Identifying Predictors of High Sodium Excretion in Patients with Heart Failure: A Mixed Effect Analysis of Longitudinal Data

BACKGROUND: A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet. AIM: The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure. METHODS: The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion. RESULTS: The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15-4.25, pp=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09-4.53, p=0.028) for patients who were cognitively intact. CONCLUSION: Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns

Cross-cultural adaptation and validation of Behçet's disease quality of life questionnaire

<p>Abstract</p> <p>Background</p> <p>Currently, there is one Behçet's disease (BD) specific self reporting questionnaire developed and published in the literature, The Leeds BD-quality of life (QoL). We conducted a cross-cultural adaptation and validation of the Arabic version of the Leeds BD-QoL</p> <p>Methods</p> <p>A cross-sectional study was conducted among 41 consecutive patients attending rheumatology clinics at the American University of Beirut Medical Center between June and December 2007. The BD-QoL questionnaire, the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living (IADL) questionnaires were co-administered during the same visit, and severity scores were calculated. Cross-cultural adaptation of BD-QoL was performed using forward and backward translations of the original questionnaire. Internal consistency and test-retest reliability of the final version were determined. Exploratory Factor Analysis (EFA) was used to assess the dimensionality of the scale items. External construct validity was examined by correlating Arabic BD-QoL with the severity score, ADL and IADL.</p> <p>Results</p> <p>The 30 items of the adapted Arabic BD-QoL showed a high internal consistency (KR-20 coefficient 0.89) and test-retest reliability (Spearman's test 0.91). The convergence of all 30 items suggests that the 30-item adapted Arabic BD-QoL scale is unidimensional. BD-QoL did not correlate with any of the patients' demographics. Still, it was positively correlated with patient severity score (r 0.4, p 0.02), and IADL (but not ADL).</p> <p>Conclusions</p> <p>This cross-cultural adaptation has produced an Arabic BD-QoL questionnaire that is now available for use in clinical settings and in research studies, among Arabic speaking patients.</p

Differences in cardiovascular event-free survival by age in adults with moderate and severe chronic kidney disease

Cardiovascular outcomes and death are major consequences of chronic kidney disease (CKD) occurring in the moderate and severe stages of the disease, prior to advancement into dialysis and transplantation. At all levels of kidney function, mortality increases with age; however, the risk of mortality decreases with age within CKD groups. Moreover, the relative risk of cardiovascular outcomes seems to be lower in older individuals. Clinical prognosis seems to vary by age, but age has not been adequately investigated as a prognostic indicator in these patients; previous studies have focused on the relationship between kidney function and outcomes. The purpose of the study was to examine the relationship between age and cardiovascular event-free survival in patients with moderate and severe CKD. This study was a secondary analysis of a cohort (aged 45–84 years) in the Multi-Ethnic Study of Atherosclerosis. The selected sample (n=762) exhibited a 15≤estimated glomerular filtration rate (eGFR)\u3c60 ml/min/1.73m2 and was followed up for over 6 years. Kaplan Meier analysis and Cox proportional hazards regressions were performed to elaborate on the role of age on time to first event of combined outcome (cardiovascular events and mortality) and non-fatal cardiovascular events. Additionally, nonlinearity of the age and outcome relationship, and the interaction effect of age and eGFR were examined. Age had a highly significant predictive role on time to combined outcome and cardiovascular events in individuals with moderate (stage 3) and severe (stage 4) CKD. Importantly, however, the effect of age on outcomes dissipated in a subsample with eGFR values below 45 ml/min/1.73m2 (stages 3b and 4), with no significant differences noted in the risk of outcomes between younger and older individuals. This study elucidated the significant moderator role of eGFR on the relationship between age and outcome in CKD patients. These findings suggest a need for the consideration of age-specific approaches in the care of patients with moderate and severe CKD. Younger adults with CKD require routine examinations and early preventive measures for the reduction of cardiovascular morbidity and mortality. In older adults, therapeutic efforts may need to be directed at comorbidities rather than a focus on eGFR-related consequences

Differences in cardiovascular event-free survival by age in adults with moderate and severe chronic kidney disease

Cardiovascular outcomes and death are major consequences of chronic kidney disease (CKD) occurring in the moderate and severe stages of the disease, prior to advancement into dialysis and transplantation. At all levels of kidney function, mortality increases with age; however, the risk of mortality decreases with age within CKD groups. Moreover, the relative risk of cardiovascular outcomes seems to be lower in older individuals. Clinical prognosis seems to vary by age, but age has not been adequately investigated as a prognostic indicator in these patients; previous studies have focused on the relationship between kidney function and outcomes. The purpose of the study was to examine the relationship between age and cardiovascular event-free survival in patients with moderate and severe CKD. This study was a secondary analysis of a cohort (aged 45–84 years) in the Multi-Ethnic Study of Atherosclerosis. The selected sample (n=762) exhibited a 15≤estimated glomerular filtration rate (eGFR)\u3c60 ml/min/1.73m2 and was followed up for over 6 years. Kaplan Meier analysis and Cox proportional hazards regressions were performed to elaborate on the role of age on time to first event of combined outcome (cardiovascular events and mortality) and non-fatal cardiovascular events. Additionally, nonlinearity of the age and outcome relationship, and the interaction effect of age and eGFR were examined. Age had a highly significant predictive role on time to combined outcome and cardiovascular events in individuals with moderate (stage 3) and severe (stage 4) CKD. Importantly, however, the effect of age on outcomes dissipated in a subsample with eGFR values below 45 ml/min/1.73m2 (stages 3b and 4), with no significant differences noted in the risk of outcomes between younger and older individuals. This study elucidated the significant moderator role of eGFR on the relationship between age and outcome in CKD patients. These findings suggest a need for the consideration of age-specific approaches in the care of patients with moderate and severe CKD. Younger adults with CKD require routine examinations and early preventive measures for the reduction of cardiovascular morbidity and mortality. In older adults, therapeutic efforts may need to be directed at comorbidities rather than a focus on eGFR-related consequences