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Context Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial.Objective To evaluate possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks.Design, Setting, and Participants Individual-level meta-analysis including 2 051 244 participants from 33 general population or high-risk (of vascular disease) cohorts and 13 CKD cohorts from Asia, Australasia, Europe, and North/South America, conducted in 1972-2011 with a mean follow-up time of 5.8 years (range, 0-31 years).Main Outcome Measures Hazard ratios (HRs) of mortality and end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholesterol, body mass index, and smoking. Absolute risks were estimated using HRs and average incidence rates.Results Mortality (112 325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age category. In general and high-risk cohorts, relative mortality risk for reduced eGFR decreased with increasing age; eg, adjusted HRs at an eGFR of 45 mL/min/1.73 m(2) vs 80 mL/min/1.73 m(2) were 3.50 (95% CI, 2.55-4.81), 2.21 (95% CI, 2.02-2.41), 1.59 (95% CI, 1.42-1.77), and 1.35 (95% CI, 1.23-1.48) in age categories 18-54, 55-64, 65-74, and >= 75 years, respectively (P Conclusions Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risk differences at older age.

Item does not contain fulltext BACKGROUND: Chronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes is unknown. METHODS: We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes. FINDINGS: We analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75,306 deaths occurred during a mean follow-up of 8.5 years (SD 5.0). In the 23 studies with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular disease during a mean follow-up of 9.2 years (SD 4.9). In the general and high-risk cohorts, mortality risks were 1.2-1.9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1.73 m(2) [vs 95 mL/min per 1.73 m(2)], HR 1.35; 95% CI 1.18-1.55; vs 1.33; 1.19-1.48 and at ACR 30 mg/g [vs 5 mg/g], 1.50; 1.35-1.65 vs 1.52; 1.38-1.67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts. INTERPRETATION: Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes. FUNDING: US National Kidney Foundation.

Contains fulltext : 110640.pdf (Publisher’s version ) (Closed access) CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking. OBJECTIVE: To evaluate risk implications of estimated GFR using the CKD-EPI equation compared with the MDRD Study equation in populations with a broad range of demographic and clinical characteristics. DESIGN, SETTING, AND PARTICIPANTS: A meta-analysis of data from 1.1 million adults (aged >/= 18 years) from 25 general population cohorts, 7 high-risk cohorts (of vascular disease), and 13 CKD cohorts. Data transfer and analyses were conducted between March 2011 and March 2012. MAIN OUTCOME MEASURES: All-cause mortality (84,482 deaths from 40 cohorts), cardiovascular mortality (22,176 events from 28 cohorts), and end-stage renal disease (ESRD) (7644 events from 21 cohorts) during 9.4 million person-years of follow-up; the median of mean follow-up time across cohorts was 7.4 years (interquartile range, 4.2-10.5 years). RESULTS: Estimated GFR was classified into 6 categories (>/=90, 60-89, 45-59, 30-44, 15-29, and /=65 years), sex, race/ethnicity (white, Asian, and black), and presence or absence of diabetes and hypertension. The results in the high-risk and CKD cohorts were largely consistent with the general population cohorts. CONCLUSION: The CKD-EPI equation classified fewer individuals as having CKD and more accurately categorized the risk for mortality and ESRD than did the MDRD Study equation across a broad range of populations.

Item does not contain fulltext BACKGROUND: Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease. However, whether the association of the kidney disease measures, estimated glomerular filtration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) differs by hypertensive status is unknown. METHODS: We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and ESRD associated with eGFR and albuminuria in individuals with and without hypertension. FINDINGS: We analysed data for 45 cohorts (25 general population, seven high-risk, and 13 chronic kidney disease) with 1,127,656 participants, 364,344 of whom had hypertension. Low eGFR and high albuminuria were associated with mortality irrespective of hypertensive status in the general population and high-risk cohorts. All-cause mortality risk was 1.1-1.2 times higher in individuals with hypertension than in those without hypertension at preserved eGFR. A steeper relative risk gradient in individuals without hypertension than in those with hypertension at eGFR range 45-75 mL/min per 1.73 m(2) led to much the same mortality risk at lower eGFR. With a reference eGFR of 95 mL/min per 1.73 m(2) in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min per 1.73 m(2) was 1.77 (95% CI 1.57-1.99) in individuals without hypertension versus 1.24 (1.11-1.39) in those with hypertension (p for overall interaction=0.0003). Similarly, for albumin-creatinine ratio of 300 mg/g (vs 5 mg/g), HR was 2.30 (1.98-2.68) in individuals without hypertension versus 2.08 (1.84-2.35) in those with hypertension (p for overall interaction=0.019). We recorded much the same results for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not differ by hypertensive status. Results for chronic kidney disease cohorts were similar to those for general and high-risk population cohorts. INTERPRETATION: Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension. FUNDING: US National Kidney Foundation.

Objective—To obtain information on menstrual patterns before and after transplantation, desire for future pregnancy, and use of contraception among premenopausal kidney transplant recipients.Study Design—This observational study collected information using self-administered anonymous questionnaires during a routine outpatient clinic visit.Results—Of the 107 women who completed the questionnaire, 41 identified themselves as being premenopausal. Among the 41 premenopausal women, approximately half of the women reported their current menstrual patterns as normal and 26% were not using any form of contraception. Overall, 10 women (24%) reported a desire to become pregnant and 4 women (10%) had a successful pregnancy after transplantation. Most of the women who desired a future pregnancy (8/10) were receiving an immunosuppressive regimen that included mycophenolate mofetil.Conclusion—Kidney transplantation in the current era is associated with a return of normal menstrual function in the majority of female tra...

Voor de normstelling van chemische stoffen, bijvoorbeeld voor het vaststellen van een Aanvaarde Dagelijkse Inname (ADI) of Toelaatbare Dagelijkse Inname (TDI), zijn gegevens over de chronische toxiciteit noodzakelijk. Vaak zijn echter slechts acute en sub-acute toxiciteitsgegevens beschikbaar. Om met de beperkte toxiciteitsgegevens toch een chronische No-observed-adverse-effect-level (NOAELchronisch ) te schatten, is een pragmatische methode ontwikkeld. Conversiefactoren werden bepaald door de distributie van de ratio's tussen (sub)-acute en chronische toxiciteitsgegevens van een groot aantal stoffen te evalueren. De 95% betrouwbaarheidsbovengrens van het 95ste percentiel van de ratio-verdeling definieren we als de conversiefactor om een NOAELchronisch te schatten (indicatieve NOAELchronisch). Op deze manier is rekening gehouden met de variatie in distributie (95ste percentiel) en met de schattingsfout (95% betrouwbaarheidsbovengrens). De NOAELsub-acuut van oraal gedoseerde stoffen correleerde beter met de NOAELchronisch dan de LD50. Voor de afleiding van de indicatieve NOAELchronisch verdient daarom de NOAELsub-acuut de voorkeur. Op basis van 57 NOAELsub-acuut/NOAELchronisch ratio's werd de conversiefactor voor de NOAELsub-acuut bepaald op 92. Voor de LD50 (n = 244) werd een conversiefactor van 1.7x10.000 afgeleid. Multiple regressie-analyse liet zien dat het combineren van een LD50 met een NOAELsub-acuut de schatting van de NOAELchronisch nauwelijks verbetert, ten opzichte van de schatting op basis van de NOAELsub-acuut als enige variabele. Gezien de slechte correlatie van de LD50 met de NOAELchronisch en de zeer beperkte meerwaarde van de LD50 bij een bekende NOAELsub-acuut, zou het vereist stellen van acute studies nader beschouwd moeten worden. Analyse van de inhalatoire data resulteerde in een conversiefactor van 8.8x10.000 en 6.8x10.000 voor respectievelijk een LC50 en een NOAELsub-acuut. Deze hoge factoren zijn gedeeltelijk te wijten aan het beperkte aantal stoffen waarvoor ratio's konden worden berekend. Evaluatie van de ratio NOAELsemi-chronisch/NOAELchronisch gaf een conversiefactor van 46 aan voor de oraal toegediende stoffen. Dit betekent dat de defaultwaarde van 10 eerder verhoogd zou moeten worden dan verlaagd, zoals soms gesuggereerd wordt. De conversiefactor voor de extrapolatie van LOAEL naar NOAEL werd op 12 geschat en ligt wel nabij de huidige defaultwaarde van 10.

In het RIVM rapport 620110001 'Derivation of conversion factors to estimate an indicative chronic NOAEL from short-term toxicity data', wordt een pragmatishe methode beschreven voor het schatten van een chronische NOAEL. Conversiefactoren werden verkregen door de ratioverdelingen van 'kort-durende' en 'langdurende' toxiciteitsgegevens statistisch te evalueren. Door conversiefactoren te definieren als de 95% betrouwbaarheidsbovengrens van het 95e percentiel van de ratio-verdeling, werd zowel rekening gehouden met de variatie in distributie (95e percentiel) als met de schattingsfout (95% betrouwbaarheidsbovengrens). Om de mogelijkheden en beperkingen van statistisch verkregen conversiefactoren te bediscussieren, werd op 24 mei 1996 een bijeenkomst georganiseerd op het RIVM te Bilthoven. Het huidige rapport is een samenvatting van de discussie en de conclusies. Hoewel men het erover eens was dat analyse van toxicologische gegevens waardevolle inzichten opleverde, was er terughoudendheid ten aanzien van het gebruik van conversiefactoren. Met name was er bezorgdheid ten aanzien van de beleidsmatige en politieke status van de indicatieve NOAEL's. Deze bezorgdheid had betrekking op de mogelijkheid dat de, met behulp van statistische methoden geschatte NOAEL, uiteindelijk niet meer te onderscheiden zou zijn van de toxicologisch afgeleide NOAEL. Een duidelijk onderscheid tussen deze twee soorten NOAEL's zou dan ook noodzakelijk zijn. Bovendien zouden conversiefactoren niet mogen worden gebruikt als toxicologische gegevens voorhanden zijn. Hoewel de conversiefactoren als hoog werden ervaren, was er overeenstemming over het feit dat de keus van het te hanteren percentiel en de betrouwbaarheidsinterval, een politieke en geen wetenschappelijke kwestie was. In het algemeen was men van mening dat conversiefactoren nog niet voor toepassing waren geschikt.

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Kann man davon ausgehen, dass Berufsdysphonien häufig mit weiteren Begleiterkrankungen vergesellschaftet sind? Welche zusätzlichen gesundheitlichen Störungen treten gehäuft bei Berufsdysphonien auf? Unterscheiden sich die begleitenden Erkrankungen bei Patienten mit funktionellen Stimmstörungen von denen mit organisch bedingten Stimmstörungen? Um diese und andere Fragen beantworten zu können, haben wir eine retrospektive Studie bei Patienten durchgeführt, die wegen einer Berufsdysphonie eine stationäre phoniatrische Rehabilitationsbehandlung durchgeführt haben. Über 100 Patienten wurden in unsere Studie aufgenommen. Alle Patienten haben in der Abteilung Phoniatrie des Reha-Zentrums Bad Gögging ein stationäres Heilverfahren durchlaufen. Bei den berufsbedingten funktionellen Stimmstörungen wird im Vergleich zu den organisch bedingten ein überdurchschnittlicher Anteil an psycho-vegetativer Begleitsymptomatik beobachtet.

In this report a brief overview is given concerning PCBs and dioxins in food. Background levels and the way PCBs and dioxins enter the environment are described. In the risk assessment part of the report an evaluation of toxicity is given, the way standards for dioxins and PCBs have been determined, which analysis methods are used as well as which levels of PCBs and dioxins have been measured in various food items. Finally, in the risk management part of this report it is tried to make clear what measures have been taken to reduce the risks related to exposure to dioxin and PCB.

The present study was performed to evaluate the effects of sodium intake and of chronic cyclooxygenase-2 (COX-2) inhibition on systolic blood pressure (SBP) in heterozygous male transgenic rats harboring the mouse Ren-2 renin gene (TGR) and in transgene-negative normotensive Hannover Sprague-Dawley (HanSD). Twenty-eight days old TGR and HanSD were randomly assigned to groups fed either normal salt (NS) or low sodium (LS) diets. COX-2 blockade was achieved with NS-398 (1 mg x kg(-1).day(-1) in drinking water). During an experimental period of 26 days, SBP was repeatedly measured by tail plethysmography in conscious animals. We found that the LS diet prevented the development of hypertension in TGR and did not change SBP in HanSD. Low sodium intake also prevented proteinuria and cardiac hypertrophy in TGR. On the other hand, irrespective of sodium intake chronic COX-2 inhibition did not alter the course of SBP in either TGR or HanSD. The present data indicate that TGR exhibit an important salt-sensitive component in the developmental phase of hypertension. They also suggest that systemic COX-2-derived prostaglandins do not act as vasodilatory counterregulatory agents in TGR in which an exaggerated vascular responsiveness to angiotensin II is assumed as the pathophysiological mechanism in the development of hypertension.

In neueren Untersuchungen zur Pathogenese des Uramiesyndroms wird vor allem der Inhibition verschiedener Enzymsysteme durch Stoffwechselmetabolite besondere Bedeutung beigemessen [3, 7, 9, 13, 15, 20]. So wurde von mehreren Autoren darauf hingewiesen, das es bei der uramischen Intoxikation offenbar zu einer Blockierung der Synthese von Co-Enzym-A-Verbindungen sowie zu einer verminderten Bildung energiereicher Phosphate kommt [8, 14, 16, 17, 18, 23]. Das gerade Phenolcarbonsauren eine solche Enzyminhibition hervorrufen konnen, wurde durch die Arbeiten von Hicks u. Mitarb. [9] nachgewiesen. Auf ihre mogliche Bedeutung in der Pathogenese des Uramiesyndroms machten bereits Arbeitsgruppen mit Hilfe mehr oder weniger spezifischer Gruppenreaktionen Phenolkonzentrationen im Serum niereninsuffizienter Patienten. Eine Beziehung zwischen der Serumphenolkonzentration und dem klinischen Schweregrad der Uramie lies sich jedoch nicht sicher erkennen [4].

Die Uramie als Endstadium der chronischen Niereninsuffizienz geht mit einer komplexen Symptomatik als Ausdruck der Beeintrachtigung verschiedener vitaler Funktionen des Organismus einher. Die beobachteten Storungen konnen dabei teilweise auf eingeschrankte Partialfunktionen der Niere, zum uberwiegenden Teil jedoch auf den globalen Ausfall der Ausscheidungsfunktion der Niere mit Retention harnpflichtiger, z. T. toxischer Metabolite, zuruckgefuhrt werden.

The present study was performed to evaluate the role of an interaction between the endothelin (ET) and the renin-angiotensin systems (RAS) in the development and maintenance of hypertension and in hypertension-associated end-organ damage in heterozygous male and female transgenic rats harboring the mouse Ren-2 renin gene (TGR). Twenty-eight days old heterozygous TGR and age-matched transgene-negative normotensive Hannover Sprague-Dawley rats (HanSD) were randomly assigned to groups with normal-salt (NS) or high-salt (HS) intake. Nonselective ET(A)/ET(B) receptor blockade was achieved with bosentan (100 mg.kg(-1).day(-1)). All male and female HanSD as well as heterozygous TGR on NS exhibited 100 % survival rate until 180 days of age (end of experiment). HS diet in heterozygous TGR induced a transition from benign to malignant phase hypertension. The survival rates in male and in female heterozygous TGR on the HS diet were 46 % and 80 %, respectively, and were significantly improved by administration of bosentan to 76 % and 97 %, respectively. Treatment with bosentan did not influence either the course of hypertension (measured by plethysmography in conscious animals) or the final levels of blood pressure (measured by a direct method in anesthetized rats) in any of the experimental groups of HanSD or TGR. Administration of bosentan in heterozygous TGR fed the HS diet markedly reduced proteinuria, glomerulosclerosis and attenuated the development of cardiac hypertrophy compared with untreated TGR. Our data show that the ET receptor blockade markedly improves the survival rate and ameliorates end-organ damage in heterozygous TGR exposed to HS diet. These findings indicate that the interaction between the RAS and ET systems plays an important role in the development of hypertension-associated end-organ damage in TGR exposed to salt-loading.

Results from space have been unexpected and not predictable from the results of ground-based simulations. Therefore, the concept of how weightlessness and gravity modulates the regulation of body fluids must be revised and a new simulation model developed. The main questions to ask in the future are the following: Does weightlessness induce a diuresis and natriuresis during the initial hours of space flight leading to an extracellular and intravascular fluid volume deficit? Can sodium in excess be stored in a hitherto unknown way, particularly during space flight? Why are fluid and sodium retaining systems activated by spaceflight? Why are the renal responses to saline and water stimuli in space attenuated compared with those of ground simulations? How can the effects of weightlessness on fluid and electrolyte regulation be correctly simulated on the ground? The information obtained from space may be of relevance to fluid and electrolyte balance in edematous patients. © 2001 by the National Kidney Foundation, Inc.

Renal excretory function and hemodynamics are determined by the effective circulating plasma volume as well as by the interplay of systemic and local vasoconstrictors and vasodilators. Microgravity results in a headward shift of body fluid. Because the control conditions of astronauts were poorly defined in many studies, controversial results have been obtained regarding diuresis and natriuresis as well as renal hemodynamic changes in response to increased central blood volume, especially during the initial phase of space flight. Renal excretory function and renal hemodynamics in microgravity are affected in a complex fashion, because during the initial phase of space flight, variable mechanisms become operative to modulate the effects of increased central blood volume. They include interactions between vasodilators (dopamine, atrial natriuretic peptide, and prostaglandins) and vasoconstrictors (sympathetic nervous system and the renin-angiotensin system). The available data suggest a moderate rise in glomerular filtration rate during the first 2 days after launch without a significant increase in effective renal plasma flow. In contrast, too few data regarding the effects of space flight on renal function during the first 12 hours after launch are available and are, in addition, partly contradictory. Thus, detailed and well-controlled studies are required to shed more light on the role of the various factors besides microgravity that determine systemic and renal hemodynamics and renal excretory function during the different stages of space flight. © 2001 by the National Kidney Foundation, Inc.