36 research outputs found
Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes
Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening
Sourcing Decisions under Conditions of Risk and Resilience: A Behavioral Study
This article continues a recent trend of exploring the linkages between supply chain risk, resilience and decisionâmaking at an individual level. Specifically, the article reports the results of a behavioral study that explores whether and how the perceptions of supply chain risk and resilience influence the decisions made regarding the selection of a new source of critical components. The study uses a full factorial design for a scenarioâbased roleâplaying experiment involving over 1,000 valid responses drawn from multiple sampling pools including supply chain managers, students, and crowdâsourced respondents. The results indicate that the perception of supply chain resilienceâwhether it is by systemic resilience communication, such as training or corporate pronouncements, or through personal exposureâsignificantly influences decisionâmaking, although personal exposure appears to have a stronger impact on the outcome. This relationship is significantly moderated by the risk propensity of the individual decisionâmakers. The article concludes with a discussion of the results and their implication for both theory and practice. The discussion provides a framework for integrating the macro and micro levels by arguing that the micro issues can potentially moderate and mediate the relationships and findings observed at the macro level. Failure to integrate the micro effects can result in variance that the macroâlevel analysis is unable to explain