Factors affecting glomerular filtration rate, as measured by iohexol disappearance, in men with or at risk for HIV infection

Objective: Formulae used to estimate glomerular filtration rate (GFR) underestimate higher GFRs and have not been well-studied in HIV-infected (HIV(+)) people; we evaluated the relationships of HIV infection and known or potential risk factors for kidney disease with directly measured GFR and the presence of chronic kidney disease (CKD). Design: Cross-sectional measurement of iohexol-based GFR (iGFR) in HIV(+) men (n = 455) receiving antiretroviral therapy, and HIV-uninfected (HIV(-)) men (n = 258) in the Multicenter AIDS Cohort Study. Methods: iGFR was calculated from disappearance of infused iohexol from plasma. Determinants of GFR and the presence of CKD were compared using iGFR and GFR estimated by the CKD-Epi equation (eGFR). Results: Median iGFR was higher among HIV(+) than HIV(-) men (109 vs. 106 ml/min/1.73 m2, respectively, p = .046), and was 7 ml/min higher than median eGFR. Mean iGFR was lower in men who were older, had chronic hepatitis C virus (HCV) infection, or had a history of AIDS. Low iGFR (≤90 ml/min/1.73 m2) was associated with these factors and with black race. Other than age, factors associated with low iGFR were not observed with low eGFR. CKD was more common in HIV(+) than HIV(-) men; predictors of CKD were similar using iGFR and eGFR. Conclusions: iGFR was higher than eGFR in this population of HIV-infected and -uninfected men who have sex with men. Presence of CKD was predicted equally well by iGFR and eGFR, but associations of chronic HCV infection and history of clinically-defined AIDS with mildly decreased GFR were seen only with iGFR. © 2014 Margolick et al

Clinical pharmacology of cancer therapies in older adults

This abbreviated review outlines the physiologic changes associated with aging, and examines how these changes may affect the pharmacokinetics and pharmacodynamics of anticancer therapies. We also provide an overview of studies that have been conducted evaluating the pharmacology of anticancer therapies in older adults, and issue a call for further research

Risk of chronic kidney disease after cancer nephrectomy.

The incidence of early stage renal cell carcinoma (RCC) is increasing and observational studies have shown equivalent oncological outcomes of partial versus radical nephrectomy for stage I tumours. Population studies suggest that compared with radical nephrectomy, partial nephrectomy is associated with decreased mortality and a lower rate of postoperative decline in kidney function. However, rates of chronic kidney disease (CKD) in patients who have undergone nephrectomy might be higher than in the general population. The risks of new-onset or accelerated CKD and worsened survival after nephrectomy might be linked, as kidney insufficiency is a risk factor for cardiovascular disease and mortality. Nephron-sparing approaches have, therefore, been proposed as the standard of care for patients with type 1a tumours and as a viable option for those with type 1b tumours. However, prospective data on the incidence of de novo and accelerated CKD after cancer nephrectomy is lacking, and the only randomized trial to date was closed prematurely. Intrinsic abnormalities in non-neoplastic kidney parenchyma and comorbid conditions (including diabetes mellitus and hypertension) might increase the risks of CKD and RCC. More research is needed to better understand the risk of CKD post-nephrectomy, to develop and validate predictive scores for risk-stratification, and to optimize patient management

A Liouville theorem for elliptic systems with degenerate ergodic coefficients

We study the behavior of second-order degenerate elliptic systems in divergence form with random coefficients which are stationary and ergodic. Assuming moment bounds like Chiarini and Deuschel (2014) on the coefficient field a and its inverse, we prove an intrinsic large-scale C1,α-regularity estimate for a-harmonic functions and obtain a first-order Liouville theorem for a-harmonic functions

A Liouville theorem for elliptic systems with degenerate ergodic coefficients

We study the behavior of second-order degenerate elliptic systems in divergence form with random coefficients which are stationary and ergodic. Assuming moment bounds like Chiarini and Deuschel (2014) on the coefficient field a and its inverse, we prove an intrinsic large-scale C1,α-regularity estimate for a-harmonic functions and obtain a first-order Liouville theorem for a-harmonic functions

Stochastic homogenization of linear elliptic equations: higher-order error estimates in weak norms via second-order correctors

We are concerned with the homogenization of second-order linear elliptic equations with random coefficient fields. For symmetric coefficient fields with only short-range correlations, quantified through a logarithmic Sobolev inequality for the ensemble, we prove that when measured in weak spatial norms, the solution to the homogenized equation provides a higher-order approximation of the solution to the equation with oscillating coefficients. In the case of nonsymmetric coefficient fields, we provide a higher-order approximation (in weak spatial norms) of the solution to the equation with oscillating coefficients in terms of solutions to constant-coefficient equations. In both settings, we also provide optimal error estimates for the two-scale expansion truncated at second order. Our results rely on novel estimates on the second-order homogenization corrector, which we establish via sensitivity estimates for the second-order corrector and a large-scale $L^p$ theory for elliptic equations with random coefficients. Our results also cover the case of elliptic systems

Stochastic homogenization of linear elliptic equations: higher-order error estimates in weak norms via second-order correctors

We are concerned with the homogenization of second-order linear elliptic equations with random coefficient fields. For symmetric coefficient fields with only short-range correlations, quantified through a logarithmic Sobolev inequality for the ensemble, we prove that when measured in weak spatial norms, the solution to the homogenized equation provides a higher-order approximation of the solution to the equation with oscillating coefficients. In the case of nonsymmetric coefficient fields, we provide a higher-order approximation (in weak spatial norms) of the solution to the equation with oscillating coefficients in terms of solutions to constant-coefficient equations. In both settings, we also provide optimal error estimates for the two-scale expansion truncated at second order. Our results rely on novel estimates on the second-order homogenization corrector, which we establish via sensitivity estimates for the second-order corrector and a large-scale $L^p$ theory for elliptic equations with random coefficients. Our results also cover the case of elliptic systems

Stochastic homogenization of linear elliptic equations: higher-order error estimates in weak norms via second-order correctors

We are concerned with the homogenization of second-order linear elliptic equations with random coefficient fields. For symmetric coefficient fields with only short-range correlations, quantified through a logarithmic Sobolev inequality for the ensemble, we prove that when measured in weak spatial norms, the solution to the homogenized equation provides a higher-order approximation of the solution to the equation with oscillating coefficients. In the case of nonsymmetric coefficient fields, we provide a higher-order approximation (in weak spatial norms) of the solution to the equation with oscillating coefficients in terms of solutions to constant-coefficient equations. In both settings, we also provide optimal error estimates for the two-scale expansion truncated at second order. Our results rely on novel estimates on the second-order homogenization corrector, which we establish via sensitivity estimates for the second-order corrector and a large-scale $L^p$ theory for elliptic equations with random coefficients. Our results also cover the case of elliptic systems