No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Alcohol consumption and kidney function decline in the elderly: Alcohol and Kidney Disease
Abstract
Alcohol consumption appears to be protective for cardiovascular disease; however, its relationship with kidney disease is unclear.
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.
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.
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.
... predisposition to death (Akinluyi et al., 2022;Shih et al., 2003). The immoderate intake of alcohol has been associated with numerous pathologies in previous studies, including cardiovascular diseases (CVD), alcoholic liver disease (ALD), memory loss, impaired cognition, movement disorders, and chronic kidney diseases (CKD), among other diseases (Menon et al., 2010;Fan et al., 2019). However, the relative impact on renal function has been consistently detrimental as seen in CKD patients with a history of alcoholism (Murray Epstein, 2016;Ajirioghene et al. 2021), yet the mechanisms are mostly unknown. ...
... However, the relative impact on renal function has been consistently detrimental as seen in CKD patients with a history of alcoholism (Murray Epstein, 2016;Ajirioghene et al. 2021), yet the mechanisms are mostly unknown. With the outbreak of these diseases associated with alcohol intoxication and exposure to stressor, the use of modern drug treatment has implicated some level of toxic side effect (Akinluyi et al., 2022;Menon et al., 2010;Shih et al., 2003;Yeh et al., 2014). Moreover, the probable remedy for alcoholic kidney problems without initiating other side effects still remains of utmost focus. ...
... Moreover, the probable remedy for alcoholic kidney problems without initiating other side effects still remains of utmost focus. Studies have associated alcoholism with an elevation of cytotoxic reactive oxygen molecules (pro-oxidants -MDA and nitric oxides), pro-inflammatory cytokines (TNF-alpha, , and a concomitant decrease in antioxidant molecules in multiple organs, through activation of monocyte macrophages that disorient the inflammatory cytokine pathway (Menon et al., 2010;Iheanyichukwu et al. 2021;Ahn et al., 2016;Saito et al., 2021). ...
... Nevertheless, a recent metanalysis concluded that, compared with no consumption, moderate alcohol consumption is associated with a reduced risk of chronic kidney disease [2]. At the level of the general population, the possible effects of alcohol intake on glomerular filtration rate are an unanswered question given that epidemiological studies reported either no independent association [3][4][5][6][7][8], negative association [9,10], or positive association [11][12][13][14][15][16]. The inconsistency of the findings could reflect the confounding effect of several factors, including socio-cultural heterogeneity in the definitions of moderate and heavy drinking patterns [17,18], heterogeneity in the target indices of kidney function [19,20], lack of information on other major dietary modulators of kidney function as protein or salt [2], and the cross-cultural heterogeneity in the type of the predominant alcohol-containing beverages (beer, wine, spirits, etc.) [21]. ...
... Another limitation is the fact that the study did not collect complete information on the habitual diet composition but only data about the dietary intake of sodium, potassium, and protein. However, only 2 of the 14 previous studies on alcohol and kidney function reported data about diet composition [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. The confounding should have been minor for examinees dead during follow-up or lost to follow-up because the differences in alcohol intake were minor and inconsistent in comparisons to examinees with complete data at all exams. ...
... As for the inconsistency of the findings between the present study and the previous studies, alcohol intake did not associate with the change of kidney function over time in five studies (3)(4)(5)(6)(7)(8). Important methodological differences could explain the lack of significant associations in those previous studies. ...
Data are conflicting about the effects of alcohol intake on kidney function. This population-based study investigated associations of alcohol intake with kidney function and mortality. The study cohort included adult participants in Exam-1, Exam-2 (6-year follow-up), and Exam-3 (20-year follow-up) of the Gubbio study. Kidney function was evaluated as estimated glomerular filtration rate (eGFR, CKD-Epi equation, mL/min × 1.73 m2). Daily habitual alcohol intake was assessed by questionnaires. Wine intake accounted for >94% of total alcohol intake at all exams. Alcohol intake significantly tracked over time (R > 0.66, p < 0.001). Alcohol intake distribution was skewed at all exams (skewness > 2) and was divided into four strata for analyses (g/day = 0, 1–24, 25–48, and >48). Strata of alcohol intake differed substantially for lab markers of alcohol intake (p < 0.001). In multivariable regression, strata of alcohol intake related cross-sectionally to eGFR at all exams (Exam-1: B = 1.70, p < 0.001; Exam-2: B = 1.03, p < 0.001; Exam-3: B = 0.55, p = 0.010) and related longitudinally to less negative eGFR change from Exam-1 to Exam-2 (B = 0.133, p = 0.002) and from Exam-2 to Exam-3 (B = 0.065, p = 0.004). In multivariable Cox models, compared to no intake, intakes > 24 g/day were not associated with different mortality while an intake of 1–24 g/day was associated with lower mortality in the whole cohort (HR = 0.77, p = 0.003) and in the subgroup with eGFR < 60 mL/min × 1.73 m2 (HR = 0.69, p = 0.033). These data indicate a positive independent association of alcohol intake with kidney function not due to a mortality-related selection.
... 5,[10][11][12] Several observational studies have examined the association between moderate alcohol consumption and CKD; however, the results have been inconsistent. Some studies have found no association between moderate alcohol consumption and renal function, [13][14][15][16] whereas others have found a protective association. [17][18][19][20][21] Many of these studies were conducted in homogeneous populations of only whites or males or had relatively small sample sizes. ...
... Although our study found an inverse association between alcohol consumption and CKD, several previous studies have found no association. [13][14][15][16] Studies from the Cardiovascular Health Study and Nurses' Health Study found no significant association between moderate alcohol consumption and kidney function decline; however, they did not examine incident CKD. 14,15 In the Cardiovascular Health Study, kidney function decline was defined as eGFR loss .3 ...
... [13][14][15][16] Studies from the Cardiovascular Health Study and Nurses' Health Study found no significant association between moderate alcohol consumption and kidney function decline; however, they did not examine incident CKD. 14,15 In the Cardiovascular Health Study, kidney function decline was defined as eGFR loss .3 mL/minute/1.73 ...
Objective(s):
Moderate alcohol consumption has been found to be associated with lower risk of coronary heart disease and myocardial infarction, which share similar risk factors and pathophysiology with chronic kidney disease (CKD). However, there is inconsistent evidence on the association between alcohol consumption and CKD.
Design and methods:
We conducted a prospective analysis of 12,692 participants aged 45-64 years from the Atherosclerosis Risk in Communities (ARIC) study. We categorized participants into 6 alcohol consumption categories: never drinkers, former drinkers, ≤1 drink per week, 2 to 7 drinks per week, 8 to 14 drinks per week, and ≥15 drinks per week based on food frequency questionnaire responses at visit 1 (1987-1989). Incident CKD was defined as estimated glomerular filtration rate <60 mL/minute/1.73 m2 accompanied by ≥25% estimated glomerular filtration rate decline, a kidney disease-related hospitalization or death or end-stage renal disease.
Results:
During a median follow-up of 24 years, there were 3,664 cases of incident CKD. Current drinkers were more likely to be men, whites, and to have a higher income level and education level. After adjusting for total energy intake, age, sex, race-center, income, education level, health insurance, smoking, and physical activity, there was no significant association between being a former drinker and risk of incident CKD. Participants who drank ≤1 drink per week, 2 to 7 drinks per week, 8 to 14 drinks per week, and ≥15 drinks per week had, respectively, a 12% (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.79-0.97), 20% (HR: 0.80, 95% CI: 0.72-0.89), 29% (HR: 0.71, 95% CI: 0.62-0.83), and 23% (HR: 0.77, 95% CI: 0.65-0.91) lower risk of CKD compared with never drinkers.
Conclusion(s):
Consuming a low or moderate amount of alcohol may lower the risk of developing CKD. Therefore, moderate consumption of alcohol may not likely be harmful to the kidneys.
... However, recent studies performed to investigate the relationship of alcohol drinking and renal insufficiency have reported inconsistent results. Some studies in the general population have reported that alcohol consumption is inversely associated with the renal dysfunction or the incidence of chronic renal disease [10][11][12][13][14], whereas others have reported that alcohol consumption is positively related to renal impairment [15,16], or that there is no relationship between alcohol consumption and renal function [14,17,18]. Furthermore, there were no studies on alcohol consumption and renal function in Korean population, and the results of previous studies in other populations may be difficult to generalise to Korean populations due to ethnic differences [10,[15][16][17][18][19][20] or dissimilar population subgroups [11,12,18]. ...
... Some studies in the general population have reported that alcohol consumption is inversely associated with the renal dysfunction or the incidence of chronic renal disease [10][11][12][13][14], whereas others have reported that alcohol consumption is positively related to renal impairment [15,16], or that there is no relationship between alcohol consumption and renal function [14,17,18]. Furthermore, there were no studies on alcohol consumption and renal function in Korean population, and the results of previous studies in other populations may be difficult to generalise to Korean populations due to ethnic differences [10,[15][16][17][18][19][20] or dissimilar population subgroups [11,12,18]. The lack of evidence about the influence of alcohol drinking on renal function has limited the use of controls on alcohol drinking as a method for preventing and monitoring the progression of renal insufficiency. ...
... Some studies in the general population have reported that alcohol consumption is inversely associated with the renal dysfunction or the incidence of chronic renal disease [10][11][12][13][14], whereas others have reported that alcohol consumption is positively related to renal impairment [15,16], or that there is no relationship between alcohol consumption and renal function [14,17,18]. Furthermore, there were no studies on alcohol consumption and renal function in Korean population, and the results of previous studies in other populations may be difficult to generalise to Korean populations due to ethnic differences [10,[15][16][17][18][19][20] or dissimilar population subgroups [11,12,18]. The lack of evidence about the influence of alcohol drinking on renal function has limited the use of controls on alcohol drinking as a method for preventing and monitoring the progression of renal insufficiency. ...
Background/aims:
We examined relationships between the average amount of daily alcohol intake, drinking patterns, and renal dysfunction among South Korean adultsaged ≥ 20 years.
Methods:
The analysis used data from the Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional survey of Korean civilians, conducted from January to December 2011. In this study, a sample of 5,251 participants was analysed.
Results:
Compared with abstinence, the odds ratio for a decrease in estimated glomerular filtration rate (eGFR) was 0.14 (95% CI: 0.01-0.91) among heavy drinkers, and 0.42 (95% CI: 0.17-0.98) among binge drinkers and the association between the amount of mean daily alcohol intake, binge-drinking status and a likelihood of reduced eGFR value showed significant trends (p = 0.041 and p = 0.038, respectively), after adjusting for age, smoking status, amount of physical activity, morbid hypertension, diabetes, dyslipidaemia, anaemia and body mass index. There was no significant association between alcohol consumption and the urine albumin to creatinine ratio in men, or between alcohol consumption and renal dysfunction in women.
Conclusions:
Alcohol consumption was inversely associated with a reduction in eGFR in Korean men. However, these findings should be interpreted cautiously, given the other harmful effects related to alcohol consumption, especially heavy and binge drinking.
... 12 However, the effect of moderate alcohol consumption on renal function is still being debated. Some studies on apparently healthy people [13][14][15] identified no increased risk of CKD among regular alcohol consumers. Others 16 reported an inverse relationship between moderate alcohol consumption and the risk of renal dysfunction. ...
... Thus, the review concerned 15 observational studies. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Quality Assessment Criteria ...
... Table 4 shows the measure of association between alcohol consumption and renal function decline and the authors' conclusions, respectively, in case-control (Table 4), cohort (Table 5), and cross-sectional (Table 6) studies. Among the 12 studies examining the adjusted association between moderate alcohol consumption (excluding categories liable to heavy consumption, e.g., .6 drinks/day) and renal function decline, 8 (2 case-control 13,23 and 6 cohort studies 14,15,18,21,22,25 ) found no such association whereas 4 (2 cross-sectional 20,27 and 2 cohort studies 16,19 ) reported an inverse association. ...
The aim of this study was to conduct a systematic review of published observational studies on the association between alcohol consumption and renal functional impairment.
A search of Medline and Scopus (1985 through June 2013) was performed and supplemented with manual searches of bibliographies. Of the 430 studies considered, 15 were judged eligible for this systematic review. The quality of the studies was scored using a checklist of 22 items recommended by the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
Among 12 studies on the adjusted association between moderate alcohol consumption and renal function decline, most of the studies with higher quality scores found no such association. This systematic review indicates that moderate alcohol consumption has not been demonstrated to be a risk factor for kidney function decline.
Although alcohol consumption in selected populations was inversely associated with renal impairment, a beneficial role of alcohol consumption on renal function has not been consistently demonstrated.
... In contrast, Menon et al. could not find any adverse or beneficial effects of alcohol consumption on kidney function in the elderly [88]. A Japanese cohort study also found that CKD is an independent risk factor for higher rates of stroke in men and women. ...
... Since many of the recent clinical studies are observational studies, the "sick quitters" hypothesis is always difficult to clarify. However, some studies confirm that long-term alcohol consumption is not related to eGFR decrease, and light-to-moderate drinking is inversely associated with the risk of CKD after all non-drinkers and former drinkers were excluded at baseline or during follow-up from their studies [80,88]. ...
Excessive drinking of alcohol is becoming a worldwide problem, and people have recognized that there exists
a close relationship between chronic kidney disease (CKD) and alcohol consumption. However, there are many
inconsistencies between experimental and clinical studies on alcohol consumption and kidney damage. The
possible reason for this contradictory conclusion is the complex drinking pattern of humans and some bio-
activators in wine. In addition, the design itself of the clinical studies can also produce conflicting interpreta -
tions of the results. Considering the benefits of light-to-moderate alcohol consumption, we recommend that
CKD patients continue light-to-moderate drinking, which is beneficial to them. Because alcohol consumption
can lead to adverse events, we do not advise non-drinkers to start to drink. Although light-to-moderate alco-
hol consumption may not pose a risk to patients with CKD, the patients’ condition needs to be considered.
Consumption of even small amounts of alcohol can be associated with increased death risk. Additional clini-
cal and experimental studies are needed to clarify the effect of alcohol on the kidneys and alcohol consump -
tion on CKD patients.
... m 2 [12]. A community-based cohort study in the USA investigated the effect of alcohol on kidneys in an elderly population (>65 years old) and found no significant association between the quantity of weekly ethanol consumption and kidney function deterioration [13]. The quantity of alcohol that was consumed weekly was related to a lower risk of developing CKD in a population-based cohort study in the Netherlands [14]. ...
... The results showed no significant association between weekly alcohol intake and kidney function deterioration, which was defined as eGFR reduction more than 3 mL/min/1.73 m 2 per year [13]. The generality of the study is limited, because only elderly individuals were investigated. ...
Alcohol consumption is a significant public health issue worldwide. The rat model and epidemiological studies have both reported conflicting results about the effects of alcohol on the kidneys. We aimed to explore the relationships between alcohol consumption and chronic kidney disease. Data from the National Health Interview Survey, the National Health Insurance research database, and the National Deaths Dataset were used. Standardized in-person interviews were executed in 2001, 2005, and 2009 to obtain the demographic characteristics of study population. The participants were followed up until 2013. The primary outcome was new-onset chronic kidney disease. We analyzed 45,200 adults older than 18 years (50.8% men and 49.2% women), and the overall mean (SD) age was 42.73 (16.64) years. During the 8.5 (3.5) years of follow-up, new-onset chronic kidney disease was recognized in 1535 (5.5%), 292 (2.7%), and 317 (4.9%) non-drinking, social-drinking, and regular-drinking participants, respectively. The participants who were social and regular drinkers had a significantly decreased risk of chronic kidney disease incidence (social drinking: adjusted hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.74–0.97; p = 0.018; regular-drinking: AHR, 0.85; 95% CI, 0.74–0.98; p = 0.024), with baseline demographics and comorbidities adjusted. In conclusion, social and regular drinkers had decreased risk of chronic kidney disease when compared with non-drinkers.
... Several studies have investigated the association of lifestyle factors and the development of kidney disease or renal function decline; the results for some lifestyle factors are inconsistent and few have investigated the impact of overall dietary patterns [5,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] . Thus, the primary aim of our study was to evaluate the association of potentially modifiable lifestyle factors with the development of incident estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 ...
... The association of alcohol intake and changes in renal function has been investigated previously in prospective analyses, with conflicting results. Moderate alcohol consumption was [22] not associated with declining renal function over 11 years follow-up in the Nurses' Health Study [30] and alcohol consumption was not associated with rapid eGFR decline in the CHS [31] , whereas results from the Beaver Dam Study suggest that heavy alcohol intake ( ≥ 4 drinks/day) is associated with an elevated risk of developing CKD over 5 years [32] . Protective associations have also been reported in other study populations. ...
Lifestyle characteristics are modifiable factors that could be targeted as part of chronic kidney disease (CKD) prevention. We sought to determine the association of lifestyle characteristics with incident estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) and rapid eGFR decline in older adults in the United States.
Prospective cohort study of Framingham Offspring participants with baseline eGFR <60 ml/min/1.73 m(2) (n = 1,802) who attended the seventh (1998-2001; baseline) and eighth (2005-2008; follow-up) examinations (mean age = 59 years, 54.8% women). Predictors included measures of diet quality, physical activity, alcohol intake, and current smoking status assessed during baseline. Outcomes were based on creatinine-based eGFR at baseline and follow-up and included incident eGFR <60 ml/min/1.73 m(2) (at follow-up) and rapid eGFR decline (annual eGFR decrease ≥3 ml/min/1.73 m(2)).
Over an average follow-up of 6.6 years, 9.5% (n = 171) of participants developed incident eGFR <60. A trend was observed across quartiles of diet quality, with higher levels of diet quality associated with a decreased odds ratio (OR) of incident eGFR <60 (p trend = 0.045). Higher diet quality was associated with decreased odds of rapid eGFR decline (p trend = 0.03) and was attenuated with additional adjustment (p trend = 0.07). In sensitivity analysis for rapid eGFR decline using a secondary definition (annual eGFR decrease ≥3 and incident eGFR <60), diet associations remained significant with additional adjustment (p trend = 0.04). No associations were observed with physical activity, smoking status, or alcohol intake with incident eGFR <60 or rapid eGFR decline (all p > 0.19).
Higher diet quality may be associated with a decreased risk of incident eGFR <60 ml/min/1.73 m(2), and rapid eGFR decline. Whether adherence to a healthy diet can prevent reduction in kidney function warrants further study. © 2015 S. Karger AG, Basel.
... The current study revealed that 73.4 % of patients had a habit of alcohol consumption, and there was a strong association between chronic kidney disease and alcohol consumption (P-value =. 001, CI 95; 0.88-1.22). Equivalent to the present study, some studies showed that alcohol consumption was correlated with CKD, in contrast with other studies [27][28][29][30]. ...
... Of the 34 publications selected, the present meta-analysis finally included 12 publications [19][20][21][32][33][34][35][36][37][38][39][40] from 11 cohort studies (N = 14,634,940), including the Physicians' Health Study (PHS) study which defined the outcome as eGFR of <55 mL/min [32]. We excluded 23 publications because two publications were crosssectional studies [41,42], two did not assess alcohol consumption (g/day) as a predictor of proteinuria and/or low GFR [43,44], three categorized alcohol consumption into only two levels (none vs. ≥1 drink/day [45], no use vs. use of alcohol [46], and alcohol consumption of <20 vs. ≥20 g/day [47]), four did not stratify current drinkers by alcohol consumption level (g/day) [48][49][50][51], one had the highest alcohol consumption category with the lower boundary of <12 g/day, [52] one had a sex-specific definition of alcohol consumption level [53], one did not define the outcome of CKD [54], seven did not have the outcome of incidence of proteinuria or low GFR [55][56][57][58][59][60][61], one had missing information on the number of participants of alcohol consumption categories [62], and one reported similar results in previous publications [63]. ...
Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular filtration rate (GFR). This systematic review, which included 14,634,940 participants from 11 cohort studies, assessed a dose-dependent association of alcohol consumption and incidence of proteinuria and low estimated GFR (eGFR) of <60 mL/min/1.73 m2. Compared with non-drinkers, the incidence of proteinuria was lower in drinkers with alcohol consumption of ≤12.0 g/day (relative risk 0.87 [95% confidence interval 0.83, 0.92]), but higher in drinkers with alcohol consumption of 36.1-60.0 g/day (1.09 [1.03, 1.15]), suggesting a J-shaped association between alcohol consumption and the incidence of proteinuria. Incidence of low eGFR was lower in drinkers with alcohol consumption of ≤12.0 and 12.1-36.0 than in non-drinkers (≤12.0, 12.1-36.0, and 36.1-60.0 g/day: 0.93 [0.90, 0.95], 0.82 [0.78, 0.86], and 0.89 [0.77, 1.03], respectively), suggesting that drinkers were at lower risk of low eGFR. In conclusion, compared with non-drinkers, mild drinkers were at lower risk of proteinuria and low eGFR, whereas heavy drinkers had a higher risk of proteinuria but a lower risk of low eGFR. The clinical impact of high alcohol consumption should be assessed in well-designed studies.
... No adverse outcome or protective effect of moderate alcohol consumption on kidney function has been shown in general population studies, but a decreased risk of the development of chronic kidney disease has been reported (23)(24)(25)(26). However, other studies reported that a daily alcohol intake of 30 g or more is an independent risk factor for the development of albuminuria (27), 2 units of alcohol per day or more increases the risk of kidney failure (28), and that alcohol use has an adverse impact on kidney function (29)(30)(31). The lack of an significant association between pretransplant and posttransplant alcohol consumption and the changes in the annual kidney function in this study may also be related to the lower proportion of heavy-frequent drinkers or other stronger immunological and demographic factors than alcohol itself. ...
The impact of pretransplant and posttransplant alcohol consumption on outcomes in kidney transplant recipients (KTRs) is uncertain. Self-reported alcohol consumption was obtained at the time of transplant and 2 years after transplant in a prospective cohort study. Among 907 KTRs, 368 (40.6%) were drinkers at the time of transplant. Compared to non-drinkers, alcohol consumption did not affect the risk of death-censored graft failure (DCGF), biopsy-proven acute rejection (BPAR), cardiovascular events, or all-cause mortality. Compared to persistent non-drinkers, the development of DCGF, BPAR, cardiovascular events, all-cause mortality, or posttransplant diabetes mellitus was not affected by the alcohol consumption pattern (persistent, de novo , or stopped drinking) over time. However, de novo drinkers had a significantly higher total cholesterol ( p < 0.001) and low-density lipoprotein cholesterol levels ( p = 0.005) compared to persistent non-drinkers 5 years after transplant, and had significantly higher total cholesterol levels ( p = 0.002) compared to the stopped drinking group 7 years after transplant, even after adjusting for the use of lipid-lowering agents, age, sex, and body mass index. Although pretransplant and posttransplant alcohol consumption were not associated with major outcomes in KTRs during the median follow-up of 6.0 years, a new start of alcohol use after KT results in a relatively poor lipid profile.
Clinical Trial Registration: clinicaltrials.gov , identifier NCT02042963.
... Moderate alcohol consumption most likely reduces the risk of coronary heart disease through its effects on insulin sensitivity, thrombotic activity, and inflammation, leading to reduction in cardiovascular mortality [8,9]. As for the influence of alcohol on kidney function, although several population-based cohort studies have evaluated the relationship between the amount of alcohol consumption and incidence of CKD, these results have been inconsistent; an inverse association [10][11][12][13], a positive association [14][15][16][17], and a J-shaped association [18][19][20][21][22][23] between alcohol intake and incidence of CKD have been reported in longitudinal studies involving the general population. Furthermore, although several studies have evaluated the difference in the clinical impact of alcohol consumption on kidney function based on sex [12,17,22,23], the results have been inconsistent. ...
Background
The difference in the clinical impact of alcohol consumption on kidney function based on sex remains to be elucidated. This study aimed to assess the association between the dose of alcohol consumption and the incidence of proteinuria and chronic kidney disease stratified by sex.
Methods
This retrospective cohort study included 26,788 workers (19,702 men and 7086 women) with normal renal function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m ² ) at annual health examinations between January 2010 and March 2015 in Japan. The main exposure was alcohol consumption. The primary outcomes were the incidence of proteinuria (dipstick urinary protein ≥ 1) and incidence of low estimated glomerular filtration rate (eGFR; rate < 60 mL/min per 1.73 m ² ; decreased from the baseline eGFR by 25%).
Results
During a median observational period of 4 years (interquartile range: 2–6), 1993 (10.1%) men and 462 (6.5%) women developed proteinuria, whereas 667 (3.4%) men and 255 (3.6%) women developed low eGFR. After adjustment for clinically relevant factors using a Cox proportional hazards model, alcohol consumption of ≥ 46 g/day in females was significantly associated with the incidence of proteinuria (hazard ratio, 1.57; 95% confidence interval, 1.10–2.26) and low eGFR (hazard ratio, 1.62; 95% confidence interval, 1.04–2.53). However, no significant association between alcohol consumption and primary outcomes was observed in men.
Conclusions
In conclusion, daily higher alcohol consumption was significantly associated with a higher incidence of proteinuria and low eGFR among women. Women might be prone to high alcohol consumption with kidney dysfunction.
... Hence, the Elderly will be able to reduce their health disease (like kidney disease and hypertension) for example (Khan et al. 2017;Cherng et al. 2018;Román et al. 2019). This is because studies have identified that when the body consumes excessive alcohol and other hard drugs, the kidney gets affected significantly (Cherng et al. 2018;Menon et al. 2010;Khan et al. 2017;Freeman et al. 2017). Therefore, this study that the condition of elderly health being affected by health diseases (such as Diabetes Mellitus, Hypertension, Hypercholesterolemia, Minor Stroke, Kidney Failure and Heart Problem) and healthy eating is negatively related. ...
Despite an increase in average life expectancy among the population due to rapid economic development, there is an epidemic increase in the cases of non-communicable diseases (NCDs) including diabetes, hypertension and stroke, which has caused over 1000 deaths over the years. This study aims to add research contribution by investigating the impact of factors of HPB on elderly health diseases. The target population is Malaysian elderly aged 60 years and above. As an ethnic diversity is an important feature of Malaysia, this study includes all the major ethnicity (such as Malay, Chinese and Indian). The sampling frame chosen includes Perak, Penang, Malacca and Kuala Lumpur, as they have been recorded as some of the states with older populations. This study employed the Logistic Regression Model for analysing the data. 400 questionnaires have been administered. The result indicated that elderly health diseases is significantly affected by the factors of HPB. Hence, Health promotion in health care services for elderly needs active support. Findings suggest that more elderly Health Promotion programs and healthcare policies can be the tools to the empowerment of elderly health condition.
... 51 On the contrary, some studies have reported no association between alcohol consumption and Kd. 16,52 Habitual analgesic and medicine intake (without a medical prescription) were not found to be a risk factor for Kd in this study. This is in agreement with previous studies. ...
Objectives:
We sought to estimate the knowledge, sociodemographic determinants, and risk-inducing lifestyles of kidney disease (KD) among Nigerians living in Lagos State.
Methods:
We conducted a cross-sectional descriptive study to assess the level of knowledge of KD and its associated sociodemographic factors of individuals living in urban and semi-urban communities of Lagos State, Nigeria. It is hoped that the results of this study will help to inform preventive modalities. We used a pretested, structured questionnaire to draw information from 1171 Nigerians aged ≥ 15 years.
Results:
The mean age of respondents was 33.5±11.1 years. In our cohort, 72.4% of respondents were knowledgeable of KD, with media as their major source of information (41.6%). Knowledge of KD was significantly associated with age (p = 0.044), education (p < 0.001), marital status (p < 0.001), and place of residence (p = 0.048). The established KD risk-inducing lifestyle factors were habitual use of herbal supplements, significant alcohol consumption, and diabetes (p < 0.050). Significant predictors of knowledge of KD included primary education (Odds ratio (OR) = 0.367, 95% confidence interval (CI): 0.11-1.22; p =0.102), secondary education (OR = 0.296, 95% CI: 0.17-0.51; p < 0.001), Igbo ethnic group (OR = 1.471, 95% CI: 0.99-2.17; p = 0.047), and place of residence (OR = 1.332, 95% CI: 1.00-1.77; p = 0.048). Age 30-39 years (OR = 0.749, 95% CI: 0.48-1.18; p = 0.214), 40-49 years (OR = 1.083, 95% CI: 0.69-1.69; p = 0.727), and not working (OR = 1.178, 95% CI: 0.88-1.57; p < 0.269) were non-significant predictors of knowledge of KD.
Conclusions:
Our cohort had inadequate knowledge of linking risk-inducing lifestyles to KD development. Effective measures and efforts should be made to create awareness and educate the general population on KD and prevention measures related to risk-inducing lifestyles to reduce the burden of KD among Nigerians.
... Moreover, LDL is the least likely risk factor for kidney dysfunction among cholesterol types 50,57 . In addition, drinking, especially moderate alcohol consumption, has no adverse effect on kidney function 93 . Accordingly, PPIs have the weakest level of evidence for being risk factors for kidney dysfunction 74 . ...
Polypharmacy, the concurrent use of multiple medicines, could increase the risk of kidney dysfunction among older adults because it likely burdens the aging kidneys to excrete multiple pharmaceutical ingredients and their metabolites. This study aimed to examine the relation between polypharmacy and kidney dysfunction among older patients. A nested case-control study was conducted using the National Health Insurance Service - Senior Cohort (NHIS-SC, 2009-2013), representative of the Korean senior population. It consisted of all health insurance claims linked to records of mandatory health examination. Kidney dysfunction was defined as having an eGFR lower than 60, with a decline rate of 10% or more compared to the baseline eGFR. Polypharmacy was defined based on daily counts of pharmaceutical ingredients during one year prior to the case's event date. It was classified into polypharmacy (five to 10 ingredients) and excessive polypharmacy (10 or more ingredients). After matching case and control groups based on a range of potential confounders, conditional logistic regression was performed incorporating adjustments on disease-specific, medication-specific, and lifestyle-related risk factors. The matching resulted in 14,577 pairs of cases and controls. Exposure to polypharmacy was significantly associated with increase in the risk of kidney dysfunction; i.e., crude model (polypharmacy: OR = 1.572, 95% CI = 1.492-1.656; excessive polypharmacy: OR = 2.069, 95% CI = 1.876-2.283) and risk adjustment model (polypharmacy: OR = 1.213, 95% CI = 1.139-1.292; excessive polypharmacy: OR = 1.461, 95% CI = 1.303-1.639). The significant associations were robust across different definitions of kidney dysfunction. These findings inform healthcare providers and policy makers of the importance of polypharmacy prevention to protect older adults from kidney dysfunction.
... 46 GGT is a common marker for alcohol intake and correlates with alcohol intake. 13,14 47 Although various prospective studies have shown the relationship between alcohol 48 consumption and the risk of low eGFR and/or that of proteinuria or albuminuria, [15][16][17][18][19][20][21][22][23][24][25] the 49 results of these studies were inconclusive. Furthermore, as far as we know, there was no 50 prospective study which had examined the joint relationship of serum GGT and alcohol 51 consumption to the risk of low eGFR versus that of proteinuria. ...
Backgound: Serum gamma-glutamyltransferase has been recognized as the risk factor of cardiovascular and metabolic diseases. However, the association between serum gamma-glutamyltransferase and the risk of chronic kidney disease is not well known and no prospective studies have examined separately the relationship of serum gamma-glutamyltransferase with the risk of proteinuria versus that of low estimated glomerular filtration rate (eGFR).
Methods: We prospectively followed 9,341 Japanese men who did not have low eGFR, proteinuria, nor diabetes, and did not take antihypertensive medications at entry for the analysis of proteinuria, and 9,299 men for that of low eGFR. We defined “persistent proteinuria” if proteinuria was detected two or more times consecutively and persistently as ≥1+ on urine dipstick at the annual check-up until the end of follow-up. Low eGFR was defined as eGFR <60 mL/min/1.73 m².
Results: During the 11-year observation period, 151 men developed persistent proteinuria and 1,276 men low eGFR. In multivariate models, the highest quartile (≥71 IU/L) of serum gamma-glutamyltransferase was independently related to the development of persistent proteinuria (hazard ratio 3.39; 95% confidence interval, 1.92-5.97) compared with the lowest quartile (≤25 IU/L). In joint analysis of alcohol consumption and serum gamma-glutamyltransferase, non-drinkers with the highest tertile (≥58 IU/L) of serum gamma-glutamyltransferase had the highest risk of persistent proteinuria. However, there was no association between serum gamma-glutamyltransferase and low eGFR.
Conclusion: In middle-aged Japanese men, elevated serum gamma-glutamyltransferase was independently associated with future persistent proteinuria, but not low eGFR.
... Conflicting results of an association between alcohol consumption and CKD might be due partly to the different definitions of highest alcohol consumption: >15-30 g/day (approximately 1-2 standard drink/day in Europe and US [11,32]) [23,25,26,34,35], > 31-60 g/day [27,36], or > 61 g/day [24,28]. The majority of the previous studies potentially failed in measuring the renal risk of the heavy drinkers with ≥ 60 g/day of alcohol consumption because the smaller number of heavy drinkers were combined with the larger number of moderate (< 15-30 g/day) or supramoderate drinkers. ...
Background:
Previous studies report conflicting results of a dose-dependent association between alcohol consumption and incidence of chronic kidney disease. Only a few studies have assessed the clinical impact of > 45-65 g/day of critically high alcohol consumption.
Methods:
This retrospective cohort study included 88,647 males and 88,925 females with dipstick urinary protein ≤ ± and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2at their first annual health examinations between April 2008 and March 2010 in Japan. The exposure was the self-reported alcohol consumption. The outcome was proteinuria defined as dipstick urinary protein ≥ 1 + or ≥ 2 +.
Results:
During median 1.8 years (interquartile range 1.0-2.1) of the observational period, 5416 (6.1%) males and 3262 (3.7%) females developed proteinuria defined as dipstick urinary protein ≥ 1 +. In males, a U-shape association between alcohol consumption and proteinuria was observed in a multivariable-adjusted Poisson regression model [incidence rate ratio (95% confidence interval) of rare, occasional, and daily drinkers with ≤ 19, 20-39, 40-59, and ≥ 60 g/day: 1.00 (reference), 0.86 (0.79-0.94), 0.70 (0.64-0.78), 0.82 (0.75-0.90), 1.00 (0.90-1.11), and 1.00 (0.85-1.17), respectively], whereas a J-shape association was observed in females [1.00 (reference), 0.81 (0.75-0.87), 0.74 (0.64-0.85), 0.93 (0.78-1.11), 1.09 (0.83-1.44), and 1.45 (1.02-2.08), respectively]. Similar associations with dipstick urinary protein ≥ 2 + were shown in males and females.
Conclusions:
Moderate alcohol consumption was associated with lower risk of proteinuria in both males and females. Females with ≥ 60 g/day of high alcohol consumption were at higher risk of proteinuria, whereas males were not. Females were more vulnerable to high alcohol consumption, than males.
... 23 For renal disease, it remains controversial whether heavy alcohol consumption affects renal prognosis. [24][25][26] Recent cohort studies have shown that moderate alcohol consumption attenuates the decline of GFR. 27 Because various background factors can affect the relevance of alcohol consumption and CKD, a variety of research reports have been reported. ...
Chronic kidney disease (CKD) is characterized by a reduced glomerular filtration rate (GFR) and proteinuria. Modifiable lifestyle factors such as smoking and alcohol contribute to CKD. Recent cohort studies have shown that moderate alcohol consumption attenuates the decline of the GFR and smoking has been previously shown to be associated with CKD. However, the association of smoking and alcohol consumption on CKD is not entirely clear. To examine whether there is evidence to assume that smoking is an effective modifier of the association between CKD and alcohol consumption, we conducted a cross-sectional study of a population of people who presented for a health checkup under a program that targets the insured population aged 40 years using data from the Specific Health Check and Guidance in Japan between April 2008 and March 2009. Of the 506 807 participants aged 40 years, 292 013 (57.6%) were included in the present analysis. Outcomes were kidney dysfunction, as an eGFR of <60 ml/min/1.73 m2, and proteinuria. In nonsmokers, drinking a small amount was associated with a lower prevalence of proteinuria, but in smokers, the association between alcohol and proteinuria was not observed. The analysis regarding eGFR <60 ml/min/1.73 m2 revealed that in both smokers and nonsmokers, alcohol consumption was inversely associated with the risk of CKD. Mild to moderate alcohol consumption might be associated with a lower risk of CKD (proteinuria and eGFR), especially among nonsmokers, because smoking might have modified the potential benefits of alcohol to prevent CKD.
... The effect of alcohol consumption on eGFR decline was controversial. Some studies reported that no association was observed in alcohol intake with the occurrence and progression of CKD 29,30) , and others described that low alcohol consumption (20 -140 g ethanol/week) was associated with an eGFR reduction of 25% in 3 years 31) , and that the risk of an eGFR decline was reduced in the subjects drinking alcohol with 23.0 -69.0 g ethanol/drinking day and 4 -7 times a week 32) . Low alcohol consumption was associated with an eGFR decline in non-CKD participants of this study and alcohol consumption of 40 -59 g/ day exhibited the lowest odds of the eGFR decline. ...
Aim:
Early intervention before the progression of chronic kidney disease (CKD) is essential to prevent end-stage renal disease (ESRD) and cardiovascular complications. This study evaluated the correlation between metabolic and lifestyle-related factors and the decline of estimated glomerular filtration rate (eGFR) over 1 year in a Japanese population without CKD.
Methods:
Subjects who received two consecutive annual health checkups from 2013 to 2015 were involved. Factors associated with eGFR decline were identified using multiple regression models.
Results:
A total of 2531 subjects aged 58.9±11.7 years old were included in this study. Baseline levels of HDL-C and ApoA1 correlated with the eGFR decline over 1 year defined as eGFR reduction rate of 15% or more and/or eGFR at the next year ＜60 ml/min/m(2) (odds ratio (OR) 0.87 (per 10 mg/dl); 95% CI, 0.80-0.94; p=0.0012, 0.90 (per 10 mg/dl); 0.86-0.96; p=0.0004, respectively). A U-shaped relationship between the eGFR decline and HDL-C or ApoA1 levels was not observed in non-CKD population of this study. Metabolic syndrome was significantly associated with eGFR decline (OR 1.32; 1.04-1.67; p=0.0205), although obesity-related factors did not show a significant correlation with eGFR decline over 1 year.
Conclusion:
Low HDL-C and ApoA1 levels significantly correlated with eGFR decline in a short period of 1 year. Metabolic syndrome also showed a significant association with eGFR decline. This study suggests the importance of hypertension and low HDL-C in the metabolic syndrome effect on eGFR decline rather than obesity in non-CKD population.
... With regard to drinking habits, increased risks of renal dysfunctions were shown among the elderly (Buja et al., 2011;Menon et al., 2010), who generally have a lower eGFR and lower rate of alcohol detoxification. Such risks for end-stage renal disease have also been shown in cohort studies that included subjects with an eGFR <30 mL/min 1.73 m 2 (Reynolds et al., 2008;Stengel, Tarver-Carr, Powe, Eberhardt, & Brancati, 2003). ...
... The relationship between an amount of alcohol consumed and kidney function varied from study to study. In a cohort study of the elderly (Cardiovascular Health Study), an amount of alcohol consumed did not correlate with the decrease in eGFR [31]. In a community-based study in Japan, the reduction of risk of incident CKD due to alcohol consumption was not observed in males (mean age, 61.8 years) at alcohol consumption of 20 g/day or more [3]. ...
Background:
Although lifestyle is associated with metabolic syndrome and cardiovascular diseases, there has been no sufficient evidence of lifestyles on incident chronic kidney disease (CKD). The purpose of this prospective cohort study is to investigate the effects of lifestyles on kidney function in healthy people.
Methods:
A total of 7473 healthy people were enrolled in this Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. Data on alcohol consumption, exercise frequency, and sleep duration were collected. The outcome event was incident CKD or decrease in estimated glomerular filtration rate (eGFR) by >25% in 3 years.
Results:
Subjects were classified into four groups according to body mass index and gender. Mean ± standard deviation of age was 38.8±10.5 years; eGFR, 78.1±15.2 ml/min/1.73m2. In the male groups, multivariate logistic regression models showed that the outcome events were associated with a small amount of alcohol consumed (20 to 140g of alcohol/week) (ref. more than 140g of alcohol/week); non-obese male, adjusted odds ratio 1.366 (95% confidence interval, 1.086, 1.718); obese male (body mass index ≥25), 1.634 (1.160, 2.302); and with frequent exercise (twice a week or more) (ref. no exercise); non-obese male, 1.417 (1.144, 1.754); obese male, 1.842 (1.317, 2.577). Sleep duration was not associated with the outcome events.
Conclusion:
These findings suggest that, regardless of obesity, a small amount of alcohol consumed and high exercise frequency were associated with the increased risk of loss of kidney function in the male groups.
... Linear GEE [38,84] log proteinuria Latent class growth analysis [9] Absolute GFR change between each visit and baseline Linear mixed model [299] Relative GFR change each year Linear GEE [163] A summary statistic for the change of renal function Individual slope of -GFR -Creatinine (serum or clearance) -UACR Linear model [37,69,96,97,118,204,224,240,246,251,252,254,267,273,278,[315][316][317][318][319][320][321][322][323][324][325][326][327][328][329][330][331] Absolute GFR change as compared to baseline Linear model [81,245,255,262,[332][333][334] Relative GFR change as compared to baseline Linear model [81] Log of absolute proteinuria change as compared to baseline Linear model [245] Abbreviations: GFR, glomerular filtration rate; GEE, generalized estimating equations; UACR, urine albumin-to-creatinine ratio a Slope of a marker is a summary statistic derived from measurements of a patient Papers that investigated outcomes that are not mentioned in Table 1 Regression models are being used to quantify the effect of an exposure on an outcome, while adjusting for potential confounders. While the type of regression model to be used is determined by the nature of the outcome variable, e.g. ...
The objective of this thesis was to illustrate the benefit of using advanced statistical methods to study associations between risk factors and chrouic kidney disease (CKD) progression. In a first time, we conducted a literature review of statistical methods used to investigate risk factors of CKD progression, identified important methodological issues, and discussed solutions. In our sec ond work, we focused on survival analyses and issues with interval-censoring, which occurs when the event of interest is the progression to a specifie CKD stage, and competing risk with death. A comparison between standard survival models and the illness-death mode! for interval-censored data allowed us to illustrate the impact of modeling on the estimates of both the effects of risk factors and the probabilities of events, using data from the NephroTest cohort. Other works fo cused on analysis of longitudinal data on renal function. We illustrated the interest of linear mixed mode! in this context and presented its extension to account for sub-populations with different trajectories of renal function. We identified five classes, including one with a strong decline and one with an improvement of renal function over time. Severa! perspectives on predictions bind the two types of analyses presented in this thesis.
... 16 Alcohol intake was not associated with rapid kidney function decline (defined as an annual decline 43 ml/min per 1.73 m 2 in a cystatin C-based eGFR) among 4343 subjects, aged 465 years, of the Cardiovascular Health Study. 17 However, alcohol consumption categories did show a positive association with the cystatin C-based eGFR at baseline. ...
There are few reports of associations between alcohol consumption and risk of chronic kidney disease (CKD). To investigate this further, we studied 5476 participants aged 28–75 years in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective population-based cohort, who were free of CKD at baseline (1997/1998). Alcohol consumption was self-reported on a questionnaire validated against serum high-density lipoprotein cholesterol. The primary outcome was de novo CKD defined as a combination of a creatinine–cystatin C–based estimated glomerular filtration rate (eGFR) under 60 ml/min per 1.73 m 2
... 8 Conversely, a number of studies have shown no associations between heavy alcohol drinking and CKD, ESRD and proteinuria. [9][10][11][12][13][14][15][16][17] In addition, a few studies have shown that high alcohol consumption is inversely associated with CKD, 12,[18][19][20][21][22] ESRD 23 and proteinuria. 11,21 The objective of this meta-analysis was to evaluate the associations between high alcohol consumption and progression of kidney damage including CKD, ESRD and proteinuria. ...
Background:
The risk of renal damage in patients with high alcohol consumption is controversial. The objective of this meta-analysis was to evaluate the associations between high alcohol consumption and progression of kidney damage including chronic kidney disease (CKD), end-stage renal disease (ESRD) and proteinuria.
Methods:
A literature search was performed using MEDLINE, EMBASE and Cochrane Databases from inception through August 2014 to identify studies investigating the association between high alcohol consumption and CKD, ESRD or proteinuria. Studies that reported odds ratios, relative risks or hazard ratios comparing the risk of CKD, ESRD or proteinuria in patients consuming high amount of alcohol versus those who did not consume alcohol were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
Results:
Twenty studies with 292 431 patients were included in our analysis to assess the associations between high alcohol consumption and progression of kidney damage. The pooled RRs of CKD, proteinuria and ESRD in patients with high alcohol consumption were 0.83 (95% CI: 0.71-0.98), 0.85 (95% CI: 0.62-1.17) and 1.00 (95% CI: 0.55-1.82), respectively. Post hoc analysis assessing the sex-specific association between high alcohol consumption and CKD demonstrated pooled RRs of 0.72 (95% CI: 0.57-0.90) in males and 0.78 (95% CI: 0.58-1.03) in females.
Conclusions:
Our study demonstrates an inverse association between high alcohol consumption and risk for developing CKD in males. There is no significant association between high alcohol consumption and the risk for developing proteinuria or ESRD.
... As described in our recent literature review [1], the most commonly used approaches to investigate changes of renal function over time are (i) linear regression with individual slopes of decline as the outcome variable (see ref. [2,3]); (ii) linear mixed models (see ref. [4,5]) and (iii) generalized estimating equations (GEEs) (see ref. [6,7]). In the statistical literature, it is well known that linear mixed models have generally a superior performance than linear regression on individual slopes, especially if many patients dropout early [8,9]. ...
Background
The most commonly used methods to investigate risk factors associated with renal function trajectory over time include linear regression on individual glomerular filtration rate (GFR) slopes, linear mixed models and generalized estimating equations (GEEs). The objective of this study was to explain the principles of these three methods and to discuss their advantages and limitations in particular when renal function trajectories are not completely observable due to dropout.
Methods
We generated data from a hypothetical cohort of 200 patients with chronic kidney disease at inclusion and seven subsequent annual measurements of GFR. The data were generated such that both baseline level and slope of GFR over time were associated with baseline albuminuria status. In a second version of the dataset, we assumed that patients systematically dropped out after a GFR measurement of <15 mL/min/1.73 m². Each dataset was analysed with the three methods.
Results
The estimated effects of baseline albuminuria status on GFR slope were similar among the three methods when no patient dropped out. When 32.7% dropped out, standard GEE provided biased estimates of the mean GFR slope in normo-, micro- and macroalbuminuric patients. Linear regression on individual slopes and linear mixed models provided slope estimates of the same magnitude, likely because most patients had at least three GFR measurements. However, the linear mixed model was the only method to provide effect estimates on both slope and baseline level of GFR unaffected by dropout.
Conclusion
This study illustrates that the linear mixed model is the preferred method to investigate risk factors associated with renal function trajectories in studies, where patients may dropout during the study period because of initiation of renal replacement therapy.
... Recent cohort studies have shown that moderate alcohol consumption attenuates the decline of GFR [24]. In contrast, whether heavy alcohol consumption affects renal prognosis [25,26] or not [27][28][29] remains controversial. Regarding GGT, higher serum GGT level is associated with the CKD incidence [30,31], identifying GGT as a predictor of CKD independent of alcohol consumption. ...
The association between alcohol consumption and chronic kidney disease (CKD), characterized by reduced glomerular filtration rate and proteinuria, is controversial. Recent studies suggest that serum γ-glutamyltransferase (GGT) level, a conventional marker of excessive alcohol consumption, predicts the CKD incidence. Little information is available on the difference in the clinical impact of alcohol consumption and GGT on proteinuria.
The present cross-sectional survey included 332,296 Japanese people aged ≥40 years in 2008. To examine the associations of GGT and alcohol consumption with proteinuria, 134,600 men and 197,696 women were classified into 20 categories based on GGT quartiles and alcohol consumption categories, and their prevalence rate ratios (PRR) of proteinuria defined as ≥1+ of dipstick urinary protein were calculated after adjusting for clinically relevant factors.
Prevalence of proteinuria was 7.5 and 3.7 % in men and women, respectively. In both gender an association between alcohol consumption and proteinuria was in a J-shaped fashion with the lowest PRR of mild drinkers with ≤19 g/day of ethanol consumption, whereas an association between serum GGT level and proteinuria was linear. Compared with rare drinkers in the lowest GGT quartile, the subjects in higher GGT quartiles had a higher probability of proteinuria, irrespective of alcohol consumption. An optimal cutoff level of serum GGT was 43.6 and 23.2 IU/L in men and women, respectively.
The subjects with higher serum GGT level had a higher probability of proteinuria, regardless of alcohol consumption, suggesting that GGT has a clinically greater impact on CKD than alcohol consumption.
... On the other hand, in a casecontrol study Perneger et al. (9) found that consumption of two alcoholic drinks daily corresponded to a fourfold increase in the risk of end-stage renal disease, whereas a case-control study by Vuppituri and Sandler (10) identified no increased risk of chronic kidney disease among regular alcohol consumers. While the association between alcohol consumption and renal function in adult populations is still under debate, information on elderly populations is lacking (11) . ...
The influence of moderate alcohol consumption on renal function is not clear in elderly people. The aim of the present study was to investigate the relationship between alcohol consumption and renal function, expressed as serum creatinine levels and glomerular filtration rates (GFR), in an elderly population.
Perspective cohort study.
Population-based study on an elderly Italian population.
A sample of 3404 Italian people (1619 women and 1785 men), aged 65-84 years, from the Italian Longitudinal Study on Aging (ILSA).
Prevalence and cumulative risk of impaired renal function (defined as GFR ≤ 60 ml/min) were estimated by sex and alcohol consumption groups. Logistic regression analysis adjusting for confounders (age, education, smoking, BMI and medications) and intermediate factors (blood cholesterol and fibrinogen, systolic hypertension and diabetes) showed that alcohol consumption level was not significantly related to the prevalence of mild renal impairment in elderly women. In men, both prevalence and incidence results seemed to suggest an inverse linear relationship between moderate alcohol consumption and the risk of mild renal impairment. A U-shaped association was shown for women at the incidence phase, suggesting a higher risk of developing renal impairment for women who drink more than 24 g alcohol/d.
Our results suggest that, in accordance with the recommendations on alcohol consumption in the elderly, moderate quantities of alcohol are not injurious to renal function in elderly men.
... We do not have information on alcohol consumption in our study population. However, alcohol consumption does not appear to impact loss of kidney function [42,43,44]. Common practice dictates that renal hemodynamic parameters be indexed to body surface area (BSA) [45], yet it has been suggested that normalizing to BSA may be inappropriate in the obese [46,47]. ...
Although obstructive sleep apnea (OSA) is more common in patients with kidney disease, whether nocturnal hypoxia affects kidney function is unknown.
We studied all adult subjects referred for diagnostic testing of sleep apnea between July 2005 and December 31 2007 who had serial measurement of their kidney function. Nocturnal hypoxia was defined as oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time. The primary outcome, accelerated loss of kidney function, was defined as a decline in estimated glomerular filtration rate (eGFR) ≥4 ml/min/1.73 m(2) per year.
858 participants were included and followed for a mean study period of 2.1 years. Overall 374 (44%) had nocturnal hypoxia, and 49 (5.7%) had accelerated loss of kidney function. Compared to controls without hypoxia, patients with nocturnal hypoxia had a significant increase in the adjusted risk of accelerated kidney function loss (odds ratio (OR) 2.89, 95% confidence interval [CI] 1.25, 6.67).
Nocturnal hypoxia was independently associated with an increased risk of accelerated kidney function loss. Further studies are required to determine whether treatment and correction of nocturnal hypoxia reduces loss of kidney function.
... Alcohol consumption and physical activity did not seem to influence cystatin C levels in the studied population. This is in accordance with most studies that have been conducted until today [13, 29, 30]. ...
Background. The aim of the present study was to examine sources of variation for serum cystatin C in a healthy Greek population. Methods. Cystatin C together with basic clinical chemistry tests was measured in a total of 490 adults (46 ± 16 yrs, 40% males) who underwent an annual health check. Demographic, anthropometric, and lifestyle characteristics were recorded. Results. Higher values of cystatin C were observed among males (P = .04), participants aged over 65 years (P < .001), current smokers (P = .001) and overweight/obese participants (P = .03). On the contrary, alcohol consumption and physical activity seemed to have no influence on cystatin C levels (P = .61; P = .95, resp.). Conclusions. In interpreting serum cystatin C values in a healthy adult population, age, gender, Body Mass Index, and cigarette smoking need to be considered, and determination of reference ranges among distinct subpopulations seem to be prudent.
Acute alcohol intoxication in burn patients has been associated with increased mortality, renal dysfunction and difficulty with adequate fluid resuscitation. It is less clear how chronic alcohol use, regardless of intoxication status on admission, impacts patient outcomes. In this study, we examine varying levels of alcohol use in burn patients and its impact on both short- and long-term outcomes.
Background and Aims
Alcohol consumption is a major threat to global health. The aim of the present study was to explore the association between alcohol consumption and chronic kidney disease (CKD) in a Chinese population.
Methods and Results
A total of 4664 participants, aged ≥18 years, who participated in a baseline alcohol survey in 1997 and were followed up in 2009 of the China Health and Nutrition Survey (CHNS), were recruited in the current study. Data on alcohol consumption was obtained using standardized questionnaires, with CKD (defined as eGFR < 60 mL/min/1.73 m²) as the outcome. The results showed that 37.3% of the participants had consumed alcohol at the baseline. Current drinkers were mainly men, with at least senior high school education, and a history of smoking In the 2009 survey, 14.5% of the participants had CKD. Association analyses revealed that alcohol drinkers had a lower likelihood of CKD than non-drinkers (11.0% vs. 16.6%, aOR: 0.76, 95%CI: 0.58-1.00), after adjusting potential covariates. Restricted cubic splines revealed that the relationship between alcohol consumption and CKD prevalence was U-shaped. The probability of CKD significantly increased when alcohol consumption exceeded 18 standard drinks per week (aOR: 1.66, 95%CI: 1.00-2.76). Approximately one-fourth of participants changed their drinking patterns during the 12-year follow-up, and male drinkers with persistent drinking patterns had the lowest prevalence of CKD (aOR: 0.48, 95% CI: 0.31-0.73).
Conclusion
Alcohol consumption showed a U-shaped association with CKD. Moderate drinkers exhibited a lower disease prevalence compared with non-drinkers and heavy drinkers. Further studies should be conducted to explore the mechanisms underlying this protective effect. However, non-drinkers should not start drinking alcohol even with this protective effect.
Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current chronic kidney disease (CKD) management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption and tobacco use on the progression of CKD, as measured by decline in glomerular filtration rate, incident end-stage kidney disease, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow up and small sample sizes, and meta-analyses were limited as the studies were sparse, had heterogenous classifications of behaviors and/or referent groups, and of CKD progression. Further research should be done to determine optimal methods to assess behaviors, to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the impact of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, blood pressure control and survival.
Background
The difference in the clinical impact of alcohol consumption on kidney function based on sex remains to be elucidated. This study aimed to assess the association between the dose of alcohol consumption and the incidence of proteinuria and chronic kidney disease stratified by sex.
Methods
This retrospective cohort study included 26,788 workers (19,702 men and 7086 women) with normal renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m²) at annual health examinations between January 2010 and March 2015 in Japan. The main exposure was alcohol consumption. The primary outcomes were the incidence of proteinuria (dipstick urinary protein ≥1) and incidence of chronic kidney disease (an estimated glomerular filtration rate <60 mL/min per 1.73 m² and a 25% decrease from the baseline estimated glomerular filtration rate).
Results
During a median observational period of 4 years (interquartile range: 2–6), 1993 (10.1%) men and 462 (6.5%) women developed proteinuria, whereas 667 (3.4%) men and 255 (3.6%) women developed chronic kidney disease. After adjustment for clinically relevant factors using a Cox proportional hazards model, alcohol consumption of ≥40 g/day in females was significantly associated with the incidence of proteinuria (hazard ratio, 1.65; 95% confidence interval, 1.09–2.51) and chronic kidney disease (hazard ratio, 1.77; 95% confidence interval, 1.09–2.85). However, no significant association between alcohol consumption and primary outcomes was observed in men.
Conclusions
In conclusion, daily higher alcohol consumption was significantly associated with a higher incidence of proteinuria and chronic kidney disease among women. Women might be prone to high alcohol consumption with kidney dysfunction.
Many prospective cohort studies have investigated the association between the consumption of alcohol and CKD risk and have revealed inconsistent results. In the present study, we aimed to perform a meta-analysis of these studies to assess this association.We searched the PubMed and Embase databases up to 2020 and reviewed the reference lists of relevant articles to identify appropriate studies. We calculated the pooled relative risks with 95% CIs using random effects models, and then performed subgroup and meta-regression analyses. Dose–response meta-analyses were performed by sex separately. We identified 25 eligible prospective cohort studies, including 514,148 participants and 35,585 incident CKD cases. Compared with the category of minimal alcohol intake, light (RR = 0.90, I2 = 49%), moderate (RR = 0.86, I2 = 40%), and heavy (RR = 0.85, I2 = 51%) alcohol intake were associated with a lower risk of CKD. Subgroup meta-analysis by sex indicated that light (RR = 0.92, I2 = 0%), moderate (RR = 0.83, I2 = 39%) and heavy (RR = 0.76, I2 = 40%), alcohol consumption were inversely associated with CKD risk in male. Dose–response meta-analyses detected a nonlinear inverse association between alcohol consumption and the risk of CKD in all participants and linear inverse association in female participants. This meta-analysis shows that light (<12 g/day), moderate (12–24 g/day), and heavy (>24 g/day) alcohol consumption are protective against chronic kidney disease in adult participants especially in males.
Diabetes and chronic kidney disease (CKD) are strongly associated with a risk of cardiovascular disease (CVD). Reduced glomerular filtration rate and albuminuria are independently associated with the development of CVD in patients with diabetes. Although the risk factors for the development of CVD have been variously discussed, diabetes, hypertension, left ventricular hypertrophy on electrocardiogram, low physical activity, low high-density lipoprotein cholesterol, and hypertriglyceridemia were reported as traditional risk factors. In addition, hyperphosphatemia, uremic toxins, stiffness of artery, anemia, and high C-reactive protein were determined as nontraditional risk factors. The mechanisms of the development of CVD in patients with diabetes and CKD remain unknown. Oxidative stress and inflammation occur because of increased glucose, and uremia can play a key role in the development of CVD. To prevent the development of CVD in patients with diabetes and CKD, a multifactorial therapy is important to control the related factors like hypertension, albuminuria, hyperglycemia, dyslipidemia, and lifestyle. We reviewed the management of these related factors to prevent and inhibit the development of CVD in patients with diabetes and CKD.
Objective
Although consumption of vegetable and 100% fruit juices are an acceptable alternative for vegetables and fruits intake, information about their actual effects on kidney function is sparse. The present study aimed to determine associations between the consumption of vegetable and fruit juices and changes in kidney function in a Japanese population over a five-year period.
Methods
A total of 2,755 Japanese (742 men and 2,013 women) who participated in both the baseline and the follow-up surveys in the Daiko study (a study within the Japan Multi-Institutional Collaborative Cohort (J-MICC) study), were analyzed in this prospective study. Estimate glomerular filtration rate (eGFR) was calculated by age, sex, and serum creatinine level. For each beverage, we categorized all participants into four consumption groups that rare (rarely consumed), low (≤2 cups/week), moderate (3–4 cups/week), or frequent (≥5 cups/week) based on a food frequency questionnaire.
Results
The mean baseline and follow-up eGFR (standard deviation) were 82.4 (14.6) and 72.2 (12.6), respectively. In fully-adjusted regression analyses, moderate consumption of vegetable juice was associated a lower decline in eGFR compared with the rare consumption group (β = –1.30, p = 0.01). Moreover, stratified analyses revealed that this significant association remained in those who were young, female, non-obese, normotensive, smoked cigarettes, consumed alcohol, or exercised. However, no significant association was found in analyses for fruit juices.
Conclusions
This five-year prospective study suggested an association between self-reported moderate consumption of vegetable juice and changes (possibly smaller decline) in kidney function in a relatively healthy Japanese population.
Patients in the earlier stages of CKD have higher rates of psychological challenges and psychiatric illness than the general population. These challenges may contribute to lower perceived quality of life and progressive kidney disease in such patients. This chapter reviews the mental health literature regarding nondialysis dependent CKD patients. Screening, diagnosis and treatment strategies are discussed for major depression, bipolar depression, anxiety, alcohol use disorder and opioid use disorder. Much of the treatment guidelines are extrapolated from general medical populations. Therefore studies uniquely addressing patients with earlier stages of CKD are needed.
Background:
Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist.
Methods:
To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m2). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria).
Results:
We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding.
Conclusions:
These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.
Background:
The relationship between alcohol intake and end-stage kidney disease (ESKD) risk is controversial. Moreover, while evidence has shown that the relationship between alcohol and atherosclerosis may be modified by diabetes, whether this applies to ESKD is unknown.
Methods:
We examined these associations in the Singapore Chinese Health Study, a prospective cohort of 63 257 adults aged 45-74 years. Information on alcohol intake, diet, lifestyle factors and medical history was collected at recruitment. We identified 1217 ESKD cases via linkage with Singapore Renal Registry after mean follow-up of 17.5 years. Cox regression models were used to estimate HRs and 95% CI of ESKD.
Results:
Among the participants without diabetes at baseline, monthly to weekly drinking was associated with a decreased risk of ESKD (HR 0.69, 95% CI 0.54-0.87) compared to non-drinkers. In contrast, this association was attenuated and not significant among those with diabetes (HR 0.82, 95% CI 0.58-1.16) (Pinteraction = 0.19). Comparatively, alcohol intake of ≥2 drinks/day was significantly associated with an increased risk of ESKD compared to non-drinkers among those with diabetes (HR 2.00, 95% CI 1.14-3.53) but not among those without diabetes (HR 0.91, 95% CI 0.53-1.56) (Pinteraction = 0.01). The risk of ESKD among those with diabetes and who also consumed ≥2 drinks/day was increased by nearly 12-fold compared to non-drinkers without diabetes (HR 11.6, 95% CI 6.73-19.9).
Conclusion:
Low-dose drinking was associated with a reduced risk of ESKD among individuals without diabetes. However, joint exposure to heavy drinking and diabetes was associated with a substantially higher risk of ESKD. This article is protected by copyright. All rights reserved.
Objective:
To assess the association of alcohol consumption with chronic kidney disease (CKD) progression in patients with CKD.
Patients and methods:
The KoreaN cohort study for Outcome in patients with CKD (KNOW-CKD) is a prospective observational study that included detailed questionnaires regarding alcohol consumption. The 1883 individuals with CKD were enrolled from April 1, 2011, through February 28, 2016, and followed until May 31, 2017. Using a questionnaire, alcohol consumption pattern was classified according to the amount of alcohol per occasion (none, moderate, or binge) or drinking frequency (none, occasional, or regular). The primary endpoint was a composite of 50% or greater decline in estimated glomerular filtration rate (eGFR) from the baseline level or end-stage renal disease.
Results:
During a follow-up of 5555 person-years (median, 2.95 years), the primary outcome occurred in 419 patients. Unadjusted cause-specific hazards model showed that the risk of the primary outcome was lower in drinkers than in non-drinkers. However, a fully adjusted model including eGFR and proteinuria yielded a reverse association. Compared with non-drinking, regular and occasional binge drinking were associated with a 2.2-fold (95% CI, 1.38-3.46) and a 2.0-fold (95% CI, 1.33-2.98) higher risk of CKD progression, respectively. This association was particularly evident in patients who had decreased kidney function and proteinuria. There was a significant interaction between alcohol consumption and eGFR for CKD progression. The slopes of eGFR decline were steeper in binge drinkers among patients with eGFR less than 60 mL/min/1.73 m2.
Conclusions:
Heavy alcohol consumption was associated with faster progression of CKD.
Background
The relationship between alcohol drinking and chronic kidney damage, mainly including declined glomerular filtration rate (GFR), proteinuria and end‐stage renal disease (ESRD) was conflicting. Thus, a meta‐analysis was conducted to investigate their potential associations.
Methods
PubMed and Web of Science were searched to identify prospective studies assessing the associations between alcohol drinking and chronic kidney damage published up to March, 2019. Random‐effects model was employed to pool the relative risks (RR) with 95% confidence intervals (CIs). Subgroup meta‐analyses stratified by the basic characteristics of subjects were performed.
Results
A total of 15 cohort studies were included in the present study, with 268,723 participants and 31,766 incident cases. Participants with low (<13 g/d), moderate (13~26 g/d) and high (26~60 g/d) dose of alcohol drinking had 12% (RR: 0.88, 95% CI: 0.83~0.93), 24% (RR: 0.76, 95% CI: 0.70~0.83) and 21% (RR: 0.79, 95% CI: 0.71~0.88) lower risk of chronic kidney damage compared with the reference group (no or occasional drinkers), respectively. The lower risk for chronic kidney damage remained significant for the declined GFR, or in men, or for participants aged less than 55 yrs, or studies with longer than 8 yrs follow‐up, while severe alcohol drinking (≥60 g/d) insignificantly increased 7% risk of chronic kidney damage (RR: 1.07, 95% CI: 0.53~2.15). No obvious heterogeneity and no publication bias were observed.
Conclusions
Based on our meta‐analysis, participants with alcohol drinking less than 60 g/d were at lower risk of declined GFR, especially in men or participants aged less than 55 yrs. Much more prospective cohort studies are required to confirm our present findings.
This article is protected by copyright. All rights reserved.
Introduction: Chronic kidney disease (CKD) is an increasingly recognized major public health problem globally and in Nepal. It has a high prevalence in the population and is associated with high morbidity, mortality and health care costs. Here, we aimed to study the socio-demographic profiles, etiologies of CKD and associated co-morbidities in patients attending a referral hospital.
Methods: We conducted a hospital based, descriptive, observational, cross-sectional study among adult patients with CKD attending Tribhuvan University Teaching Hospital (TUTH), Kathmandu. Patients younger than 16 years and renal allograft recipients were excluded from the study. A diagnosis of CKD was established by the treating nephrologist based on KDIGO 2012 clinical practice guideline. Prior informed consent was taken. Data was collected on clinical features, socio-demographic profiles, major co-morbidities, presumed etiology of CKD and hematological and biochemical parameters of the
patients. SPSS version 24 (Chicago, IL, USA) was used for the analysis of data. The study protocol was approved by the Institutional Review Board (IRB) of Institute of Medicine (IOM).
Results: A total of 401 patients with CKD were included in the study. The mean age of the patient was 50.92 years (SD=17.98), male to female ratio was 1.8:1. Among these patients, 86% were Hindu, 24.4% were farmers, 57% were from the Hilly region of Nepal, 51% were active smokers, and 51.6% were alcohol consumers. Chronic glomerulonephritis (CGN) (36.2%; n= 145), diabetes mellitus (31.9%; n= 128) and hypertension (21.7%; n=87) were the three most common identified causes of CKD. Among the biopsy proven CGN patients, IgA nephropathy was the most common cause. In a large proportion of patients (68.3%) cause of CGN was not known. Most of the patients were in CKD stage 5 (27%), and stage 5D (55.8%). Coronary artery disease (CAD) (in 7% patients), heart failure (in 2.7%) and stroke (in 2.2%) were the most common comorbidities. Anemia was prevalent in CKD from stage 3 onwards, the severity increased with increasing stage (p <0.001). Hemodialysis was the predominant mode of renal
replacement therapy (RRT) used by 98.2% of CKD 5D patients.
Conclusion: Nepalese patients of CKD are younger; males are more affected than females. CGN, diabetes and hypertension are three most common causes of CKD; IgA nephropathy is the most common cause of biopsy proven CGN leading to CKD. Anemia is common from CKD stage 3 onwards. The most common associated co-morbidity is CAD.
Key words: Chronic kidney disease, CKD; Chronic glomerulonephritis, CGN; Diabetes mellitus, DM; Hypertension; Nepal
Chronic kidney disease (CKD) is a public health prob‑ lem due not only to the heavy burden of renal replace‑ ment therapy, but also to the increased cardiovascular risk and higher mortality. Emerging evidence suggests that dietary patterns play a more significant role than the nutrients in CKD. Thus, several macronutrients, especially high protein intake, could be risk factors for CKD, while a vegetarian, Mediterranean or a Dietary Approaches to Stop Hypertension (DASH) diet could be at least as effective as protein restriction in reduc‑ ing CKD progression. This review summarizes both the association between several macro‑/micronutrients and CKD, and the existing data on the relationship between dietary patterns and renal outcome.
Introduction
Alcohol use disorder (AUD) is a spectrum of high risk behaviors including alcohol abuse and dependence. Chronic kidney disease (CKD) is progressive loss of renal function for more or equal to 3 months or presence of any irreversible kidney damage. Common risk factors of CKD have been identified, but the impact of alcohol consumption on kidney function is controversial. The study aims to investigate the relationship between alcohol use disorder and CKD on a national scale.
Methods
This retrospective cohort study was conducted using Taiwan’s National Health Insurance research database. Patients aged 20 years or older, without CKD and with the diagnosis of AUD (ICD-9-CM codes 303.X; 305.0, V113) from years 2000 to 2013 were enrolled. Control cohort was selected to match the demographics of the target population. Patients were followed until the end of 2013 or earlier if they developed CKD, died, or lost follow up. Baseline characteristics and comorbidities were identified for risk stratification.
Results
We identified 11639 patients in the AUD cohort and 46556 patients in the control cohort. Compared to patients in the control cohort, those in the AUD group were more likely to have multiple comorbidities (p < 0.001 for all comorbidities). After adjustment of age, gender, baseline comorbidities, and nonsteroidal anti-inflammatory drug use, the diagnosis of AUD was associated with an increased risk of CKD development (aHR = 1.62, 95% CI, 1.46–1.81).
During the mean follow up periods of 6.47 (standard deviation (SD) = 3.80) years for the AUD cohort and 7.23 (SD = 3.75) years for the control cohort, the overall incidence density of CKD was significantly higher in patients with AUD than those in the control cohort (3.48 vs 6.51 per 1000 person-years, aHR = 1.68, 95% CI, 1.50–1.87). Kaplan-Meier analysis showed that the AUD cohort had a higher cumulative incidence of CKD than the control cohort (log-rank test, p value < 0.001). Patients with AUD had higher risks of CKD in all the stratified groups, except for the subgroup with age over 65 years old.
Conclusion
Our study suggested that AUD was associated with an increased incidence of newly diagnosed CKD by nearly two folds. Young age, in particular, had a higher association between AUD and CKD. Considering the preventable nature of AUD, establishing effective health policies is imperative to reduce high-risk alcohol behaviors and thereby prevent alcohol-related kidney disease. Further prospective studies are warranted to further elucidate the causation of AUD on kidney function.
Background and Objectives: Gout is an inflammatory arthritis involving the deposition of uric crystals. It has been known to cause renal disease in the form of acute or chronic urate nephropathy, or urolithiases. Numerous studies have been published worldwide, defining proper handling and management of such cases. Despite such recommendations, the renal function of these patients complicates the management. Administration of the properly-adjusted medications and referrals to appropriate services are delayed because of lack of data at the patient’s initial visit. This study therefore aims to describe the renal function at index consult of Filipino patients with gout, and identify the factors that correlate with a depressed kidney function in such patients. Methods: This study is a retrospective descriptive study involving gout patients seen in four rheumatology clinics. A total of 485 patients were identified. Records of the patients’ index consult, were reviewed. Demographic and disease characteristics were noted. Renal function was identified using the Cockroft-Gault equation for estimated glomerular filtration rate. Univariate analysis was done, characteristics of patients with good and poor renal function were compared. Results: A total of 485 patients were studied. Most were males with presenting with a monoarticular joint involvement, with attacks occurring more than three times a year. Tophi were present in 28.2% of patients at the initial consult. The most commonly reported comorbidity was hypertension. At index consult, the average serum creatinine and uric acid are 1.7mg/dL and 9.1 mg/ dL, respectively. The average creatinine clearance is 65.0±34.1 mL/min, and 51.3% presented with an eGFR of <60 mL/min at index consult. Poor renal function (eGFR <60mL/min) was associated with late onset (p<.0001) and prolonged disease duration (p<.0001), higher serum uric acid (p<.0001), a history of urolithiasis (p<.035), frequent attacks (p<.0001), with coexisting hypertension (p<.0001) or diabetes mellitus (p<.013). Interestingly, results also showed that females tend to have poorer renal function at index consult compared to males (p<.0001). Conclusion: In this cohort of 485 Filipino patients with gout, 51.3% have eGFR<60 ml/min on first consultation. The clinical findings with significant associations with poor renal function should alert Filipino physicians to the high probability of renal disease among Filipino patients with gout and make the necessary adjustments in treatment plans.
Chronic kidney disease (CKD) is a major global medical and public health
challenge. Based primarily on a modest number of prospective epidemiological studies it
appears that alcohol consumption reduces the risk of CKD in the general population. Our
understanding of the potential benefits of alcohol consumption on CKD is likely to evolve
in the future and will be informed primarily from observational epidemiological
studies.
Background/aims:
The association between alcohol consumption and the risk of chronic kidney disease (CKD) has been reported. What is not known is whether drinking pattern combined with the weekly frequency of alcohol consumption and the quantity per drinking day is associated with the risk of CKD.
Methods:
We enrolled 9,112 Japanese nondiabetic men aged 40 to 55 years with absence of proteinuria, an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m(2) or higher, and not on antihypertensive medications at baseline. CKD was defined if eGFR was <60 ml/min/1.73 m(2). The weekly frequency classification was nondrinkers, 1-3 drinking days/week, or 4-7 drinking days/week. The quantity consumed per drinking day was classified as 0.1-23.0 g ethanol/drinking day, 23.1-46.0 g ethanol/drinking day, 46.1-69.0 g ethanol/drinking day, and ≥69.1 g ethanol/drinking day.
Results:
During the 79,099 person-years, 1,253 subjects developed CKD. Compared to nondrinkers, those who consumed 23.1-46.0 or 46.1-69.0 g ethanol/drinking day on 4-7 drinking days/week had a decreased risk of CKD (multiple-adjusted hazard ratio (HR) 0.62 (0.52-0.74) and 0.76 (0.59-0.97), respectively). The association between the quantity per drinking day and the incidence of CKD was U-shaped among each category of the weekly frequency. HRs within similar categories of quantity per drinking day were lower in the 4-7 drinking days/week group than in the 1-3 drinking days/week group.
Conclusion:
Among middle-aged Japanese men, the people who drank middle-range quantity, specifically who drank 4-7 days/week, had lower risk of CKD than nondrinkers.
Objectives:
This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups.
Methods:
Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities).
Results:
Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status.
Discussion:
In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.
Inflammation and hemostasis may increase the risk of kidney function decline; however, data from prospective studies are sparse.
The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort.
We used data from 14,854 middle-aged adults from 4 different US communities.
Markers of inflammation and hemostasis were examined.
The risk of kidney function decrease associated with these markers was studied. Glomerular filtration rate (GFR) was calculated from serum creatinine levels using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. Chronic kidney disease (CKD) was defined as: (1) a decrease in estimated GFR to less than 60 mL/min/1.73 m2 from greater than 60 mL/min/1.73 m2 at baseline, or (2) a hospitalization discharge or death coded for CKD. Serum creatinine was measured at baseline and the 3- and 9-year follow-up visits. Hazard ratios (HRs) of CKD associated with increased levels of inflammatory and hemostatic variables were estimated by using multivariate Cox proportional hazards regression.
1,787 cases of CKD developed between 1987 and 2004. After adjusting for demographics, smoking, blood pressure, diabetes, lipid levels, prior myocardial infarction, antihypertensive use, alcohol use, year of marker measurement, and baseline renal function using estimated GFR, the risk of incident CKD increased with increasing quartiles of white blood cell count (HR quartile 4 versus quartile 1, 1.30; 95% confidence interval [CI], 1.12 to 1.50; P trend = 0.001), fibrinogen (HR, 1.25; 95% CI, 1.09 to 1.44; P < 0.001), von Willebrand factor (HR, 1.46; 95% CI, 1.26 to 1.68; P < 0.001), and factor VIIIc (HR, 1.39; 95% CI, 1.20 to 1.60; P < 0.001). A strong inverse association was found between serum albumin level and risk of CKD (HR, 0.63; 95% CI, 0.55 to 0.72; P < 0.001). No independent association was found with factor VIIc level.
Although we lacked a direct measure of kidney function, associations were robust to case definitions.
Markers of inflammation and hemostasis are associated with greater risk of kidney function decrease. Findings suggest that inflammation and hemostasis are antecedent pathways for CKD.
To summarise quantitatively the association between moderate alcohol intake and biological markers of risk of coronary heart disease and to predict how these changes would lower the risk.
Meta-analysis of all experimental studies that assessed the effects of moderate alcohol intake on concentrations of high density lipoprotein cholesterol, apolipoprotein A I, fibrinogen, triglycerides, and other biological markers previously found to be associated with risk of coronary heart disease.
Men and women free of previous chronic disease and who were not dependent on alcohol. Studies were included in which biomarkers were assessed before and after participants consumed up to 100 g of alcohol a day.
Alcohol as ethanol, beer, wine, or spirits.
Changes in concentrations of high density lipoprotein cholesterol, apolipoprotein A I, Lp(a) lipoprotein, triglycerides, tissue type plasminogen activator activity, tissue type plasminogen activator antigen, insulin, and glucose after consuming an experimental dose of alcohol for 1 to 9 weeks; a shorter period was accepted for studies of change in concentrations of fibrinogen, factor VII, von Willebrand factor, tissue type plasminogen activator activity, and tissue type plasminogen activator antigen.
61 data records were abstracted from 42 eligible studies with information on change in biological markers of risk of coronary heart disease. An experimental dose of 30 g of ethanol a day increased concentrations of high density lipoprotein cholesterol by 3.99 mg/dl (95% confidence interval 3.25 to 4.73), apolipoprotein A I by 8.82 mg/dl (7.79 to 9.86), and triglyceride by 5.69 mg/dl (2.49 to 8.89). Several haemostatic factors related to a thrombolytic profile were modestly affected by alcohol. On the basis of published associations between these biomarkers and risk of coronary heart disease 30 g of alcohol a day would cause an estimated reduction of 24.7% in risk of coronary heart disease.
Alcohol intake is causally related to lower risk of coronary heart disease through changes in lipids and haemostatic factors.
Alcohol consumption has been linked to kidney disorders in selected patient groups, but whether it contributes to the burden of end-stage renal disease (ESRD) in the general population is unknown. The authors conducted a population-based case-control study to assess the relation between alcohol consumption and risk of ESRD. The study took place in Maryland, Virginia, West Virginia, and Washington, DC, in 1991. Participants were 716 patients who had started treatment for ESRD and 361 control subjects of similar age (20-64 years) selected by random digit dialing. The main risk factor of interest was self-reported consumption of alcoholic beverages (frequency of drinking days and number of drinks consumed per drinking day). In univariate analysis, consumption of alcohol exhibited a J-shaped association with risk of ESRD. The J shape disappeared after exclusion of persons who had ever consumed home-distilled whiskey ("moonshine") and adjustment for age, race, sex, income, history of hypertension, history of diabetes mellitus, use of acetaminophen, use of opiates, and cigarette smoking; however, the odds ratio for ESRD remained significantly increased (odds ratio = 4.0; 95% confidence interval: 1.2, 13.0) among persons who consumed an average of >2 alcoholic drinks per day. The corresponding population attributable risk was 9 percent. Thus, consumption of more than two alcoholic drinks per day, on average, was associated with an increased risk of kidney failure in the general population. A lower intake of alcohol did not appear to be harmful. Because these results are based on self-reports in a case-control study, they should be seen as preliminary.
Whether the association of alcohol consumption and cardiovascular disease is the product of confounding and the degree to which this concern applies to other behaviors are unclear.
Using the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of adults in the US, we compared chronic disease risk factors between 123,359 abstainers and 126,674 moderate drinkers, defined as intake of < or = 2 drinks per day among men and < or = 1 drink per day among women, using age- and sex- and multivariable-adjusted models. We also compared sedentary and active individuals, defined as moderate physical activity > or = 30 minutes per day for > or = 5 days per week, or vigorous activity for > or = 20 minutes per day on > or = 3 days.
Chronic disease risk factors and features of unhealthy lifestyle were generally more prevalent among abstainers than drinkers in age- and sex-adjusted analyses, but these differences were generally attenuated or eliminated by additional adjustment for race and education. For low fruit and vegetable intake, divorced marital status, and absence of a personal physician, adjustment for race and education reversed initially positive age- and sex-adjusted associations with abstention. Comparison of sedentary and active individuals produced similar findings, with generally lower levels of risk factors among more physical active individuals.
The differences between abstainers and drinkers are attenuated after adjustment for limited sociodemographic features, and sedentary and active individuals share a similar pattern. Although observational studies of both factors may be susceptible to uncontrolled confounding, our results provide no evidence that moderate drinking is unique in this regard. Ultimately, randomized trials of all such lifestyle factors will be needed to answer these questions definitively.
Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease, and reduce the risk of cardiovascular disease (CVD). Translating these advances to simple and applicable public health measures must be adopted as a goal worldwide. Understanding the relationship between CKD and other chronic diseases is important to developing a public health policy to improve outcomes. The 2004 Kidney Disease Improving Global Outcomes (KDIGO) Controversies Conference on 'Definition and Classification of Chronic Kidney Disease' represented an important endorsement of the Kidney Disease Outcome Quality Initiative definition and classification of CKD by the international community. The 2006 KDIGO Controversies Conference on CKD was convened to consider six major topics: (1) CKD classification, (2) CKD screening and surveillance, (3) public policy for CKD, (4) CVD and CVD risk factors as risk factors for development and progression of CKD, (5) association of CKD with chronic infections, and (6) association of CKD with cancer. This report contains the recommendations from the meeting. It has been reviewed by the conference participants and approved as position statement by the KDIGO Board of Directors. KDIGO will work in collaboration with international and national public health organizations to facilitate implementation of these recommendations.
We examined the relationship between alcohol consumption and incidence of end-stage renal disease (ESRD) in a prospective cohort of 65 601 Chinese men aged 40 years and older. Information on the amount and type of alcohol consumed was collected at a baseline examination with follow-up evaluations conducted 8-9 years later. During the 500 876 person-years of follow-up, 176 participants initiated renal replacement therapy or died from renal failure. Compared to non-drinkers, the relative risk of ESRD was 0.67 among men consuming less than 21 drinks per week and 0.52 among men consuming this amount or more after adjustment for age, geographic region, urbanization, education, body mass index, physical activity, and cigarette smoking. The inverse association between alcohol consumption and ESRD existed even after adjustment for systolic blood pressure, and history of diabetes and cardiovascular disease. Our results suggest an inverse relationship between alcohol consumption and risk of ESRD in Chinese men. Heavy alcohol consumption, however, may lead to increased risk of morbidity and mortality from other causes; therefore, the implications from these findings should be interpreted cautiously.
Background. The impact of moderate alcohol consumption on renal function has important public health implications given the high prevalence
of alcohol use. Experimentally, alcohol may adversely affect renal function, but clinical data are limited and no large, prospective
studies have examined this issue.
Methods. In a prospective study of 1658 nurses enrolled in the Nurses’ Health Study, we sought to determine if there was an association
between moderate alcohol consumption and rate of decline in renal function. Daily alcohol intake was measured in 1990, 1994
and 1998 using a detailed questionnaire. Maximum daily alcohol intake was measured in 1988. Creatinine, measured from blood
samples provided in 1989 and 2000, was used to estimate glomerular filtration rate (GFR) and creatinine clearance (CCr).
Results. Compared to individuals with no alcohol intake, the odds ratios (ORs) for developing a ≥25% estimated GFR decline were: 0.98
(95% CI: 0.72–1.32) for 0.1–4.9 g/day, 0.83 (95% CI: 0.56–1.21) for 5–14.9 g/day and 0.81 (95% CI: 0.50–1.31) for 15–59.9
g/day. For women with hypertension (n = 726), the ORs for a ≥25% estimated GFR decline were: 0.98 (95% CI: 0.53–1.21) for 0.1–4.9 g/day, 0.62 (95% CI: 0.34–1.12)
for 5–14.9 g/day and 0.53 (95% CI: 0.25–1.12) for 15–59.9 g/day.
Conclusions. Moderate alcohol consumption had no substantial adverse effect on renal function in women over an 11 year follow-up period.
Background: Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR). Objective: To develop an equation to predict GFR from serum creatinine concentration and other factors. Design: Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease. Patients: 1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample ; the remaining 558 patients constituted the validation sample. Methods: The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample. Results: To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.001 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively. Conclusion: The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.
Decreased kidney function, determined using a serum creatinine-based estimation of GFR, is associated with a higher risk for mortality from cardiovascular disease. Equations incorporating cystatin C improve the estimation of GFR, but whether this improves the prediction of risk for mortality is unknown. We measured cystatin C on 6942 adult participants in the Third National Health and Nutrition Examination Survey Linked Mortality File, including all participants who had high serum creatinine (>1.2 mg/dl for men; >1.0 mg/dl for women) or were older than 60 yr and 25% random sample of participants who were younger than 60 yr. We estimated GFR using equations that included standardized serum creatinine, cystatin C, or both. Participant data were linked to the National Death Index. A total of 1573 (22.7%) deaths (713 deaths from cardiovascular disease) occurred during a median of 8 yr. Lower estimated GFR based on cystatin C was strongly associated with higher risk for overall and cardiovascular mortality across the range of normal to moderately decreased estimated GFR. Creatinine-based estimates of GFR resulted in weaker associations, with the association between estimated GFR and all-cause mortality reversed at higher levels of estimated GFR. An equation using both creatinine and cystatin C (in addition to age, race, and gender) resulted in weaker associations than equations using only cystatin C (with or without age, race, and gender). In conclusion, despite better performance in terms of estimating GFR, equations based on both cystatin C and creatinine do not predict mortality as well as equations based on cystatin C alone.
Adiposity is associated with cystatin C. Cystatin C-based glomerular filtration rate (GFR) equations may result in overestimation of chronic kidney disease (CKD) prevalence at greater body mass index (BMI) levels.
Cross-sectional.
6,709 US adult Third National Health and Nutrition Examination Survey participants.
BMI.
Absolute percentage of difference in prevalence of stage 3 or 4 CKD between creatinine- and cystatin C-based estimating equations by level of BMI.
Normal weight, overweight, and obesity were defined as BMI of 18.5 to less than 25.0, 25 to less than 30.0, and 30 kg/m(2) or greater, respectively. Stage 3 or 4 CKD (estimated glomerular filtration rate [eGFR], 15 to 59 mL/min/1.73 m(2)) was defined using the 4-variable creatinine-based Modification of Diet in Renal Disease Study equation (eGFR(MDRD)); cystatin C level, age, sex, and race equation (eGFR(CysC,age,sex,race)); cystatin C-only equation (eGFR(CysC)); cystatin C level of 1.12 mg/L or greater (increased cystatin C); and an equation incorporating serum creatinine level, cystatin C level, age, sex, and race (eGFR(Cr,CysC,age,sex,race)).
Differences in stage 3 or 4 CKD prevalence estimates between eGFR(CysC,age,sex,race), eGFR(CysC), and increased cystatin C, separately, and eGFR(MDRD) were greater at higher BMI levels. Specifically, compared with estimates derived using eGFR(MDRD) for normal-weight, overweight, and obese participants, estimated prevalences of stage 3 or 4 CKD were 2.1%, 3.0%, and 6.5% greater when estimated by using eGFR(CysC,age,sex,race) (P trend = 0.005); 0.1%, 0.6%, and 2.2% greater for eGFR(CysC) (P trend = 0.03); 2.9%, 5.2%, and 9.5% greater for increased cystatin C (P trend < 0.001); and -0.1%, -0.4%, and 0.0% greater for eGFR(Cr,CysC,age,sex,race), respectively (P trend = 0.7).
No gold-standard measure of GFR was available.
BMI may influence the estimated prevalence of stage 3 or 4 CKD when cystatin C-based equations are used.
Impaired kidney function is associated with increased mortality risk in older adults. It remains unknown, however, whether longitudinal declines in kidney function are independently associated with increased cardiovascular and all-cause mortality in older adults.
The Cardiovascular Health Study evaluated a cohort of community-dwelling older adults enrolled from 1989 to 1993 in 4 US communities with follow-up through 2005. Among 4380 participants, the slope of annual decline in estimated glomerular filtration rate (eGFR) was estimated using both serum creatinine (eGFR(creat)) and cystatin C (eGFR(cys)) rates, which were measured at baseline, year 3, and year 7 of follow-up. Rapid decline in eGFR was defined as a loss greater than 3 mL/min/1.73 m(2) per year, and cardiovascular and all-cause mortality were assessed over a mean of 9.9 years of follow-up.
Mean (SD) levels of creatinine and cystatin C were 0.93 (0.30) mg/dL and 1.03 (0.25) mg/L, respectively; mean (SD) eGFR(creat) and eGFR(cys) were 79 (23) mL/min/1.73 m(2) and 79 (19) mL/min/1.73 m(2), respectively. Individuals with rapid decline measured by eGFR(creat) (n = 714; 16%) had increased risk of cardiovascular (adjusted hazard ratio [AHR], 1.70; 95% confidence interval [CI], 1.40-2.06) and all-cause (AHR, 1.73; 95% CI, 1.54-1.94) mortality. Individuals with rapid decline measured by eGFR(cys) (n = 1083; 25%) also had increased risk of cardiovascular (AHR, 1.53; 95% CI, 1.29-1.80) and all-cause (AHR, 1.53; 95% CI, 1.38-1.69) mortality. The association of rapid decline in eGFR with elevated mortality risk did not differ across subgroups based on baseline kidney function, age, sex, race, or prevalent coronary heart disease.
Rapid decline in eGFR is associated with an increased risk of cardiovascular and all-cause mortality in older adults, independent of baseline eGFR and other demographic variables.
The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of coronary heart disease and stroke in adults aged 65 years and older. The main objective of the study is to identify factors related to the onset and course of coronary heart disease and stroke. CHS is designed to determine the importance of conventional cardiovascular disease (CVD) risk factors in older adults, and to identify new risk factors in this age group, especially those that may be protective and modifiable. The study design called for enrollment of 1250 men and women in each of four communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. Eligible participants were sampled from Medicare eligibility lists in each area. Extensive physical and laboratory evaluations were performed at baseline to identify the presence and severity of CVD risk factors such as hypertension, hypercholesterolemia and glucose intolerance; subclinical disease such as carotid artery atherosclerosis, left ventricular enlargement, and transient ischemia; and clinically overt CVD. These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old. The first of two examination cycles began in June 1989. A second comprehensive examination will be repeated three years later. Periodic interim contacts are scheduled to ascertain and verify the incidence of CVD events, the frequency of recurrent events, and the sequellae of CVD.
From the records of an automated multi-phasic health testing centre, daily drinkers in four alcohol consumption groups were each separately matched for sex, age and obesity to a single non-drinker control. All subjects satisfied strict eligibility criteria selected to exclude the effects of other factors known to influence blood pressure or renal function or both. The 5500 pairs of subjects were compared for systolic and diastolic blood pressure and serum creatinine. After allowing for smoking, drinkers had significantly elevated blood pressure compared with their controls, and the elevation was greater the heavier the alcohol intake, except for the heaviest drinking females. This result was more pronounced in males than females, and for systolic than diastolic blood pressure. By contrast, smoking cigarettes was shown to be associated with lower blood pressure, independent of sex and drinking history. Smoking was also associated with a decreased serum creatinine concentration as was drinking three or more drinks per day. However, drinkers of two or fewer drinks daily had higher serum creatinine concentrations than their non-drinker controls.
Few large-scale epidemiologic studies have enrolled older adults; hence, little is known about the feasibility of recruiting this group for long-term population-based studies. In this article we present the recruitment experience of the Cardiovascular Health Study (CHS), a population-based, longitudinal study of cardiovascular diseases in adults 65 years and older. Participants were sampled from the Health Care Financing Administration's (HCFA) Medicare eligibility lists in four US communities. Letters were mailed to 11,955 sampled individuals. Persons recruited were required to complete an extensive home interview and then a 4-hour in-clinic examination. Excluded were persons who were expected to be able to complete the baseline examination and who were not expected to return for the 3-year follow-up. Some 3654 participants were recruited from those randomly selected from the Medicare sampling frame. In addition, 1547 other age-eligible persons living in the household with the sampled individuals also participated, yielding a total of 5201 participants. Of those who were contacted, 9.6% were ineligible and 34.9% refused participation. Among those eligible, 38.6% refused and 57.3% were enrolled (the remaining did not refuse but were not enrolled before the recruitment ended). Data from a subsample indicate that compared to those who were ineligible or who refused, enrolled participants were younger, more highly educated, more likely to be married, and less likely to report limitations in activity. Compared to those who were eligible but refused, enrolled participants were less likely to have high blood pressure and stroke and more likely to have quit smoking and to perceive their health status as very good or excellent.(ABSTRACT TRUNCATED AT 250 WORDS)
Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR).
To develop an equation to predict GFR from serum creatinine concentration and other factors.
Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease.
1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample; the remaining 558 patients constituted the validation sample.
The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample.
To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.001 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively.
The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.
To examine the association between low to moderate alcohol consumption and the incidence of type 2 diabetes mellitus (DM) in men.
Prospective cohort study.
Over an average period of 12.1 years, we evaluated 20 951 participants in the Physicians' Health Study between ages 40 and 84 years who were free of cardiovascular disease, cancer, and diabetes and provided data on alcohol consumption at baseline.
Type 2 DM diagnosed after randomization.
Among 20 951 physicians, 766 cases of incident DM were reported over an average follow-up period of 12.1 years. After adjustment for age, randomized treatment assignment, smoking, physical activity, and body mass index, the relative risk estimates and 95% confidence intervals for those reporting alcohol use of rarely/ never, 1 to 3 drinks per month, 1 drink per week, 2 to 4 drinks per week, 5 to 6 drinks per week, and 1 or more drinks per day were 1.00 (referent), 1.03 (0.80-1.33), 0.89 (0.70-1.14), 0.74 (0.59-0.93), 0.67 (0.51-0.89), and 0.57 (0.45-0.73), respectively (linear trend, P<.001). Additional adjustment for baseline history of hypertension, high cholesterol level, or parental history of myocardial infarction or family history of diabetes (data collected at 9 years) did not materially alter the results. These associations persisted in analyses stratified by age, smoking status, body mass index, physical activity, and family history of DM.
These data indicate that apparently healthy men who self-select for light to moderate alcohol consumption have a decreased subsequent risk of type 2 DM.
Serum cystatin C, a cysteine proteinase inhibitor, has been proposed as a marker of glomerular filtration rate (GFR). Serum cystatin C, serum creatinine and creatinine clearance were measured in 226 patients with various nephropathies, covering the entire range of renal function, to evaluate the efficacy of cystatin C as a screening test to detect reduced creatinine clearance in comparison to creatinine. Subgroups of 53 patients with glomerular and 26 patients with tubular impairment were compared to assess whether cystatin C performed differently in either glomerular or tubular impairment. Cystatin C detected reduced creatinine clearance with higher sensitivity (97 vs. 83%), and higher negative predictive value (96 vs. 87%) compared to creatinine. In parallel, 95% sensitivity of cystatin C as derived from receiver-operating characteristic plot was significantly higher (p < 0.05). In the subgroups with glomerular or tubular impairment, cystatin C and creatinine did not significantly differ with regard to efficacy. Serum cystatin C is as efficacious as serum creatinine to detect reduced GFR as measured by creatinine clearance. The efficacy of cystatin C as a screening test may even be superior compared to creatinine. In addition, the efficacy of cystatin C is independent of either glomerular or tubular impairment.
Alcohol is a common risk factor in the general population for a variety of health outcomes. In the present review, we discuss the recent literature on alcohol, hypertension, and renal disease. The regular consumption of more than two drinks per day is associated with both hypertension and renal disease. The mechanisms by which consumption of alcohol leads to hypertension and perhaps renal disease are unknown.
Over the last decade, oxidative stress has been implicated in the pathogenesis of a wide variety of seemingly unrelated renal diseases. Epidemiological studies have documented an association of moderate wine consumption with a decreased risk of cardiovascular and neurological diseases; however, similar studies in the kidney are still lacking. The kidney is an organ highly vulnerable to damage caused by reactive oxygen species (ROS), likely due to the abundance of polyunsaturated fatty acids in the composition of renal lipids. ROS are involved in the pathogenic mechanism of conditions such as glomerulosclerosis and tubulointerstitial fibrosis. The health benefits of moderate consumption of red wine can be partly attributed to its antioxidant properties. Indeed, the kidney antioxidant defense system is enhanced after chronic exposure to moderate amounts of wine, a response arising from the combined effects of ethanol and the nonalcoholic components, mainly polyphenols. Polyphenols behave as potent ROS scavengers and metal chelators; ethanol, in turn, modulates the activity of antioxidant enzymes. Therefore, a hypothesis that red wine causes a decreased vulnerability of the kidney to the oxidative challenges could be proposed. This view is partly supported by direct evidences indicating that wine and antioxidants isolated from red wine, as well as other antioxidants, significantly attenuate or prevent the oxidative damage to the kidney. The present hypothesis paper provides a collective body of evidence suggesting a protective role of moderate wine consumption against the production and progression of renal diseases, based on the existing concepts on the pathophysiology of kidney injury mediated by oxidative stress.
Recent clinical and experimental studies have demonstrated that the habitual consumption of large amounts of ethanol has deleterious effects on the kidney. A variety of tubular defects have been described in patients with chronic alcoholism. Evidence is emerging that tubular dysfunction has an important pathophysiological role in a wide range of electrolyte and acid-base disturbances commonly observed in these patients, and possibly in alcohol-induced bone disease. These renal abnormalities are often reversible, disappearing with abstinence. However, since 1990 a few cases of a syndrome of acute tubular necrosis due to binge drinking of ethanol in the absence of other evident nephrotoxic mechanisms, or in association with the use of nonsteroidal anti-inflammatory drugs, have been reported. A link between glomerulonephritis and alcoholism has become evident. IgA nephropathy has been demonstrated at autopsy in 64% of chronic alcoholics and, more recently, the association between alcoholism and postinfectious glomerulonephritis has been described. Structural and functional abnormalities of the kidney are reported with increasing frequency in the fetal alcohol syndrome seen in children who have been prenatally exposed to ethanol. In addition, over the last few years experimental studies in vitro or in animal models have provided information about the biochemical and molecular basis of alcohol-induced injury to kidney. It is hoped that future experimental and clinical research will provide us with a more comprehensive knowledge of the mechanisms of renal damage in alcohol misuse.
The association of alcohol use with atherosclerosis is inconsistent in previous studies.
For the Cardiovascular Health Study, 5888 adults aged 65 years and older underwent a standardized interview and examination. They reported beer, wine, and liquor use individually and underwent B-mode ultrasonography to determine internal and common carotid intima-media thickness (IMT). We compared composite carotid IMT values cross-sectionally using linear regression to adjust for demographic and clinical characteristics. Among 4247 participants free of cardiovascular disease, consumers of 1 to 6 drinks per week had 0.07+/-0.04-mm lower composite IMT and consumers of 14 or more drinks per week had 0.07+/-0.05-mm higher IMT than abstainers (P quadratic trend=0.02). We found similar relationships using internal and common carotid thickness measures and among men and women. The higher IMT associated with heavier alcohol use was particularly strong among 1592 participants with confirmed cardiovascular disease (0.24+/-0.09 mm greater than abstainers). Controlling for HDL cholesterol levels reduced the effect on composite IMT among consumers of 1 to 6 drinks per week by 22%.
Relative to older adults who abstain from alcohol, consumption of 1 to 6 drinks per week had an inverse association with carotid atherosclerosis whereas consumption of 14 or more drinks had a positive association.
To examine the effects of lifestyle risk factors such as alcohol consumption, cigarette smoking and body mass index (BMI) on the development of chronic kidney disease.
We used a case-control study of 554 hospital cases and 516 age, race, and gender-matched community controls. The main outcome measure was newly-diagnosed chronic kidney disease, assessed by chart review. Self-reported history of alcohol consumption, smoking, and BMI as well as other co-variables were obtained during telephone interviews. Logistic regression models assessed the association between lifestyle risk factors and chronic kidney disease and were adjusted for important co-variables.
We found no significant associations between alcohol consumption and chronic kidney disease, with the exception of moonshine, which resulted in an increased risk of chronic kidney disease (including all subtypes). The effects of smoking on chronic kidney disease were inconsistent, but pointed to no appreciable excess risk among smokers. Increasing quartiles of BMI were positively and significantly associated with nephrosclerosis (ORs [95% CI]: 2.5 [1.0-6.0], 2.8 [1.2-6.8] and 4.6 [1.8-11.6], for the second, third, and fourth quartiles of BMI, respectively).
Our study revealed a significant positive association between BMI and nephrosclerosis. We did not find an increased risk of chronic kidney disease associated with alcohol or cigarette smoking.
Moderate alcohol consumption is widely recognized as beneficial in the prevention of cardiovascular disease, yet the renal effects of alcohol intake are still controversial. The present study is designed to investigate the influence of alcohol consumption on calculated creatinine clearance rate (CCr) and glomerular filtration rate (GFR) in a Southern Taiwan Pai-Wan aboriginal community with a high prevalence of alcohol consumption.
This is a cross-sectional community-based study. The 1466 aboriginal subjects, 40-95 years of age, are a stratified random subpopulation identified during an integrative health care programme. They were sampled for drinking patterns. The main outcome measurements were serum creatinine, estimated CCr and GFR.
Subjects with alcohol consumption had significantly higher levels of serum triglycerides, high-density lipoprotein cholesterol, uric acid, estimated CCr and GFR values than non-drinkers. Their blood pressure was also significantly higher. They had lower total cholesterol and low-density lipoprotein cholesterol concentrations. Increasing alcohol consumption was independently and significantly associated with a higher level of estimated CCr and GFR when analysed as both a categorical and continuous variable.
The present study shows that chronic alcohol consumption has a negative effect on blood pressure and lipid profile and stimulates the estimated GFR.
Moderate alcohol consumption has been consistently associated with beneficial health effects on cardiovascular disease. In contrast, the association between alcohol consumption and renal dysfunction is less clear.
We conducted a prospective cohort study of 11,023 initially healthy men who provided blood samples 14 years after a baseline assessment of alcohol consumption. We categorized alcohol consumption into 1 or fewer, 2 to 4, 5 to 6, and 7 or more drinks per week. The main outcome measures were elevated creatinine levels (defined as > or = 1.5 mg/dL [> or = 133 micromol/L]) and reduced estimated glomerular filtration rates (defined as < or = 55 mL/min). We used logistic regression to calculate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
After 14 years, 473 men (4.3%) had elevated creatinine levels and 1296 (11.8%) had reduced glomerular filtration rates. Compared with men who consumed no more than 1 drink per week, men who consumed 2 to 4 drinks weekly had a multivariable-adjusted OR of 1.04 (95% CI, 0.81-1.32), men who consumed 5 to 6 drinks per week had an OR of 0.92 (95% CI, 0.68-1.25), and men who consumed at least 7 drinks weekly had an OR of 0.71 (95% CI, 0.55-0.92) (P = .01 for trend across categories). Similar associations were observed between alcohol consumption and decreased glomerular filtration rates. Hypertension, diabetes mellitus, and cholesterol level did not attenuate these effects.
In this large cohort of apparently healthy men, alcohol consumption was not associated with an increased risk of renal dysfunction. Instead, these data suggest an inverse relationship between moderate alcohol consumption and the risk of renal dysfunction.
The association of light to moderate alcohol consumption with risk of ischemic stroke remains uncertain, as are the roles of potentially mediating factors and modification by apolipoprotein E (apoE) genotype.
We studied the prospective association of alcohol consumption and risk of ischemic stroke among 4410 participants free of cardiovascular disease at baseline in the Cardiovascular Health Study, a population-based cohort study of older adults from 4 US communities. Participants reported their consumption of alcoholic beverages yearly.
During an average follow-up period of 9.2 years, 434 cases of incident ischemic stroke occurred. Compared with long-term abstainers, the multivariate relative risks of ischemic stroke were 0.85 (95% CI, 0.63 to 1.13), 0.75 (95% CI, 0.53 to 1.06), 0.82 (95% CI, 0.51 to 1.30), and 1.03 (95% CI, 0.68 to 1.57) among consumers of <1, 1 to 6, 7 to 13, and > or =14 drinks per week (P quadratic trend 0.06). ApoE genotype appeared to modify the alcohol-ischemic stroke relationship (P interaction 0.08), with generally lower risks among drinkers than abstainers in apoE4-negative participants but higher risks among drinkers than abstainers among apoE4-positive participants. We could not identify candidate mediators among lipid, inflammatory, and prothrombotic factors.
In this study of older adults, the association of alcohol use and risk of ischemic stroke was U-shaped, with modestly lower risk among consumers of 1 to 6 drinks per week. However, apoE genotype may modify this association, and even moderate alcohol intake may be associated with an increased risk of ischemic stroke among apoE4-positive older adults.
To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome.
Prospective cohort study.
Four U.S. communities.
Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline.
Risk of incident myocardial infarction or coronary death according to self-reported consumption of beer, wine, and spirits ascertained yearly.
During an average follow-up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long-term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71-1.14), 0.93 (95% CI=0.73-1.20), 0.76 (95% CI=0.53-1.10), and 0.58 (95% CI=0.39-0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele.
In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.
Several factors for chronic kidney disease (CKD), including diabetes, hypertension, and obesity, are described consistently in the literature; studies describing modifiable lifestyle factors, including smoking and consumption of alcohol, are sparse, sometimes contradictory. The authors examined the factors associated with CKD in a population-based cohort in Wisconsin, with emphasis on smoking and consumption of alcohol. CKD was defined as an estimated glomerular filtration rate of less than 60 ml/minute per 1.73 m(2) from serum creatinine. The authors performed two analyses: 1) cross-sectional analysis among 4,898 persons with prevalent CKD (n = 324) as the outcome of interest and 2) longitudinal analysis among 3,392 CKD-free persons at baseline, with 5-year incident CKD (n = 114) between 1993 and 1995 as the outcome of interest. Smoking and heavy drinking, defined as consumption of four or more servings of alcohol per day, were associated with CKD, independent of several important confounders. Compared with that among never smokers, the odds ratio of developing CKD was 1.12 (95% confidence interval (CI): 0.63, 2.00) among former smokers and 1.97 (95% CI: 1.15, 3.36) among current smokers. Heavy drinking was associated with CKD, with an odds ratio of 1.99 (95% CI: 0.99, 4.01). Joint exposure to both current smoking and heavy drinking was associated with almost fivefold odds of developing CKD compared with their absence (odds ratio = 4.93, 95% CI: 2.45, 9.94). Smoking and consumption of four or more servings of alcohol per day are associated with CKD.
We investigated the association between alcohol consumption and incident congestive heart failure (CHF) both overall and after adjusting for incident myocardial infarction (MI).
Moderate alcohol consumption has been associated with lower risk of CHF and MI.
The Cardiovascular Health study, a prospective cohort study of cardiovascular disease risk factors and outcomes, followed 5,888 subjects > or =65 years old for 7 to 10 years. Cox models were used to estimate the adjusted risk of CHF by reported alcohol consumption.
There were 5,595 subjects at baseline at risk for incident CHF with alcohol data and 1,056 events during follow-up. Compared with abstainers, the adjusted risk of CHF was lower among subjects who reported consuming 1 to 6 drinks per week (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.67 to 1.00, p = 0.05) and 7 to 13 drinks per week (HR 0.66, 95% CI 0.47 to 0.91, p = 0.01). Time-dependent adjustment for incident MI altered only slightly the association between moderate alcohol consumption and CHF (for 1 to 6 drinks per week, HR 0.84, 95% CI 0.65 to 1.04; for 7 to 13 drinks per week, HR 0.69, 95% CI 0.49 to 0.99). Baseline former drinkers had a higher risk of CHF than abstainers (HR 1.51, p < 0.01), but those who quit during the study did not have a higher risk (HR 0.83, 95% CI 0.66 to 1.03).
Moderate alcohol use is associated with a lower risk of incident CHF among older adults, even after accounting for incident MI and other factors.
The impact of moderate alcohol consumption on renal function has important public health implications given the high prevalence of alcohol use. Experimentally, alcohol may adversely affect renal function, but clinical data are limited and no large, prospective studies have examined this issue.
In a prospective study of 1658 nurses enrolled in the Nurses' Health Study, we sought to determine if there was an association between moderate alcohol consumption and rate of decline in renal function. Daily alcohol intake was measured in 1990, 1994 and 1998 using a detailed questionnaire. Maximum daily alcohol intake was measured in 1988. Creatinine, measured from blood samples provided in 1989 and 2000, was used to estimate glomerular filtration rate (GFR) and creatinine clearance (CCr).
Compared to individuals with no alcohol intake, the odds ratios (ORs) for developing a >or=25% estimated GFR decline were: 0.98 (95% CI: 0.72-1.32) for 0.1-4.9 g/day, 0.83 (95% CI: 0.56-1.21) for 5-14.9 g/day and 0.81 (95% CI: 0.50-1.31) for 15-59.9 g/day. For women with hypertension (n = 726), the ORs for a >or=25% estimated GFR decline were: 0.98 (95% CI: 0.53-1.21) for 0.1-4.9 g/day, 0.62 (95% CI: 0.34-1.12) for 5-14.9 g/day and 0.53 (95% CI: 0.25-1.12) for 15-59.9 g/day.
Moderate alcohol consumption had no substantial adverse effect on renal function in women over an 11 year follow-up period.
Serum cystatin C was proposed as a potential replacement for serum creatinine in glomerular filtration rate (GFR) estimation. We report the development and evaluation of GFR-estimating equations using serum cystatin C alone and serum cystatin C, serum creatinine, or both with demographic variables.
Test of diagnostic accuracy.
Participants screened for 3 chronic kidney disease (CKD) studies in the United States (n = 2,980) and a clinical population in Paris, France (n = 438).
Measured GFR (mGFR).
Estimated GFR using the 4 new equations based on serum cystatin C alone, serum cystatin C, serum creatinine, or both with age, sex, and race. New equations were developed by using linear regression with log GFR as the outcome in two thirds of data from US studies. Internal validation was performed in the remaining one third of data from US CKD studies; external validation was performed in the Paris study.
GFR was measured by using urinary clearance of iodine-125-iothalamate in the US studies and chromium-51-EDTA in the Paris study. Serum cystatin C was measured by using Dade-Behring assay, standardized serum creatinine values were used.
Mean mGFR, serum creatinine, and serum cystatin C values were 48 mL/min/1.73 m(2) (5th to 95th percentile, 15 to 95), 2.1 mg/dL, and 1.8 mg/L, respectively. For the new equations, coefficients for age, sex, and race were significant in the equation with serum cystatin C, but 2- to 4-fold smaller than in the equation with serum creatinine. Measures of performance in new equations were consistent across the development and internal and external validation data sets. Percentages of estimated GFR within 30% of mGFR for equations based on serum cystatin C alone, serum cystatin C, serum creatinine, or both levels with age, sex, and race were 81%, 83%, 85%, and 89%, respectively. The equation using serum cystatin C level alone yields estimates with small biases in age, sex, and race subgroups, which are improved in equations including these variables.
Study population composed mainly of patients with CKD.
Serum cystatin C level alone provides GFR estimates that are nearly as accurate as serum creatinine level adjusted for age, sex, and race, thus providing an alternative GFR estimate that is not linked to muscle mass. An equation including serum cystatin C level in combination with serum creatinine level, age, sex, and race provides the most accurate estimates.