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Mg Shlipak - One of the best experts on this subject based on the ideXlab platform.

  • Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium
    'Elsevier BV', 2017
    Co-Authors: Matsuhita K, Sh Ballew, Coresh J, Arima H, Arnlo J, Cirillo M, Ebert N, Js Hiramoto, Kimm H, Mg Shlipak
    Abstract:

    Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, Leg Revascularization, and Leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.

  • Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium
    'Elsevier BV', 2017
    Co-Authors: Matsuhita K, Sh Ballew, Coresh J, Arima H, Arnlo J, Cirillo M, Ebert N, Js Hiramoto, Kimm H, Mg Shlipak
    Abstract:

    Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, Leg Revascularization, and Leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR <30 ml/min/1.73m2 plus ACR ≥300 mg/g vs. eGFR ≥90 plus ACR <10). Both eGFR and ACR significantly improved PAD risk discrimination beyond traditional predictors, with a considerable improvement for amputation with ACR (Δc-statistic: 0.058 [0.045-0.070]). Patterns were consistent across clinical subgroups and with dipstick proteinuria. Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.

Matsuhita K - One of the best experts on this subject based on the ideXlab platform.

  • Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium
    'Elsevier BV', 2017
    Co-Authors: Matsuhita K, Sh Ballew, Coresh J, Arima H, Arnlo J, Cirillo M, Ebert N, Js Hiramoto, Kimm H, Mg Shlipak
    Abstract:

    Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, Leg Revascularization, and Leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.

  • Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium
    'Elsevier BV', 2017
    Co-Authors: Matsuhita K, Sh Ballew, Coresh J, Arima H, Arnlo J, Cirillo M, Ebert N, Js Hiramoto, Kimm H, Mg Shlipak
    Abstract:

    Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, Leg Revascularization, and Leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR <30 ml/min/1.73m2 plus ACR ≥300 mg/g vs. eGFR ≥90 plus ACR <10). Both eGFR and ACR significantly improved PAD risk discrimination beyond traditional predictors, with a considerable improvement for amputation with ACR (Δc-statistic: 0.058 [0.045-0.070]). Patterns were consistent across clinical subgroups and with dipstick proteinuria. Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.

Christie M Ballantyne - One of the best experts on this subject based on the ideXlab platform.

  • high sensitivity cardiac troponin and natriuretic peptide with risk of lower extremity peripheral artery disease the atherosclerosis risk in communities aric study
    European Heart Journal, 2018
    Co-Authors: Kunihiro Matsushita, Lucia Kwak, Chao Yang, Yuanjie Pang, Shoshana H Ballew, Yingying Sang, Ron C Hoogeveen, Bernard G Jaar, Elizabeth Selvin, Christie M Ballantyne
    Abstract:

    Aims: Cardiac troponin T (cTnT) is suggested as a predictor of amputation in patients with peripheral artery disease (PAD). However, cTnT-PAD association has not been systematically studied in a large study. This study evaluated the association of high-sensitivity cTnT (hs-cTnT) with PAD incidence and also explored whether natriuretic peptide (NT-proBNP), another representative cardiac marker, predicts PAD risk. Methods and results: Among 12 288 middle-aged adults, the associations of hs-cTnT and NT-proBNP with incident PAD (hospitalizations with PAD diagnosis or Leg Revascularization [cases with rest pain or tissue loss considered as critical limb ischaemia (CLI)]) were quantified with multivariable Cox regression models. The risk discrimination was assessed by c-statistic. During a follow-up over 22 years, 454 participants developed PAD (164 CLI cases). In demographically adjusted models, the highest category of hs-cTnT (≥14 vs. <3 ng/L) and NT-proBNP (≥258.3 vs. <51.5 pg/mL) showed ∼8- and 10-20-fold higher risk of PAD and CLI, respectively. Even after adjusting for potential confounders and each other, hazard ratios were greater for CLI than for PAD (7.74 95% confidence interval [95% CI 4.43-13.55] vs. 2.84 [2.02-4.00] for the highest vs. reference hs-cTnT category and 4.63 [2.61-8.23] vs. 3.16 [2.23-4.49] for the highest vs. reference NT-proBNP category). The addition of these cardiac markers improved c-statistics for CLI. Conclusion: High-sensitivity cTnT and NT-proBNP were independently associated with incident PAD, particularly its severe form, CLI. Although future studies are warranted to investigate pathophysiological mechanisms behind these associations, our study suggests the usefulness of cardiac markers to identify individuals at high risk of CLI.

William R Hiatt - One of the best experts on this subject based on the ideXlab platform.

  • adjunctive parenteral therapy with lipo ecraprost a prostaglandin e1 analog in patients with critical limb ischemia undergoing distal Revascularization does not improve 6 month outcomes
    Journal of Vascular Surgery, 2007
    Co-Authors: Mark R Nehler, Eric P Brass, Richard Anthony, J A Dormandy, Jenny Jiao, Thomas O Mcnamara, William R Hiatt
    Abstract:

    Purpose In patients with critical limb ischemia (CLI), distal Revascularization remains the procedure of choice for preventing limb loss, but long-term outcomes for pain relief, wound healing, and prevention of amputation remain suboptimal. Prostaglandin drug therapy as an adjuvant to Revascularization may improve these outcomes. The current trial was designed to test the hypothesis that the use of lipo-ecraprost, a lipid encapsulated prostaglandin E 1 prodrug, as an adjunctive therapy after distal Revascularization would improve amputation-free survival in patients with CLI. Methods The study was randomized, multicenter, double blind, and placebo controlled. Patients meeting clinical and hemodynamic criteria for CLI who were undergoing either bypass or endovascular Revascularization of the below knee popliteal or more distal arteries were randomized to receive placebo or a 60-μg dose of lipo-ecraprost administered intravenously starting ≤72 hours of the index Revascularization and then 5 days per week for 8 weeks. The study primary end point was the composite end point of death or amputation at or above the level of the ankle at 180 days. Results The study randomized 322 patients, and 284 received at least one dose of study medication and were included in the intention-to-treat population. A total of 213 patients underwent surgical bypass, and 71 underwent endovascular Revascularization before receiving study medication. The distribution of index Revascularization procedures and location of distal target arteries were similar for both placebo and lipo-ecraprost groups. At 180 days, 21 patients (7.4%) were lost to follow-up before reaching the primary end point. Seventy-one percent of the patients taking the placebo completed at least half the doses of the study medication compared with 48% of those taking lipo-ecraprost. Index Leg Revascularization-assisted primary patency was 82% in the placebo group and 84% in the lipo-ecraprost group ( P = .874). Changes in lower extremity hemodynamics as a result of the Revascularization during the study period did not differ between the placebo and lipo-ecraprost treatment arms. For the primary event of amputation-free survival, there were no differences between groups: 19 major amputations occurred in the placebo group and 17 in the lipo-ecraprost group; 19 deaths occurred in the placebo group and 13 in the lipo-ecraprost group. Conclusion Eight weeks of parenteral therapy with lipo-ecraprost after distal Revascularization in patients with CLI provided no additional benefit in the reduction of major amputation or death at 180 days.

Js Hiramoto - One of the best experts on this subject based on the ideXlab platform.

  • Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium
    'Elsevier BV', 2017
    Co-Authors: Matsuhita K, Sh Ballew, Coresh J, Arima H, Arnlo J, Cirillo M, Ebert N, Js Hiramoto, Kimm H, Mg Shlipak
    Abstract:

    Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, Leg Revascularization, and Leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.

  • Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium
    'Elsevier BV', 2017
    Co-Authors: Matsuhita K, Sh Ballew, Coresh J, Arima H, Arnlo J, Cirillo M, Ebert N, Js Hiramoto, Kimm H, Mg Shlipak
    Abstract:

    Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, Leg Revascularization, and Leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR <30 ml/min/1.73m2 plus ACR ≥300 mg/g vs. eGFR ≥90 plus ACR <10). Both eGFR and ACR significantly improved PAD risk discrimination beyond traditional predictors, with a considerable improvement for amputation with ACR (Δc-statistic: 0.058 [0.045-0.070]). Patterns were consistent across clinical subgroups and with dipstick proteinuria. Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.