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Social participation and the onset of hypertension among the middle-aged and older population: Evidence from the China Health and Retirement Longitudinal Study. Tu Raoping,Inoue Yosuke,Yazawa Aki,Hao Xiaoning,Cai Guoxi,Li Yueping,Lin Xiuquan,He Fei,Yamamoto Taro Geriatrics & gerontology international AIM:While previous studies have examined the association between health-related behaviors and hypertension, comparatively little attention has been paid to the role of social participation (i.e. participating in community organizations). The aim of the present study was to investigate the longitudinal association between social participation and hypertension among the middle-aged and older population (aged ≥45 years) in China where the prevalence of hypertension has been increasing rapidly in the past few decades. METHODS:Data came from the China Health and Retirement Longitudinal Study waves 2011 and 2013. Information was obtained from 5483 participants on blood pressure, social participation and covariates. A sex-stratified Poisson regression model with a robust variance estimator was used to examine the associations. RESULTS:During the period between 2011 and 2013, 20.6% of men and 17.2% of women developed hypertension. A Poisson regression model showed that participating in community organizations once a week or more frequently was inversely associated with the onset of hypertension in women (incidence rate ratio 0.80, 95% confidence interval 0.67-0.95, P = 0.012). Among men, no such association was found. CONCLUSION:The present study suggests that promoting social participation might help mitigate the disease burden associated with hypertension in China, particularly among women. Geriatr Gerontol Int 2018; 18: 1093-1099. 10.1111/ggi.13317
Genetic insights into rapid kidney function decline. Terzi Fabiola,Devuyst Olivier Kidney international Gorski et al. report a meta-GWAS of rapid kidney function decline in 42 longitudinal studies from the CKDGen Consortium and UK Biobank, amounting to more than 270'000 individuals with two eGFRcrea measurements. They identified genome-wide significant variants associated with two indexes of rapid kidney function decline, involving genes with a high potential for causality. These data increase our understanding of kidney function and risk of disease. 10.1016/j.kint.2020.11.017
Association of short sleep duration and rapid decline in renal function. McMullan Ciaran J,Curhan Gary C,Forman John P Kidney international The kidney is influenced by circadian rhythms and is entrained to the sleep-wake cycle allowing anticipation of the metabolic and physiological demands of the kidney throughout a 24-hour cycle. Although sleep disruption has been studied extensively in cardiovascular and metabolic disease, its association with chronic kidney disease has not been shown. We examined this in a prospective cohort study of 4238 participants from the Nurses' Health Study and analyzed the association of self-reported sleep duration with decline in renal function over an 11-year period (1989 to 2000). Individuals who reported shorter sleep duration were more likely to experience a rapid decline in estimated glomerular filtration rate (30% or more). Compared with sleeping 7 to 8 hours per night, the adjusted odds ratios for a rapid decline in renal function were a significant 1.79 (95% CI, 1.06-3.03) for 5 hours or less sleep per night, a significant 1.31 (95% CI, 1.01-1.71) for 6 hours sleep per night, but an insignificant 0.88 (95% CI, 0.50-1.57) for 9 or more hours sleep per night. Similarly, there was a significant trend in the adjusted annualized decline in estimated glomerular filtration rate of 1.2 ml/min/1.73 m(2)/year, 0.9 ml/min/1.73 m(2)/year, 0.8 ml/min/1.73 m(2)/year, and 0.8 ml/min/1.73 m(2)/year for individuals sleeping 5 hours or less per night, 6 hours per night, 7 to 8 hours per night, and 9 hours or more per night, respectively. Thus, shorter sleep duration is prospectively and independently associated with faster decline in renal function. 10.1016/j.kint.2015.12.048
Relationship between blood pressure and incident chronic kidney disease in hypertensive patients. Hanratty Rebecca,Chonchol Michel,Havranek Edward P,Powers J David,Dickinson L Miriam,Ho P Michael,Magid David J,Steiner John F Clinical journal of the American Society of Nephrology : CJASN BACKGROUND AND OBJECTIVES:Hypertension is an important cause of chronic kidney disease (CKD). Identifying risk factors for progression to CKD in patients with normal kidney function and hypertension may help target therapies to slow or prevent decline of kidney function. Our objective was to identify risk factors for development of incident CKD and decline in estimated GFR (eGFR) in hypertensive patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Cox proportional hazards models were used to assess the relationship between incident CKD (defined as eGFR <60 ml/min per 1.73 m(2)) and potential risk factors for CKD from a registry of hypertensive patients. RESULTS:Of 43,305 patients meeting the inclusion criteria, 12.1% (5236 patients) developed incident CKD. Diabetes was the strongest predictor of incident CKD (hazard ratio, 1.96; 95% confidence interval, 1.84 to 2.09) and was associated with the greatest rate of decline in eGFR (-2.2 ml/min per 1.73 m(2) per year). Time-varying systolic BP was associated with incident CKD with risk increasing above 120 mmHg; each 10-mmHg increase in baseline and time-varying systolic BP was associated with a 6% increase in the risk of developing CKD (hazard ratio, 1.06; 95% confidence interval, 1.04 to 1.08 for both). Time-weighted systolic BP was associated with a more rapid decline in eGFR of an additional 0.2 ml/min per 1.73 m(2) per year decline for every 10-mmHg increase in systolic BP. CONCLUSIONS:We found that time-varying systolic BP was associated with incident CKD, with an increase in risk above a systolic BP of 120 mmHg among individuals with hypertension. 10.2215/CJN.02240311
Elevated Serum Uric Acid is Associated with Rapid Decline in Kidney Function: A 10-Year Follow-Up Study. International journal of general medicine PURPOSE:The long-term impact of changes in serum uric acid (SUA) concentration on the estimated glomerular filtration rate (eGFR) among the general population remains unclear. We investigated the longitudinal associations between changes in SUA and eGFR over 10 years in 1222 participants with baseline eGFR ≥60 mL/min/1.73 m. METHODS:This was a 10-year retrospective cohort study conducted from 2007 to 2017. Rapid eGFR decline (defined as the highest quartile of change in eGFR between 2007 and 2017) and new-onset kidney disease (defined as an eGFR <60 mL/min/1.73 m at a 10-year follow-up) were examined using multiple logistic regression analysis, adjusted for sex, age, body mass index, systolic blood pressure, SUA, fasting plasma glucose, serum total cholesterol, and triglyceride at baseline. RESULTS:SUA was inversely correlated with eGFR, and the slopes of the SUA-eGFR regression lines were consistently steeper in females than males. A significant inverse correlation was also observed between 10-year changes in SUA and eGFR in both sexes. Multivariate analysis showed that every 1 mg/dL increase in SUA from baseline was associated with higher risk of rapid eGFR decline and new-onset kidney disease (OR 1.25; 95% CI 1.14-1.33 and OR 1.40; 95% CI 1.26-1.49, respectively). Furthermore, the subjects in the highest SUA quartile (>6.0 mg/dL) had a 2.45 times higher risk of rapid eGFR decline (95% CI 1.51-3.42) compared to those in the lowest SUA quartile (<3.9 mg/dL). CONCLUSION:Elevated baseline SUA is an independent risk factor for rapid eGFR decline and new-onset kidney disease in the general population. 10.2147/IJGM.S277957
Association of pulse wave velocity and pulse pressure with decline in kidney function. Kim Chang Seong,Kim Ha Yeon,Kang Yong Un,Choi Joon Seok,Bae Eun Hui,Ma Seong Kwon,Kim Soo Wan Journal of clinical hypertension (Greenwich, Conn.) The association between arterial stiffness and decline in kidney function in patients with mild to moderate chronic kidney disease (CKD) is not well established. This study investigated whether pulse wave velocity (PWV) and pulse pressure (PP) are independently associated with glomerular filtration rate (GFR) and rapid decline in kidney function in early CKD. Carotid femoral PWV (cfPWV), brachial-ankle PWV (baPWV), and PP were measured in a cohort of 913 patients (mean age, 63±10 years; baseline estimated GFR, 84±18 mL/min/1.73 m(2) ). Estimated GFR was measured at baseline and at follow-up. The renal outcome examined was rapid decline in kidney function (estimated GFR loss, >3 mL/min/1.73 m(2) per year). The median follow-up duration was 3.2 years. Multivariable adjusted linear regression model indicated that arterial PWV (both cfPWV and baPWV) and PP increased as estimated GFR declined, but neither was associated with kidney function after adjustment for various covariates. Multivariable logistic regression analysis found that cfPWV and baPWV were not associated with rapid decline in kidney function (odds ratio [OR], 1.39, 95% confidence interval [CI], 0.41-4.65; OR, 2.51, 95% CI, 0.66-9.46, respectively), but PP was (OR, 1.22, 95% CI, 1.01-1.48; P=.045). Arterial stiffness assessed using cfPWV and baPWV was not correlated with lower estimated GFR and rapid decline in kidney function after adjustment for various confounders. Thus, PP is an independent risk factor for rapid decline in kidney function in populations with relatively preserved kidney function (estimated GFR ≥30 mL/min/1.73 m(2) ). 10.1111/jch.12302
Blood pressure components and decline in kidney function in community-living older adults: the Cardiovascular Health Study. Rifkin Dena E,Katz Ronit,Chonchol Michel,Shlipak Michael G,Sarnak Mark J,Fried Linda F,Newman Anne B,Siscovick David S,Peralta Carmen A American journal of hypertension BACKGROUND:Although hypertension contributes to kidney dysfunction in the general population, the contributions of elevated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) to kidney function decline in community-dwelling older adults are unknown. METHODS:We used linear and logistic regression to examine the separate and combined associations of SBP, DBP, and PP at baseline with kidney function decline among 4,365 older adults in the Cardiovascular Health Study. We used cystatin C to estimate glomerular filtration rate on 3 occasions over 7 years of follow-up. We defined rapid decline ≥ 3ml/min/year. RESULTS:Average age was 72.2 and mean (standard deviation) SBP, DBP, and PP were 135 (21), 71 (11), and 65 (18) mm Hg, respectively. SBP and PP, rather than DBP, were most significantly associated with kidney function decline. In adjusted linear models, each 10-mm Hg increment in SBP and PP was associated with 0.13ml/min/year (-0.19, -0.08, P < 0.001) and 0.15-ml/min/year faster decline (-0.21, -0.09, P < 0.001), respectively. Each 10-mm Hg increment in DBP was associated with a nonsignificant 0.10-ml/min/year faster decline (95% confidence interval, -0.20, 0.01). In adjusted logistic models, SBP had the strongest associations with rapid decline, with 14% increased hazard of rapid decline (95% confidence interval, 10% to 17%, P < 0.01) per 10mm Hg. In models combining BP components, only SBP consistently had independent associations with rapid decline. CONCLUSIONS:Our findings suggest that elevated BP, particularly SBP, contributes to declining kidney function in older adults. 10.1093/ajh/hpt067
Longitudinal Blood Pressure Changes and Kidney Function Decline in Persons Without Chronic Kidney Disease: Findings From the MESA Study. American journal of hypertension BACKGROUND:While changes in blood pressure (BP) are independently associated with cardiovascular events, less is known about the association between changes in BP and subsequent changes in renal function in adults with an estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m2. METHODS:The present study included 3,920 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study who had ≥2 BP measurements during the first 5 years of MESA and had eGFR measurements at both year 5 and 10. Change in BP was estimated as the annualized slope of BP between year 0 and 5 based on linear mixed models (mean number of measurements = 4.0). Participants were then grouped into 1 of 3 categories based on the distribution of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) change (top 20%, middle 21-79%, bottom 20%). We calculated eGFR from cystatin C (ml/min/1.73 m2), estimated annual change in eGFR (ml/min/1.73 m2/year), and defined rapid kidney function decline as a >30% decrease in eGFR from year 5 to 10. We used multivariable logistic regression adjusting for year 0 demographic and clinical characteristics, including eGFR and BP, to determine associations of BP change with rapid kidney function decline. RESULTS:Median age was 59 [interquartile range (IQR): 52, 67] and median eGFR at year 0 was 95.5 (IQR: 81.7, 105.9) ml/min/1.73 m2. Median SBP at year 0 was 111, 121, and 147 mm Hg for increasing, stable, and decreasing SBP change, respectively. Increasing SBP and widening PP change were each associated with higher odds of rapid kidney function decline compared with stable SBP and PP groups, respectively [odds ratio, OR 1.7 (95% confidence interval, CI 1.3, 2.4) for SBP; OR 1.4 (95% CI 1.1, 1.9) for PP]. Decreasing SBP was associated with rapid kidney function decline after adjusting for all covariates except for year 0 BP [OR 1.4 (95% CI 1.0, 1.8)], but this association was no longer statistically significant after adjustment for year 0 BP. There were no significant associations between DBP change and rapid decline in the fully adjusted models. Similar findings were seen with annual change in eGFR. CONCLUSIONS:Increasing SBP and widening PP over time were associated with greater risk for accelerated kidney function decline even at BP levels below established hypertension thresholds. 10.1093/ajh/hpx177
Association between pulse pressure, systolic blood pressure and the risk of rapid decline of kidney function among general population without hypertension: results from the China health and retirement longitudinal study (CHARLS). Journal of translational medicine BACKGROUND:Association between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear. METHODS:Participants aged ≥ 45 years, with complete data in 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study(CHARLS), and without pre-existing hypertension were included. Systolic BP (SBP) was categorized as low (< 120 mmHg), medium (120-129 mmHg), and high (120-139 mmHg). Diastolic BP (DBP) was categorized as low (< 60 mmHg), medium (60-74 mmHg), and high (75-89 mmHg). Pulse pressure (PP) was categorized as normal (< 60 mmHg) and high (≥ 60 mmHg). The outcome was defined as rapid decline of estimated glomerular filtration rate(eGFR, decline ≥ 4 ml/min/1.73 m/year). BP combination was designed according to the category of SBP and PP. The association between BP components, types of BP combination, and the risk of rapid decline of eGFR was analyzed using multivariate logistic regression models, respectively. Age-stratified analyses were conducted. RESULTS:Of 4,534 participants included, 695(15.3%) individuals were recognized as having rapid decline of eGFR. High PP[odds ratio(OR) = 1.34, 95%confidence interval(CI) 1.02-1.75], low SBP (OR = 1.28, 95%CI 1.03-1.59), and high SBP (OR = 1.32, 95% CI 1.02-1.71) were significantly associated with the risk of eGFR decline. Low SBP were associated with 65% increment of the risk of eGFR decline among participants aged < 55 years. The combination of high SBP and high PP (OR = 1.79, 95% CI 1.27-2.54) and the combination of low SBP and high PP (OR = 3.07, 95% CI 1.24-7.58) were associated with the increased risk of eGFR decline among the middle and old aged general population. CONCLUSION:Single and combination of high PP and high SBP could be the risk indicators of eGFR decline among the middle and old aged general population. 10.1186/s12967-021-03176-8
Social stress increases blood pressure and cardiovascular pathology in a normotensive rat model. Andrews Ellen,Jenkins Cathleen,Seachrist Darcie,Dunphy Gail,Ely Daniel Clinical and experimental hypertension (New York, N.Y. : 1993) Territorial stress (TS) elevates blood pressure (BP) in several mammalian species. However, cardiovascular pathology following chronic stress has not been consistently shown in a non-genetic hypertension model. Therefore, the hypothesis tested was that social stress would directly increase: BP, collagen deposition in coronary and mesenteric arteries, and myocardial fibrosis. Wistar-Kyoto (WKY) male rats, four weeks of age, were divided into one of three groups: controls (n = 9), territorial stress (TS, n = 12), and social isolation followed by territorial stress (SITS, n = 11). Blood pressure was measured biweekly, and blood samples biweekly for serum testosterone, corticosterone, epinephrine and norepinephrine. Blood pressure significantly increased in the TS (130 mmHg, p < 0.05) and SITS (150 mmHg, p < 0.05) groups, compared to controls (120 mmHg, ANOVA, F = 6.7, p < 0.001). Coronary collagen was increased 47% in the TS group and 90% in the SITS group compared to controls (p < 0.05). The coronary wall/lumen ratio increased significantly (45%, p < 0.05) in the SITS group compared to the controls. Myocardial fibrosis was increased 27% in the TS group and 74% in the SITS group compared to controls (p < 0.05). In conclusion, stress treatments increased BP and cardiac pathology in a normotensive rat strain. 10.1081/ceh-120017930
The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Tomaka Joe,Thompson Sharon,Palacios Rebecca Journal of aging and health OBJECTIVE:This study examined relations between social isolation, loneliness, and social support to health outcomes in a sample of New Mexico seniors. METHOD:We used random-digit dialing to obtain a random sample of 755 southern New Mexico seniors. Participants answered questions pertaining to demographics, social isolation and loneliness, social support, and disease diagnosis including diabetes, hypertension, heart disease, liver disease, arthritis, emphysema, tuberculosis, kidney disease, cancer, asthma, and stroke. The sample allowed for comparison of Caucasian and Hispanic participants. RESULTS:Correlational and logistic analyses indicated that belongingness support related most consistently to health outcomes. Ethnic subgroup analysis revealed similarities and differences in the pattern of associations among the predictor and outcome variables. DISCUSSION:The results demonstrate the importance of social variables for predicting disease outcomes in the elderly and across ethnic groups. 10.1177/0898264305280993
Social isolation, loneliness, and the risk of incident acute kidney injury in middle-aged and older adults: A prospective cohort study. Journal of psychosomatic research OBJECTIVE:The relationships of social isolation and loneliness with acute kidney injury (AKI) risk remained uncertain. We aimed to investigate the associations of social isolation and loneliness with incident AKI. METHODS:450,868 participants without prior AKI were included from the UK Biobank. The social isolation index was constructed based on living alone, social contact, and participation in social activities. Loneliness was assessed by asking about "Do you often feel lonely?". The study outcome was incident AKI. RESULTS:During a median follow-up of 12.0 years, 18,679 (4.1%) participants developed AKI, including 18,428 participants ascertained by hospital admission records with a median duration of hospitalization of 3 (25th-75th, 1-8) days. The hazard ratio for incident AKI for social isolation compared with no social isolation was 1.50 (95% CI: 1.44-1.55) after adjusting for age and race (minimally adjusted), and was 1.10 (95% CI: 1.06-1.14) after further adjusting for socioeconomic factors, health behaviors, biological and health-related factors, psychologic factors, and loneliness (fully adjusted). The minimally adjusted and fully adjusted hazard ratios for incident AKI for loneliness compared with no loneliness was 1.57 (95% CI: 1.52-1.62), and 1.10 (95% CI: 1.06-1.15), respectively. In the fully adjusted models, the highest risk of AKI was found in those with both social isolation and loneliness. Living alone and less social contact, rather than less participation in social activities, were significantly associated with a higher risk of incident AKI. CONCLUSIONS:Both social isolation and loneliness were independently and significantly associated with a higher risk of incident AKI. 10.1016/j.jpsychores.2023.111587
Physical Activity Intensity and Biopsychosocial Correlates in Chinese Middle-Aged and Older Adults With Chronic Kidney Disease. Chen Jieling,Nicklett Emily Joy,He Yaping,Lou Vivian Wq Journal of aging and physical activity BACKGROUND:The study aims to characterize physical activity (PA) participation by intensity and examine the biopsychosocial correlates among middle-aged and older adults with CKD in China. METHOD:Data are examined from the 2011 China Health and Retirement Longitudinal Study. RESULTS:The percentages of participation in vigorous, moderate, and light activity among participants with CKD were 22.7%, 42.1%, and 76.3%, respectively. Participants were less likely to engage in vigorous and moderate PA if they were 70 years of age or older, not married/partnered, unemployed, lived in urban areas, had advanced disease stage, had heart disease, and/or experienced mobility limitations. The magnitude of associations between biophysical factors and PA participation was small for light PA. CONCLUSION:The higher the intensity of regular PA, the less likely older adults with CKD were to participate; Practitioners could consider the psychosocial characteristics of the older adults with CKD and facilitate their participation in PA. 10.1123/japa.2018-0078
Blood Pressure is Associated with Rapid Kidney Function Decline in a Very Elderly Hypertensive Chinese Population. Clinical interventions in aging PURPOSE:In prior analyses, blood pressure (BP) was related to rapid kidney function decline (RKFD). However, studies of this relationship in populations of advanced age are lacking. In the present study, we therefore examined the relationship between BP and RKFD in a population of 284 hypertensive Chinese individuals over the age of 80. PATIENTS AND METHODS:All study participants were diagnosed with hypertension (systolic BP [SBP] 160-200 mmHg; diastolic BP [DBP] <110 mmHg). RKFD was defined based upon a decline in estimated glomerular filtration rate (eGFR) >5mL/min per 1.73 m per year during follow-up. The Cox regression models (competing risk models) were used for calculating hazard ratios (HRs) to examine the relationship between SBP, DBP, pulse pressure (PP) and RKFD. RESULTS:Over a 3.3-year median follow-up period, 68 study participants (23.9%) were diagnosed with RKFD, while 35 (12.3%) died. After adjusting for confounding variables, we determined that each 10 mmHg rise in SBP and PP was associated with a 34% and 110% increase, respectively, in RKFD risk (adjusted HR: 1.34, 95% confidence interval [CI]: 1.05-1.71 for SBP, =0.02; HR: 2.10, 95% CI: 0.87-5.08 for PP, =0.10). In addition, we determined that each 10 mmHg increase in DBP was linked to a 10% reduction in RKFD risk (adjusted HR: 0.90, 95% CI: 0.70-1.14, =0.37). CONCLUSION:Our results indicate that SBP, but not DBP or PP, is positively correlated with RKFD risk in a very elderly hypertensive Chinese population. 10.2147/CIA.S255640
The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study. Sun Huimin,Qin Kang,Zou Chenfeng,Wang Harry Haoxiang,Lu Ciyong,Chen Weiqing,Guo Vivian Yawei Sleep medicine OBJECTIVE:This cohort study aimed to assess the associations between sleep duration and quality with the risk of incident chronic kidney disease (CKD) in middle-aged and older Chinese. METHODS:We used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Nighttime sleep duration was categorized into five groups: ≤4, (4-6], (6-8], (8-10], and >10 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression was used to assess the association between sleep duration and quality with incident CKD. RESULTS:A total of 11,339 participants free of CKD at baseline were included in this study. After four years follow-up, the incidence of CKD was 7.8%. There was a "U-shaped" association between sleep duration and risk of CKD. Compared to 6-8 h of nighttime sleep duration, those who slept ≤4 h/night (RR: 1.639, 95% CI: 1.287-2.087) or >10 h/night (RR: 2.342, 95% CI: 1.007-5.451) had increased risk of developing CKD after adjustment for confounders. Participants with 5-7 restless days per week had significantly increased risk of CKD (adjusted RR: 1.686, 95% CI: 1.352-2.102), compared to those who rarely or never had a restless sleep. CONCLUSIONS:Extreme nighttime sleep duration and poor sleep quality were associated with increased risk of CKD in middle-aged and older Chinese. Obtaining an optimal nighttime sleep duration and better sleep quality might reduce the risk of CKD. 10.1016/j.sleep.2021.08.007
The effect of triglycerides to high-density lipoprotein cholesterol ratio on the reduction of renal function: findings from China health and retirement longitudinal study (CHARLS). Lipids in health and disease BACKGROUND:Previous studies show that abnormal lipoprotein metabolism can increase the prevalence of chronic kidney disease (CKD). This study prospectively investigated the association of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and renal dysfunction in the Chinese population. METHODS:This longitudinal cohort research examined 7,316 participants (age range: 22-93) from the China Health and Retirement Longitudinal Study (CHARLS), including 6,560 individuals with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m (normal renal function, NRF) group and 756 with eGFR < 60 mL/min/1.73 m (impaired renal function, IRF) group. In NRF group, reduction in renal function was defined as eGFR < 60 mL/min/1.73 m at exit visit and in IRF group, it was defined as decline in eGFR category, average eGFR decline > 5 mL/min/1.73 m per year or > 30 % decrease in eGFR from baseline. RESULTS:The study results showed that TG/HDL-C ratio was positively associated with the risk of renal function decline in the NRF group (OR 1.30, 95 %CI 1.03-1.65, P = 0.03) and the IRF group (OR 1.90, 95 %CI 1.21-3.23, P = 0.02) when adjusting for age, gender, obesity, diabetes, hypertension, waist circumference, drinking, smoking, history of heart disease and stroke, low-density lipoprotein cholesterol and eGFR category. Analysis of the IRF group indicated that relative to the group of TG/HDL-C < 1.60, the group of TG/HDL-C ≥ 2.97 had an increased risk for the decline of eGFR category (OR 1.89, 95 %CI 1.12-3.21, P = 0.02) and > 30 % decline in eGFR (OR 2.56, 95 %CI 1.05-6.38, P = 0.04). CONCLUSIONS:The high TG/HDL-C ratio was an independent risk factor for declining renal function in the Chinese population. 10.1186/s12944-021-01542-5
Longitudinal Evidence for the Effects of Social Group Engagement on the Cognitive and Mental Health of Chinese Retirees. Lam Ben C P,Haslam Catherine,Steffens Niklas K,Yang Jie,Haslam S Alexander,Cruwys Tegan,Pachana Nancy A The journals of gerontology. Series B, Psychological sciences and social sciences BACKGROUND:Research investigating the health benefits of social group participation in the retirement transition has provided little insight into the longitudinal effects on cognitive health and the generalizability of these relationships to non-Western samples. The present paper addresses these issues by examining the effects of social group engagement on the cognitive performance and depression symptoms of Chinese older adults followed over 4 years in their transition to retirement. METHODS:Using the China Health and Retirement Longitudinal Study (CHARLS) data, a sample of 1,297 Chinese seniors transitioning to retirement were followed between 2011 and 2013, and then 2 years later (in 2015) after retirement. Group-based social engagement was used to predict retiree cognitive performance and depression symptoms across time. RESULTS:After controlling for established demographic covariates and close relationship factors at baseline, social group engagement at baseline positively predicted overall cognitive performance and depression symptoms. Moreover, positive change in group engagement was associated with reduced decline in cognitive performance over the 4-year retirement transition period. DISCUSSION:The current findings demonstrate the generalizability of the health benefits of social group engagement to cognitive health and to a non-Western (Chinese) sample of retirees. 10.1093/geronb/gbz134
Melancholy or mahjong? Diversity, frequency, type, and rural-urban divide of social participation and depression in middle- and old-aged Chinese: A fixed-effects analysis. Wang Ruoxi,Chen Zhuo,Zhou Yongjie,Shen Lining,Zhang Zhiguo,Wu Xiang Social science & medicine (1982) The potential benefit of social participation (SP) to one's mental health has been widely acknowledged. Nevertheless, the specific type and amount of SP that is associated with improved depressive symptoms in middle- and old-aged Chinese awaits further investigation. This study aimed to understand the patterns of depression and SP by comparing urban vs rural China, and according to which, measure the associations between changes in SP and that in depressive symptoms. A total of 10,988 community residents aged 45 years and above were selected from wave 1 (2011), wave 2 (2013), and wave 4 (2015) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. The fixed-effects analysis was used to explore the association between the changes in diversity, frequency, and type of SP and the changes in depressive symptoms. The results indicated that rural respondents suffered from a significantly higher risk of depression and took less SP than their urban counterparts. Transitioning from no SP to 1 or more types of SP or to a once a week or higher frequency was associated with a decline in depressive symptoms. For urban respondents, playing mah-jong or cards and joining sports or social clubs predicted a decline in depressive symptoms. For rural residents, interacting with friends regularly was associated with fewer depressive symptoms. In conclusion, more diverse and higher frequency of SP was associated with better mental health, while the social significance of SP varied across different types of SP and between rural and urban areas. 10.1016/j.socscimed.2019.112518
Social participation and health in middle-aged and older empty nesters: A study on gender differences. SSM - population health Background:The growing population of middle-aged and older empty nesters is characterized by poorer health, and social participation (SP) has been shown to improve this situation. However, few studies have investigated specific performance and gender differences between SP and health. The present study aims to address these issues. Methods:A total of 1207 middle-aged and older empty nesters over 45 years old were selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). Random-effects analyses were used to explore the association between changes in SP (diversity, frequency, type) and changes in health status. Health status include physical health, mental health, self-reported health (SRH). Results:Female middle-aged and olderly empty nesters have significantly poorer health and participate in SP more frequently. The higher the diversity of SP, the better the health of middle-aged and olderly empty nesters, while higher frequency is beneficial to SRH. Female's participation in sports and Internet had better mental health and SRH, and mahjong helped female's mental health. Clubs are helpful for male's SRH. Conclusions:This study reveals the specifics of the association between SP and health status of middle-aged and older empty nesters. Therefore, all aspects of SP and gender differences should be taken into account when predicting and improving the health status. Help the government to better formulate policies to better cope with the increasing empty nest phenomenon and build a harmonious and stable society. 10.1016/j.ssmph.2024.101641
Association between social participation and cognitive function among middle- and old-aged Chinese: A fixed-effects analysis. Journal of global health BACKGROUND:Social Participation (SP) is known to benefit cognitive function. However, whether the positive relationship holds across different types of SP and dimensions of cognitive function, and whether the statement stays true in middle- and old-aged Chinese have not been investigated. The present study aimed to understand the current patterns of SP and cognitive function in China's context, and therefore, explore the associations between cognitive function and SP at different levels from various aspects. METHODS:A total of 7973 community residents aged 45 years and older were selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). A fixed-effects analysis was used to explore the association between changes in SP (diversity, frequency, and type) and that in cognitive function (memory and mental status) over a four-year period. RESULTS:Changing from no SP to more variety (β = 0.377, 95% confidence interval (CI) = 0.192-0.562 for 1 type, β = 0.703, 95% CI = 0.470-0.937 for ≥2 types) or higher frequency (β = 0.235, 95% CI = 0.007-0.462 for not regularly, β = 0.604, 95% CI = 0.411-0.798) of SP was associated with improvements in cognitive function. Playing mah-jong and using Internet were associated with improved memory but not with mental status. Sports and volunteering were associated with improved mental status but not with memory. The same pattern was observed in men and in women. CONCLUSIONS:The study confirmed that more diversity and higher frequency of SP was associated with improved cognitive function, whereas reminded policymakers to consider cultural context when developing target strategies to improve cognitive function. 10.7189/jogh.10.020801
Concurrent and lagged associations of social participation and frailty among older adults. Health & social care in the community Frailty is a pervasive symptom among the older population, and social participation is a beneficial factor of late-life well-being. However, studies on the bidirectional association between social participation and frailty are limited. This study examined the cross-sectional and lagged associations of social participation and frailty. The analytic sample contained 6865 community-dwelling older adults, with 21,141 observations, from the first four waves (2011-2018) China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by the Frailty Index (FI). Social participation was measured by the accumulation of the frequencies of six social activities. Random intercept two-level models were used to analyse the concurrent and lagged association between social participation and frailty. The results showed significantly cross-sectional associations between higher levels of frailty and lower levels of social participation in the same wave. Moreover, there was a lagged association of social participation in the prior wave with the current frailty (b = -0.001, SE = 0.001, p = 0.028), and frailty in the prior wave with the current social participation (b = -0.634, SE = 0.088, p < 0.001) even after adjusting for sociodemographic characteristics, and frailty or social participation in the prior wave. The bidirectional associations between social participation and frailty imply the necessity of enhancing social participation to prevent or slow the frailty progression, and improving the physical and social environment to reduce social participation restrictions imposed by frailty status. 10.1111/hsc.13888
The Effect of Activity Participation in Middle-Aged and Older People on the Trajectory of Depression in Later Life: National Cohort Study. JMIR public health and surveillance BACKGROUND:More activity participation is an important means of handling depression and promoting positive aging, but the impact of changes in activity participation on the developmental trajectory of depression has not been fully studied. OBJECTIVE:The purpose of this study is to study the relationship between current activity participation and depression in middle-aged and older people (≥45 years old) and the relationship between activity participation and the developmental trajectory of depression in later life in China. METHODS:This study used data from the China Health and Retirement Longitudinal Study (CHARLS) across 7 years and included a total of 4818 middle-aged and older people (≥45 years old). Controlling for relevant control variables, the latent growth curve model and the cross-lag model were used to assess the effect of changes in activity participation on the depression trajectory in later life and the main lag relationship between activity participation and depression. Activity participation as well as depression were measured using the self-reported activity and health status based on the CHARLS questionnaire. RESULTS:Among the 4818 respondents, the mean values of physical activity participation, social leisure activity participation, and depression ranged from 76.98 (SD 15.16) to 83.95 (SD 5.72), from 7.43 (SD 8.67) to 9.25 (SD 10.16), and from 7.61 (SD 5.72) to 8.82 (SD 6.51), respectively. Our findings revealed that activity participation could be related to depression. Physical activity participation predicted initial depression (β=-0.631, P<.001) and its trajectory (β=0.461, P<.001). However, social leisure activity participation predicted initial depression (β=-0.223, P<.001) but did not predict its trajectory (β=0.067, P=.159). Finally, cross-lag regression analysis further demonstrated the predictive effect of activity participation on depression. CONCLUSIONS:This study demonstrates the prediction of activity participation for future depression in the Chinese middle-aged and older populations. The data showed that activity participation is significantly associated with changes in depression and future depression among middle-aged and older people in China. The Chinese government should encourage middle-aged and older people to participate in various activities, which can effectively prevent the aggravation of depression and also have a positive significance for positive aging. 10.2196/44682
Behavioral Medicine for Sedentary Behavior, Daily Physical Activity, and Exercise to Prevent Cardiovascular Disease: A Review. Current atherosclerosis reports PURPOSE OF REVIEW:Behavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed. RECENT FINDINGS:Behavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors. Behavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted. 10.1007/s11883-021-00948-x
Identifying associations between the social network index, its components, and the prevalence of cardiovascular diseases in Polish adults. Results of the cross-sectional WOBASZ II study. Kardiologia polska BACKGROUND:Psychosocial risk factors are important determinants of cardiovascular diseases (CVDs): people involved in positive relationships live longer than those with low social support (SS). AIMS:Our study aimed to evaluate the association between SS, components of the social network, and CVDs. METHODS:A cross-sectional population-based survey WOBASZ II conducted in the years 2013-2014 included a sample of 6043 individuals, aged 20 and over, who completed the Berkman-Syme questionnaire to assess SS using the social network index (SNI). RESULTS:Higher percentage of low SS was observed in women (52.15%) compared to men (45.4%) (P <0.001). People with a low SNI had a worse CVD risk factor profile. None of the analyzed social contacts (with children, relatives, or friends), regardless of how satisfactory they were, was associated with CVDs in men. In women, satisfying contact with children or relatives appeared to be associated with better cardiovascular health. Furthermore, active participation in organized social activity increased the chance of arrhythmia in both sexes: 1.50 (1.04-2.15); P = 0.029 in men; 1.47 (1.11-1.95); P = 0.007 in women. Although a low SNI was associated with analyzed CVDs in the univariate analysis, it was not confirmed in the fully adjusted model. CONCLUSIONS:More women had low SS compared to men. People with low SS had a worse CVD risk factor profile. There was a significant independent relationship between different components of the SNI, such as social contacts and CVDs in women and active participation in organized social activity and arrhythmia in both sexes. 10.33963/v.kp.98066
Community participation and sustainability--evidence over 25 years in the Västerbotten Intervention Programme. Norberg Margareta,Blomstedt Yulia,Lönnberg Göran,Nyström Lennarth,Stenlund Hans,Wall Stig,Weinehall Lars Global health action BACKGROUND:Selection bias and declining participation rates are of concern in many long-term epidemiological studies. The Västerbotten Intervention Programme (VIP) was launched in 1985 as a response to alarming reports on elevated cardiovascular disease (CVD) mortality in Västerbotten County in Northern Sweden. The VIP invites women and men to a health examination and health counselling during the year of their 40th, 50th, and 60th birthdays. OBJECTIVE:To evaluate trends in participation rates and determinants of participation in the VIP from 1990 to 2006. DESIGN:Registry data on socio-economic status from Statistics Sweden, and mortality and hospitalisation data from the National Board of Health and Welfare, both covering the whole Swedish population, were linked to the VIP and analysed for participants and non-participants. RESULTS:During 1990-2006, 117,710 individuals were eligible to participate in the VIP, and 40,472 of them were eligible to participate twice. There were 96,560 observations for participants and 61,622 for non-participants. The overall participation rate increased from 56 to 65%. Participants and non-participants had minimal differences in education and age. Initial small differences by sex and degree of urban residence decreased over time. Despite an increasing participation rate in all groups, those with low income or who were single had an approximately 10% lower participation rate than those with high or medium-income or who were married or cohabitating. CONCLUSION:Sustainability of the VIP is based on organisational integration into primary health care services and targeting of the entire middle-aged population. This enables the programme to meet population expectations of health promotion and to identify high-risk individuals who are then entered into routine preventive health care services. This has the potential to increase participation rates, to minimise social selection bias, and to reinforce other community-based interventions. 10.3402/gha.v5i0.19166
Walking and sports participation and mortality from coronary heart disease and stroke. Noda Hiroyuki,Iso Hiroyasu,Toyoshima Hideaki,Date Chigusa,Yamamoto Akio,Kikuchi Shogo,Koizumi Akio,Kondo Takaaki,Watanabe Yoshiyuki,Wada Yasuhiko,Inaba Yutaka,Tamakoshi Akiko, Journal of the American College of Cardiology OBJECTIVES:We aimed to examine the impact of exercise on mortality from cardiovascular disease (CVD) in Asian populations. BACKGROUND:Few data have been available in Asian countries, where job-related physical activity is higher than that in Western countries. METHODS:Between 1988 and 1990, 31,023 men and 42,242 women in Japan, ages 40 to 79 years with no history of stroke, coronary heart disease (CHD), or cancer, completed a self-administered questionnaire. Systematic mortality surveillance was performed through 1999, and 1,946 cardiovascular deaths were identified. We chose the second lowest categories of walking and sports participation as the reference to reduce a potential effect of ill health. RESULTS:Men and women who reported having physical activity in the highest category (i.e., walking > or =1 h/day or doing sports > or =5 h/week) had a 20% to 60% lower age-adjusted risk of mortality from CVD, compared with those in the second lowest physical activity category (i.e., walking 0.5 h/day, or sports participation for 1 to 2 h/week). Adjustment for known risk factors, exclusion of individuals who died within two years of baseline inquiry, or gender-specific analysis did not substantially alter these associations. The multivariate-adjusted hazard ratios (95% confidence interval) for the highest versus the second lowest categories of walking or sports participation were 0.71 (0.54 to 0.94) and 0.80 (0.48 to 1.31), respectively, for ischemic stroke (IS); 0.84 (0.64 to 1.09) and 0.51 (0.32 to 0.82), respectively, for CHD; and 0.84 (0.75 to 0.95) and 0.73 (0.60 to 0.90), respectively, for CVD. CONCLUSIONS:Physical activity through walking and sports participation might reduce the risk of mortality from IS and CHD. 10.1016/j.jacc.2005.07.038
Physical activity volume, intensity, and incident cardiovascular disease. European heart journal AIMS:The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. METHODS AND RESULTS:Data were from 88 412 UK Biobank middle-aged adults (58% women) without prevalent CVD who wore accelerometers on their dominant wrist for 7 days, from which we estimated total PA energy expenditure (PAEE) using population-specific validation. Cox proportional hazards regressions modelled associations between PAEE (kJ/kg/day) and PA intensity (%MVPA; the fraction of PAEE accumulated from moderate-to-vigorous-intensity PA) with incident CVD (ischaemic heart disease or cerebrovascular disease), adjusted for potential confounders. There were 4068 CVD events during 584 568 person-years of follow-up (median 6.8 years). Higher PAEE and higher %MVPA (adjusted for PAEE) were associated with lower rates of incident CVD. In interaction analyses, CVD rates were 14% (95% confidence interval: 5-23%) lower when MVPA accounted for 20% rather than 10% of 15 kJ/kg/d PAEE; equivalent to converting a 14 min stroll into a brisk 7 min walk. CVD rates did not differ significantly between values of PAEE when the %MVPA was fixed at 10%. However, the lowest CVD rates were observed for combinations of both higher PAEE and %MVPA. CONCLUSION:Reductions in CVD risk may be achievable through higher PA volume and intensity, with the role of moderately intense PA appearing particularly important. This supports multiple approaches or strategies to PA participation, some of which may be more practical or appealing to different individuals. 10.1093/eurheartj/ehac613
Social participation and older adults' sleep. Chen Jen-Hao,Lauderdale Diane S,Waite Linda J Social science & medicine (1982) Sleep complaints are common among older adults, and poor sleep has been found to predict chronic diseases and mortality. Many studies suggest that social participation benefits healthy aging. We examined the relationships between older adults' social participation and their sleep using two waves (2005-2006, 2010-2011) of data from the National Social Life, Health, and Aging Project (NSHAP). The NSHAP recorded older adults' social participation (including religious attendance, volunteer work, and attendance at meetings of organized groups) over five years, and included self-reported sleep duration in both waves and, in the second wave, measures of insomnia symptoms and measures of sleep patterns and rhythms using actigraphy for a subsample. Cross-sectional analysis of the second wave indicates that those reporting higher levels of social participation had better actigraphic sleep but not better self-reported sleep. However, longitudinal analysis suggests that change in social participation was not associated with actigraphic or self-reported sleep characteristics in the second wave data. Further analysis using fixed-effects model showed no association between change in social participation and change in self-reported sleep duration. Thus, although older adults with greater social participation slept better, we did not find that increasing social participation improved sleep. These findings imply that a self-selection process may at work; or if social participation does affect sleep, the causal effect may be over a much shorter time frame than five years. 10.1016/j.socscimed.2015.11.045
Social participation and risk of developing dementia. Nature aging The increasing number of people with dementia globally illustrates the urgent need to reduce dementia's scale and impact. Lifetime social participation may affect dementia risk by increasing cognitive reserve, and through brain maintenance by reducing stress and improving cerebrovascular health. It may therefore have important implications for individual behavior and public health policy aimed at reducing dementia burden. Observational study evidence indicates that greater social participation in midlife and late life is associated with 30-50% lower subsequent dementia risk, although some of this may not be causal. Social participation interventions have led to improved cognition but, partly due to short follow-up and small numbers of participants, no reduction in risk of dementia. We summarize the evidence linking social participation with dementia, discuss potential mechanisms by which social participation is likely to reduce and mitigate the impact of neuropathology in the brain, and consider the implications for future clinical and policy dementia prevention interventions. 10.1038/s43587-023-00387-0
Lipophilic index, kidney function, and kidney function decline. Xu H,Ärnlöv J,Sandhagen B,Risérus U,Lindholm B,Lind L,Carrero J J Nutrition, metabolism, and cardiovascular diseases : NMCD BACKGROUND AND AIMS:Unhealthy dietary fats are associated with faster kidney function decline. The cell membrane composition of phospholipid fatty acids (FAs) is a determinant of membrane fluidity and rheological properties. These properties, which have been linked to kidney damage, are thought to be reflected by the lipophilic index (LI). We prospectively investigated the associations of LI with kidney function and its decline. METHODS AND RESULTS:Observational study from the Prospective Investigation of Vasculature in Uppsala Seniors including 975 men and women with plasma phospholipid FAs composition and cystatin-C estimate glomerular filtration rate (eGFR). Of these, 780 attended re-examination after 5 years, and eGFR changes were assessed. Participants with a 5-year eGFR reduction ≥30% were considered chronic kidney disease (CKD) progressors (n = 198). LI was calculated as the sum of the products of the FA proportions with the respective FAs melting points. Blood rheology/viscosity measurements were performed in a random subsample of 559 subjects at baseline. Increased LI showed a statistically significant but overall weak association with blood, plasma viscosity (both Spearman rho = 0.16, p < 0.01), and erythrocyte deformability (rho = -0.09, p < 0.05). In cross-sectional analyses, LI associated with lower eGFR (regression coefficient 3.00 ml/min/1.73 m 1-standard deviation (SD) increment in LI, 95% CI: -4.31, -1.69, p < 0.001). In longitudinal analyses, LI associated with a faster eGFR decline (-2.13 [95% CI -3.58, -0.69] ml/min/1.73 m, p < 0.01) and with 32% increased odds of CKD progression (adjusted OR 1.32 [95%, CI 1.05-1.65]). CONCLUSIONS:A high LI was associated with lower kidney function, kidney function decline, and CKD progression. 10.1016/j.numecd.2016.09.006
Optimism is associated with chronic kidney disease and rapid kidney function decline among African Americans in the Jackson Heart Study. Journal of psychosomatic research OBJECTIVE:Investigate the association of dispositional optimism with chronic kidney disease (CKD) and rapid kidney function decline (RKFD) and determine if there is modification by age, sex, and educational attainment among African Americans. METHODS:Optimism was measured using the 6-item Life Orientation Test-Revised scale (categorized into tertiles and log transformed) among participants from the Jackson Heart Study (n = 1960). CKD was defined as the presence of albuminuria or reduced glomerular filtration rate of <60 mL/min/1.73m, or report of dialysis at baseline examination (2000-2004). RKFD was defined as a decline >3 mL/min/1.73m/year between baseline and exam 3 (2009-2013). The cross-sectional and prospective associations between optimism and kidney outcomes were tested using multivariable logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI), adjusting for demographics, education, risk factors, behaviors, and depressive symptoms. We tested effect modification by age, sex, and education. RESULTS:569 participants had CKD and 326 were classified as having RKFD by exam 3. After full adjustment, the OR for CKD was 0.73 for those who reported high (vs. low) optimism (95% CI 0.55-0.99) and 0.56 (95% CI 0.27-1.15) for the optimism score. After 7.21 median years of follow up, the OR for RKFD was 0.51 for those who reported high (vs. low) optimism (95% CI 0.34-0.76), and 0.26 (95% CI 0.10-0.56) for the optimism score, after full adjustment. There was no evidence of effect modification by demographics or educational attainment. CONCLUSIONS:Higher optimism was associated with a lower odds of CKD and a lower odds of RKFD. 10.1016/j.jpsychores.2020.110267
Metabolic Syndrome Is Associated With Rapid Estimated Glomerular Filtration Rate Decline In A Chinese Community-Based Population. Diabetes, metabolic syndrome and obesity : targets and therapy PURPOSE:This study aimed to determine the relationship between the metabolic syndrome (MetS) and rapid estimated glomerular filtration rate (eGFR) decline in a Chinese community-based population. PATIENTS AND METHODS:A total of 3108 participants were recruited between December 2011 and July 2014 from an observational study cohort designed for the study of atherosclerotic diseases in Beijing, China. The outcome was a rapid eGFR decline. Subgroup and interaction analyses were performed with respect to a number of covariates. RESULTS:Over a median follow-up period of 2.34 (IQR: 2.29-2.41) years, the overall incidence of rapid eGFR decline was 7.24%. We found that the MetS was significantly associated with the risk of rapid eGFR decline (odds ratio [OR]=1.69, 95% confidence interval [CI]: 1.28-2.23, <0.001) in a model adjusted for age, sex, and eGFR, and this relationship remained significant after adjustment for smoking, drinking, and low-density lipoprotein-cholesterol (OR=1.78, 95% CI: 1.34-2.35, <0.001). Waist circumference (OR=1.38, 95% CI: 1.04-1.83, =0.027), triglycerides (OR=1.40, 95% CI: 1.05-1.86, =0.022), blood pressure (OR=2.05, 95% CI: 1.49-2.82, <0.001), and fasting plasma glucose (OR=2.12, 95% CI: 1.57-2.85, <0.001), but not high-density lipoprotein-cholesterol (OR=1.26, 95% CI: 0.94-1.69, =0.117), were positively associated with the risk of rapid eGFR decline. Similarly, an increase in the number of MetS components present was associated with an increase in the risk of rapid eGFR decline. Furthermore, this association was modified by smoking status (OR=3.78, 95% CI: 1.68-8.49, -interaction=0.030). CONCLUSION:The MetS independently predicted rapid eGFR decline in a Chinese community-based cohort recruited for the study of atherosclerosis. The relationship between the MetS and the risk of rapid eGFR decline was modified by smoking status. 10.2147/DMSO.S217326
Relationship between changes in body fat and a decline of renal function in the elderly. PloS one Obesity is a risk factor for chronic kidney disease, and its prevalence among the elderly is increasing. We investigated the effects of changes in body fat percentage (BFP) on the longitudinal changes in the estimated glomerular filtration rate (eGFR) in the elderly. This prospective cohort study included 390 participants aged >65 years who underwent bioelectrical impedance analysis at baseline and follow-up as a part of the Korean Longitudinal Study on Health and Aging. After a median follow-up period of 5.3 years, BFP was significantly higher than that at the start point (P<0.05). Participants who had the largest increase in BFP had the highest BMI and waist circumference (WC) (P<0.001). The highest tertile had the highest white blood cell count and erythrocyte sedimentation rate, incidence of rapid progression, and decline in eGFR >25% (P≤0.017, P = 0.025, P = 0.005, respectively). The lowest tertile had the lowest triglyceride and highest high-density lipoprotein levels (P<0.05). The adjusted decline rate in eGFR was correlated with a change in BFP (P = 0.039), but not with that in BMI or WC. The highest tertile had a 4.875-fold increase in the risk for rapid progression to a decline in eGFR (95% CI: 1.366-17.397) and a 4.931-fold decrease in the risk to a decline in eGFR>25% (95% CI: 1.617-15.037), when compared with the lowest tertile. In subgroup analysis, the incidence of renal outcomes was significantly increased according to the increase in BFP in patients with lower eGFR (P≤0.010). A change in BFP may be associated with inflammation and dyslipidemia development, and longitudinal changes in body fat are related to a decrease in eGFR in the elderly. 10.1371/journal.pone.0084052
White blood cell count predicts the odds of kidney function decline in a Chinese community-based population. Fan Fangfang,Jia Jia,Li Jianping,Huo Yong,Zhang Yan BMC nephrology BACKGROUND:Inflammatory processes are very important in the development of kidney disease. Nevertheless, the association between white blood cell (WBC) count and the risk of renal dysfunction has not been well-established, especially in subjects without chronic kidney disease (CKD). Our study investigated the association between WBC count and kidney function decline in a Chinese community-based population with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m. METHODS:A total of 3768 subjects who were enrolled in an atherosclerosis cohort in Beijing were included in this study. EGFRs were calculated at baseline and follow-up using the CKD-EPI formula. The outcomes of this study were renal function decline (RFD) (a drop in eGFR stage along with a decline in eGFR of 25% or exceeding 5 mL/min/1.73 m/year), rapid eGFR decline (an annual decrease in eGFR exceeding 3 mL/min/1.73 m), and incident CKD (eGFR <60 min/1.73 m at follow-up). Multivariate logistic regression models were used to evaluate the associations between WBC count and each outcome. RESULTS:On average, the subjects were 56.6 ± 8.5 years old, and 35.9% were male. Of the participants, 48.6% had hypertension and 17.4% had diabetes. The mean (SD) WBC count at baseline was 6.1 ± 1.5 × 10/L. The mean (SD) eGFR at baseline was 101.1 ± 10.6 mL/min/1.73 m. After 2.3 years follow-up, the incidence rates of RFD, rapid eGFR decline and new CKD were 7.7, 20.9, and 0.8%, respectively. WBC count was significantly related to RFD, rapid eGFR decline and new CKD in the univariate analyses. Even after adjustment for demographic variables, comorbidities, medications and baseline eGFR, these associations remained. Moreover, similar trends in RFD were observed in nearly all subgroups stratified by each confounding variable. The increase in the odds of RFD associated with each 10/L increase in WBC count was significantly greater in subjects not undergoing treatment with lipid-lowering drugs than those not undergoing this treatment (P-interaction: 0.05). CONCLUSIONS:In conclusion, elevated WBC count served as a predictor of the odds of kidney function decline in this population, which supports the hypothesis that systemic inflammation may serve as a risk factor for CKD development. 10.1186/s12882-017-0608-4
Association of serum uric acid levels with the incident of kidney disease and rapid eGFR decline in Chinese individuals with eGFR > 60 mL/min/1.73 m and negative proteinuria. Zhou Fangfang,Yu Geping,Wang Guoyu,Liu Yunzi,Zhang Liwen,Wang Weiming,Chen Nan Clinical and experimental nephrology BACKGROUND:Epidemiological studies suggest that higher serum uric acid (SUA) level is significantly associated with kidney disease development. However, it remains debatable whether higher SUA is independently associated with new-onset kidney disease and rapid eGFR decline in individuals with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m and negative proteinuria. METHODS:This was a large, single-center, retrospective 6-year cohort study at People's Hospital of Tonglu County, Zhejiang, from 2001 to 2006. We enrolled 10,677 participants (19-92 years) with eGFR ≥ 60 mL/min/1.73 m and without dipstick proteinuria at baseline. The association between SUA change and the occurrence of renal outcomes and annual eGFR decline were evaluated using Cox models with adjustment for confounders. RESULTS:Higher quartiles (2.51%) of SUA levels were associated with greater prevalence of kidney disease compared with quartile 1 (0.52%), 2 (1.13%) and 3 (1.76%), respectively. In addition, greater baseline SUA levels [OR (95% CI) 3.29(1.68-6.45), p < 0.001] and increased SUA [1.36(1.23-1.50), p < 0.001] were all associated with greater odds of renal disease progression when comparing the 4th quartile of annual eGFR decline rate with the 1st quartile. In addition, both of higher baseline SUA levels and increased SUA change were the risk factors of rapid annual eGFR decline along with male gender, lower albumin, hematocrit and creatinine levels, higher hemoglobin levels and hyperlipidemia after multivariable adjustments when compared with each quartile group. CONCLUSIONS:Increasing SUA were independent risk factor for the prevalent of kidney disease and rapid eGFR decline and reduced SUA over time could abate kidney disease development in a Chinese community. 10.1007/s10157-019-01705-w
Body mass index and early kidney function decline in young adults: a longitudinal analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) study. American journal of kidney diseases : the official journal of the National Kidney Foundation BACKGROUND:Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline. STUDY DESIGN:Longitudinal cohort. SETTING & PARTICIPANTS:2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFRcys)>90mL/min/1.73m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. PREDICTOR:BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2). OUTCOMES:Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFRcys <60mL/min/1.73m(2) over 10 years of follow-up. MEASUREMENTS:GFRcys estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and 20. RESULTS:At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114mL/min/1.73m(2), and 24.5% had BMI≥30.0kg/m(2). After age 30 years, average eGFRcys was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57 [95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFRcys<60mL/min/1.73m(2). In unadjusted analysis, higher BMI category was associated with incident eGFRcys<60mL/min/1.73m(2) (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant. LIMITATIONS:Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level. CONCLUSIONS:Higher BMI categories are associated with greater declines in kidney function in a cohort of young adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline. 10.1053/j.ajkd.2013.10.055
The correlation between blood pressure and kidney function decline in older people: a registry-based cohort study. Vaes Bert,Beke Emilie,Truyers Carla,Elli Steven,Buntinx Frank,Verbakel Jan Y,Goderis Geert,Van Pottelbergh Gijs BMJ open OBJECTIVES:To examine the relation between static and dynamic blood pressure (BP) measurements and the evolution of kidney function in older people, adjusted for the presence of multimorbidity. DESIGN:Retrospective cohort study during a 10-year time interval (2002-2012) in three age strata of patients aged 60 and older. SETTING:Primary care registration network with 97 general practitioners working in 55 practices regularly submitting collected patient data. PARTICIPANTS:All patients with at least one BP measurement in 2002 and at least four serum creatine measurements after 2002 (n=8636). A modified Charlson Comorbidity Index (mCCI) at baseline was registered. Change in systolic and diastolic BP (DBP) and pulse pressure (PP) from 2002 onwards was calculated. The relation between kidney function evolution and baseline BP and change in BP was examined using linear and logistic regression analysis. MAIN OUTCOME MEASURES:The slope of the estimated glomerular filtration rate (eGFR, MDRD, Modification of Diet in Renal Disease equation) was calculated by the ordinal least square method. A rapid annual decline of kidney function was defined as ≥ 3 L/min/1.73 m(2)/year. RESULTS:Rapid annual decline of kidney function occurred in 1130 patients (13.1%). High baseline systolic BP (SBP) and PP predicted kidney function decline in participants aged 60-79 years. No correlation between baseline BP and kidney function decline was found in participants aged 80 years and older. An annual decline of ≥ 1 mm Hg in SBP and PP was a strong risk factor for a rapid annual kidney function decline in all age strata, independent of baseline BP and mCCI. A decline in DBP as also a strong independent predictor in participants aged 60-79 years. CONCLUSIONS:The present study identified a decline in BP over time as a strong risk factor for kidney function decline in all age strata, adjusted for mCCI and baseline kidney function and BP. 10.1136/bmjopen-2015-007571
Serum Calcitriol Concentrations and Kidney Function Decline, Heart Failure, and Mortality in Elderly Community-Living Adults: The Health, Aging, and Body Composition Study. American journal of kidney diseases : the official journal of the National Kidney Foundation RATIONALE & OBJECTIVES:Lower 25-hydroxyvitamin D concentrations have been associated with risk for kidney function decline, heart failure, and mortality. However, 25-hydroxyvitamin D requires conversion to its active metabolite, calcitriol, for most biological effects. The associations of calcitriol concentrations with clinical events have not been well explored. STUDY DESIGN:Case-cohort study. SETTING & PARTICIPANTS:Well-functioning community-living older adults aged 70 to 79 years at inception who participated in the Health, Aging, and Body Composition (Health ABC) Study. PREDICTOR:Serum calcitriol measured using positive ion electrospray ionization-tandem mass spectrometry. OUTCOMES:Major kidney function decline (≥30% decline in estimated glomerular filtration rate from baseline), incident heart failure (HF), and all-cause mortality during 10 years of follow-up. ANALYTIC APPROACH:Baseline calcitriol concentrations were measured in a random subcohort of 479 participants and also in cases with major kidney function decline [n=397]) and incident HF (n=207) during 10 years of follow-up. Associations of serum calcitriol concentrations with these end points were evaluated using weighted Cox regression to account for the case-cohort design, while associations with mortality were assessed in the subcohort alone using unweighted Cox regression. RESULTS:During 8.6 years of mean follow-up, 212 (44%) subcohort participants died. In fully adjusted models, each 1-standard deviation lower calcitriol concentration was associated with 30% higher risk for major kidney function decline (95% CI, 1.03-1.65; P=0.03). Calcitriol was not significantly associated with incident HF (HR, 1.16; 95% CI, 0.94-1.47) or mortality (HR, 1.01; 95% CI, 0.81-1.26). We observed no significant interactions between calcitriol concentrations and chronic kidney disease status, baseline intact parathyroid or fibroblast factor 23 concentrations. LIMITATIONS:Observational study design, calcitriol measurements at a single time point, selective study population of older adults only of white or black race. CONCLUSIONS:Lower calcitriol concentrations are independently associated with kidney function decline in community-living older adults. Future studies will be needed to clarify whether these associations reflect lower calcitriol concentrations resulting from abnormal kidney tubule dysfunction or direct mechanisms relating lower calcitriol concentrations to more rapid loss of kidney function. 10.1053/j.ajkd.2018.03.026
Alcohol consumption and kidney function decline in the elderly: alcohol and kidney disease. Menon Vandana,Katz Ronit,Mukamal Kenneth,Kestenbaum Bryan,de Boer Ian H,Siscovick David S,Sarnak Mark J,Shlipak Michael G Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association BACKGROUND:Alcohol consumption appears to be protective for cardiovascular disease; however, its relationship with kidney disease is unclear. METHODS:This prospective cohort study included 4343 subjects from the Cardiovascular Health Study, a longitudinal, community-based cohort of persons aged ≥65 from four US communities. We used previously defined categories based on weekly alcohol consumption: none, former, <1 drink, 1-6 drinks, 7-13 drinks and ≥14 drinks. Cystatin C was measured at baseline, year 3 and year 7; eligible subjects had at least two measures. Estimated GFR(cys) was calculated from cystatin C. The primary outcome was rapid kidney function as an annual estimated GFR (eGFR(cys)) loss >3 mL/min/1.73 m(2)/year. RESULTS:Eight percent of the cohort reported former alcohol use and 52% reported current alcohol consumption. During a mean follow-up of 5.6 years, 1075 (25%) participants had rapid kidney function decline. In adjusted logistic regression models, there was no association between alcohol use and kidney function decline (odds ratio, 95% confidence interval: none = reference; former = 1.18, 0.89-1.56; <1 drink = 1.20, 0.99-1.47; 1-6 = 1.18, 0.95-1.45; 7-13 = 1.10, 0.80-1.53; >14 = 0.89, 0.61-1.13). Results were similar with kidney function decline as a continuous outcome. CONCLUSIONS:Our results suggest that moderate alcohol consumption has neither adverse nor beneficial effects on kidney function. Although clinicians will need to consider the potential deleterious effects associated with alcohol consumption, there does not appear to be a basis for recommending that older adults discontinue or initiate light to moderate alcohol consumption to protect against kidney disease. 10.1093/ndt/gfq188
Silent brain infarction and rapid decline of kidney function in patients with CKD: a prospective cohort study. Kobayashi Mayumi,Hirawa Nobuhito,Morita Satoshi,Yatsu Keisuke,Kobayashi Yusuke,Yamamoto Yuichiro,Saka Sanae,Toya Yoshiyuki,Yasuda Gen,Umemura Satoshi American journal of kidney diseases : the official journal of the National Kidney Foundation BACKGROUND:Several reports have found that chronic kidney disease (CKD) is an independent risk factor for stroke. However, little is known about whether cerebrovascular disease conversely predicts the outcome of kidney function. In view of the similarities between vascular beds of the kidney and brain, we hypothesized that silent brain infarction (SBI) could reflect the degree of injury in renal small vessels and predict the risk of progression of kidney disease. STUDY DESIGN:Prospective cohort study. SETTING & PARTICIPANTS:142 patients with CKD (stages 3-5) admitted to our clinic for education about CKD from January 2006 to July 2007 were recruited and followed up for 2 years. PREDICTOR:SBI. OUTCOMES:Composite primary outcomes: doubling of serum creatinine level, development of end-stage renal disease defined as dialysis or transplant, and death from cardiovascular causes. Secondary outcome: rate of decrease in estimated glomerular filtration rate. MEASUREMENTS:Brain magnetic resonance imaging was performed to determine the presence or absence of SBI. RESULTS:At baseline, 87 patients had SBI. During follow-up, 43 patients (30.3%) developed the following primary outcomes: doubling of serum creatinine level (8 patients), dialysis therapy (32 patients), and death from cardiovascular causes (3 patients). In crude analysis, the presence of SBI predicted time to primary outcomes (P=0.01). A multivariate Cox model confirmed the presence of SBI to be an independent predictor of study outcomes (HR, 2.16; 95% CI, 1.01-4.64; P=0.04). Estimated glomerular filtration rate decreased more in patients with SBI than in those without SBI (-0.11/y vs -0.06/y relative to baseline value; P=0.005). LIMITATIONS:Study size was small. CONCLUSION:We showed that SBI was an important independent prognostic factor for the progression of kidney disease in patients with CKD. Our findings suggest that patients with SBI should be considered a high-risk population for decreased kidney function. 10.1053/j.ajkd.2010.03.018
Association of sarcopenia with rapid kidney function decline and chronic kidney disease in adults with normal kidney function. The British journal of nutrition The association between sarcopenia and kidney function remains poorly investigated. We aimed to evaluate the associations between sarcopenia status and kidney function (rapid kidney function decline and chronic kidney disease (CKD)) in middle-aged and older Chinese population. A total of 9375 participants from the China Health and Retirement Longitudinal Study 2011 were included in the cross-sectional analyses. A total of 5864 participants with eGFRcr-cys ≥ 60 ml/min per 1·73 m at baseline were included in the longitudinal analyses and were followed up in 2015. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 criteria. In the cross-sectional analyses, possible sarcopenia and sarcopenia were significantly associated with an increased risk of CKD. During the 4 years of follow-up, 359 (6·12 %) participants experienced rapid decline in kidney function and 126 (2·15 %) participants developed CKD. After multivariable adjustment of baseline eGFRcr-cys level and other risk factors, possible sarcopenia (OR, 1·33; 95 % CI 1·01, 2·12) and sarcopenia (OR, 1·49; 95 % CI 1·05, 2·12) were associated with an increased risk of primary outcome (composite of rapid decline in kidney function (annualised decline in eGFRcr-cys ≥ 5 ml/min per 1·73 m) and progression to CKD (eGFRcr-cys < 60 ml/min per 1·73 m). Individuals with low muscle mass or low muscle strength alone also had an increased risk of rapid decline in kidney function and progression to CKD. 10.1017/S0007114523002313
Serum 25-hydroxyvitamin D level and kidney function decline in a Swiss general adult population. Guessous Idris,McClellan William,Kleinbaum David,Vaccarino Viola,Hugues Henry,Boulat Olivier,Marques-Vidal Pedro,Paccaud Fred,Theler Jean-Marc,Gaspoz Jean-Michel,Burnier Michel,Waeber Gérard,Vollenweider Peter,Bochud Murielle Clinical journal of the American Society of Nephrology : CJASN BACKGROUND AND OBJECTIVES:Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Baseline (2003-2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m(2)), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography-tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors. RESULTS:Among the 4280 people included in the analysis, the mean±SD annual eGFR change was -0.57±1.78 ml/min per 1.73 m(2), and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was -0.005 ml/min per 1.73 m(2) (95% confidence interval, -0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria. CONCLUSIONS:The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR. 10.2215/CJN.04960514
Renal function and long-term decline in cognitive function: the Baltimore Longitudinal Study of Aging. Seliger Stephen L,Wendell Carrington R,Waldstein Shari R,Ferrucci Luigi,Zonderman Alan B American journal of nephrology BACKGROUND:Renal disease has been associated with greater risk of dementia and greater cognitive impairment. However, the relationship of lower renal function with long-term decline in specific domains of cognitive function remains unclear among community-dwelling, non-demented individuals. METHODS:Stroke- and dementia-free participants (n = 2,116) were enrolled in the Baltimore Longitudinal Study of Aging, a community-based, prospective, longitudinal study. Renal function was estimated by the inverse of serum creatinine adjusted for age, sex and race and (in sensitivity analyses) estimated glomerular filtration rate (eGFR) using the MDRD formula. Outcome measures were changes in scores on 6 cognitive tests encompassing a range of cognitive functions, measured at 2-year intervals. Mixed-effects regression models examined the longitudinal relations of renal function with cognitive functions after adjusting for demographics, comorbidity and other potential confounders. RESULTS:Mean age at initial testing was 53.9 years (SD 17.1), and 94 participants (4.4%) had an eGFR <60 ml/min/1.73 m(2) and 18.5% had at least one comorbidity. With increasing age, longitudinal increases in creatinine concentrations were associated with more rapid decline in performance on several cognitive measures, including the learning slope of the California Verbal Learning Test, a test of verbal learning (p < 0.01), and the Benton Visual Retention Test, a test of visual memory (p < 0.01). Associations were similar for changes in eGFRMDRD, which was also associated with the rate of decline in verbal memory. CONCLUSION:In a community-based adult population, declines in renal function independently associated with greater long-term declines in visual memory and verbal memory and learning. 10.1159/000430922
Body-fat indicators and kidney function decline in older post-myocardial infarction patients: The Alpha Omega Cohort Study. European journal of preventive cardiology Background Obesity increases risk of hypertension and diabetes, the leading causes of end-stage renal disease. The effect of obesity on kidney function decline in stable post-myocardial infarction patients is poorly documented. This relation was investigated in a large cohort of older post-myocardial infarction patients. Design Data were analysed from 2410 post-myocardial infarction patients in the Alpha Omega Trial, aged 60-80 years receiving optimal pharmacotherapy treatment (79% men, 18% diabetes). Methods Cystatin C based estimated glomerular filtration rate (eGFR) was calculated at baseline and after 41 months, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Obesity was defined as body mass index ≥ 30 kg/m and high waist circumference as ≥102 and ≥88 cm for men and women. The relation between body mass index, waist circumference and annual eGFR decline was evaluated by linear regression. Results At baseline, mean (standard deviation) eGFR was 81.5 (19.6) ml/min/1.73 m, 23% of all patients were obese. After multivariable adjustment, the annual mean (95% confidence interval) eGFR decline in men and women was -1.45 (-1.59 to -1.31) and -0.92 (-1.20 to -0.63) ml/min/1.73 m, respectively ( p = 0.001). Obese versus non-obese patients and patients with high versus normal waist circumference experienced greater annual eGFR decline. Men and women showed an additional annual eGFR decline of -0.35 (-0.56 to -0.14) and -0.21 (-0.55 to 0.14) ml/min/1.73 m per 5 kg/m body mass index increment ( p for interaction 0.3). Conclusions High compared to normal body mass index or waist circumference were associated with more rapid kidney function decline in older stable post-myocardial infarction patients receiving optimal drug therapy. 10.1177/2047487317739986
Rapid decline of kidney function increases cardiovascular risk in the elderly. Shlipak Michael G,Katz Ronit,Kestenbaum Bryan,Siscovick David,Fried Linda,Newman Anne,Rifkin Dena,Sarnak Mark J Journal of the American Society of Nephrology : JASN Chronic kidney disease (CKD), defined at a specific time point, is an important risk factor for cardiovascular disease. Whether the rate of kidney function decline contributes additional cardiovascular risk is unknown. In the Cardiovascular Health Study, we compared the associations of changes in kidney function during the first 7 yr with the incidence of heart failure (HF), myocardial infarction (MI), stroke, and peripheral arterial disease (PAD) during the subsequent 8 yr. We defined a rapid decline in cystatin C-based estimated GFR as >3 ml/min per 1.73 m(2)/yr, on the basis of determination at baseline, year 3, and year 7. Among eligible participants, 1083 (24%) had rapid kidney decline. The incidence of each type of cardiovascular event was significantly higher among patients with rapid decline (all P < 0.001). After multivariate adjustment for demographics, cardiovascular disease risk factors, and baseline kidney function, rapid kidney function decline was significantly associated with HF (adjusted hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.13 to 1.53), MI (HR 1.48; 95% CI 1.21 to 1.83), and PAD (HR 1.67; 95% CI 1.02 to 2.75) but not with stroke (HR 1.19; 95% CI 0.97 to 1.45). The association of rapid decline with each outcome did not differ by the presence or absence of CKD. In conclusion, declining kidney function associates with higher risk for HF, MI, and PAD among patients with or without CKD. 10.1681/ASN.2009050546
Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function. Clinical journal of the American Society of Nephrology : CJASN BACKGROUND AND OBJECTIVES:The relationship of depressive symptoms with kidney function remains poorly investigated. We aimed to evaluate the prospective association between depressive symptoms and rapid decline in kidney function in Chinese adults with normal kidney function. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:A total of 4763 participants with eGFR≥60 ml/min per 1.73 m at baseline were enrolled from the China Health and Retirement Longitudinal Study. Baseline depressive symptoms were determined using a ten-item Center for Epidemiologic Studies Depression scale with a cutoff score of greater than or equal to ten to define high depressive symptoms. The GFR was estimated by a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in kidney function, defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m. Secondary outcome was defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m and to a level of <60 ml/min per 1.73 m at the exit visit. RESULTS:During a median follow-up of 4 years (interquartile range, 3.92-4.00), 260 (6%) participants developed rapid decline in kidney function. Overall, there was a significant positive association between baseline depressive symptoms and rapid decline in kidney function (per five-scores increment; adjusted odds ratio, 1.15; 95% confidence interval, 1.03 to 1.28) after adjustments for major demographic, clinical, or psychosocial covariates. Consistently, compared with participants with low depressive symptoms (total Center for Epidemiologic Studies Depression scale score less than ten), a significantly higher risk of rapid decline in kidney function was found among those with high depressive symptoms (total Center for Epidemiologic Studies Depression scale score greater than or equal to ten; adjusted odds ratio, 1.39; 95% confidence interval, 1.03 to 1.88). Similar results were found for the secondary outcome (per five-scores increment; adjusted odds ratio, 1.26; 95% confidence interval, 1.06 to 1.51). CONCLUSIONS:High depressive symptoms were significantly associated with a higher risk of rapid kidney function decline among Chinese adults with normal kidney function. 10.2215/CJN.18441120
Association between sleep duration and quality with rapid kidney function decline and development of chronic kidney diseases in adults with normal kidney function: The China health and retirement longitudinal study. Frontiers in public health Research have shown that sleep is associated with renal function. However, the potential effects of sleep duration or quality on kidney function in middle-aged and older Chinese adults with normal kidney function has rarely been studied. Our study aimed to investigate the association of sleep and kidney function in middle-aged and older Chinese adults. Four thousand and eighty six participants with an eGFR ≥60 ml/min/1.73 m at baseline were enrolled between 2011 and 2015 from the China Health and Retirement Longitudinal Study. Survey questionnaire data were collected from conducted interviews in the 2011. The eGFR was estimated from serum creatinine and/or cystatin C using the Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI). The primary outcome was defined as rapid kidney function decline. Secondary outcome was defined as rapid kidney function decline with clinical eGFR of <60 ml/min/1.73 m at the exit visit. The associations between sleep duration, sleep quality and renal function decline or chronic kidney disease (CKD) were assessed based with logistic regression model. Our results showed that 244 (6.0%) participants developed rapid decline in kidney function, while 102 (2.5%) developed CKD. In addition, participants who had 3-7 days of poor sleep quality per week had higher risks of CKD development (OR 1.86, 95% CI 1.24-2.80). However, compared with those who had 6-8 h of night-time sleep, no significantly higher risks of rapid decline in kidney function was found among those who had <6 h or >8 h of night time sleep after adjustments for demographic, clinical, or psychosocial covariates. Furthermore, daytime nap did not present significant risk in both rapid eGFR decline or CKD development. In conclusion, sleep quality was significantly associated with the development of CKD in middle-aged and older Chinese adults with normal kidney function. 10.3389/fpubh.2022.1072238
Relationships Between Metabolic Body Composition Status and Rapid Kidney Function Decline in a Community-Based Population: A Prospective Observational Study. Frontiers in public health Obesity and metabolic syndrome are strong risk factors for incident chronic kidney disease (CKD). However, the predictive accuracy of metabolic body composition status (MBCS), which combines the status of obesity and metabolic syndrome, for rapid kidney function decline (RKFD) is unclear. The aim of this study was to investigate the relationship between MBCS and RKFD in a healthy population in a prospective community-based cohort study. In the current study, we followed changes in renal function in 731 people residing in northern Taiwan for 5 years. The participants were divided into four groups according to their MBCS, including metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight (MUOW). We evaluated traditional risk factors for CKD and metabolic profiles. The primary outcome was RKFD, which was defined as a 15% decline in estimated glomerular filtration rate (eGFR) within the first 4 years, and a reduction in eGFR which did not improve in the 5th year. During the study period, a total of 731 participants were enrolled. The incidence of RKFD was 17.1% (125/731). Multiple Cox logistic regression hazard analysis revealed that age, cerebrovascular accident, eGFR, urine albumin-to-creatinine ratio, use of painkillers, depressive mood, MUNW and MUOW were independent predictors of RKFD. After adjusting for age, sex, eGFR and total cholesterol, the participants with MUNW and MUOW had higher hazard ratios (HRs) for RKFD [HR: 2.19, 95% confidence interval (CI): 1.22-3.95 for MUNW; HR: 1.86, 95% CI: 1.21-2.87 for MUOW] than those with MHNW. Similar results were also observed in subgroup analysis of those aged above 65 years. On the basis of the results of this study, we conclude that MBCS was independently associated with RKFD, especially in the older adults. On the basis of our results, we suggest that MUNW and MUOW should be considered as risk factors for RKFD. 10.3389/fpubh.2022.895787
Causal effects of systemic inflammatory regulators on chronic kidney diseases and renal function: a bidirectional Mendelian randomization study. Frontiers in immunology Background:While targeted systemic inflammatory modulators show promise in preventing chronic kidney disease (CKD) progression, the causal link between specific inflammatory factors and CKD remains uncertain. Methods:Using a genome-wide association study of 41 serum cytokines from 8,293 Finnish individuals, we conducted a bidirectional two-sample Mendelian randomization (MR) analysis. In addition, we genetically predicted causal associations between inflammatory factors and 5 phenotypes, including CKD, estimated glomerular filtration rate (eGFR), dialysis, rapid progression of CKD, and rapid decline in eGFR. Inverse variance weighting (IVW) served as the primary MR method, while MR-Egger, weighted median, and MR-pleiotropy residual sum and outlier (MR-PRESSO) were utilized for sensitivity analysis. Cochrane's Q test for heterogeneity. Leave-one-out method ensured stability of MR results, and Bonferroni correction assessed causal relationship strength. Results:Seventeen cytokines were associated with diverse renal outcomes. Among them, after Bonferroni correction test, higher tumor necrosis factor alpha levels were associated with a rapid decrease in eGFR (OR = 1.064, 95% CI 1.028 - 1.103, = 0.001), higher interleukin-4 levels were associated with an increase in eGFR (β = 0.003, 95% CI 0.001 - 0.005, = 0.002), and higher growth regulated oncogene alpha (GROα) levels were associated with an increased risk of CKD (OR=1.035, 95% CI 1.012 - 1.058, = 0.003). In contrast, genetic susceptibility to CKD was associated with an increase in GROa, and a decrease in eGFR may lead to an increase in stem cell factor. We did not find the presence of horizontal pleiotropy during the analysis. Conclusion:We discovered causally related inflammatory factors that contribute to the initiation and progression of CKD at the genetic prediction level. 10.3389/fimmu.2023.1229636
Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial. JAMA internal medicine Importance:Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults. Objective:To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults. Design, Setting, and Participants:This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022. Interventions:Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers. Main Outcomes and Measures:The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y. Results:Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97). Conclusions and Relevance:Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC. Trial Registration:ClinicalTrials.gov Identifier: NCT01072500. 10.1001/jamainternmed.2022.1449
The differential impact of subjective and objective aspects of social engagement on cardiovascular risk factors. Kamiya Yumiko,Whelan Brendan,Timonen Virpi,Kenny Rose Anne BMC geriatrics BACKGROUND:This article provides new insights into the impact of social engagement on CVD risk factors in older adults. We hypothesized that objective (social participation, social ties and marital status) and subjective (emotional support) aspects of social engagement are independently associated with objective measures of cardiovascular risk. METHODS:Data from the English Longitudinal Study on Ageing (ELSA) were analyzed. The effects of social participation, social ties, marital status, and emotional support on hypertension, obesity, high sensitivity C-reactive protein, and fibrinogen were estimated by logistic regression controlling for age, sex, education, physical function, depression, cardiovascular disease, other chronic diseases, physical activity, and smoking. RESULTS:Social participation is a consistent predictor of low risk for four risk factors, even after controlling for a wide range of covariates. Being married is associated with lower risk for hypertension. Social ties and emotional support are not significantly associated with any of the cardiovascular risk factors. CONCLUSION:Our analysis suggests that participation in social activities has a stronger association with CV risk factors than marital status, social ties or emotional support. Different forms of social engagement may therefore have different implications for the biological risk factors involved. 10.1186/1471-2318-10-81
Is social participation associated with cardiovascular disease risk factors? Ellaway Anne,Macintyre Sally Social science & medicine (1982) There is increasing interest in the idea that social participation (operationalised as taking part in formal groups and associations) is an important determinant of health and survival. However, although a large body of literature exists which supports the notion that social contact is associated with good health, few studies have examined whether participation in specific groups and associations is related to specific risk factors, which are in turn linked to a major cause of death. In this paper, we focus on risk markers (BMI, waist-hip ratio, blood pressure, resting heart rate, anxiety and depression) for cardiovascular disease (CVD), which contributes around a third to all cause mortality in the UK. Using survey data (n=2334 individuals) from the West of Scotland Twenty-07 Study, we examine, separately by sex, cross-sectional associations between participation in groups and associations and CVD risk markers. There is no consistent patterning in the results. For some types of groups, there is a relationship between participation and risk factors in one sex but not the other, or better functioning on one health measure but worse in another. The most consistent results are found for psychological distress where, with the exception of church-related activities, participation in groups and associations is related to less distress (although more strongly in men than in women). Our findings do not therefore lend unequivocal support to the notion of social participation having a strong relationship with CVD risk factors at a cross-sectional level. 10.1016/j.socscimed.2006.11.022
Community-level group sports participation and all-cause, cardiovascular disease, and cancer mortality: a 7-year longitudinal study. The international journal of behavioral nutrition and physical activity BACKGROUND:Community-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. METHODS:In this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. "Participation" was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS:Among the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0-52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83-0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81-0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82-1.09). CONCLUSIONS:Our findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups. 10.1186/s12966-024-01592-9
Social Activities, Incident Cardiovascular Disease, and Mortality. Han Sae Hwang,Tavares Jane L,Evans Molly,Saczynski Jane,Burr Jeffrey A Journal of aging and health OBJECTIVE:This study examined the relationships between social activities, incident cardiovascular disease (CVD), and non-CVD mortality among older adults in the United States. METHOD:Data from the Health and Retirement Study (2006-2010) were employed. Two measures of social engagement, volunteering and informal helping, along with two measures of social participation, attendance at religious services and social group meetings, were included. Mediation models for health behaviors were estimated. RESULTS:Multinomial logistic regression models demonstrated that volunteering provided the most consistent results in terms of a lower risk of incident CVD and mortality. Furthermore, volunteering at higher time commitments is related to lower CVD incidence and death; informally helping others at a modest time commitment is related to lower risk of death only. Health behaviors mediated the relationships. Social participation was not related to either CVD or mortality. DISCUSSION:Social activity is a modifiable behavior that may be considered a potential health intervention. 10.1177/0898264316635565
Serum Lipids and Risk of Rapid Renal Function Decline in Treated Hypertensive Adults With Normal Renal Function. Zhang Xianglin,Wang Binyan,Yang Juan,Wang Jiancheng,Yu Yaren,Jiang Chongfei,Xie Liling,Song Yun,Zhong Biyan,Li Youbao,Liang Min,Wang Guobao,Li Jianping,Zhang Yan,Huo Yong,Xu Xiping,Qin Xianhui American journal of hypertension BACKGROUND:We aim to evaluate the effect of different lipids parameters, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), the TG to HDL-C (TG:HDL-C) ratio, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), on the risk of rapid renal function decline and examine any possible effect modifiers in general hypertensive patients with normal renal function. METHODS:A total of 12,549 hypertensive patients with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2 in the renal sub-study of the China Stroke Primary Prevention Trial were included in the analyses. The primary outcome was rapid renal function decline, defined as an average decline in eGFR ≥ 5 ml/min/1.73 m2 per year. RESULTS:The median treatment duration was 4.4 years. After the full adjustment for TC, TG, HDL-C, and other major covariates, a significantly higher risk of rapid renal function decline was found in participants with higher TG [≥150 vs. <150 mg/dl, 7.7% vs. 5.5%; odds ratios (OR): 1.27; 95% confidence interval (CI): 1.06-1.51], higher TG:HDL-C ratio [≥2.7 (median) vs. <2.7, 7.7% vs. 5.0%; OR: 1.39; 95% CI: 1.14-1.71), lower TC (≥200 vs. <200 mg/dl, 6.0% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.93), or lower LDL-C levels (≥130 vs. <130 mg/dl, 6.1% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.94). Moreover, the increased risk of the primary outcome associated with elevated TG was particularly evident among individuals with lower total homocysteine levels [<12.4 (median) vs. ≥ 12.4 μmol/l, P interaction = 0.036]. CONCLUSIONS:Higher TG and TG:HDL-C ratio were independent risk factors for rapid renal function decline in hypertensive adults with normal renal function. 10.1093/ajh/hpz001