytes, 03 medical and health sciences, Dialysis solutions, 0302 clinical medicine, Medicine, Renal replacement therapy, Intensive care medicine, Dialysis, Transplantation, hypernatremia, urogenital system, business.industry, Acute kidney injury, medicine.disease, Continuous venovenous hemofiltration, acute kidney injury, chemistry, Nephrology, dialysis, Hypernatremia, business
Abstract

The initiation of continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) with severe hypernatremia is challenging since sodium concentrations in commercial replacement fluid (RF) and dialysate solutions are usually fixed at 140 mEq/L. We present a case of AKI with severe hypernatremia successfully treated with CRRT using commercial RF solutions customized to prevent rapid correction of hypernatremia. None of the few case reports published on hypernatremia and AKI requiring CRRT have included formulas to help modulate the sodium content in the solutions. We present an equation to facilitate adjustment of the sodium concentration in this setting.

Published
2016

36. Uric acid association with pulsatile and steady components of central and peripheral blood pressures

Author

Pierre-Luc Lavoie, Mohsen Agharazii, Fanny Lepeytre, François Madore, Stéphan Troyanov, and Rémi Goupil

Subjects
Elevated uric acid, Male, medicine.medical_specialty, Central Venous Pressure, Physiology, Systole, Pulsatile flow, 030204 cardiovascular system & hematology, Pulse Wave Analysis, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Diastole, Internal medicine, Internal Medicine, medicine, Humans, Arterial Pressure, 030212 general & internal medicine, Antihypertensive Agents, business.industry, Serum uric acid, Blood Pressure Determination, Middle Aged, Peripheral blood, Peripheral, Uric Acid, Endocrinology, Blood pressure, Cross-Sectional Studies, chemistry, Hypertension, Uric acid, Female, Gradual increase, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVE Whether the cardiovascular risk attributed to elevated uric acid levels may be explained by changes in central and peripheral pulsatile and/or steady blood pressure (BP) components remains controversial. METHODS In a cross-sectional analysis of normotensive and untreated hypertensive participants of the CARTaGENE populational cohort, we examined the relationship between uric acid, and both pulsatile and steady components of peripheral and central BP, using sex-stratified linear regressions. RESULTS Of the 20 004 participants, 10 161 individuals without antihypertensive or uric acid-lowering drugs had valid pulse wave analysis and serum uric acid levels. In multivariate analysis, pulsatile components of BP were not associated with uric acid levels, whereas steady components [mean BP (MBP), peripheral and central DBP] were all associated with higher levels of uric acid levels in women and men (all P

Published
2017

37. The impact of renal protection clinics on prescription of and adherence to cardioprotective drug therapy in chronic kidney disease patients

Author

Vincent Pichette, François Madore, Lorraine Fradette, Fanny Lepeytre, Marc Dorais, Jacobien C. Verhave, Jacques LeLorier, and Héloïse Cardinal

Subjects
medicine.medical_specialty, Referral, Angiotensin II Receptor Blockers, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Internal medicine, medicine, In patient, 030212 general & internal medicine, Medical prescription, Prescribed medications, Intensive care medicine, cardioprotective medications, Transplantation, business.industry, medicine.disease, renal protection clinic, Nephrology, Cardiovascular Disease and CKD, Renal protection, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, chronic kidney disease, Kidney disease
Abstract

Contains fulltext : 174174.pdf (Publisher’s version ) (Open Access) Background: The aim of this study was to assess the impact of follow-up in renal protection clinics on the prescription of and adherence to cardioprotective drugs in patients with chronic kidney disease (CKD). Methods: We studied stage 4 and 5 CKD patients who initiated follow-up in three renal protection clinics. The prescription pattern of antihypertensive agents (AHA) and lipid-lowering agents (LLAs) was measured as the percentage of patients who are prescribed the agents of interest at a given time. Adherence to drug therapy was defined as the percentage of days, during a pre-defined observation period, in which patients have an on-hand supply of their prescribed medications. Results: A total of 259 CKD patients were enrolled and followed for up to 1 year after referral to renal protection clinics. There was a significant increase in the prescription of angiotensin-converting enzyme inhibitors (34-39%), angiotensin II receptor blockers (11-14%), beta-blockers (40-51%), calcium channel blockers (62-74%), diuretics (66-78%) and LLAs (39-47%) during follow-up in the renal protection clinic compared with baseline (P-values /= 80%) and poor (< 80%) adherence to AHA (P = 0.41) and LLAs (P = 0.11) were similar in the year preceding and the year following the first visit to the renal protection clinics. Conclusion: Our results suggest that referral and follow-up in a renal protection clinic may increase the prescription of cardioprotective agents in CKD patients, but does not appear to improve adherence to these medications.

Published
2017

38. Heart Failure With Anemia

Author

Martin G. Sirois, Bergeron, Paul-Eduard Neagoe, Dupuis, Giannetti, Mark Liszkowski, Dion, Normand Racine, Joel Lavoie, Lucie Blondeau, Jean L. Rouleau, Jean-Claude Tardif, François Madore, Nadeau, Eileen O'Meara, Huynh, Michel White, Anique Ducharme, Simon de Denus, and Karine Roy

Subjects
Male, medicine.medical_specialty, Heart disease, Systole, Anemia, Heart Ventricles, Volume overload, Systemic inflammation, Ventricular Function, Left, Internal medicine, medicine, Humans, Prospective Studies, Ventricular remodeling, Aged, Heart Failure, Ejection fraction, Ventricular Remodeling, business.industry, Interleukins, Stroke Volume, Middle Aged, Prognosis, medicine.disease, Cross-Sectional Studies, Echocardiography, Heart failure, Cardiology, Kidney Failure, Chronic, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Glomerular Filtration Rate, Kidney disease
Abstract

Background— Anemia is a highly prevalent and strong independent prognostic marker in heart failure (HF), yet this association is not completely understood. Whether anemia is simply a marker of disease severity and concomitant chronic kidney disease or represents the activation of other detrimental pathways remains uncertain. We sought to determine which pathophysiological pathways are exacerbated in patients with HF, reduced ejection fraction (HFrEF) and anemia in comparison with those without anemia. Methods and Results— In a prospective study involving 151 patients, selected biomarkers were analyzed, each representing proposed contributive mechanisms in the pathophysiology of anemia in HF. We compared clinical, echocardiographic, and circulating biomarkers profiles among patients with HFrEF and anemia (group 1), HFrEF without anemia (group 2), and chronic kidney disease with preserved EF, without established HF (chronic kidney disease control group 3). We demonstrate here that many processes other than those related to chronic kidney disease are involved in the anemia–HF relationship. These are linked to the pathophysiological mechanisms pertaining to left ventricular systolic dysfunction and remodeling, systemic inflammation and volume overload. We found that levels of interleukin-6 and interleukin-10, specific markers of cardiac remodeling (procollagen type III N-terminal peptide, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase 1, left atrial volume), myocardial stretch (NT-proBNP [N-terminal probrain natriuretic peptide]), and myocyte death (troponin T) are related to anemia in HFrEF. Conclusions— Anemia is strongly associated not only with markers of more advanced and active heart disease but also with the level of renal dysfunction in HFrEF. Increased myocardial remodeling, inflammation, and volume overload are the hallmarks of patients with anemia and HF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00834691.

Published
2014

39. CKD PATHOPHYSIOLOGY AND CLINICAL STUDIES

Author

Paola Achilli, Francesco Marino, Ioannis Karatzas, Steven Fishbane, Alessandro Domenico Quercia, Yu Du, Richard R. Furman, Katarzyna Maresz, Jack F.M. Wetzels, Gerard A. Rongen, Hyun Yul Rhew, Ogo Egbuna, Mariano Rodriguez, Leena Patel, Kiyoto Koibuchi, Anna-Ewa O Kulik, M Weiswasser, Ken Sakai, Antoine Bouquegneau, Myles Wolf, Ilona Kurnatowska, Chantal Loirat, Alberto Ortiz, Stéphane Poitevin, Tilo Hanowski, Elvira Fernández, Abdul Rashid Qureshi, Françoise Dignat-George, Christophe Legendre, Juan Jesus Carrero, Jeffrey Kaupke, Maurizio Postorino, Pablo E. Pergola, Jaco Botha, Bernhard K Kraemer, Mariusz Kusztal, Camille L. Bedrosian, Ada Braun, Marion Sallée, Katarzyna Jankowska, Marcus E. Kleber, Magdalena Kaczmarska, Georg Schlieper, Yeon Soon Jung, Giuseppe Enia, Rosaria Lupica, Beatriz Martínez Fernández, Taro Hoshino, Peter Boor, Mai Ots-Rosenberg, Maria Pina P Madonna, Ayako Tsuchiya, Cesare Guarena, Usama Elewa, Rika Miura, Graciela E. Delgado, Winfried Maerz, Jacek C Szepietowski, Yoshifumi Ubara, Alan G. Jardine, Thiane Gama-Axelsson, Kaoru Tabei, Vincenzo Cantaluppi, Franco Brescia, Carmine Zoccali, Yao Yu, Akihiro Tsuda, Viatcheslav Rakov, Yasemin G Kurt, Sergio Dellepiane, Mahmut Ilker Yilmaz, Winnie Sohn, Bengt Lindholm, Claudia Carmone, Rabab Mohamed Elbehidy, Ye Na Kim, Bertrand Gondouin, Hark Rim, Larry Greenbaum, Dimitrios Arvanitis, Cristina Masini, Michael Chen, Laetitia Dou, Vincenzo Panichi, Leszek Bieniaszewski, Etienne Cavalier, Federica Genovese, Hikmet Tekce, Giovanni Camussi, Mahmut I Yilmaz, Tacyano Tavares Leite, Stéphane Burtey, Yoshiteru Ohno, Atsushi Aikawa, Peter Braunhofer, Johan Vande Walle, Irina Mititiuc, Olivier Devuyst, Amit Sharma, Stefan Degenhardt, Glenn M. Chertow, Henrik S. Rasmussen, Rannveig Skrunes, Dimitra Nastou, E. Marie Freel, Zbigniew Heleniak, Mahmut Gok, Heike Kielstein, Jesús Egido, Steven Zeig, Patrick B. Mark, David Arroyo, Katarzyna Kunicka, Dimosthenis Vlassopoulos, Paweł Poznański, Bruce Spinowitz, Gian Domenico D Fabbri, Jaap Deinum, Yasmine Draz, Marina Foramitti, K. Lysaja, Marian Klinger, Iris Fuhrmann, Cees Vermeer, A. Villari, Piotr Skrzypczyk, Hubert Scharnagl, Emily P. McQuarrie, Giuseppina Pettinato, Kentaro Tanaka, Bożena Werner, Yasuhisa Sakurai, MałGorzata Sojka, Bolesław Rutkowski, Cric Study Investigators, Song Rong, Adrian Covic, Lisa M. Bernard, Carlo Massimetti, Candice Bezerra Torres De Melo, Davide Medica, Jose M. Valdivielso, Martin Flamant, Markus Ketteler, Morten A. Karsdal, Shay Shemesh, Domenico Santoro, Aoi Nabata, Bhupinder Singh, Jean-Marie Krzesinski, Emmanuelle Vidal-Petiot, Tanja B. Grammer, Sandro Feriozzi, Fabio Malberti, Camilla Tøndel, Tayfun Eyileten, Nikolaos Manolios, K K Larsen, Camillo Porta, Junichi Hoshino, Filippo Benedetto, Jesper N. Bech, Larry A. Greenbaum, Rolfdieter Krause, Dimitrie Siriopol, Catherine Delmas-Frenette, Hideaki Shima, Reginaldo Filho, Katarzyna Kilis-Pstrusinska, Stuart M. Sprague, Akifumi Kushiyama, Kiyonori Ito, Katsunori Saito, Ludomir Stefańczyk, Mari Aoe, Juliette Hadchouel, Juergen Floege, Jürgen Floege, Lara Cavalcante Vaz Cunha, Fernanda Macedo de Oliveira Neves, Honami Mori, Mutlu Saglam, Giovanni Tripepi, Yasemin Gulcan Kurt, Mohamed A El-Shahawy, Ewa Aleksandrowicz, Kristin Jäger, Graziella Caridi, Pierre Delanaye, Moriatsu Miyagi, Desmond Padhi, Mai Sugahara, Kiryong Park, Mait Raag, Renata de Almeida Leitão, Thomas D. Wooldridge, Keiji Hirai, Gianluca Trifirò, Elzbieta Prus-Wojtowicz, Naoki Sawa, Murat Karaman, Alexandre Braga Libório, François Vrtovsnik, Ewa Świerblewska, Yuichirou Ueda, Eiji Ishimura, Yusuf Oguz, Masayo Ogawa, Geoffrey A. Block, Frank H Mose, Ho Sik Shin, Yahsou Delmas, Magdalena Okarska-Napierała, Toshiyuki Aoki, Richard Amdur, Hilmi Umut Unal, Stéphan Troyanov, Tammo Lesch, Amal A Alshal, Edward Chong, Ülle Pechter, Alison Taylor, Katsuhito Mori, Mehmet Kanbay, Akinobu Ochi, Claire Cerini, Naobumi Mise, Susumu Ookawara, Joris H. Robben, Hakki Cetinkaya, Anna Masajtis-Zagajewska, Davide Bolignano, Hilmi Umut Ünal, Mitsuru Ichii, Kensuke Hamada, Naoya Sugiyama, Sebahattin Sari, Gianluca Leonardi, Abdulgaffar Vural, Noémie Jourde-Chiche, Sankar D. Navaneethan, N. Dimkovic, Franziska Knöfel, Marios Papasotiriou, Peter Mt Deen, Fadi Fakhouri, Dimitrios Hadjiyannakos, Erling B. Pedersen, Luigi Biancone, Vassilis Filiopoulos, N. Marx, Masayoshi Mori, Zbigniew Zdrojewski, Giovanni F.M. Strippoli, Yoshio Kaku, Masatomo Chikamori, Angels Betriu, Michele Buemi, Kenmei Takaichi, William T. Smith, Izumi Sugimoto, A. Savvaidis, Daijo Inaguma, Giuseppe Costantino, John F Kincaid, Laura Cosmai, Radosław Pietrzak, Roberto Sabbatini, Michał Nowicki, Stephen R. Ash, Kenichi Ishizawa, Masaaki Inaba, Daniela Leonardis, Piotr Grzelak, Jonas Axelsson, Robert A. Fenton, Massimiliano Migliori, Junichiro Yamamoto, Diana J Leeming, Giovanna Parlongo, Philip T. Lavin, Buket Kin Tekce, Dominic S. Raj, James Cotton, David J. Cohen, Shinya Nakatani, Sangeon Gwoo, Shigeko Hara, Frank Schiepe, Philip Awadalla, Gulali Aktas, Massimo Gai, Maria Roszkowska-Blaim, Neil S. Sheerin, Lei Nan, K: Hess, Haruhisa Miyazawa, Silvia Lucisano, Grahame J Elder, François Madore, Helena Ziółkowska, Cai-Li Wang, Einar Svarstad, Giuseppina Lorenzano, Maria Teresa T Muratore, Alex Yang, Graziella D'Arrigo, Doaa Mohammed Youssef, Janni M Jensen, Marta Gracia, Suetonia C. Palmer, Valeria Cernaro, Borja Quiroga, Anton E. Daul, Francesca Mallamaci, Philippe Brunet, Tomoko Honda, Gerjan Navis, Izumi Yoshida, Domenico Trimboli, and Anjay Rastogi

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Medicine, business, Intensive care medicine, Pathophysiology
Published
2014

40. The risk of thromboembolic events in kidney transplant patients

Author

Vicky Tagalakis, Héloïse Cardinal, François Madore, Jacobien C. Verhave, Marie-Josée Hébert, and Samy Suissa

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Population, Patient Readmission, Risk Assessment, Tertiary Care Centers, Young Adult, Risk Factors, Thromboembolism, Internal medicine, medicine, Humans, education, Kidney transplantation, Aged, Retrospective Studies, Sirolimus, education.field_of_study, business.industry, Quebec, Retrospective cohort study, Middle Aged, medicine.disease, Kidney Transplantation, Thrombosis, Surgery, Venous thrombosis, Treatment Outcome, Nephrology, Cohort, Female, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Risk assessment, Immunosuppressive Agents, medicine.drug
Abstract

Item does not contain fulltext Little is known about the risk of venous thrombosis following kidney transplant. To determine this we estimated the risk of thromboembolic events (TEs) in a cohort of consecutive patients who underwent kidney transplantation at a single tertiary care center over an 11-year period and calculated standardized incidence ratios (SIRs) for a first TE in kidney transplant recipients compared with the general population. We then performed a nested case-control study and compared patients with and without TEs to identify risk factors for thrombosis. Among 913 kidney transplant recipients (KTRs), 68 patients developed these events. The SIR for TEs in KTRs compared with the general population was 7.9 over the duration of follow-up. The risk was particularly higher in the first post-transplant year (SIR 26.1) but remained elevated afterward (SIR 5.2). Hospitalization, use of sirolimus, low hemoglobin level, and use of renin-angiotensin system inhibitors were independently associated with these events. When cases of TEs that occurred during hospitalization were excluded, the risk of these events remained elevated. The risk of TEs in KTRs was eightfold higher than in the general population but not fully explained by the increased risk associated with hospitalization. Our results underscore the important risk of thrombosis in patients who received a kidney transplant, making vigilance mandatory especially during hospitalization.

Published
2014

41. Formulas for Calculated Osmolarity and Osmolal Gap: A Study of Diagnostic Accuracy

Author

Rémi Goupil, Josée Bouchard, Stéphan Troyanov, François Madore, Hélène Ammann, Marc Ghannoum, and Fanny Lepeytre

Subjects
Adult, Blood Glucose, Male, Canada, Sodium, 030232 urology & nephrology, chemistry.chemical_element, Alcohol, Diagnostic accuracy, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Predictive Value of Tests, Linear regression, Medicine, Humans, Urea, 030212 general & internal medicine, Retrospective Studies, Chromatography, Ethanol, Osmotic concentration, business.industry, Osmolar Concentration, Reproducibility of Results, Improved performance, chemistry, Biochemistry, Nephrology, Dimensional Measurement Accuracy, Alcohols, Linear Models, Female, business, Chemically-Induced Disorders
Abstract

Background The osmolal gap has been used for decades to screen for exposure to toxic alcohols. However, several issues may affect its reliability. We aimed to develop equations to calculate osmolarity with improved performance when used to screen for intoxication to toxic alcohols. Study Design Retrospective cohort study. Setting & Participants 7,525 patients undergoing simultaneous measurements of osmolality, sodium, potassium, urea, glucose, and ethanol or undergoing similar measurements performed within 30 minutes of a measurement of toxic alcohol levels at a single tertiary-care center from April 2001 to June 2016. Patients with detectable toxic alcohols were excluded. Index Test Equations to calculate osmolarity using multiple linear regression. Outcomes The performance of new equations compared with published equations developed to calculate osmolarity, and to diagnose toxic alcohol intoxications more accurately. Results We obtained 7,525 measurements, including 100 with undetectable toxic alcohols. Among them, 3,875 had undetectable and 3,650 had detectable ethanol levels. In the entire cohort, the best equation to calculate osmolarity was 2.006×Na + 1.228×Urea + 1.387×Glucose + 1.207×Ethanol (values in mmol/L, R2=0.96). A simplified equation, 2.0×Na + 1.2×Urea + 1.4×Glucose + 1.2×Ethanol, had a similar R2 with 95% of osmolal gap values between −10.9 and 13.8. In patients with undetectable ethanol concentrations, the range of 95% of osmolal gap values was narrower than previous published formulas, and in patients with detectable ethanol concentrations, the range was narrower or similar. We performed a subanalysis of 138 cases for which both the toxic alcohol concentration could be measured and the osmolal gap could be calculated. Our simplified equation had superior diagnostic accuracy for toxic alcohol exposure. Limitations Single center, no external validation, limited number of cases with detectable toxic alcohols. Conclusions In a large cohort, coefficients from regression analyses estimating the contribution of glucose, urea, and ethanol were higher than 1.0. Our simplified formula to precisely calculate osmolarity yielded improved diagnostic accuracy for suspected toxic alcohol exposures than previously published formulas.

Published
2016

42. SUN-312 HEALTHY DIET SCORE AND KIDNEY FUNCTION: A CROSS-SECTIONAL ANALYSIS

Author

Amélie Bernier-Jean, Stéphan Troyanov, Myriam Khalili, François Madore, Josée Bouchard, Dominique S. Genest, and Rémi Goupil

Subjects
medicine.medical_specialty, Nephrology, Cross-sectional study, business.industry, Internal medicine, medicine, Renal function, Healthy diet, business
Published
2019

43. Clinical value of inflammatory urinary biomarkers in overt diabetic nephropathy: A prospective study

Author

Rémi Goupil, Stéphan Troyanov, Josée Bouchard, Soumeya Brachemi, Jacobien C. Verhave, Vincent Pichette, and François Madore

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Urinary system, Urology, Renal function, Transforming Growth Factor beta1, Diabetic nephropathy, Endocrinology, Diabetes mellitus, Internal medicine, Plasminogen Activator Inhibitor 1, Internal Medicine, Humans, Medicine, Diabetic Nephropathies, Prospective Studies, Prospective cohort study, Chemokine CCL2, Inflammation, Proteinuria, Interleukin-6, Tumor Necrosis Factor-alpha, business.industry, Interleukin-8, General Medicine, medicine.disease, Blood pressure, Biomarker (medicine), medicine.symptom, business, Biomarkers, Glomerular Filtration Rate
Abstract

Aims The evolution of diabetic nephropathy is incompletely accounted by current clinical tools. New biomarkers may refine patient assessment and help monitor therapy. We compared the added predictive value of 7 candidate inflammatory urinary biomarkers to known risk factors of progression. Methods We prospectively followed 83 patients with overt diabetic nephropathy for a median 2.1 years and obtained repeated measurements of proteinuria, IL-1β, IL-6, IL-8, MCP-1, TNF-α, TGF-β1, and PAI-1. Results Patients had an initial estimated glomerular filtration rate of 25 ± 9 mL/min/1.73 m 2 , blood pressure of 142/69 mmHg and used a median of 4 anti-hypertensive medications over the course of the study. The observed rate of renal function decline was 2.9 ± 3.0 mL/min/1.73 m 2 /year. All urinary biomarkers levels were collinear and for each one except IL-1β, elevated levels predicted a more rapid progression. MCP-1 was the only biomarker increasing during follow-up, which also correlated with a worst outcome. Using multivariate linear regression adjusting for clinical risk factors of progression, urinary MCP-1 and TGF-β1 predicted progression independently and additively to the degree of proteinuria. We dichotomized these 3 biomarkers and observed a renal function decline with 0, 1, 2 or 3 elevated biomarkers of −0.8 ± 1.4, −2.1 ± 2.1, −4.2 ± 2.8 and −6.0 ± 2.8 mL/min/1.73 m 2 /year, respectively ( p Conclusions Multiple urinary biomarkers predict outcome in overt diabetic nephropathy. However, urinary MCP-1 and TGF-β1 are also independent and additive to proteinuria in predicting the rate of renal function decline and could serve as useful clinical tools in patient risk stratification.

Published
2013

44. Plasmapheresis in myeloma cast nephropathy

Author

Isabelle Chapdelaine and François Madore

Subjects
Male, medicine.medical_specialty, Biopsy, medicine.medical_treatment, Urology, Renal function, law.invention, Nephropathy, Randomized controlled trial, law, medicine, Humans, Myeloma cast nephropathy, Multiple myeloma, Dexamethasone, Chemotherapy, business.industry, Plasmapheresis, General Medicine, Middle Aged, medicine.disease, Kidney Tubules, Nephrology, Kidney Diseases, Multiple Myeloma, business, medicine.drug
Abstract

Renal failure in multiple myeloma is frequent, and portends a dismal prognosis. Precipitation of free light chains in tubules contributes to development of cast nephropathy and renal failure. Treatment with plasmapheresis is reported as an adjunct to chemotherapy in these patients, but evidence regarding its efficacy in the literature is conflicting. In this article, we report the case of a 63-year-old man who presented with severe acute renal failure due to myeloma cast nephropathy and whose kidney function improved significantly following treatment with dexamethasone and a course of 8 plasma exchanges. We then provide a review of the technical aspects of plasmapheresis, followed by an analysis of the randomized trials that have been published to date on the efficacy of plasmapheresis for myeloma cast nephropathy.

Published
2013

45. Heart rate dependent and independent effects of beta-blockers on central hemodynamic parameters: a propensity score analysis

Author

François Madore, Rémi Goupil, Dominique Dupuis, Mohsen Agharazii, and Stéphan Troyanov

Subjects
Male, medicine.medical_specialty, Physiology, Hemodynamics, Blood Pressure, 030204 cardiovascular system & hematology, Pulse Wave Analysis, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Bayesian multivariate linear regression, Internal medicine, Heart rate, Internal Medicine, medicine, Bisoprolol, Humans, 030212 general & internal medicine, Propensity Score, Metoprolol, Aged, business.industry, Middle Aged, Atenolol, Adrenergic beta-1 Receptor Antagonists, Pulse pressure, Blood pressure, Cross-Sectional Studies, Hypertension, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

OBJECTIVES Central hemodynamic parameters are better predictors of the cardiovascular burden than peripheral blood pressure (BP). Beta-blockers are known to reduce central BP to a lesser extent than peripheral BP, a hypothesized mechanistic consequence of heart rate (HR) reduction. METHODS The association between beta-blocker use, HR and central hemodynamics indices was studied in treated hypertensive participants of the CARTaGENE study using propensity score analyses and multivariate linear regressions. RESULTS Of the 20 004 participants, 2575 were treated hypertensive patients with valid pulse wave analysis. Using propensity score analyses, beta-blocker users (n = 605) were matched to nonusers having similar clinical characteristics with (Model 1) and without (Model 2) adjustment for HR. This resulted in 457 and 510 pairs with adequate balance, except for a HR difference in Model 2 (62.5 ± 10.5 vs. 70.4 ± 11.5 bpm, p

Published
2016

46. Clinical, genetic, and urinary factors associated with uromodulin excretion

Author

Philip Awadalla, Sonia Youhanna, Catherine Delmas-Frenette, Vanessa Bruat, Guillaume Bollée, François Madore, Olivier Devuyst, Stéphan Troyanov, University of Zurich, and Troyanov, S

Subjects
Glycosuria, medicine.medical_specialty, Uricosuric, Tamm–Horsfall protein, Epidemiology, 2747 Transplantation, Population, 030232 urology & nephrology, Renal function, 610 Medicine & health, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 10052 Institute of Physiology, Excretion, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, education, Transplantation, Creatinine, education.field_of_study, 2727 Nephrology, biology, business.industry, Original Articles, Endocrinology, chemistry, Nephrology, 10076 Center for Integrative Human Physiology, biology.protein, Uric acid, 570 Life sciences, medicine.symptom, business, 2706 Critical Care and Intensive Care Medicine, 2713 Epidemiology
Abstract

Background and objectives The urinary excretion of uromodulin is influenced by common variants in the UMOD gene, and it may be related to NaCl retention and hypertension. Levels of uromodulin are also dependent of the renal function, but other determinants remain unknown. Design, setting, participants, & measurements We tested associations between the urinary excretion of uromodulin; medical history and medication; serum and urinary levels of electrolytes, glucose, and uric acid; and the genotype at the UMOD/Protein Disulfide Isomerase–Like, Testis Expressed locus (rs4293393 and rs12446492); 943 participants from the CARTaGENE Cohort, a random sample from the Canadian population of 20,004 individuals, were analyzed. Participants with available genotyping were obtained from a substudy addressing associations between common variants and cardiovascular disease in paired participants with high and low Framingham risk scores and vascular rigidity indexes. Results The population studied was 54±9 years old, with 51% women and eGFR of 9±14 ml/min per 1.73 m 2 . Uromodulin excretion was 25 (11–42) mg/g creatinine. Using linear regression, it was independently higher among patients with higher eGFR, the TT genotype of rs4293393, and the TT genotype of rs12446492. The fractional excretions of urate and sodium showed a strong positive correlation with uromodulin, likely linked to the extracellular volume status. The presence of glycosuria and the use of uricosuric drugs, which both increased the fraction excretion of urate, were independently associated with a lower uromodulin excretion, suggesting novel interactions between uric acid and uromodulin excretion. Conclusions In this large cohort, the excretion of uromodulin correlates with clinical, genetic, and urinary factors. The strongest associations were between uric acid, sodium, and uromodulin excretions and are likely linked to the extracellular volume status.

Published
2016

47. Alteration of the platelet transcriptome in chronic kidney disease

Author

Hélène Plé, Aurélie Corduan, François Madore, Manon Maltais, Patrick Provost, and Guy Rousseau

Subjects
Adult, Blood Platelets, Male, 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Biology, Article, Transcriptome, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Internal medicine, microRNA, medicine, Humans, Platelet, RNA, Messenger, Phospholipid Transfer Proteins, Renal Insufficiency, Chronic, Dialysis, Aged, Uremia, Blood Platelet Disorders, Microfilament Proteins, Case-control study, Hematology, Middle Aged, medicine.disease, MicroRNAs, 030104 developmental biology, Endocrinology, Case-Control Studies, Female, Kidney disease
Abstract

SummaryBleeding and thrombotic disorders are major complications affecting patients with chronic kidney disease (CKD). Exposure of circulating platelets to uraemic toxins and contact with artificial surfaces during dialysis induce platelet abnormalities and alter the platelet proteome. We hypothesised that these changes may be subsequent to changes in the composition and/or regulation of the platelet transcriptome. In this study, we investigated the circulating platelets of 10 CKD patients (i.e. five chronic haemodialysis patients and five stage 4 CKD uraemic patients) and five age- and sex-matched healthy subjects. We observed an alteration of the platelet messenger RNA (mRNA) and microRNA transcriptome in CKD patients. Impaired in uraemic platelets, the levels of some mRNAs and of most microRNAs appeared to be corrected by dialysis, which is consistent with a beneficial effect of dialysis and a mRNA regulatory role of platelet microRNAs. Reduced in platelets of uraemic patients, phosphatidylcholine transfer protein (PCTP) and WD repeat-containing protein 1 (WDR1) were found to be regulated by microRNAs, the latter of which involving hsa-miR-19b, a microRNA increased in platelets of uraemic patients and involved in platelet reactivity. These results suggest that an alteration of microRNA-based mRNA regulatory mechanisms may underlie the platelet response to uremia and entail the development of platelet-related complications in CKD.

Published
2012

48. Contents Vol. 121, 2012

Author

Holly Tomlin, William G. Goodman, Eishin Oki, J.N. Boletis, Marta Crespo, Rémi Goupil, Tomomi Aizawa-Yashiro, R. Pérez García, Satz Mengensatzproduktion, Valeria Azcoitia, M. Rubert, Kerry Cooper, Etsuro Ito, A. Ortiz, Yumi Kubo, Marisa Mir, Isabelle Chapdelaine, C. Barreto, J. Vinhas, Jean-Philippe Rioux, A. Vaz, Youssef M.K. Farag, Fadel Jaber, Hans-Ulrich Häring, Zhou Yi, Nils Heyne, Shojiro Watanabe, María José Soler, Julia Krieger, Druck Reinhardt Druck Basel, Hiroshi Tanaka, Luan Truong, L. Nieto, Michael Haap, Ali Abdulnabi Mohamed, Ajay K. Singh, M. Albalate, Yuan Weijie, Biruh Workeneh, J. Hernández Pérez, Kazushi Tsuruga, Stéphan Troyanov, P. de Sequera, Naonori Kumagai, Wang Jialin, Martina Guthoff, J. Assunção, Julio Pascual, Khaled M. Musallam, François Madore, Naji S. Mallat, K. Kolovou, S. Marinaki, Suzanne Koussa, Salman Ahmed, Ali T. Taher, Samir G. Mallat, Marta Riera, María José Pascual, Fuad N. Ziyadeh, J. Egido, P. Zazo, L. Parreira, Stéphanie Raymond-Carrier, Garabed Eknoyan, Jameela A. Kari, C. de la Piedra, Darryl Quarles, Eva Márquez, and J. M. Puig

Subjects
medicine.medical_specialty, Endocrinology, Traditional medicine, Nephrology, Physiology, business.industry, Physiology (medical), Internal medicine, medicine, General Medicine, business
Published
2012

50. URINARY UROMODULIN IN A PATHWAY BETWEEN DECREASED URINARY URIC ACID EXCRETION AND ALBUMINURIA

Author

Francois-Christophe Marois-Blanchet, Stéphan Troyanov, Johanne Tremblay, Renata Cifkova, P. Hamet, Alena Krajčoviechová, Philip Awadalla, Pierre Dumas, François Madore, and Francois Harvey

Subjects
medicine.medical_specialty, Tamm–Horsfall protein, biology, Physiology, business.industry, Urinary system, Endocrinology, Internal medicine, Internal Medicine, biology.protein, medicine, Albuminuria, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Uric acid excretion
Published
2018

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