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ABSTRACT: Kidney transplantation is the treatment of choice for the majority of pediatric patients with end-stage kidney disease. Previous studies demonstrating racial or gender disparities in access to the deceased donor transplant list could not evaluate the impact of medical concerns or patient preference on waitlist status. We undertook a retrospective cohort study using the NAPRTCS registry to begin to determine barriers to wait list registration for kidney transplantation among pediatric dialysis patients. Clinical and demographic factors were compared in listed vs. non-listed patients. Reasons cited for not listing patients were examined by clinical and demographic factors. At dialysis initiation, 88.7% of pediatric dialysis patients were not on the renal transplant wait list. Twelve months after dialysis initiation, 67.1% of pediatric dialysis patients were not on the wait list. The groups least likely to be on the wait list were infants (adjusted OR 0.23, 95% CI 0.16, 0.32) and girls (adjusted OR 0.78, 95% CI 0.67, 0.90) after adjusting for multiple confounders. The reason most often cited for not listing was medical reason for young infants and that the transplant workup was pending for girls. Further study is needed to identify barriers to wait list registration.
Pediatric Transplantation 04/2011; 15(4):376-83. · 1.48 Impact Factor
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Expert Review of Cardiovascular Therapy 11/2010; 8(11):1497-9.
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The Journal of pediatrics 03/2010; · 4.02 Impact Factor
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ABSTRACT: To evaluate whether sugar-sweetened beverage consumption, a significant source of dietary fructose, is associated with higher serum uric acid levels and blood pressure in adolescents.
We analyzed cross-sectional data from 4867 adolescents aged 12 to 18 years in the National Health and Nutrition Examination Survey, 1999-2004. Dietary data were assessed from 24-hour dietary recall interviews. Sugar-sweetened beverages included fruit drinks, sports drinks, soda, and sweetened coffee or tea. We used multivariate linear regression to evaluate the association of sugar-sweetened beverage consumption with serum uric acid and with blood pressure.
Adolescents who drank more sugar-sweetened beverages tended to be older and male. In the adjusted model, serum uric acid increased by 0.18 mg/dL and systolic blood pressure z-score increased by 0.17 from the lowest to the highest category of sugar-sweetened beverage consumption (P for trend, .01 and .03, respectively).
These results from a nationally representative sample of US adolescents indicate that higher sugar-sweetened beverage consumption is associated with higher serum uric acid levels and systolic blood pressure, which may lead to downstream adverse health outcomes.
The Journal of pediatrics 05/2009; 154(6):807-13. · 4.02 Impact Factor
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ABSTRACT: The goal was to determine the association between cardiovascular risk factors and microalbuminuria in a nationally representative sample of adolescents and to determine whether being overweight modifies this association.
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (1999-2004) for 2515 adolescents 12 to 19 years of age. Cardiovascular risk factors included abdominal obesity, impaired fasting glucose, diabetes mellitus, insulin resistance, high triglyceride levels, low high-density lipoprotein cholesterol levels, hypertension, smoking, and the metabolic syndrome. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30 to 299 mg/g in a random morning sample. Overweight was defined as BMI of > or = 95th percentile, according to the Centers for Disease Control and Prevention 2000 growth charts.
Microalbuminuria was present in 8.9% of adolescents. The prevalence of microalbuminuria was higher among nonoverweight adolescents than among overweight adolescents. The median albumin/creatinine ratio decreased with increasing BMI z scores. The association of microalbuminuria with cardiovascular risk factors differed according to BMI category. Among nonoverweight adolescents, microalbuminuria was not associated with any cardiovascular disease risk factor except for overt diabetes mellitus. Among overweight adolescents, however, microalbuminuria was associated with impaired fasting glucose, insulin resistance, hypertension, and smoking, as well as diabetes mellitus.
For the majority of adolescents, microalbuminuria is not associated with cardiovascular risk factors. Among overweight adolescents, however, microalbuminuria is associated with cardiovascular risk factors. The prognostic importance of microalbuminuria in overweight and nonoverweight adolescents with regard to future cardiovascular and renal disease needs to be defined in prospective studies conducted specifically in children.
PEDIATRICS 01/2008; 121(1):37-45. · 4.47 Impact Factor
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ABSTRACT: The increasing incidence of end-stage renal disease and the epidemic of obesity are major public health problems. We review recent epidemiological evidence that excess weight is an important risk factor for chronic kidney disease and end-stage renal disease.
A cohort study of over 300 000 adults and 8 million years of follow-up determined that elevated BMI was a significant risk factor for end-stage renal disease. This relationship was evident starting at a BMI of 25 kg/m and persisted after adjustment for hypertension and diabetes. A population-based case-control study showed that a BMI of at least 25 kg/m at age 20 was significantly associated with development of advanced chronic kidney disease. This was true even among those without diabetes or hypertension.
Excess weight is a common, strong and modifiable risk factor for chronic kidney disease and end-stage renal disease. Even individuals who are not overtly obese are at risk. Excess weight contributes to chronic kidney disease and end-stage renal disease over and above its role in hypertension and diabetes. Weight loss may represent a novel intervention to reduce risk of chronic kidney disease development and progression.
Current Opinion in Nephrology and Hypertension 04/2007; 16(2):71-6. · 4.33 Impact Factor
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ABSTRACT: Natural killer (NK) cell alloreactivity is reported to mediate strong GvL (graft versus leukemia) effect in patients after haploidentical stem-cell transplantation (SCT) for acute myeloid leukemia (AML). Because subsequent immune reconstitution remains a major concern, we studied NK-cell recovery in 10 patients with AML who received haplomismatched SC transplants, among whom no GvL effect was observed, despite the mismatched immunoglobulin-like receptor (KIR) ligand in the GvH direction for 8 of 10 patients. NK cells generated after SCT exhibited an immature phenotype: the cytotoxic CD3- CD56(dim) subset was small, expression of KIRs and NKp30 was reduced, while CD94/NKG2A expression was increased. This phenotype was associated to in vitro lower levels of cytotoxicity against a K562 cell line and against primary mismatched AML blasts than donor samples. This impaired lysis was correlated with CD94/NKG2A expression in NK cells. Blockading CD94/NKG2A restored lysis against the AML blasts, which all expressed HLA-E, the ligand for CD94/NKG2A. Our present study allows a better understanding of the NK-cell differentiation after SCT. These results revealed that the NK cells generated after haplomismatched SCT are blocked at an immature state characterized by specific phenotypic features and impaired functioning, having potential impact for immune responsiveness and transplantation outcome.
Blood 06/2005; 105(10):4135-42. · 9.90 Impact Factor
