28 research outputs found

    Will universal access to health care mean equitable access to kidney transplantation?

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    Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study

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    Objectives Recent studies in Central America indicate that mortality attributable to chronic kidney disease (CKD) is rising rapidly. We sought to determine the prevalence and regional variation of CKD and the relationship of biologic and socio-economic factors to CKD risk in the older-adult population of Costa Rica. Methods We used data from the Costa Rican Longevity and Health Aging Study (CRELES). The cohort was comprised of 2657 adults born before 1946 in Costa Rica, chosen through a sampling algorithm to represent the national population of Costa Ricans >60 years of age. Participants answered questionnaire data and completed laboratory testing. The primary outcome of this study was CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Results The estimated prevalence of CKD for older Costa Ricans was 20% (95% CI 18.5–21.9%). In multivariable logistic regression, older age (adjusted odds ratio [aOR] 1.08 per year, 95% CI 1.07–1.10, P < 0.001) was independently associated with CKD. For every 200 m above sea level of residence, subjects' odds of CKD increased 26% (aOR 1.26 95% CI 1.15–1.38, P < 0.001). There was large regional variation in adjusted CKD prevalence, highest in Limon (40%, 95% CI 30–50%) and Guanacaste (36%, 95% CI 26–46%) provinces. Regional and altitude effects remained robust after adjustment for socio-economic status. Conclusions We observed large regional and altitude-related variations in CKD prevalence in Costa Rica, not explained by the distribution of traditional CKD risk factors. More studies are needed to explore the potential association of geographic and environmental exposures with the risk of CKD.National Institute of Diabetes and Digestive and Kidney Diseases of the United States National Institutes of Health/[K23-DK105207-01]//Estados UnidosWellcome Trust///Estados UnidosNational Heart, Lung And Blood Institute///Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP

    Operational challenges in the COVID‐19 era: Asymptomatic infections and vaccination timing

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    The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for solid organ transplant programs. While transplant activity has largely recovered, appropriate management of deceased donor candidates who are asymptomatic but have positive nucleic acid test (NAT) for COVID-19 is unclear as this may reflect active infection or prolonged viral shedding. Furthermore, candidates who are unvaccinated or partially vaccinated continue to receive donor offers. In the absence of prospective data, transplant professionals at U.S. adult kidney transplant centers were surveyed to determine community practice (N: 92 centers, capturing 40.8% of centers and 56.6% of transplants performed). The majority (96.8%) of responding centers declined organs for asymptomatic NAT+ patients without documented prior infection. However, 31.6% of centers proceeded with kidney transplant in NAT+ patients who were at least 30 days from initial diagnosis with negative chest imaging. Less than 7% of programs reported inactivating patients who were unvaccinated or partially vaccinated. In conclusion, despite national recommendations to wait for negative testing, many centers are proceeding with transplant in patients with positive tests due to presumed viral shedding. Furthermore, very few centers are requiring COVID-19 vaccination prior to transplantation despite early evidence suggesting reduced immunogenicity in transplant patients on immunosuppression

    Clinically adjudicated deceased donor acute kidney injury and graft outcomes

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    Background: Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association. Methods: In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes. Results: Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI. Conclusion: iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization

    The Value of Anthropometric Measures in Nutrition and Metabolism: Comment on Anthropometrically Predicted Visceral Adipose Tissue and Blood-Based Biomarkers: A Cross-Sectional Analysis

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    Visceral adipose tissue (VAT)—fat stored deep in the abdominal cavity that surrounds vital organs—is associated with a variety of chronic health conditions. Computed tomography and magnetic resonance imaging are the gold standards to quantify VAT. However, the high cost, limited accessibility, and potential exposure to radiation limit the use of these imaging modalities. In this commentary, we review the application of a previously validated regression equation that estimates anthropometrically predicted VAT (apVAT) to explain variance in blood-based biomarkers and predict mortality in a large sample of adults. In our first study (Brown et al. 2018 Eur J Nutr ; doi:10.1007/s00394-016-1308-8), apVAT accounted for more variance in biomarkers of glucose homeostasis, inflammation, and lipid metabolism, than body mass index (BMI), waist circumference (WC), or the combination of BMI + WC. In our second study (Brown et al. 2017 Am J Hum Biol ; doi:10.1002/ajhb.22898), compared with BMI, WC, and BMI + WC, apVAT more accurately predicted mortality from all causes, cardiovascular disease, and cancer. These studies demonstrate that apVAT can be used in clinical practice and in clinical nutrition and metabolism research when imaging modalities to quantify VAT may not be feasible

    Epidemiology of prediabetes and diabetes in Namibia, Africa: a multilevel analysis.

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    BACKGROUND Diabetes is a leading cause of progressive morbidity and early mortality worldwide. Little is known on the burden of diabetes and pre-diabetes in Namibia, a Sub-Saharan African (SSA) country that is undergoing a demographic transition. METHODS We estimated the prevalence and correlates of diabetes (defined as fasting [capillary] blood glucose [FBG] >126 mg/dL) and prediabetes (defined by World Health Organization [WHO] and American Diabetes Association [ADA] criteria [FBG 110-125 mg/dL and 100-125 mg/dL, respectively]) in a random sample of 3278 participants aged 35-64 from the 2013 Namibia Demographic and Health Survey. RESULTS The prevalence of diabetes was 5.1% (95% Confidence Interval [CI]: 4.2-6.2), with no evidence of gender differences (p=0.45). The prevalence of prediabetes was 6.8% (5.8-8.0) and 20.1% (18.4-21.9) using WHO and ADA criteria, respectively. Male sex, older age, higher body mass index (BMI) and occupation independently increased the odds of diabetes in Namibia, while higher BMI was associated with the higher odds of prediabetes and residing in household categorized as middle wealth index were associated with lower odds of prediabetes (Adjusted odds ratio [aOR] = 0.71; 95% Credible Interval [CrI] = 0.46-0.99). There was significant clustering of prediabetes and diabetes at the community-level. CONCLUSIONS One in five adult Namibians has prediabetes by ADA criteria. Resources should be invested at the community level to promote efforts to prevent progression of this disease and its complications. This article is protected by copyright. All rights reserved
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