Publications (144) View all
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Article: Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis.
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ABSTRACT: AimsThe effects of statin therapy in patients with chronic kidney disease (CKD) remain uncertain. We undertook a systematic review and meta-analysis to investigate the effects of statin on major clinical outcomes.Methods and resultsWe systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between 1970 and November 2011. We included prospective, randomized, controlled trials assessing the effects of statins on cardiovascular outcomes in people with kidney disease. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Thirty-one trials that include at least one event were identified, providing data for 48 429 patients with CKD, including 6690 major cardiovascular events and 6653 deaths. Statin therapy produced a 23% RR reduction (16-30) for major cardiovascular events (P<0.001), an 18% RR reduction (8-27) for coronary events, and 9% (1-16) reduction in cardiovascular or all-cause deaths, but had no significantly effect on stroke (21%, -12 to 44) or no clear effect on kidney failure events (5%, -1 to 10). Adverse events were not significantly increased by statins, including hepatic (RR 1.13, 95% CI 0.92-1.39) or muscular disorders (RR 1.02, 95% CI 0.95-1.09). Subgroup analysis demonstrated the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (P < 0.001) but that the absolute risk reductions were comparable.Conclusion Statin therapy reduces the risk of major cardiovascular events in patients with chronic kidney disease including those receiving dialysis.European Heart Journal 03/2013; · 10.48 Impact Factor -
Article: Association Between Aristolochic Acid and CKD: A Cross-sectional Survey in China.
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ABSTRACT: BACKGROUND: Long-term intake of herbs containing aristolochic acid (AA) has been reported to be associated with increased risk of chronic kidney disease (CKD), whereas population-based studies are limited. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: A national representative sample of 47,204 adults in China. PREDICTOR: Self-reported long-term use of medications containing AA. OUTCOMES & MEASUREMENTS: CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or the presence of albuminuria, defined as albumin-creatinine ratio >30 mg/g. RESULTS: 467 participants reported long-term AA intake, with a prevalence adjusting for a synthesized weight of 1.5% (95% CI, 1.2%-1.7%). After adjusting for age, sex, and other potential confounders, long-term AA intake was associated with eGFR <60 mL/min/1.73 m2 and albuminuria, with ORs of 1.83 (95% CI, 1.22-2.74) and 1.39 (95% CI, 1.03-1.87), respectively. Further adjustment for intake of nonsteroidal anti-inflammatory drugs did not change ORs substantially. A positive association between accumulated time of AA intake and kidney disease also was observed, with fully adjusted ORs of 1.07 (95% CI, 1.03-1.12) per 6-month longer intake for eGFR <60 mL/min/1.73 m2 and 1.04 (95% CI, 1.01-1.08) per 6-month longer intake for albuminuria. LIMITATIONS: Self-reported intake of herbs containing AA; the AA content of the preparations by weight was unknown; single measurement of indicators of kidney damage. CONCLUSIONS: Long-term intake of medications containing AA is prevalent in China and is associated with the presence of CKD.American Journal of Kidney Diseases 03/2013; · 5.43 Impact Factor -
Article: Common genetic variants of the human uromodulin gene regulate transcription and predict plasma uric acid levels.
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ABSTRACT: Uromodulin (UMOD) genetic variants cause familial juvenile hyperuricemic nephropathy, characterized by hyperuricemia with decreased renal excretion of UMOD and uric acid, suggesting a role for UMOD in the regulation of plasma uric acid. To determine this, we screened common variants across the UMOD locus in one community-based Chinese population of 1000 individuals and the other population from 642 American twins and siblings of European and Hispanic ancestry. Transcriptional activity of promoter variants was estimated in luciferase reporter plasmids transfected into HEK-293 cells and mIMCD3 cells. In the primary Chinese population, we found that carriers of the GCC haplotype had higher plasma uric acid, and three promoter variants were associated with plasma uric acid. UMOD promoter variants displayed reciprocal effects on urine uric acid excretion and plasma uric acid concentration, suggesting a primary effect on renal tubular handling of urate. These UMOD genetic marker-on-trait associations for uric acid were replicated in the independent American cohort. Site-directed mutagenesis at trait-associated UMOD promoter variants altered promoter activity in transfected luciferase reporter plasmids. Thus, UMOD promoter variants seem to initiate a cascade of transcriptional and biochemical changes influencing UMOD secretion, leading to altered plasma uric acid levels.Kidney International advance online publication, 23 January 2013; doi:10.1038/ki.2012.449.Kidney International 01/2013; · 6.61 Impact Factor -
Article: Association between family members of dialysis patients and chronic kidney disease: a multicenter study in China.
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ABSTRACT: BACKGROUND: Family members of patients with end stage renal disease were reported to have an increased prevalence of chronic kidney disease (CKD). However, studies differentiated genetic and non-genetic family members are limited. We sought to investigate the prevalence of CKD among fist-degree relatives and spouses of dialysis patients in China. METHODS: Seventeen dialysis facilities from 4 cities of China including 1062 first-degree relatives and 450 spouses of dialysis patients were enrolled. Sex- and age- matched controls were randomly selected from a representative sample of general population in Beijing. CKD was defined as decreased estimated glomerular (eGFR < 60 mL/min/1.73 m2) or albuminuria. RESULTS: The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis spouses were compared with their counterpart controls, which was 3.8% vs. 7.8% (P < 0.01), 16.8% vs. 14.6% (P = 0.29) and 18.4% vs. 19.8% (P = 0.61), respectively. The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis relatives were also compared with their counterpart controls, which was 1.5% vs. 2.4% (P = 0.12), 14.4% vs. 8.4% (P < 0.01) and 14.6% vs. 10.5% (P < 0.01), respectively. Multivariable Logistic regression analysis indicated that being spouses of dialysis patients is negatively associated with presence of low eGFR, and being relatives of dialysis patients is positively associated with presence of albuminuria. CONCLUSIONS: The association between being family members of dialysis patients and presence of CKD is different between first-degree relatives and spouses. The underlying mechanisms deserve further investigation.BMC Nephrology 01/2013; 14(1):19. · 2.18 Impact Factor -
Article: Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating glomerular filtration rate in the Chinese population.
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ABSTRACT: Background Previous studies have indicated that the performance of glomerular filtration rate (GFR) estimation equations vary according to the races of the target population. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has not been validated in the Chinese population including patients with chronic kidney disease (CKD) and healthy controls.MethodsA total of 977 adult persons (682 patients with CKD and 295 healthy volunteers) from nine renal institutes of university hospitals located in nine geographic regions of China were enrolled in the study. A diagnostic test study comparing the CKD-EPI two-level and four-level race equation, the Modification of Diet in Renal Disease (MDRD) Study equation and the modified MDRD equation for Chinese (the Chinese equation). The (99m)Tc- diethylenetriamine pentaacetic acid dual plasma clearance was used as a reference method for measuring GFR.ResultsThe mean age of participants was 48.3 ± 16.0 years and 479 (49.0%) were male. The CKD-EPI two-level race equation and the Chinese equation performed better than the MDRD Study equation and CKD-EPI four-level race equation, with less bias (median difference between estimated GFR and reference GFR, 0.2 and 0.3 versus -2.4 and 3.0 mL/min/1.73 m(2)), improved precision (interquartile range of the difference, 20.5 and 20.8 versus 23.4 and 20.5 mL/min/1.73 m(2)) and greater accuracy (percentage of estimated GFR within 30% of reference GFR, 73.4 and 73.0% versus 69.8 and 70.1%).Conclusions The CKD-EPI two-level race equation and the Chinese equation performed similarly in the Chinese population, and both performed better than the MDRD Study equation and the CKD-EPI four-level race equation.Nephrology Dialysis Transplantation 11/2012; · 3.40 Impact Factor
