Publications by authors named "Michael A Mao"

97 Publications

Impact of serum magnesium levels at hospital discharge and one-year mortality.

Postgrad Med 2021 May 31:1-5. Epub 2021 May 31.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

: We aimed to determine the optimal range of discharge serum magnesium in hospitalized patients by evaluating one-year mortality risk according to discharge serum magnesium.: This was a single-center cohort study of hospitalized adult patients who survived until hospital discharge. We classified discharge serum magnesium, defined as the last serum magnesium within 48 hours of hospital discharge, into ≤1.6, 1.7-1.8, 1.9-2.0, 2.1-2.2, and ≥2.3 mg/dL. We assessed one-year mortality risk after hospital discharge based on discharge serum magnesium, using discharge magnesium of 2.1-2.2 mg/dL as the reference group.: Of 39,193 eligible patients, 8%, 23%, 34%, 23%, and 12% had a serum magnesium of ≤1.6, 1.7-1.8, 1.9-2.0, 2.1-2.2, and ≥2.3 mg/dL, respectively, at hospital discharge. After the adjustment for several confounders, discharge serum magnesium of ≤1.6, 1.7-1.8, and ≥2.3 mg/dL were associated with higher one-year mortality with hazard ratio of 1.35 (95% CI 1.21-1.50), 1.14 (95% CI 1.06-1.24), and 1.17 (95% CI 1.07-1.28), respectively, compared to discharge serum magnesium of 2.1-2.2 mg/dL. There was no significant difference in one-year mortality between patients with discharge serum magnesium of 1.9-2.0 and 2.1-2.2 mg/dL.: The optimal range of serum magnesium at discharge was 1.9-2.2 mg/dL. Both hypomagnesemia and hypermagnesemia at discharge were associated with higher one-year mortality.
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http://dx.doi.org/10.1080/00325481.2021.1931369DOI Listing
May 2021

Acute Kidney Injury and Cardiac Arrest in the Modern Era: An Updated Systematic Review and Meta-analysis.

Hosp Pract (1995) 2021 May 15. Epub 2021 May 15.

Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Objective: Acute kidney injury (AKI) is associated with higher morbidity and mortality in cardiac arrest (CA). There are limited contemporary data on the incidence and outcomes of AKI in CA.

Methods: We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED, and the Cochrane from inception to November 2020. Observational studies that reported the incidence of AKI in CA survivors were included. Data from each study were combined using the random effects to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). The primary outcome was short-term mortality and secondary outcomes included long-term mortality, incidence of AKI and use of renal replacement therapy (RRT). Subgroup and meta-regression analyses were performed to explore heterogeneity.

Main Results: A total of 25 observational studies comprising 8,165 patients were included. The incidence of AKI in CA survivors was 40.3%, (range 32.9-47.8%). In stage 3 AKI, 1/4 of patients required RRT. AKI was associated with an increased risk of both short-term (OR 2.27 [95% CI 1.74-2.96]; <0.001) and long-term mortality (OR 1.51 [95% CI 1.93-3.25]; <0.001). Meta-regression and subgroup analyses did not suggest any effect of hypothermia on incidence of AKI.

Conclusion: AKI complicates the care of 40% of CA survivors and is associated with significantly increased short and long-term mortality.
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http://dx.doi.org/10.1080/21548331.2021.1931234DOI Listing
May 2021

Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis.

World J Gastroenterol 2021 Mar;27(12):1240-1254

Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States.

Background: Hepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death.

Aim: To demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients.

Methods: We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay.

Results: Of 563 citations, a total of 22 studies ( = 4557) were included in this meta-analysis. The pooled estimated prevalence of HEV infection in SOT patients was 20.2% [95% confidence interval (CI): 14.9-26.8]. The pooled estimated prevalence of HEV infection for each organ transplant was as follows: liver (27.2%; 95%CI: 20.0-35.8), kidney (12.8%; 95%CI: 9.3-17.3), heart (12.8%; 95%CI: 9.3-17.3), and lung (5.6%; 95%CI: 1.6-17.9). Comparison across organ transplants demonstrated statistical significance (Q = 16.721, = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. The pooled estimated prevalence of de novo HEV infection was 5.1% (95%CI: 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95%CI: 1.9-9.4).

Conclusion: HEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.
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http://dx.doi.org/10.3748/wjg.v27.i12.1240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006097PMC
March 2021

Is It Time for Machine Learning Algorithms to Predict the Risk of Kidney Failure in Patients with Chronic Kidney Disease?

J Clin Med 2021 Mar 8;10(5). Epub 2021 Mar 8.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Chronic kidney disease (CKD) is a common clinical problem affecting more than 800 million people with different kidney diseases [...].
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http://dx.doi.org/10.3390/jcm10051121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962455PMC
March 2021

Acute kidney injury in hospitalized patients with methanol intoxication: National Inpatient Sample 2003-2014.

Hosp Pract (1995) 2021 Feb 14:1-6. Epub 2021 Feb 14.

Department of Medicine, Division of Nephrology and Hypertension, Rochester, MN, USA.

: This study aimed to 1) determine the incidence of acute kidney injury (AKI), 2) identify risk factors for AKI, and 3) evaluate the impact of AKI on in-hospital outcomes in hospitalized patients for methanol intoxication.: We searched the National Inpatient Sample Database for hospitalized patients from 2003 to 2014 with a primary diagnosis of methanol intoxication. We excluded patients with end-stage kidney disease. We identified the AKI using a discharge diagnosis code. We compared clinical characteristics, in-hospital treatment, outcomes, and resource use between AKI and non-AKI patients.: A total of 603 hospital admissions for methanol intoxication were analyzed. AKI developed in 135 (22.4%) admissions. Anemia (OR 3.43 p < 0.001), hypertension (OR 1.86; p = 0.02), volume depletion (OR 3.46; p = 0.001), sepsis (OR 6.91; p < 0.001), rhabdomyolysis (OR 6.25; p = 0.003), and acute pancreatitis (OR 5.30; p = 0.004) were independent risk factors for AKI development. AKI was significantly associated with increased risk of in-hospital mortality and organ failure. AKI patients needed more mechanical ventilation, and extracorporeal therapy, had longer length of hospital stay, and higher hospitalization costs.: Over one-fifth of methanol intoxication patients developed AKI during hospitalization. AKI was associated with higher morbidity, mortality, and resource utilization.
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http://dx.doi.org/10.1080/21548331.2021.1882239DOI Listing
February 2021

Circulatory Shock among Hospitalized Patients for Salicylate Intoxication.

Diseases 2021 Jan 12;9(1). Epub 2021 Jan 12.

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.

Background: This study aimed to evaluate the risk factors for circulatory shock and its impact on outcomes in patients hospitalized for salicylate intoxication.

Methods: We used the National Inpatient Sample to identify patients hospitalized primarily for salicylate intoxication from 2003-2014. Circulatory shock was identified based on hospital diagnosis code for any type of shock or hypotension. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between patients with and without circulatory shock associated with salicylate intoxication.

Results: Of 13,805 hospital admissions for salicylate intoxication, circulatory shock developed in 484 (4%) admissions. Risk factors for development of circulatory shock included older age, female sex, concurrent psychotropic medication overdose, anemia, congestive heart failure, volume depletion, rhabdomyolysis, seizure, gastrointestinal bleeding, and sepsis. Circulatory shock was significantly associated with increased odds of any organ failure and in-hospital mortality. Length of hospital stay and hospitalization cost was significantly higher in patients with circulatory shock.

Conclusion: Approximately 4% of patients admitted for salicylate intoxication developed circulatory shock. Circulatory shock was associated with worse clinical outcomes and increased resource use.
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http://dx.doi.org/10.3390/diseases9010007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839009PMC
January 2021

Outcomes of Kidney Transplantation in Fabry Disease: A Meta-Analysis.

Diseases 2020 Dec 23;9(1). Epub 2020 Dec 23.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Background: Fabry disease (FD) is a rare X-linked lysosomal storage disorder with progressive systemic deposition of globotriaosylceramide, leading to life-threatening cardiac, central nervous system, and kidney disease. Current therapy involves symptomatic medical management, enzyme replacement therapy (ERT), dialysis, kidney transplantation, and, more recently, gene therapy. The aim of this systematic review was to assess outcomes of kidney transplantation among patients with FD.

Methods: A comprehensive literature review was conducted utilizing MEDLINE, EMBASE, and Cochrane Database, from inception through to 28 February 2020, to identify studies that evaluate outcomes of kidney transplantation including patient and allograft survival among kidney transplant patients with FD. Effect estimates from each study were extracted and combined using the random-effects generic inverse variance method of DerSimonian and Laird.

Results: In total, 11 studies, including 424 kidney transplant recipients with FD, were enrolled. The post-transplant median follow-up time ranged from 3 to 11.5 years. Overall, the pooled estimated rates of all-cause graft failure, graft failure before death, and allograft rejection were 32.5% (95%CI: 23.9%-42.5%), 14.5% (95%CI: 8.4%-23.7%), and 20.2% (95%CI: 15.4%-25.9%), respectively. In the sensitivity analysis, limited only to the recent studies (year 2001 or newer when ERT became available), the pooled estimated rates of all-cause graft failure, graft failure before death, and allograft rejection were 28.1% (95%CI: 20.5%-37.3%), 11.7% (95%CI: 8.4%-16.0%), and 20.2% (95%CI: 15.5%-26.0%), respectively. The pooled estimated rate of biopsy proven FD recurrence was 11.1% (95%CI: 3.6%-29.4%), respectively. There are no significant differences in the risks of all-cause graft failure ( = 0.10) or mortality (0.48) among recipients with vs. without FD.

Conclusions: Despite possible FD recurrence after transplantation of 11.1%, allograft and patient survival are comparable among kidney transplant recipients with vs. without FD.
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http://dx.doi.org/10.3390/diseases9010002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838795PMC
December 2020

Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States.

Diseases 2020 Dec 24;9(1). Epub 2020 Dec 24.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Background: This study aimed to evaluate thrombotic microangiopathy's (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE).

Methods: We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003-2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLE patients with and without TMA.

Results: Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMA patients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMA patients.

Conclusion: TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use.
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http://dx.doi.org/10.3390/diseases9010003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838946PMC
December 2020

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality.

Medicines (Basel) 2020 Nov 19;7(11). Epub 2020 Nov 19.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

: The objective of this study was to report the incidence of in-hospital serum ionized calcium derangement and its impact on mortality. We included 12,599 non-dialytic adult patients hospitalized at a tertiary medical center from January 2009 to December 2013 with normal serum ionized calcium at admission and at least 2 in-hospital serum ionized calcium values. Using serum ionized calcium of 4.60-5.40 mg/dL as the normal reference range, in-hospital serum ionized calcium levels were categorized based on the presence of hypocalcemia and hypercalcemia in hospital. We performed logistic regression to assess the relationship of in-hospital serum ionized calcium derangement with mortality. Fifty-four percent of patients developed new serum ionized calcium derangements: 42% had in-hospital hypocalcemia only, 4% had in-hospital hypercalcemia only, and 8% had both in-hospital hypocalcemia and hypercalcemia. In-hospital hypocalcemia only (OR 1.28; 95% CI 1.01-1.64), in-hospital hypercalcemia only (OR 1.64; 95% CI 1.02-2.68), and both in-hospital hypocalcemia and hypercalcemia (OR 1.73; 95% CI 1.14-2.62) were all significantly associated with increased in-hospital mortality, compared with persistently normal serum ionized calcium levels. In-hospital serum ionized calcium derangements affect more than half of hospitalized patients and are associated with increased in-hospital mortality.
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http://dx.doi.org/10.3390/medicines7110070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699179PMC
November 2020

Outcomes of kidney retransplantation in recipients with prior posttransplant lymphoproliferative disorders: An analysis of the 2000-2019 UNOS/OPTN database.

Am J Transplant 2021 02 21;21(2):846-853. Epub 2020 Nov 21.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.

This study utilized the UNOS database to assess clinical outcomes after kidney retransplantation in patients with a history of posttransplant lymphoproliferative disease (PTLD). Among second kidney transplant patients from 2000 to 2019, 254 had history of PTLD in their first kidney transplant, whereas 28,113 did not. After a second kidney transplant, PTLD occurred in 2.8% and 0.8% of patients with and without history of PTLD, respectively (p = .001). Over a median follow-up time of 4.5 years after a second kidney transplant, 5-year death-censored graft failure was 9.5% vs. 12.6% (p = .21), all-cause mortality was 8.3% vs. 11.8% (p = .51), and 1-year acute rejection was 11.0% vs. 9.3% (p = .36) in the PTLD vs. non-PTLD groups, respectively. There was no significant difference in death-censored graft failure, mortality, and acute rejection between PTLD and non-PTLD groups in adjusted analysis and after propensity score matching. We conclude that graft survival, patient survival, and acute rejection after kidney retransplantation are comparable between patients with and without history of PTLD, but PTLD occurrence after kidney retransplantation remains higher in patients with history of PTLD.
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http://dx.doi.org/10.1111/ajt.16385DOI Listing
February 2021

Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: A meta-analysis.

Urol Ann 2020 Jul-Sep;12(3):241-247. Epub 2020 Jun 10.

Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA.

Background: Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia.

Materials And Methods: A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716).

Results: Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%-76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1 year after KTx was 10.3% (95% CI: 5.5%-18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%-15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%-41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA ( = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses.

Conclusion: The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.
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http://dx.doi.org/10.4103/UA.UA_89_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546070PMC
June 2020

Treatment of C3 Glomerulopathy in Adult Kidney Transplant Recipients: A Systematic Review.

Med Sci (Basel) 2020 Oct 21;8(4). Epub 2020 Oct 21.

Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.

Background: C3 glomerulopathy (C3G), a rare glomerular disease mediated by alternative complement pathway dysregulation, is associated with a high rate of recurrence and graft loss after kidney transplantation (KTx). We aimed to assess the efficacy of different treatments for C3G recurrence after KTx.

Methods: Databases (MEDLINE, EMBASE, and Cochrane Database) were searched from inception through 3 May, 2019. Studies were included that reported outcomes of adult KTx recipients with C3G. Effect estimates from individual studies were combined using the random-effects, generic inverse variance method of DerSimonian and Laird., The protocol for this meta-analysis is registered with PROSPERO (no. CRD42019125718).

Results: Twelve studies (7 cohort studies and 5 case series) consisting of 122 KTx patients with C3G (73 C3 glomerulonephritis (C3GN) and 49 dense deposit disease (DDD)) were included. The pooled estimated rates of allograft loss among KTx patients with C3G were 33% (95% CI: 12-57%) after eculizumab, 42% (95% CI: 2-89%) after therapeutic plasma exchange (TPE), and 81% (95% CI: 50-100%) after rituximab. Subgroup analysis based on type of C3G was performed. Pooled estimated rates of allograft loss in C3GN KTx patients were 22% (95% CI: 5-46%) after eculizumab, 56% (95% CI: 6-100%) after TPE, and 70% (95% CI: 24-100%) after rituximab. Pooled estimated rates of allograft loss in DDD KTx patients were 53% (95% CI: 0-100%) after eculizumab. Data on allograft loss in DDD after TPE (1 case series, 0/2 (0%) allograft loss at 6 months) and rituximab (1 cohort, 3/3 (100%) allograft loss) were limited. Among 66 patients (38 C3GN, 28 DDD) who received no treatment (due to stable allograft function at presentation and/or clinical judgment of physicians), pooled estimated rates of allograft loss were 32% (95% CI: 7-64%) and 53% (95% CI: 28-77%) for C3GN and DDD, respectively. Among treated C3G patients, data on soluble membrane attack complex of complement (sMAC) were limited to patients treated with eculizumab (N = 7). 80% of patients with elevated sMAC before eculizumab responded to treatment. In addition, all patients who responded to eculizumab had normal sMAC levels after post-eculizumab.

Conclusions: Our study suggests that the lowest incidence of allograft loss (33%) among KTX patients with C3G are those treated with eculizumab. Among those who received no treatment for C3G due to stable allograft function, there is a high incidence of allograft loss of 32% in C3GN and 53% in DDD. sMAC level may help to select good responders to eculizumab.
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http://dx.doi.org/10.3390/medsci8040044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712822PMC
October 2020

Hospital-acquired serum phosphate derangements and their associated in-hospital mortality.

Postgrad Med J 2020 Oct 21. Epub 2020 Oct 21.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Background: We aimed to report the incidence of hospital-acquired hypophosphataemia and hyperphosphataemia along with their associated in-hospital mortality.

Methods: We included 15 869 adult patients hospitalised at a tertiary medical referral centre from January 2009 to December 2013, who had normal serum phosphate levels at admission and at least two serum phosphate measurements during their hospitalisation. The normal range of serum phosphate was defined as 2.5-4.2 mg/dL. In-hospital serum phosphate levels were categorised based on the occurrence of hospital-acquired hypophosphataemia and hyperphosphataemia. We analysed the association of hospital-acquired hypophosphataemia and hyperphosphataemia with in-hospital mortality using multivariable logistic regression.

Results: Fifty-three per cent (n=8464) of the patients developed new serum phosphate derangements during their hospitalisation. The incidence of hospital-acquired hypophosphataemia and hyperphosphataemia was 35% and 27%, respectively. Hospital-acquired hypophosphataemia and hyperphosphataemia were associated with odds ratio (OR) of 1.56 and 2.60 for in-hospital mortality, respectively (p value<0.001 for both). Compared with patients with persistently normal in-hospital phosphate levels, patients with hospital-acquired hypophosphataemia only (OR 1.64), hospital-acquired hyperphosphataemia only (OR 2.74) and both hospital-acquired hypophosphataemia and hyperphosphataemia (ie, phosphate fluctuations; OR 4.00) were significantly associated with increased in-hospital mortality (all p values <0.001).

Conclusion: Hospital-acquired serum phosphate derangements affect approximately half of the hospitalised patients and are associated with increased in-hospital mortality rate.
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http://dx.doi.org/10.1136/postgradmedj-2020-138872DOI Listing
October 2020

Impact of serum phosphate changes on in-hospital mortality.

BMC Nephrol 2020 10 7;21(1):427. Epub 2020 Oct 7.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.

Background: Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality.

Methods: We included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0-0.6, 0.7-1.3, 1.4-2.0, 2.1-2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0-0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis.

Results: A total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0-0.6, 0.7-1.3, 1.4-2.0, 2.1-2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04-1.74) in 0.7-1.3 mg/dL, 1.98 (95% CI 1.53-2.55) in 1.4-2.0 mg/dL, 2.68 (95% CI 2.07-3.48) in 2.1-2.7 mg/dL, and 5.04 (95% CI 3.94-6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0-0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization.

Conclusion: Greater serum phosphate changes were progressively associated with increased in-hospital mortality.
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http://dx.doi.org/10.1186/s12882-020-02090-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542949PMC
October 2020

Acute kidney injury among salicylate intoxication hospitalisations in the United States.

Int J Clin Pract 2021 Mar 27;75(3):e13745. Epub 2020 Oct 27.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Background: This study aimed to evaluate the risk factors and the association of acute kidney injury (AKI) with outcomes, and resource utilisation in patients hospitalised because of salicylate intoxication in the United States.

Methods: Hospitalised patients with a primary diagnosis of salicylate intoxication from 2003 to 2014 were identified in the National Inpatient Sample (NIS) database. End-stage kidney disease patients were excluded. The occurrence of AKI was identified using hospital diagnosis code. Clinical characteristics, in-hospital treatment, outcomes and resource utilisation were compared between patients with and without AKI.

Results: A total of 13 787 eligible hospital admissions were included in the analysis. AKI occurred in 1279 (9.3%) admissions. Older age, male sex, more recent year of hospitalisation, anaemia, hypertension, congestive heart failure, chronic kidney disease, volume depletion, sepsis and ventricular arrhythmia/cardiac arrest were significantly associated with increased risk of AKI, whereas Hispanic race was associated with decreased risk. AKI was significantly associated with increased risk of organ failure, and in-hospital mortality. In addition, the need for ventilation support, blood component transfusion, renal replacement therapy, length of hospital stay and hospitalisation cost were higher in AKI patients.

Conclusion: Approximately one tenth of salicylate intoxication patients developed AKI during hospitalisation. AKI was associated with higher morbidity, mortality and resource utilisations.
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http://dx.doi.org/10.1111/ijcp.13745DOI Listing
March 2021

The impact of race on hospitalization outcomes for goodpasture's syndrome in the United States: nationwide inpatient sample 2003-2014.

Hosp Pract (1995) 2021 Feb 19;49(1):22-26. Epub 2020 Oct 19.

Department of Military and Community Medicine, Phramongkutklao College of Medicine , Bangkok, Thailand.

Background: Goodpasture's syndrome is a rare and life-threatening autoimmune disease. While Goodpasture's syndrome is well described in Caucasian and Asian populations, its prevalence and outcomes among African American and Hispanic populations are unclear. We conducted this study to assess the impacts of race on hospital outcomes among patients with Goodpasture's syndrome.

Methods: The National Inpatient Sample database was used to identify hospitalized patients with a principal diagnosis of Goodpasture's syndrome from 2003 to 2014. Goodpasture's syndrome patients were grouped based on their race. The differences in-hospital supportive care for organ failure and outcomes between Caucasian, African American, and Hispanic Goodpasture's syndrome patients were assessed using logistic regression analysis.

Results: Nine hundred and sixty-four patients were hospitalized with a primary diagnosis of Goodpasture's syndrome. Of these, 786 were included in the analysis: 622 (79%) were Caucasian, 73 (9%) were African American, and 91 (12%) were Hispanic. Hispanics had significantly lower use of plasmapheresis. The use for mechanical ventilation, noninvasive ventilation support, and renal replacement therapy in African Americans and Hispanics were comparable to Caucasians. There was no significant difference in organ failure, sepsis, and in-hospital mortality between African Americans and Caucasians. In contrast, Hispanics had higher in-hospital mortality than Caucasians but similar risk of organ failure and sepsis.

Conclusion: African American and Hispanic populations account for 9% and 12% of hospitalizations for Goodpasture's syndrome, respectively. While there is no significant difference in in-hospital mortality between African Americans and Caucasians, Hispanics with Goodpasture's syndrome carry a higher in-hospital mortality compared to Caucasians.
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http://dx.doi.org/10.1080/21548331.2020.1828887DOI Listing
February 2021

Hospital-Acquired Dysmagnesemia and In-Hospital Mortality.

Med Sci (Basel) 2020 Sep 1;8(3). Epub 2020 Sep 1.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

This study aimed to report the incidence of hospital-acquired dysmagnesemia and its association with in-hospital mortality in adult general hospitalized patients. We studied 26,020 adult hospitalized patients from 2009 to 2013 who had normal admission serum magnesium levels and at least two serum magnesium measurements during hospitalization. The normal range of serum magnesium was 1.7-2.3 mg/dL. We categorized in-hospital serum magnesium levels based on the occurrence of hospital-acquired hypomagnesemia and/or hypermagnesemia. We assessed the association between hospital-acquired dysmagnesemia and in-hospital mortality using multivariable logistic regression. 28% of patients developed hospital-acquired dysmagnesemia. Fifteen per cent had hospital-acquired hypomagnesemia only, 10% had hospital-acquired hypermagnesemia only, and 3% had both hospital-acquired hypomagnesemia and hypermagnesemia. Compared with patients with persistently normal serum magnesium levels in hospital, those with hospital-acquired hypomagnesemia only (OR 1.77; < 0.001), hospital-acquired hypermagnesemia only (OR 2.31; < 0.001), and both hospital-acquired hypomagnesemia and hypermagnesemia (OR 2.14; < 0.001) were significantly associated with higher in-hospital mortality. Hospital-acquired dysmagnesemia affected approximately one-fourth of hospitalized patients. Hospital-acquired hypomagnesemia and hypermagnesemia were significantly associated with increased in-hospital mortality.
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http://dx.doi.org/10.3390/medsci8030037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565056PMC
September 2020

Hospitalizations for Acute Salicylate Intoxication in the United States.

J Clin Med 2020 Aug 14;9(8). Epub 2020 Aug 14.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Background: The objective of this study was to describe inpatient prevalence, characteristics, outcomes, and resource use for acute salicylate intoxication hospitalizations in the United States.

Methods: A total of 13,805 admissions with a primary diagnosis of salicylate intoxication from 2003 to 2014 in the National Inpatient Sample database were analyzed. Prognostic factors for in-hospital mortality were determined using multivariable logistic regression.

Results: The overall inpatient prevalence of salicylate intoxication among hospitalized patients was 147.8 cases per 1,000,000 admissions in the United States. The average age was 34 ± 19 years. Of these, 35.0% were male and 65.4% used salicylate for suicidal attempts. Overall, 6% required renal replacement therapy. The most common complications of salicylate intoxication were electrolyte and acid-base disorders, including hypokalemia (25.4%), acidosis (19.1%), and alkalosis (11.1%). Kidney failure (9.3%) was the most common observed organ dysfunction. In-hospital mortality was 1.0%. Increased in-hospital mortality was associated with age ≥30, Asian/Pacific Islander race, diabetes mellitus, hyponatremia, ventricular arrhythmia, kidney failure, respiratory failure, and neurological failure, while decreased in-hospital mortality was associated with African American and Hispanic race.

Conclusion: hospitalization for salicylate intoxication occurred in 148 per 1,000,000 admissions in the United States. Several factors were associated with in-hospital mortality.
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http://dx.doi.org/10.3390/jcm9082638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465677PMC
August 2020

Impact of Admission Calcium-phosphate Product on 1-year Mortality among Hospitalized Patients.

Adv Biomed Res 2020 22;9:14. Epub 2020 Apr 22.

Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.

Background: Calcium-phosphate product is associated with mortality among patients with end-stage kidney disease on dialysis. However, clinical evidence among hospitalized patients is limited. The objective of this study was to investigate the relationship between admission calcium-phosphate product and 1-year mortality in hospitalized patients.

Materials And Methods: All adult patients admitted to a tertiary referral hospital in 2009-2013 were studied. Patients who had both available serum calcium and phosphate measurement within 24 h of hospital admission were included. Admission calcium-phosphate product (calcium × phosphate) was stratified based on its distribution into six groups: <21, 21-<27, 27-<33, 33-<39, 39-<45, and ≥45 mg/dL. Multivariate cox proportional hazard analysis was performed to evaluate the association between admission calcium-phosphate product and 1-year mortality, using the calcium-phosphate product of 33-<39 mg/dL as the reference group.

Results: A total of 14,772 patients were included in this study. The mean admission calcium-phosphate product was 34.4 ± 11.3 mg/dL. Of these patients, 3194 (22%) died within 1 year of hospital admission. In adjusted analysis, admission calcium-phosphate product of ≥45 mg/dL was significantly associated with increased 1-year mortality with hazard ratio of 1.41 (95% 95% confidence interval 1.25-1.67), whereas lower admission calcium-phosphate product was not significantly associated with 1-year mortality.

Conclusion: Elevated calcium-phosphate product was significantly associated with increased 1-year mortality in hospitalized patients.
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http://dx.doi.org/10.4103/abr.abr_249_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282693PMC
April 2020

Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients.

Sci Rep 2020 07 23;10(1):12316. Epub 2020 Jul 23.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.

This study aimed to investigate the risk of acute kidney injury (AKI) in hospitalized patients based on admission serum ionized calcium levels. This is a cohort study of all hospitalized adult patients, from January 2009 to December 2013 at a tertiary referral hospital, who had available serum ionized calcium at the time of admission. We excluded patients who had end-stage kidney disease or AKI at admission. We stratified admission serum ionized calcium into 6 groups; ≤ 4.39, 4.40-4.59, 4.60-4.79, 4.80-4.99, 5.00-5.19, and ≥ 5.20 mg/dL. We used serum creatinine criterion of KDIGO definition for diagnosis of AKI. We performed logistic regression analysis to assess the risk of in-hospital AKI occurrence based on admission serum ionized calcium, using serum ionized calcium of 5.00-5.19 mg/dL as the reference group. We studied a total of 25,844 hospitalized patients. Of these, 3,294 (12.7%) developed AKI in hospital, and 622 (2.4%) had AKI stage 2 or 3. We observed a U-shaped association between admission serum ionized calcium and in-hospital AKI, with nadir in-hospital AKI was in serum ionized calcium of 5.00-5.19 mg/dL. After adjustment for confounders, low serum ionized calcium of 4.40-4.59, ≤ 4.39 mg/dL and elevated serum ionized calcium ≥ 5.20 mg/dL were associated with increased risk of AKI with odds ratio of 1.33 (95% CI 1.14-1.56), 1.45 (95% CI 1.21-1.74), and 1.26 (95% CI 1.04-1.54), respectively. Both hypocalcemia, and hypercalcemia at the time of admission were associated with an increased risk of hospital-acquired AKI.
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http://dx.doi.org/10.1038/s41598-020-69405-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378261PMC
July 2020

Incidence and Risk Factors Associated with Outpatient Hypoglycemia in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Study.

Endocr Res 2020 Nov 14;45(4):217-225. Epub 2020 Jul 14.

Department of Medicine, University of Mississippi Medical Center , Jackson, MS, USA.

Background: Chronic kidney disease and hypoglycemia are common complications in individuals with diabetes. Currently, the association of renal function with hypoglycemic complications in type 2 diabetes mellitus (T2DM) is inconclusive. This study aims to assess the associations between estimated glomerular filtration rate (eGFR) and cumulative incidence of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia among T2DM patients in Thailand using a nationwide patient sample.

Methods: We conducted a nationwide retrospective cohort study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study assessed adult T2DM patients from 831 public hospitals in Thailand in the year 2012-2013. eGFR was categorized into ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m. The associations between eGFR and hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia were assessed using multivariate logistic regression and Poisson regression.

Results: A total of 25,056 T2DM patients with available eGFR were included in the analysis. The mean age was 60.9 ± 10.5 years. The cumulative incidence of hypoglycemia and hypoglycemia-related hospitalizations was 3.6% and 1.7%, respectively. Incidence of outpatient hypoglycemia, mild hypoglycemia, and severe hypoglycemia was 2.99 (2.59-3.43), 2.47 (2.11-2.88), and 0.52 (0.36-0.72) per 100 patient-years, respectively. Patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m were significantly associated with an increased risk of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia when compared to patients with eGFR of ≥90 mL/min/1.73 m.

Conclusion: Reduced eGFR was independently associated with increased hypoglycemia, hypoglycemia-related hospitalizations, and risk of outpatient hypoglycemia. Increasing awareness of the heightened risk of hypoglycemia with declining renal function may prompt changes to diabetic management for at-risk individuals.
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http://dx.doi.org/10.1080/07435800.2020.1792921DOI Listing
November 2020

Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality.

Medicines (Basel) 2020 Jun 29;7(7). Epub 2020 Jun 29.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

We aimed to describe the incidence of hospital-acquired dyschloremia and its association with in-hospital mortality in general hospitalized patients. All hospitalized patients from 2009 to 2013 who had normal admission serum chloride and at least two serum chloride measurements in the hospital were studied. The normal range of serum chloride was defined as 100-108 mmol/L. Hospital serum chloride levels were grouped based on the occurrence of hospital-acquired hypochloremia and hyperchloremia. The association of hospital-acquired hypochloremia and hyperchloremia with in-hospital mortality was analyzed using logistic regression. Among the total of 39,298 hospitalized patients, 59% had persistently normal hospital serum chloride levels, 21% had hospital-acquired hypochloremia only, 15% had hospital-acquired hyperchloremia only, and 5% had both hypochloremia and hyperchloremia. Compared with patients with persistently normal hospital serum chloride levels, hospital-acquired hyperchloremia only (odds ratio or OR 2.84; < 0.001) and both hospital-acquired hypochloremia and hyperchloremia (OR 1.72; = 0.004) were associated with increased in-hospital mortality, whereas hospital-acquired hypochloremia only was not (OR 0.91; = 0.54). Approximately 40% of hospitalized patients developed serum chloride derangements. Hospital-acquired hyperchloremia, but not hypochloremia, was associated with increased in-hospital mortality.
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http://dx.doi.org/10.3390/medicines7070038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400070PMC
June 2020

Serum Klotho in Living Kidney Donors and Kidney Transplant Recipients: A Meta-Analysis.

J Clin Med 2020 Jun 12;9(6). Epub 2020 Jun 12.

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.

α-Klotho is a known anti-aging protein that exerts diverse physiological effects, including phosphate homeostasis. Klotho expression occurs predominantly in the kidney and is significantly decreased in patients with chronic kidney disease. However, changes in serum klotho levels and impacts of klotho on outcomes among kidney transplant (KTx) recipients and kidney donors remain unclear. A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through October 2019 to identify studies evaluating serum klotho levels and impacts of klotho on outcomes among KTx recipients and kidney donors. Study results were pooled and analyzed utilizing a random-effects model. Ten cohort studies with a total of 431 KTx recipients and 5 cohort studies with a total of 108 living kidney donors and were identified. After KTx, recipients had a significant increase in serum klotho levels (at 4 to 13 months post-KTx) with a mean difference (MD) of 243.11 pg/mL (three studies; 95% CI 67.41 to 418.81 pg/mL). Although KTx recipients had a lower serum klotho level with a MD of = -234.50 pg/mL (five studies; 95% CI -444.84 to -24.16 pg/mL) compared to healthy unmatched volunteers, one study demonstrated comparable klotho levels between KTx recipients and eGFR-matched controls. Among kidney donors, there was a significant decrease in serum klotho levels post-nephrectomy (day 3 to day 5) with a mean difference (MD) of -232.24 pg/mL (three studies; 95% CI -299.41 to -165.07 pg/mL). At one year following kidney donation, serum klotho levels remained lower than baseline before nephrectomy with a MD of = -110.80 pg/mL (two studies; 95% CI 166.35 to 55.24 pg/mL). Compared to healthy volunteers, living kidney donors had lower serum klotho levels with a MD of = -92.41 pg/mL (two studies; 95% CI -180.53 to -4.29 pg/mL). There is a significant reduction in serum klotho levels after living kidney donation and an increase in serum klotho levels after KTx. Future prospective studies are needed to assess the impact of changes in klotho on clinical outcomes in KTx recipients and living kidney donors.
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http://dx.doi.org/10.3390/jcm9061834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355868PMC
June 2020

Impact of Circadian Blood Pressure Pattern on Silent Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis.

J Am Heart Assoc 2020 06 1;9(12):e016299. Epub 2020 Jun 1.

King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand.

Background Abnormal circadian blood pressure (BP) variations during sleep, specifically the non-dipping (<10% fall in nocturnal BP) and reverse-dipping patterns (rise in nocturnal BP), have been associated with an increased risk of cardiovascular events and target organ damage. However, the relationship between abnormal sleep BP variations and cerebral small vessel disease markers is poorly established. This study aims to assess the association between non-dipping and reverse-dipping BP patterns with markers of silent cerebral small vessel disease. Methods and Results MEDLINE, Embase, and Cochrane Databases were searched from inception through November 2019. Studies that reported the odds ratios (ORs) for cerebral small vessel disease markers in patients with non-dipping or reverse-dipping BP patterns were included. Effect estimates from the individual studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Twelve observational studies composed of 3497 patients were included in this analysis. The reverse-dipping compared with normal dipping BP pattern was associated with a higher prevalence of white matter hyperintensity with a pooled adjusted OR of 2.00 (95% CI, 1.13-2.37; I=36%). Non-dipping BP pattern compared with normal dipping BP pattern was associated with higher prevalence of white matter hyperintensity and asymptomatic lacunar infarction, with pooled ORs of 1.38 (95% CI, 0.95-2.02; I=52%) and 2.33 (95% CI, 1.30-4.18; I=73%), respectively. Limiting to only studies with confounder-adjusted analysis resulted in a pooled OR of 1.38 (95% CI, 0.95-2.02; I=52%) for white matter hyperintensity and 1.44 (95% CI, 0.97-2.13; I=0%) for asymptomatic lacunar infarction. Conclusions The non-dipping and reverse-dipping BP patterns are associated with neuroimaging cerebral small vessel disease markers.
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http://dx.doi.org/10.1161/JAHA.119.016299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429026PMC
June 2020

The Association between Serum Uric Acid and Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus: A Multicenter Nationwide CrossSectional Study.

Korean J Fam Med 2020 May 20;41(3):189-194. Epub 2020 May 20.

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.

Background: The role of uric acid in the development of diabetic peripheral neuropathy remains unclear. This study aimed to determine the association between uric acid and peripheral neuropathy among type 2 diabetes mellitus (T2DM) patients.

Methods: We conducted a nationwide cross-sectional study based on the diabetes and hypertension study of the Medical Research Network of the Consortium of Thai Medical Schools. Adult T2DM patients from 831 public hospitals in Thailand were evaluated. The serum uric acid level was categorized into five groups based on quintiles (<4.4, 4.4-5.3, 5.3-6.2, 6.2-7.3, and >7.3 mg/dL). A multivariate logistic regression model was used to assess the independent association between serum uric acid level and peripheral neuropathy.

Results: In total, 7,511 T2DM patients with available data about serum uric acid levels were included in the analysis. The mean age of the participants was 61.7±10.9 years, and approximately 35.6% were men. The prevalence rate of peripheral neuropathy was 3.0%. Moreover, the prevalence rates of peripheral neuropathy stratified according to uric acid levels <4.4, 4.4-5.3, 5.3-6.2, 6.2-7.3, and >7.3 mg/dL were 2.5%, 2.8%, 2.4%, 2.5%, and 4.7%, respectively. A serum uric acid level ≥7.3 mg/dL was found to be associated with an increase in odds ratio (1.54; 95% confidence interval, 1.02-2.32) for peripheral neuropathy compared with a serum uric acid level <4.4 mg/dL.

Conclusion: Serum uric acid level is independently associated with peripheral neuropathy in T2DM patients, and elevated serum uric acid levels should be considered a risk factor for diabetic peripheral neuropathy in clinical practice.
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http://dx.doi.org/10.4082/kjfm.18.0205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272369PMC
May 2020

The association between simple renal cyst and aortic diseases: A systematic review and meta-analysis of observational studies.

J Evid Based Med 2020 Nov 25;13(4):265-274. Epub 2020 May 25.

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.

Objective: The objective of this meta-analysis of observational studies was to evaluate the association between simple renal cysts (SRC) and presence of aortic pathology such as aortic aneurysms and dissection.

Methods: We conducted searches in Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1960 to August 2019 to identify observational studies that examined the association between SRCs and any aortic diseases, including aortic aneurysms and dissection. Two reviewers independently extracted the data and assessed the risk of bias. The meta-analysis was performed by STATA 14.1.

Results: In total, 11 observational studies with 19 719 participants were included in this meta-analysis. Compared to individuals without SRCs, patients with SRCs had higher odds of abdominal aortic aneurysm (AAA) (adjusted OR = 2.61, 95% CI 2.34-2.91, P < 0.001, I = 0%), ascending thoracic aortic aneurysm (TAA) (adjusted OR = 1.98, 95% CI 1.09-3.63, P = 0.03, I = 90.1%), descending TAA (adjusted OR = 3.44, 95% CI, 2.67-4.43, P < 0.001, I = 0%), type A aortic dissection (AD) (adjusted OR = 1.98, 95% CI 1.32-2.96, P = 0.001, I = 12.9%), and type B AD (adjusted OR = 2.55, 95% CI, 1.31-4.96, P = 0.006, I = 76.2%). There was a higher average in the sum of diameter of SRCs among AAA compared to patients without AAA (WMD = 19.80 mm, 95% CI 13.92-25.67, P < 0.001, I = 63.8%).

Conclusion: SRC is associated with higher odds of aortic diseases including AAA, ascending and descending TAA, type A and type B dissection even after adjusting for confounders.
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http://dx.doi.org/10.1111/jebm.12385DOI Listing
November 2020

Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis.

Ren Fail 2020 Nov;42(1):495-512

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.

We aimed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD). A systematic literature search in Ovid MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird. Fifty-six cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%-30.4%) but rose to 36.9% (95%CI: 31.1%-43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%-15.0%). AKI incidence did not differ significantly between types of LVAD ( = .35) or indication for LVAD use ( = .62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence ( = .55), the study year was negatively correlated with the incidence of severe AKI requiring RRT (slope = -0.068,  < .001). The pooled odds ratios (ORs) of mortality at 30 days and one year in AKI patients were 3.66 (95% CI, 2.00-6.70) and 2.22 (95% CI, 1.62-3.04), respectively. The pooled ORs of mortality at 30 days and one year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58-12.33) and 5.41 (95% CI, 3.63-8.06), respectively. We found that more than one-third of LVAD patients develop AKI based on standard definitions, and 13% develop severe AKI requiring RRT. There has been a potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1 year mortality.
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http://dx.doi.org/10.1080/0886022X.2020.1768116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301695PMC
November 2020

Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients.

Medicina (Kaunas) 2020 May 14;56(5). Epub 2020 May 14.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.

The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 hours prior to hospital discharge and categorized into ≤ 2.9, 3.0-3.4, 3.5-3.9, 4.0-4.4, 4.5-4.9, 5.0-5.4 and ≥ 5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0-4.4 mEq/L as the reference group. Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0-4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤ 3.9 mEq/L and ≥ 4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0-4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤ 3.9 mEq/L in patients with an admission serum potassium of ≥ 5.0 mEq/L. The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0-4.4 mEq/L.
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http://dx.doi.org/10.3390/medicina56050236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279137PMC
May 2020

Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes.

J Clin Med 2020 May 14;9(5). Epub 2020 May 14.

Renal Transplant Program, School of Medicine/Saint Luke's Health System, University of Missouri-Kansas City, Kansas City, MO 64110, USA.

This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0-10%, 11-20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Of 22,006 kidneys, 91.2% were biopsied showing 0-10% GS (58.0%), 11-20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0-10% GS, 68.9% in 11-20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0-10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11-20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, < 0.001), compared with 0-10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes.
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http://dx.doi.org/10.3390/jcm9051469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291279PMC
May 2020

Vitamin D deficiency is not associated with graft versus host disease after hematopoietic stem cell transplantation: A meta-analysis.

J Evid Based Med 2020 Aug 5;13(3):183-191. Epub 2020 May 5.

King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.

Objective: Vitamin D status plays an important role in immunoregulation, and a deficiency is believed to be related to Graft Versus Host Disease (GVHD) in patients after hematopoietic stem cell transplantation (HSCT). We aim to study the association between vitamin D deficiency and GVHD after HSCT.

Methods: A literature search was conducted utilizing MEDLINE, EMBASE, and The Cochrane Library Database from inception to July 2019. Eligible studies were required to be clinical trials or observational studies (cohort, case-control, or cross-sectional studies); provide data to calculate the odds ratios (OR) of GVHD in HSCT patients with vitamin D deficiency. Two reviewers independently extracted the data and assessed the risk of bias. Pooled odds ratios (OR) with 95% confidence interval (CI) were estimated using random-effects meta-analysis through the Comprehensive Meta-Analysis 3.3 software.

Results: In total, 8 observational studies consisting of 1335 HSCT patients were enrolled in this systematic review. Overall, there was no significant association between vitamin D deficiency and acute GVHD (OR = 1.06, 95% CI 0.74-1.53, P > 0.05). There was no significant association between vitamin D deficiency and chronic GVHD (OR = 1.75, 95% CI 0.72-4.26, P > 0.05). Funnel plots and Egger regression asymmetry test were performed and showed no publication bias.

Conclusion: There is not a statistically significant association between vitamin D deficiency and neither acute nor chronic GVHD.
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http://dx.doi.org/10.1111/jebm.12383DOI Listing
August 2020