Variation in Sodium Intake and Intra-individual Change in Blood Pressure in Chronic Kidney Disease.

OBJECTIVE: In the kidney disease clinic setting, higher-than-usual blood pressure is often ascribed to recent dietary sodium indiscretion. While clinical trials demonstrate a clear relationship between salt intake and blood pressure on the population level, it is uncertain whether real-world variation in sodium intake within individual chronic kidney disease (CKD) patients is associated with fluctuations in blood pressure. METHODS: We analyzed data from the Phosphorus Normalization Trial, in which participants with CKD eating their usual diets completed at least three 24-hour urine collections over 9 months, from which we measured sodium. Blood pressure was measured at the time of 24-hour urine collections. For each individual participant, we assessed the slope of the relationship between sodium intake and mean arterial blood pressure (MAP). RESULTS: Among 119 participants (mean age 67 years and mean estimated glomerular filtration rate 31 mL/minute/1.73 m2), there was substantial variation in sodium intake as measured by 24-hour urine collections (mean intake 3,903 mg/day, standard deviation 1037 mg/day). Individual participants had highly variable associations between their sodium intake and their MAP; 47% (n = 56) had inverse associations between sodium and MAP, whereas the remainder had positive (salt-sensitive) associations. CONCLUSIONS: Among CKD patients, there is substantial variation in sodium intake but no predictable relationship between dietary sodium and blood pressure in individuals. The frequent dismissal of elevated blood pressure readings as related to recent sodium intake in clinic may be a misapplication of large-scale population data to explain individual variability and may contribute to clinical inertia regarding high blood pressure treatment

Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease

Background: Sodium intake influences blood pressure and proteinuria, yet the impact on long-term outcomes is uncertain in chronic kidney disease (CKD). Accurate assessment is essential for clinical and public policy recommendations, but few large-scale studies use 24-h urine collections. Recent studies that used spot urine sodium and associated estimating equations suggest that they may provide a suitable alternative, but their accuracy in patients with CKD is unknown. Objective: We compared the accuracy of 4 equations [the Nerbass, INTERSALT (International Cooperative Study on Salt, Other Factors, and Blood Pressure), Tanaka, and Kawasaki equations] that use spot urine sodium to estimate 24-h sodium excretion in patients with moderate to advanced CKD. Design: We evaluated the accuracy of spot urine sodium to predict mean 24-h urine sodium excretion over 9 mo in 129 participants with stage 3–4 CKD. Spot morning urine sodium was used in 4 estimating equations. Bias, precision, and accuracy were assessed and compared across each equation. Results: The mean age of the participants was 67 y, 52% were female, and the mean estimated glomerular filtration rate was 31 ± 9 mL · min(–1) · 1.73 m(–2). The mean ± SD number of 24-h urine collections was 3.5 ± 0.8/participant, and the mean 24-h sodium excretion was 168.2 ± 67.5 mmol/d. Although the Tanaka equation demonstrated the least bias (mean: −8.2 mmol/d), all 4 equations had poor precision and accuracy. The INTERSALT equation demonstrated the highest accuracy but derived an estimate only within 30% of mean measured sodium excretion in only 57% of observations. Bland-Altman plots revealed systematic bias with the Nerbass, INTERSALT, and Tanaka equations, underestimating sodium excretion when intake was high. Conclusion: These findings do not support the use of spot urine specimens to estimate dietary sodium intake in patients with CKD and research studies enriched with patients with CKD. The parent data for this study come from a clinical trial that was registered at clinicaltrials.gov as NCT00785629

Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease.

Sodium intake influences blood pressure and proteinuria, yet the impact on long-term outcomes is uncertain in chronic kidney disease (CKD). Accurate assessment is essential for clinical and public policy recommendations, but few large-scale studies use 24-h urine collections. Recent studies that used spot urine sodium and associated estimating equations suggest that they may provide a suitable alternative, but their accuracy in patients with CKD is unknown.We compared the accuracy of 4 equations [the Nerbass, INTERSALT (International Cooperative Study on Salt, Other Factors, and Blood Pressure), Tanaka, and Kawasaki equations] that use spot urine sodium to estimate 24-h sodium excretion in patients with moderate to advanced CKD.We evaluated the accuracy of spot urine sodium to predict mean 24-h urine sodium excretion over 9 mo in 129 participants with stage 3-4 CKD. Spot morning urine sodium was used in 4 estimating equations. Bias, precision, and accuracy were assessed and compared across each equation.The mean age of the participants was 67 y, 52% were female, and the mean estimated glomerular filtration rate was 31 ± 9 mL · min(-1) · 1.73 m(-2) The mean ± SD number of 24-h urine collections was 3.5 ± 0.8/participant, and the mean 24-h sodium excretion was 168.2 ± 67.5 mmol/d. Although the Tanaka equation demonstrated the least bias (mean: -8.2 mmol/d), all 4 equations had poor precision and accuracy. The INTERSALT equation demonstrated the highest accuracy but derived an estimate only within 30% of mean measured sodium excretion in only 57% of observations. Bland-Altman plots revealed systematic bias with the Nerbass, INTERSALT, and Tanaka equations, underestimating sodium excretion when intake was high.These findings do not support the use of spot urine specimens to estimate dietary sodium intake in patients with CKD and research studies enriched with patients with CKD. The parent data for this study come from a clinical trial that was registered at clinicaltrials.gov as NCT00785629

Cinacalcet Use Patterns and Effect on Laboratory Values and Other Medications in a Large Dialysis Organization, 2004 through 2006

Background and objectives: Cinacalcet was introduced in mid-2004 to treat secondary hyperparathyroidism in dialysis patients. We aimed to characterize adult patients who received cinacalcet prescriptions and to determine (1) dosage titration and effects on laboratory values, active intravenous vitamin D use, and phosphate binder prescriptions and (2) percentage who achieved National Kidney Foundation Kidney Disease Outcomes Quality Initiative targets for serum parathyroid hormone, calcium, and phosphorus and experienced biochemical adverse effects

Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos

ObjectiveCardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers.MethodsCross-sectional data from 7404 employed individuals, aged 18–74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models.ResultsHispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures.ConclusionsOur results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively

Abstract P072: Association of Occupational Exposures with Cardiovascular Disease among Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos

Background: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in the US. Acute, high-dose exposures to some solvents, metals, and pesticides can be cardiotoxic, but little is known about the cardiovascular effects of chronic, low-level exposures. Thus, we evaluated cross-sectional associations of self-reported occupational exposures to solvents, metals, and pesticides with CVD prevalence among diverse Hispanics/Latinos in the US. Methods: The analyses included baseline data from 7,404 currently employed participants, ages 18-74 years, from the HCHS/SOL. CVD was defined as the presence of one or more of the following: coronary heart disease (self-reported angina, myocardial infarction, coronary bypass surgery, balloon angioplasty, or stent placement in coronary arteries, or electrocardiogram [ECG] evidence of major Q wave abnormalities or minor Q, QS waves with ST, T abnormalities); atrial fibrillation (self-reported or ECG evidence of atrial fibrillation or flutter); heart failure (self-reported); or cerebrovascular disease (self-reported stroke or transient ischemic attack). Survey-weighted Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CIs) for each occupational exposure, adjusted for sociodemographic (age, gender, field center, Hispanic/Latino background, health insurance), acculturation (language, years of duration in the US), lifestyle (smoking, alcohol, physical activity, diet), and occupational (full- or part-time employment) characteristics. Results: Overall, 6.1% of participants had any prevalent CVD; coronary heart disease (4.3%) was most common, followed by cerebrovascular disease (1.0%), heart failure (0.8%), and atrial fibrillation (0.7%). Current occupational exposures to solvents, metals, and pesticides were reported by 6.5%, 8.5%, and 4.7% of participants, respectively. The prevalence of any CVD (PR: 2.18, 95% CI: 1.34-3.55), coronary heart disease (PR: 2.20, 95% CI: 1.31-3.71), and atrial fibrillation (PR: 5.92, 95% CI: 1.89-18.61) were significantly elevated for participants who reported current occupational pesticide exposure compared to no exposure. Current occupational metal exposure was associated with a greater prevalence of atrial fibrillation (PR: 3.78, 95% CI: 1.24-11.46). Further adjustment for hypertension, hypercholesterolemia, diabetes, or body mass index did not appreciably change the results. Current occupational solvent exposure was not associated with CVD prevalence. Conclusions: Occupational exposure to pesticides and metals is associated with higher CVD prevalence at baseline. These cross-sectional associations do not appear to be attenuated by hypertension, hypercholesterolemia, diabetes, or obesity. Further research is needed to examine other biologic mechanisms that may underlie these associations

Barriers to Enrollment of Elderly Adults in Early-Phase Cancer Clinical Trials

Potential strategies to overcome barriers to enrollment of seniors into early-phase trials

Thyroid-related hormones and hypertension incidence in middle aged and older Hispanic/Latino adults - Supplemental Materials

Supplemental materials for manuscript - Abasilim, C., Persky, V., Sargis, R.M. et al.  Abasilim, C., Persky, V., Sargis, R. M., Argos, M., Daviglus, M. L., Freels, S., ... & Turyk, M. E. (2023). Association of Acculturation and Hispanic/Latino Background with Endogenous Sex and Thyroid-Related Hormones Among Middle-Aged and Older Hispanic/Latino Adults: the HCHS/SOL Study. Journal of racial and ethnic health disparities, 1-16. </p

Thyroid-related hormones and hypertension incidence in middle aged and older Hispanic/Latino adults - Supplemental Materials

Supplemental materials for manuscript - Abasilim, C., Persky, V., Sargis, R.M. et al.  Abasilim, C., Persky, V., Sargis, R. M., Argos, M., Daviglus, M. L., Freels, S., ... & Turyk, M. E. (2023). Association of Acculturation and Hispanic/Latino Background with Endogenous Sex and Thyroid-Related Hormones Among Middle-Aged and Older Hispanic/Latino Adults: the HCHS/SOL Study. Journal of racial and ethnic health disparities, 1-16. </p

Supplemental materials

Supplemental materials for manuscript - Abasilim, C., Persky, V., Sargis, R.M. et al. Thyroid-related hormones and hypertension incidence in middle aged and older Hispanic/Latino adults: The Hispanic Community Health Study/Study of Latinos</p