R T Gansevoort

Publications (53)193.21 Total impact

• Article: Copeptin, a surrogate marker for arginine vasopressin, is associated with declining glomerular filtration in patients with diabetes mellitus (ZODIAC-33).

  W E Boertien, I J Riphagen, I Drion, A Alkhalaf, S J L Bakker, K H Groenier, J Struck, P E de Jong, H J G Bilo, N Kleefstra, R T Gansevoort
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  ABSTRACT: AIM/HYPOTHESIS: Arginine vasopressin (AVP), the hormone important for maintaining fluid balance, has been shown to cause kidney damage in rodent models of diabetes. We investigated the potential role of AVP in the natural course of kidney function decline in diabetes in an epidemiological study. METHODS: Plasma copeptin, a surrogate for AVP, was measured in baseline samples from patients with type 2 diabetes treated in primary care and included in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) cohort. RESULTS: Samples from 1,328 patients were available; 349 were analysed separately because they used renin-angiotensin-aldosterone system inhibition (RAASi), which influences albumin/creatinine ratio (ACR) and estimated (e)GFR. In the other 979 patients (46% men, age 68 years [58-75], ACR 1.8 mg/mmol [0.9-5.7], eGFR 67 ± 14 ml min(-1) 1.73 m(-2)) baseline copeptin (5.3 pmol/l [3.2-9.5]) was significantly associated with log e [ACR] and eGFR, even after adjustment for sex, age and risk factors for kidney function decline (standardised [std] β 0.13, p < 0.001, std β -0.20, p < 0.001 respectively). Follow-up data were available for 756 patients (6.5 years [4.1-9.6]). Baseline copeptin was associated with increase in ACR (std β 0.09, p = 0.02), but lost significance after adjustment (std β 0.07, p = 0.08). Copeptin was associated with a decrease in eGFR after adjustment (std β -0.09, p = 0.03). The strength of the association of copeptin with change in eGFR was stronger than that of established risk factors for kidney function decline (e.g. BMI, HbA1c). In patients who used RAASi there was a significant association between baseline copeptin and ACR and eGFR, but not with change in ACR and eGFR. CONCLUSIONS/INTERPRETATION: In patients with diabetes not using RAASi a higher baseline copeptin concentration is significantly associated with higher baseline ACR and lower eGFR values and with a decline in eGFR during follow-up. This last association is independent of, and stronger than, most traditional risk factors for kidney function decline.
  Diabetologia 04/2013; · 6.81 Impact Factor
• Source

  Available from: Petra Zürbig

  Article: A urinary peptide biomarker set predicts worsening of albuminuria in type 2 diabetes mellitus.

  S S Roscioni, D de Zeeuw, M E Hellemons, H Mischak, P Zürbig, S J L Bakker, R T Gansevoort, H Reinhard, F Persson, M Lajer, P Rossing, H J Lambers Heerspink
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  ABSTRACT: AIMS/HYPOTHESIS: Microalbuminuria is considered the first clinical sign of kidney dysfunction and is associated with a poor renal and cardiovascular prognosis in type 2 diabetes. Detection of patients who are prone to develop micro- or macroalbuminuria may represent an effective strategy to start or optimise therapeutic intervention. Here we assessed the value of a urinary proteomic-based risk score (classifier) in predicting the development and progression of microalbuminuria. METHODS: We conducted a prospective case-control study. Cases (n = 44) and controls (n = 44) were selected from the PREVEND (Prevention of Renal and Vascular End-stage Disease) study and from the Steno Diabetes Center (Gentofte, Denmark). Cases were defined by transition from normo- to microalbuminuria or from micro- to macroalbuminuria over a follow-up of 3 years. Controls with no transitions in albuminuria were pair-matched for age, sex and albuminuria status. A model for the progression of albuminuria was built using a proteomic classifier based on 273 urinary peptides. RESULTS: The proteomic classifier was independently associated with transition to micro- or macroalbuminuria (OR 1.35 [95% CI 1.02, 1.79], p = 0.035). The classifier predicted the development and progression of albuminuria on top of albuminuria and estimated GFR (eGFR, area under the receiver operating characteristic [ROC] curve increase of 0.03, p = 0.002; integrated discrimination index [IDI]: 0.105, p = 0.002). Fragments of collagen and α-2-HS-glycoprotein showed significantly different expression between cases and controls. CONCLUSIONS/INTERPRETATION: Although limited by the relatively small sample size, these results suggest that analysis of a urinary biomarker set enables early renal risk assessment in patients with diabetes. Further work is required to confirm the role of urinary proteomics in the prevention of renal failure in diabetes.
  Diabetologia 10/2012; · 6.81 Impact Factor
• Article: Lipid levels do not influence the risk of venous thromboembolism. Results of a population-based cohort study.

  I M van Schouwenburg, B K Mahmoodi, R T Gansevoort, F L H Muntinghe, R P F Dullaart, H C Kluin-Nelemans, N J G M Veeger, K Meijer
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  ABSTRACT: Studies on the association between lipid profile and venous thromboembolism (VTE) are inconsistent. This could be caused by classical lipoproteins being inferior to apolipoproteins as markers for VTE risk. Therefore, we examined whether apolipoproteins are more strongly related to VTE than lipoproteins. For this analysis we used the PREVEND prospective community based observational cohort study. Levels of apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), total cholesterol (TC), high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL), triglycerides (TG), lipoprotein(a), ApoB/ApoA1 and TC/HDL ratio were assessed. Subjects with VTE were identified using databases of the national registries of hospital discharge diagnoses, death certificates, and the regional anticoagulation clinic. Out of 7,627 subjects, 110 developed VTE during a median follow-up of 10.5 years. In both univariate and multivariable analyses no significant associations between apolipoproteins and overall VTE were observed. Of the classical lipoproteins, TC, non-HDL, LDL, TG, and TC/HDL ratio were significantly associated with overall VTE in univariate analysis. Significant associations were no longer present in multivariable analysis. TGL and LDL were significantly associated with unprovoked VTE in univariate analysis. After adjustment for age and sex this significance was lost. No significant associations between (apo-) lipoproteins and provoked VTE were found. We conclude that apolipoproteins are not better in predicting VTE risk than the classical lipoproteins. Our population-based cohort study does not show an association between both apolipoproteins and the classical lipoproteins and VTE risk.
  Thrombosis and Haemostasis 09/2012; 108(5). · 5.04 Impact Factor
• Article: Sex differences in the association between plasma copeptin and incident type 2 diabetes: the Prevention of Renal and Vascular Endstage Disease (PREVEND) study.

  A Abbasi, E Corpeleijn, E Meijer, D Postmus, R T Gansevoort, R O B Gans, J Struck, H L Hillege, R P Stolk, G Navis, S J L Bakker
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  ABSTRACT: Vasopressin plays a role in osmoregulation, glucose homeostasis and inflammation. Therefore, plasma copeptin, the stable C-terminal portion of the precursor of vasopressin, has strong potential as a biomarker for the cardiometabolic syndrome and diabetes. Previous results were contradictory, which may be explained by differences between men and women in responsiveness of the vasopressin system. The aim of this study was to evaluate the usefulness of copeptin for prediction of future type 2 diabetes in men and women separately. From the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, 4,063 women and 3,909 men without diabetes at baseline were included. A total of 208 women and 288 men developed diabetes during a median follow-up of 7.7 years. In multivariable-adjusted models, we observed a stronger association of copeptin with risk of future diabetes in women (OR 1.49 [95% CI 1.24, 1.79]) than in men (OR 1.01 [95% CI 0.85, 1.19]) (p (interaction) < 0.01). The addition of copeptin to the Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR) clinical model improved the discriminative value (C-statistic,+0.007, p = 0.02) and reclassification (integrated discrimination improvement [IDI] = 0.004, p < 0.01) in women. However, we observed no improvement in men. The additive value of copeptin in women was maintained when other independent predictors, such as glucose, high sensitivity C-reactive protein (hs-CRP) and 24 h urinary albumin excretion (UAE), were included in the model. The association of plasma copeptin with the risk of developing diabetes was stronger in women than in men. Plasma copeptin alone, and along with existing biomarkers (glucose, hs-CRP and UAE), significantly improved the risk prediction for diabetes in women.
  Diabetologia 04/2012; 55(7):1963-70. · 6.81 Impact Factor
• Article: Insulin resistance and risk of venous thromboembolism: results of a population-based cohort study.

  I M Van Schouwenburg, B K Mahmoodi, N J G M Veeger, S J L Bakker, H C Kluin-Nelemans, K Meijer, R T Gansevoort
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  ABSTRACT: Obesity is an established risk factor for venous thromboembolism (VTE), but it is uncertain how this is mediated. Insulin resistance has a central role in the pathophysiology of the metabolic effects of obesity. We aimed to investigate whether insulin resistance is a risk factor for VTE. For this analysis we used the PREVEND prospective community-based observational cohort study. Insulin resistance was measured as HOMA-IR (homeostasis model assessment of insulin resistance) and fasting insulin. VTE was assessed using databases of the national registries of hospital discharge diagnoses, death certificates and the regional anticoagulation clinic. Out of 7393 subjects, 114 developed VTE during a median follow-up of 10.5 years. High HOMA-IR was associated with increased risk of VTE after adjustment for traditional cardiovascular risk factors, CRP and markers of endothelial dysfunction (hazard ratio [HR], 1.38; 95% confidence interval [95% CI], 1.09-1.75; P=0.007). When body mass index (BMI) was added to the model, BMI was a strong risk predictor for VTE (HR, 1.53; 95% CI, 1.24-1.88; P<0.001) whereas HOMA-IR no longer showed such an association (HR, 1.11; 95% CI, 0.85-1.43; P=0.45). Results were similar for fasting insulin. Our population-based cohort study shows an increased risk of VTE in subjects with increasing insulin resistance but not independently of BMI.
  Journal of Thrombosis and Haemostasis 03/2012; 10(6):1012-8. · 5.73 Impact Factor
• Article: The fibrosis marker galectin‐3 and outcome in the general population

  R. A. de Boer, D. J. van Veldhuisen, R. T. Gansevoort, A. C. Muller Kobold, W. H. van Gilst, H. L. Hillege, S. J. L. Bakker, P. van der Harst
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  ABSTRACT:   de Boer RA, van Veldhuisen DJ, Gansevoort RT, Muller Kobold AC, van Gilst WH, Hillege HL, Bakker SJL, van der Harst P (University of Groningen). The fibrosis marker galectin-3 and outcome in the general population. J Intern Med 2012; 272: 55–64.Objective.  Galectin-3 is involved in fibrosis and inflammation and plays a role in heart failure, renal disease, obesity and cancer. We aimed to establish the relationship between galectin-3 and cardiovascular (CV) risk factors and mortality in the general population.Design and subjects.  This study included 7968 subjects from the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort, with a median follow-up of approximately 10 years. Plasma galectin-3 was measured in baseline samples.Main outcome measures.  We investigated the relationships between galectin-3 levels, demographic characteristics and risk factors of CV disease. We determined the prognostic value for all-cause, CV and cancer mortality.Results.  The mean age of the population was 50 ± 13 years. Mean blood pressure was 129/74 mmHg, mean cholesterol was 5.7 ± 1.1 mmol L−1 and median galectin-3 was 10.9 ng mL−1 [interquartile range (IQR) 9.0–13.1]. Galectin-3 levels correlated with a wide range of risk factors of CV disease, including blood pressure, serum lipids, body mass index, renal function and N-terminal pro-B-type natriuretic peptide (P < 0.0001). We observed a strong association between galectin-3 and age. Furthermore, we found a gender interaction, with female subjects (n = 4001) having higher median galectin-3 levels (11.0 ng mL−1, IQR 9.1–13.4 vs. men (n = 3967) 10.7 ng mL−1, IQR 8.9–12.8; P < 0.0001), and galectin-3 levels in women more strongly correlated with risk factors of CV disease. After correction for the classical CV risk factors (smoking, blood pressure, cholesterol and diabetes), galectin-3 levels independently predicted all-cause mortality (hazard ratio per SD galectin-3 1.09, 95% CI 1.01–1.19; P = 0.036), but not CV and cancer mortality separately.Conclusions.  Galectin-3 is associated with age and risk factors of CV disease, with a strong gender interaction for these correlations. Galectin-3 predicts all-cause mortality in the general population.
  Journal of Internal Medicine 11/2011; 272(1):55 - 64. · 5.48 Impact Factor
• Article: The fibrosis marker galectin-3 and outcome in the general population.

  R A de Boer, D J van Veldhuisen, R T Gansevoort, A C Muller Kobold, W H van Gilst, H L Hillege, S J L Bakker, P van der Harst
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  ABSTRACT: Galectin-3 is involved in fibrosis and inflammation and plays a role in heart failure, renal disease, obesity and cancer. We aimed to establish the relationship between galectin-3 and cardiovascular (CV) risk factors and mortality in the general population. This study included 7968 subjects from the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort, with a median follow-up of approximately 10 years. Plasma galectin-3 was measured in baseline samples. We investigated the relationships between galectin-3 levels, demographic characteristics and risk factors of CV disease. We determined the prognostic value for all-cause, CV and cancer mortality. The mean age of the population was 50 ± 13 years. Mean blood pressure was 129/74 mmHg, mean cholesterol was 5.7 ± 1.1 mmol L(-1) and median galectin-3 was 10.9 ng mL(-1) [interquartile range (IQR) 9.0-13.1]. Galectin-3 levels correlated with a wide range of risk factors of CV disease, including blood pressure, serum lipids, body mass index, renal function and N-terminal pro-B-type natriuretic peptide (P < 0.0001). We observed a strong association between galectin-3 and age. Furthermore, we found a gender interaction, with female subjects (n = 4001) having higher median galectin-3 levels (11.0 ng mL(-1) , IQR 9.1-13.4 vs. men (n = 3967) 10.7 ng mL(-1) , IQR 8.9-12.8; P < 0.0001), and galectin-3 levels in women more strongly correlated with risk factors of CV disease. After correction for the classical CV risk factors (smoking, blood pressure, cholesterol and diabetes), galectin-3 levels independently predicted all-cause mortality (hazard ratio per SD galectin-3 1.09, 95% CI 1.01-1.19; P = 0.036), but not CV and cancer mortality separately. Galectin-3 is associated with age and risk factors of CV disease, with a strong gender interaction for these correlations. Galectin-3 predicts all-cause mortality in the general population.
  Journal of Internal Medicine 10/2011; 272(1):55-64. · 5.48 Impact Factor
• Article: Plasma procalcitonin and risk of type 2 diabetes in the general population.

  A Abbasi, E Corpeleijn, D Postmus, R T Gansevoort, P E de Jong, R O B Gans, J Struck, H L Hillege, R P Stolk, G Navis, S J L Bakker
  Diabetologia 06/2011; 54(9):2463-5. · 6.81 Impact Factor
• Article: Therapeutic potential of vasopressin V2 receptor antagonist in a mouse model for autosomal dominant polycystic kidney disease: optimal timing and dosing of the drug.

  E Meijer, R T Gansevoort, P E de Jong, A M van der Wal, W N Leonhard, S R de Krey, J van den Born, G M Mulder, H van Goor, J Struck, E de Heer, D J M Peters
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  ABSTRACT: The renoprotective effect of vasopressin V2 receptor antagonist (V2RA) is currently being tested in a clinical trial in early autosomal dominant polycystic kidney disease (ADPKD). If efficacious, this warrants life-long treatment with V2RA, however, with associated side effects as polydipsia and polyuria. We questioned whether we could reduce the side effects without influencing the renoprotective effect by starting the treatment later in the disease or by lowering drug dosage. To investigate this, we administered V2RA OPC-31260 at a high (0.1%) and low (0.05%) dose to a tamoxifen-inducible kidney epithelium-specific Pkd1-deletion mouse model starting treatment at Day 21 (early) or 42 (advanced). After 3 and 6 weeks of treatment, we monitored physiologic and potential renoprotective effects. Initiation of V2RA treatment at advanced stage of the disease lacked renoprotective effects and had less pronounced physiologic effects than early initiation. After 3 weeks on a high dose, cyst ratio and kidney weight were reduced versus untreated controls (18 versus 25%, P = 0.05, and 0.33 versus 0.45 g, P = 0.03, respectively). After 6 weeks of treatment, however, this did not reach significance anymore, even at a high dose (cyst ratio 24 versus 27%, P = 0.12, and kidney weight 0.55 versus 0.66 g, P = 0.38). Our results suggest that intervention with V2RA should be instituted early in ADPKD and that it might be necessary to further increase the dosage of this drug later in the disease to decrease cyst growth.
  Nephrology Dialysis Transplantation 03/2011; 26(8):2445-53. · 3.40 Impact Factor
• Article: Apolipoprotein B/A-I and total cholesterol/high-density lipoprotein cholesterol ratios both predict cardiovascular events in the general population independently of nonlipid risk factors, albuminuria and C-reactive protein.

  P J W H Kappelle, R T Gansevoort, J L Hillege, B H R Wolffenbuttel, R P F Dullaart
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  ABSTRACT: the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and apolipoprotein (apo) B/A-I ratios predict major adverse cardiovascular events (MACEs). The extent to which these associations are modified by high-sensitivity C-reactive protein (hs-CRP) and albuminuria is largely unknown. We compared the strength of these ratios with first MACE in the general population and determined whether these associations remain when taking account of these risk markers. a prospective case-cohort study was performed among 6948 subjects (PREVEND cohort) without previous cardiovascular disease and who did not use lipid-lowering drugs initially. Fasting serum TC, low-density lipoprotein cholesterol (LDL-C), HDL-C, non-HDL-C, apoB, apoA-I, triglycerides, hs-CRP and albuminuria were measured at baseline. The composite endpoint was incident MACE. a total of 362 first cardiovascular events occurred during 7.9 years of follow-up. All pro- and anti-atherogenic measures of lipoproteins and apos predicted MACEs in age- and sex-adjusted Cox proportional hazard analyses (P = 0.018 to P < 0.001). The age- and sex-adjusted hazard ratio (HR) was 1.37 [95% confidence interval (CI), 1.26-1.48] for the apoB/apoA-I ratio and 1.24 (95% CI, 1.18-1.29) for the TC/HDL-C ratio (both P < 0.001). These relationships were essentially unaltered after additional adjustment for triglyceride levels. Pair-wise comparison revealed that these ratios were of similar importance in age- and sex-adjusted analysis (P = 0.397). The HRs of apoB/apoA-I (P < 0.001) and TC/HDL-C (P < 0.001) for risk of MACEs were only marginally attenuated by additional controlling for traditional risk factors (hypertension, diabetes, obesity and smoking), hs-CRP and albuminuria. first MACE is associated with both the fasting serum apoB/apoA-I ratio and the TC/HDL-C ratio in the general population, independently of triglycerides, hs-CRP and albuminuria.
  Journal of Internal Medicine 02/2011; 269(2):232-42. · 5.48 Impact Factor
• Article: Potential deleterious effects of vasopressin in chronic kidney disease and particularly autosomal dominant polycystic kidney disease.

  E Meijer, W E Boertien, R Zietse, R T Gansevoort
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  ABSTRACT: The antidiuretic hormone vasopressin is crucial for regulating free water clearance in normal physiology. However, it has also been hypothesized that vasopressin has deleterious effects on the kidney. Vasopressin is elevated in animals and patients with chronic kidney disease. Suppression of vasopressin activity reduces proteinuria, renal hypertrophy, glomerulosclerosis and tubulointerstitial fibrosis in animal models. The potential detrimental influence of vasopressin is probably mediated by its effects on mesangial cell proliferation, renin secretion, renal hemodynamics, and blood pressure. In this review, we discuss the increasing body of evidence pointing towards the contribution of vasopressin to chronic kidney disease progression in general and to autosomal dominant polycystic kidney disease in particular. These data allude to the possibility that interventions directed at lowering vasopressin activity, for example by the administration of vasopressin receptor antagonists or by drinking more water, may be beneficial in chronic kidney disease.
  Kidney and Blood Pressure Research 01/2011; 34(4):235-44. · 1.46 Impact Factor
• Article: Chronic kidney disease stages 1-3 increase the risk of venous thrombosis.

  G Ocak, M Verduijn, C Y Vossen, W M Lijfering, F W Dekker, F R Rosendaal, R T Gansevoort, B K Mahmoodi
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  ABSTRACT: End-stage renal disease has been associated with venous thrombosis (VT). However, the risk of VT in the early stages of chronic kidney disease (CKD) has not yet been investigated. The aim of this study was to investigate whether CKD patients with stage 1-3 disease are at increased risk of VT. Eight thousand four hundred and ninety-five subjects were included in a prospective cohort study, in which renal function and albuminuria were assessed, starting in 1997-1998, and were followed for the occurrence of VT until 1 June 2007. CKD patients were staged according to the Kidney Disease Outcomes Quality Initiative guidelines, on the basis of 24-h urine albumin excretion and estimated glomerular filtration rates. Objectively verified symptomatic VT was considered to be the endpoint. Of the 8495 subjects, 243 had CKD stage 1, 856 CKD stage 2, and 491 CKD stage 3. During a median follow-up period of 9.2 years, 128 individuals developed VT. The hazard ratios (HRs) for CKD stages 1, 2 and 3 were, respectively, 2.2 [95% confidence interval (CI) 0.9-5.1], 1.9 (95% CI 1.1-3.1) and 1.6 (95% CI 0.9-2.8) relative to those without CKD after adjustment for age, sex, body mass index, hypertension, diabetes, malignancy, and high-sensitivity C-reactive protein. Subjects with CKD stage 3 and albuminuria (≥ 30 mg d(-1)) had an adjusted HR of 3.0, and subjects with CKD stage 3 without albuminuria had an adjusted HR of 1.0. CKD stages 1 and 2, and CKD stage 3 in the presence of albuminuria, are risk factors for VT. The risk of VT is more related to albuminuria than to impaired glomerular filtration rate.
  Journal of Thrombosis and Haemostasis 11/2010; 8(11):2428-35. · 5.73 Impact Factor
• Article: Alkalinization of urine samples preserves albumin concentrations during prolonged frozen storage in patients with diabetes mellitus.

  H J Lambers Heerspink, F L Nauta, C P van der Zee, J W Brinkman, R T Gansevoort, D de Zeeuw, S J L Bakker
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  ABSTRACT: In epidemiological studies in patients with diabetes, urine samples are often stored frozen prior to assessment of urinary albumin concentration (UAC). However, prolonged frozen storage may result in a falsely low UAC. In the current study, we investigated whether adjustment of urinary pH to alkaline values prior to frozen storage can prevent this problem. Urine samples were collected in 90 patients from our diabetes outpatient clinic and divided into two portions. One portion was first adjusted to pH > 8.0 with 0.1 m sodium hydroxide, the other was left unprocessed. Both portions were divided into aliquots. UAC was assessed in fresh samples and after 7 days, 1, 6 and 12 months of storage at -20 and -80 degrees C. Until 1 month of storage there were no significant changes in UAC. After longer storage, UAC fell significantly in pH unadjusted samples stored at -20 degrees C, with a -7.6% (27.8) and -13.6% (31.7) change after 6 and 12 months storage, respectively. No significant change in UAC occurred in pH adjusted samples stored at -20 degrees C or when samples were stored at -80 degrees C, both with and without pH adjustment. Variation in UAC assessed after 12 months of storage was larger for samples stored at -20 degrees C without adjustment of pH than for the samples stored with pH adjustment or stored at -80 degrees C. Urine alkalinization to pH > 8.0 prevents the decline in UAC associated with 12 months of frozen storage at -20 degrees C and results in lower variation between samples after storage.
  Diabetic Medicine 05/2009; 26(5):556-9. · 2.90 Impact Factor
• Source

  Available from: Marjan Alssema

  Article: [Finnish questionnaire reasonably good predictor of the incidence of diabetes in The Netherlands].

  M Alssema, E J M Feskens, S J L Bakker, R T Gansevoort, J M A Boer, R J Heine, G Nijpels, C D A Stehouwer, M van der Kraan, J M Dekker
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  ABSTRACT: To establish whether the Finnish diabetes risk score for predicting the incidence of diabetes (FINDRISK) is also valid in the Netherlands, and to choose cut-off points suitable for the Dutch situation. . Descriptive. The FINDRISK was validated in 3 Dutch cohort studies by means of repeated glucose measurements: the Hoorn study (n=5434), the PREVEND study (n=2713) and part of the Maastricht cohort from the MORGEN study (n=863). The predictive value was evaluated using receiver operating characteristic (ROC) analyses. The risk categories were defined on the basis of sensitivity, specificity and positive predictive value. The predictive value of the FINDRISK was best in the PREVEND cohort (area under the ROC curve 0.77) and was lower for the Hoorn study and the Maastricht cohort (area under the ROC-curve 0.71 for both). The scores were divided into three risk categories: low risk (score lower than 7), slightly increased risk (score 7-9) and increased risk (score so or higher). The percentage of persons with incident diabetes within about 5 years was < 6 in the low risk category, 6-14 in the category with slightly increased risk and 12-26 in the category with increased risk. 16-28% of the Dutch population studied had a score of 10 or higher. The FINDRISK is a reasonably good predictor for incident diabetes in the Netherlands.
  Nederlands tijdschrift voor geneeskunde 12/2008; 152(44):2418-24.
• Article: [Population screening for urinary protein loss: a sensible action].

  P E de Jong, R T Gansevoort, J F M Wetzels
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  ABSTRACT: In 2006, the Dutch Nierstichting (Kidney Foundation) provided people with urinary dipsticks to determine whether they suffered from urinary protein loss. It was suspected that 0.5% of adult inhabitants would have hidden renal disease. Within two weeks, more than one million people had applied to receive the dipsticks. They were advised to contact their general practitioner if they tested positive. Blockade of the renin-angiotensin-aldosterone system (RAAS) in subjects with known renal disease and proteinuria improves renal and cardiac survival. However, many patients currently develop end-stage renal disease without prior knowledge ofhaving chronic kidney disease. These patients can be detected by screening for proteinuria or albuminuria. Japanese studies showed that about 5% of the general population have positive dipstick tests. It is to be expected that about 1% will be truly macroalbuminuric and another 2-3% will be microalbuminuric. Macroalbuminuria is the consequence of manifest glomerular damage, while microalbuminuria is in most cases related to underlying diabetes or hypertension (which frequently are not yet diagnosed). In both conditions, treatment with RAAS blockade is indicated and is aimed at both cardiac and renal protection. There are arguments indicating that screening of the general population for urinary protein loss is cost-effective.
  Nederlands tijdschrift voor geneeskunde 06/2007; 151(19):1055-8.
• Article: [Estimating renal function with formulas].

  J C Verhave, J F M Wetzels, S J L Bakker, R T Gansevoort
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  ABSTRACT: A glomerular filtration rate (GFR) <60 ml/min/1.73 m2 is associated with an increased risk of cardiovascular disease and renal insufficiency. The formula of the 'Modification of diet in renal disease' (MDRD) study is derived from plasma-creatinine concentrations and estimates GFR based on age, sex and race. Many clinical laboratories have started to report estimated GFR using this formula, which may lead to earlier recognition of chronic kidney disease. Clinicians should understand for which patients the MDRD formula may be appropriate and be aware of its limitations.
  Nederlands tijdschrift voor geneeskunde 05/2007; 151(18):1002-4.
• Article: The predictive value of renal vascular resistance for late renal allograft loss.

  A P J de Vries, W J van Son, J J Homan van der Heide, R J Ploeg, G Navis, P E de Jong, R O B Gans, S J L Bakker, R T Gansevoort
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  ABSTRACT: The renal artery resistance index (RI), assessed by Doppler ultrasonography, was recently identified as a new risk marker for late renal allograft loss. This finding requires confirmation since RI in that study was not measured at predetermined time points and ultrasonography is operator-dependent. We investigated the predictive value of renal vascular resistance (RVR), a less operator-dependent method as assessed by mean arterial pressure divided by renal blood flow, for the prediction of recipient mortality and death-censored graft loss. RVR was compared to commonly used risk markers such as creatinine clearance (CrCl), serum creatinine (SCreat) and proteinuria (UProt) in 793 first-time cadaveric renal transplant recipients at predetermined time points after transplantation using receiver operating characteristics (ROC) and Cox survival analyses. The present study showed that RVR is a prominent risk marker for recipient mortality and death-censored graft loss. However, the predictive value of RVR for recipient mortality owed mainly to the impact of mean arterial blood pressure. In contrast, RVR constituted more than the sum of its components for death-censored graft loss, but showed less predictive value than SCreat in univariate analysis. As the assessment of RVR is expensive and time-consuming, we believe that RVR holds no clinical merit for the follow-up of renal transplant recipients.
  American Journal of Transplantation 03/2006; 6(2):364-70. · 6.39 Impact Factor
• Article: [Prevention of contrast nephropathy; guidelines from the Department Nephrology of the University Medical Centre Groningen].

  I A Huisman, C A Stegeman, R O B Gans, R T Gansevoort
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  ABSTRACT: Contrast nephropathy' is commonly defined as an increase in serum creatinine concentration of more than 44 micromol/l or 25% of the reference value within 48 hours after administration of radiological contrast media. Risk factors are pre-existing renal dysfunction, diabetes mellitus, heart failure, paraproteinaemia, advanced age, use of nephrotoxic medication, intra-arterial use of contrast media and use of large volumes of contrast media. The only form of therapy possible is supportive care, such as renal function replacement therapy. Prevention of contrast nephropathy is of great importance. For patients with risk factors, the treatment of first choice is hydration with intravenous sodium chloride 0.9% combined with oral acetylcysteine given before and after the administration of contrast media.
  Nederlands tijdschrift voor geneeskunde 11/2005; 149(42):2329-33.
• Article: [Methods of collecting urine for the determination of microalbuminuria: time for consensus].

  R T Gansevoort, S J L Bakker, D de Zeeuw, P E de Jong
  Nederlands tijdschrift voor geneeskunde 01/2005; 148(51):2563; author reply 2564.
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  Available from: Johannes G M Burgerhof

  Article: Sodium intake affects urinary albumin excretion especially in overweight subjects.

  J C Verhave, H L Hillege, J G M Burgerhof, W M T Janssen, R T Gansevoort, G J Navis, D de Zeeuw, P E de Jong
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  ABSTRACT: To examine the relationship between sodium intake and urinary albumin excretion, being an established risk marker for later cardiovascular morbidity and mortality. Cross-sectional cohort study using linear regression analysis. Setting. University hospital outpatient clinic. A cohort drawn from the general population, consisting of 7850 subjects 28-75 years of age, all inhabitants of the city of Groningen, the Netherlands. The cohort is enriched for the presence of subjects with elevated urinary albumin concentration. The results show a positive relationship between dietary sodium intake and urinary albumin excretion. The association was independent of other cardiovascular risk factors (such as sex, age, blood pressure, body mass index (BMI), waist-to-hip ratio, serum cholesterol, plasma glucose and smoking) and other food constituents (calcium, potassium and protein). The relationship between sodium intake and urinary albumin excretion was steeper in subjects with a higher BMI compared with a lower BMI. Sodium intake is positively related to urinary albumin excretion. This relation is more pronounced in subjects with a higher BMI. These results suggest that high sodium intake may unfavourably influences cardiovascular prognosis especially in overweight and obese subjects.
  Journal of Internal Medicine 11/2004; 256(4):324-30. · 5.48 Impact Factor